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MSF in Sri Lanka, 2009
Field Staff: 347
Reason for Intervention:
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The decades-long civil war between the Sri Lankan security forces and the separatist Tamil Tigers (Liberation Tigers of Tamil Eelam) came to an end in May 2009. During the final phase of the bitter conflict, tens of thousands of civilians were trapped on a narrow strip of beach and jungle in the northeast of the country with little or no access to healthcare.
In 2009, surgical teams worked in hospitals in the north of the country to treat those who had escaped the war zone. MSF also helped to provide clean water in government-run camps for 300,000 displaced people and provided supplementary feeding for around 10,000 undernourished people.
From mid-April till the end of May, thousands of people managed to escape the conflict area. Many needed medical assistance after months of limited access to it, and others needed treatment for severe injuries inflicted by shrapnel, gunshots or landmines. Hospitals in the area treated as many civilians as they could, but the numbers were overwhelming. On April 21st, in just one 36-hour period, more than 400 patients were treated for life-threatening conditions in Vavuniya hospital. Overall, MSF treated almost 4,000 war-wounded between February and June.
More than 150 MSF staff supported patients, many of whom had been separated from their families. Medical teams also cared for more than 60 patients with spinal-cord injuries who needed rehabilitation.
Many displaced people were malnourished, so in February, MSF started to distribute supplementary food daily to every child under five years old, as well as to pregnant and lactating women and the elderly. In August, at the peak of its activity, the program reached more than 26,000 people.
In late May, MSF was authorized to open a 160-bed referral hospital in Vavuniya with an inflatable operating theater and surgical facilities just outside the government-run Menik Farm camps housing hundreds of thousands of people displaced by the conflict. Between May 2009 and January 2010, there were more than 4,200 admissions. Teams performed more than 1,600 surgical procedures and more than 13,500 consultations. A further 850 people were treated for war-related injuries, and 200 patients began receiving psychological support after conflict-related trauma.
Towards the end of the year, people detained in the government camps were released, and medical needs decreased. By the end of 2009, around 100,000 people remained in the camps and government health facilities were able to cope, so activity at the MSF hospital was scaled down. It was closed in January 2010.
Throughout the year, MSF also supported surgical, emergency and obstetric treatment for patients at the Ministry of Health hospital at Point Pedro in Jaffna district. Primary and secondary healthcare needs in the district on the northern tip of the island have increased since October, because around 70,000 people who had been displaced by the war returned. MSF performed more than 2,000 emergency consultations and 1,300 surgical interventions. The hospital psychological support team carried out 430 consultations.
Throughout 2009 the lengthy and bureaucratic government process of issuing visas for international staff hampered MSF’s work. Teams were also refused permission to enter some camps, and were unable to carry out independent assessments of displaced people’s needs. Although MSF had the capacity to scale up activities and provide medical and mental-health care for the people inside the camps, the authorities often rejected such assistance. Unclear procedures at feeding camps hindered MSF’s work, sometimes delaying it by hours or even days.
Rajasekaran, 29, married with two children
‘After doctors told me I would never be able to walk again, I lost all hope. I spent my days lying in a hospital bed, which caused painful pressure sores that became infected. I was embarrassed that I was unable to control my bladder and bowel movements and that I was entirely dependent on others and could not provide for my family.
‘I signed up to the MSF rehabilitation program for patients with spinal-cord injuries in November and now no longer feel so depressed about my future. After physiotherapy, nursing care, and medication, I am now out and about in my fitted wheelchair, can wash and dress myself and go to the bathroom alone. I hope to continue my work as a motor mechanic and learn more English.’
MSF has worked in Sri Lanka since 2007.