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Sri Lanka Report: Civil War Ends, But Needs RemainJuly 24, 2009
Sri Lanka 2009 © Anne Yzebe/MSF
An MSF surgeon prepares to treat a child who was injured during the conflict.
Sri Lanka 2009 © Anne Yzebe/MSF
A doctor conducts consultations inside the MSF field hospital near the displaced persons camps in Manik Farm.
More than 77,000 traumatized and exhausted civilians poured out of Sri Lanka’s conflict zone in May after being trapped for months on a narrow strip of jungle and beach under nearly constant artillery fire and bombardment. Thousands leaving the Vanni had shrapnel, gunshot, or landmine injuries, while others were malnourished and dehydrated. At Omanthai, the main crossing point for about 10,000 people every day for five days, Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams performed triage. MSF staff identified and immediately treated hundreds of the most seriously injured—still only a fraction of those who needed medical attention—and transferred many of them to Vavuniya hospital, 50 miles to the south. “We treat as many people as we can directly on site because the hospital is more than full,” said MSF’s Dr. Alexa ter Horst. “It is always a difficult decision to make: treat on site, or let them go to the displaced persons camps with the follow-up that can be provided there, or send them to the hospital, where there are already four patients to a bed.” Overwhelmed with Severely Wounded PeopleIn mid-May 2009, the 26-year civil war in Sri Lanka came to an end after the Sri Lankan military cornered the Liberation Tigers of Tamil Eelam in the northeastern Vanni area. By May 20, Vavuniya hospital, a Ministry of Health facility where MSF medical staff worked side by side with government health staff, became overwhelmed with admissions. The 450-bed hospital was holding 1,900 patients. 
Sri Lanka 2009 © Voitek Asztabski/MSF
A family displaced by fighting sleeps at a camp in Vavuniya district, where MSF was distributing food and relief items.
“I’ve been doing around 30 surgical procedures per day over the last few days. Normally, I would do five,” said Dr. Matthew Deeter, one of four MSF surgeons working at the hospital. “We sometimes work together on the same patient; one is amputating the leg and the other is amputating the arm. Or one is taking care of wounds in a foot and the others are treating chest wounds.” This was not the first time during the recent fighting that Vavuniya hospital had been over capacity with warwounded patients. On April 21, some 60,000 civilians managed to escape the Vanni and hundreds of severely wounded children, women, and men were in dire need of assistance. Over a 36-hour period, medical staff treated 400 patients with life-threatening injuries. Within two days, 1,700 patients were sleeping on mattresses on the floor, in hallways, and under beds occupied by other patients. MSF surgeon Dr. Paul McMaster and his colleagues had been working without pause to treat the constant influx of patients. “These are deeply, deeply traumatized people,” he said on April 22. Nearly every patient had lost family members to the violence or did not know where their families were, he said, including many children. “We’re seeing children that have no parents with them. We had a little boy with a blast amputation of his leg; I think he’s about five, and he’s being looked after by his big brother, who’s about seven. We don’t know where the parents are or whether they’re even alive. But these two little children are in the middle of a very traumatic hospital setting on their own.” 
Sri Lanka 2009 © Anne Yzebe/MSF
A baby receives a medical consultation.
The massive increase in patients meant that staff at the hospital were stretched thin and the quality of post-operative care suffered. Doctors, nurses, and others were working 24 hours a day treating so many people that it was difficult to move inside the wards, said Dr. McMaster. “There are simply too many people to treat them all; we are not able to save some people because we need to provide more aftercare. There are simply not enough nurses.” Huge Needs in CampsIn the 43 displaced persons’ camps run by the government, the trauma and needs continued. There were reports of chicken pox breaking out due to people’s extremely weak immune systems. MSF had limited access, but was able to distribute supplementary food to children under five, pregnant and nursing mothers, and other vulnerable groups in five of the camps around Vavuniya. MSF head of mission in Sri Lanka, Annemarie Loof, described the camps. “The camps are surrounded by two rows of barbed wire, with about six feet between them. People outside and inside look at each other, trying to recognize relatives. There are no lists showing who is living in which camp. The people are not allowed to leave and they cannot have contact with the outside world.” People inside the camps were desperate, said Loof. “They ask, ‘Can you help me? I am looking for my child.’ ‘I am searching for my husband.’ ‘Do you know who is in the other camps?’ I spoke to a woman who had eight children. She had been separated from her husband. Her eldest child, age 17, and her youngest, only four months old, were both dead. Her 15-year-old son could no longer speak. They come up to you, hold you tight and begin to cry. The fear is deep inside of them.” After the Conflict, MSF Begins New ActivitiesIn late May, MSF set up a new 100-bed field hospital in Manik Farm, a camp in northern Vavuniya district sheltering about 220,000 people, according to he United Nations. This was in response to the camp receiving 23,000 people during three days after the end of the conflict. Also in May, MSF was supporting the Ministry of Health-run Pampaimadu Ayurvedic Hospital in the north of the district, and was preparing to start treatment there for the hundreds of people discharged from hospitals who were still in critical need of post-operative care. MSF has provided medical care in Sri Lanka since 1986. Related:
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