An experienced Filipino doctor deliver
babies day in and day out as her colleague, a South African
anesthesiologist, helps mothers endure the toughest deliveries.
And in Burundi...
Full Name: Divina
Read frequently asked
questions about the MSF projects featured in the series and
give us your own feedback
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
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.