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MSF in Sri Lanka, 2006/2007
Field Staff: 30
Reason for Intervention:
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After 20 years of civil war in which more than 60,000 people died, the Sri Lankan Government and the Tamil Tigers rebels (LTTE ) finally concluded a ceasefire in 2002 and civilian life reestablished a certain sense of normalcy. The country, however, remained the site of many violent incidents throughout this period. At the end of 2005, clashes resumed on a larger scale and rapidly led to the de facto collapse of the ceasefire, with dramatic consequences for the civilian population.
More than 300,000 people have been displaced because of fighting in the north and the east and another 10,000 have sought refuge in neighboring India. According to official figures, more than 3,000 persons died in 2006. People in conflict-affected areas live in fear and are victims of fighting, murder and kidnapping. Aid organizations have been affected by the violence as well, the worst incident taking place in August 2006, when 17 national staff of Action Contre la Faim/Action Against Hunger (ACF) were killed in Muttur.
As a result of the conflict, large parts of the civilian population are isolated. Movements are limited, roads are cut-off and the supply of essential goods is extremely difficult. This isolation has a serious economic impact, with a dramatic increase in prices and restriction of fishing and trade. Health services have also been severely affected: many medical specialists have fled, leaving the population largely without access to needed medical care.
MSF had worked in Sri Lanka since 1986, throughout the years of war, and with all programs closing gradually after the 2002 ceasefire agreement. In May 2006, with the resumption of hostilities, MSF decided to return to assist the population in conflict-affected areas. Despite the Ministry of Health’s (MoH) requests for assistance, bureaucratic obstacles prevented teams from continuing work that had started during the summer of 2006 in Point Pedro Hospital, on the Jaffna Peninsula.
All necessary authorizations and permits were not granted until January 2007, when activities resumed. MSF opened three surgical programs in Point Pedro, Vavuniya and Mannar, all in conflict-affected areas controlled by the government. The proximity to the frontline and restriction of movement make the inhabitants of these regions extremely vulnerable. MSF provides surgical support to the public hospitals, which mainly lack specialized staff. Since the beginning of 2007, teams have been performing an average of 450 surgeries per month.
Once the first three projects were running, further expansion of medical programs in conflict and LTTE-controlled areas was possible. Health facilities there suffer major shortages of staff and supplies and the population often remains stuck because of fighting. In May, MSF started a new program in Batticaloa district in the east, where thousands of people have been displaced. The team organized mobile clinics offering primary healthcare to displaced people living in camps and supplies them with relief items and water. Gynecological support is also provided to the Valachenai hospital. Another program started in the LTTE-held town of Killinochchi, supporting pediatric and emergency obstetrics care in the general hospital.
In July 2007, MSF awaits government authorization to open a project in Adampan, an LTTE-controlled area of Mannar district.
MSF has worked in Sri Lanka since 2007.