Episode:"Deliverance"

Sri Lanka

Country Background
Since 1972, when the former British colony of Ceylon adopted a constitution and was renamed Sri Lanka, ethnic and religious tension has wrought destruction upon the island nation. Favoring the primarily Buddhist Sinhalese ethnic group predominant in the south, the new constitution named Buddhism as the official religion of Sri Lanka, a decision that angered Hindu ethnic Tamils in the north.

Sensing that his people would be marginalized under the new order, Tamil leader Vellupillai Prabhakaran founded the Tamil New Tigers (TNT) in 1972, and later, the Liberation Tigers of Tamil Eelam (LTTE) in 1976. Both movements called for an independent constitution for the provinces of the north and east of Sri Lanka. Violent confrontations began, triggered notably by the TNT’s assassination of the mayor of Jaffna, a town in the heart of the Tamil peninsula in the country’s north.

However, it was not until 1983, after 13 Sri Lankan army soldiers were killed in an LTTE ambush, that the civil war fully began. Riots broke out at the soldiers’ funeral in the capital city, Colombo, and 3,000 Tamils were killed. In the north, the Sri Lankan army launched massive retaliation strikes against rebel Tamils centered around Jaffna. Since these events, 20 years of brutal conflict have left more than 60,000 dead and hundreds of thousands of people refugees or missing.

MSF in Sri Lanka
Since 1986, Doctors Without Borders/Médecins Sans Frontières (MSF) has pursued the same objective in Sri Lanka: providing assistance to populations directly victimized or isolated by the conflict, while denouncing violations of human and humanitarian rights.

With these principles in mind, MSF set up two types of programs. The first type aimed to ensure that essential health services were provided in the large hospitals situated in conflict zones. For these programs, surgical expertise quickly emerged as the most pressing need: in the last 17 years, nearly 260 expatriate surgeons have worked in the operating theaters of Sri Lanka. The second type of program established mobile clinics capable of extending vital health care to populations isolated by physical distance, military blockades, and active combat.

On Both Sides of the Front Line
Throughout the conflict, MSF worked on both sides of the frontline. The organization’s apolitical non-governmental status allowed MSF to negotiate with the Sri Lankan ministry of defense and rebel groups for access to regions affected by the conflict.

In addition to hospitals under government control, MSF aid workers staffed public hospitals in Trincomalee, Point Pedro, Jaffna and Batticaloa – cities controlled by the LTTE. MSF’s work in these areas filled a crucial gap, helping to make up for the lack of Tamil specialist doctors (many of whom had been forced to flee the conflict) as well as a lack of material resources. MSF provided surgeons, anesthetists, midwives, nurses, and even pediatricians, gynecologists, obstetricians, in addition to the usual administrators and technicians.

In the zones under LTTE control and the so-called “gray zones” (those controlled by the army but with pockets of LTTE resistance) MSF strived to provide access to care for people in vulnerable situations, including many displaced people. At Madhu and in the entire Jaffna peninsula, as well as around Batticaloa, MSF provided food and medical assistance, and set up epidemiological prevention programs and vaccination campaigns.

In addition to offering direct medical aid, MSF provided transportation for many patients in need of emergency medical care to appropriate facilities. As an independent NGO, MSF was able to get past checkpoints and travel through and around conflict areas that prevented patients from getting to a hospital.

Peace at Last
After three failed rounds of peace negotiations, the current talks seem to be promising. In February 2002, the government signed a permanent cease-fire with the Tamil Tigers, paving the way for the new negotiations. Since then, further steps have been taken towards a stabile and sustainable peace. Links between the Jaffna peninsula and the rest of the island have been reopened. The disarmament process has begun and the two sides have exchanged prisoners of war. On a political level, the Tamil Tigers have abandoned their claim for an independent state. And in an agreement signed in December 2002, the government agreed to the principle of autonomy in the northern and eastern regions. New rounds of talks were due to take place in Japan on 9-10 of June, but the LTTE boycotted them. Although tensions still subsist, hope has returned to Sri Lanka.

With these hopes have come radical transformations in the landscape of the war-torn nation. Commercial and social normality are returning to the northern and eastern areas of Sri Lanka. The health system in these former zones of conflict is being restored and doctors and nurses are returning to take up long vacant positions. After fleeing violence many years ago, many populations are returning to their villages in the hope of building a new life.

Outside the zones of conflict, the Sri Lankan health system has always been highly developed and effective, with competent staff. Most importantly, the health system is free of charge and therefore accessible to the poorest members of society. The reasons for MSF’s presence in the areas isolated by the conflict no longer exist. MSF has therefore decided to close down most of its programs by the end of 2003.To document the professional and personal experiences of the volunteers and national staff members who contributed to MSF’s work throughout the Sri Lankan civil war, this summer the French office of MSF released a collection of interviews, writings, and remembrances. To read more about Sri Lanka, click here.