Embargo foments Vanni health crisis

Place: Vanni | Courtesy: TamilGuardian
| Date: 20001104

Sri Lanka's embargo on medical supplies to the Tamil areas leaves hospitals there with acute shortages of drugs, equipment and other necessary supplies. Consequently, many lives are being put at peril, writes Ramani Vinayakapillai.

Eight-year old Kiriaviraj was admitted to Puthukkudiyiruppu District Hospital in July 1998. For a child suffering rabies, probably caught from a dog bite, the treatment should have been pretty routine. But not at Puthukkudiyiruppu; for the town is located within an area of this island nation that is subject to a government embargo on medical supplies. With no suitable drugs in stock, all that the medical staff could do was to make the last moments of his life as comfortable as possible.

The economic blockade on areas not controlled by the Sri Lanka Army is now almost ten years old and is resolutely enforced to the extent that even the simplest drugs such as panadol and aspirin are only available in tiny quantities - at a premium. As in all scenarios where public health is at risk, children are the first to be affected. Health workers report many cases have occurred where children, especially infants, have lost their lives due to lack of access to basic medical care. Kiriraj is just one in a catalogue of cases of stories that aid workers continued to report from what the government euphemistically calls the "uncleared" areas.

Apart from medical supplies, the embargo extends to food, construction material and other essential supplies, all of which contribute to a deterioration in public health. Many dispensaries and pharmacies in the Vanni region are on the verge of closure due to these restrictions, according to health workers with international humanitarian organisations such as the International Committee of the Red Cross and Medecins Sans Frontiers (MSF).

The ICRC has repeatedly been refused permission to take drugs into the Vanni. Its spokesman, Harsha Gunewardene told reporters after yet another supply run was blocked last April that even when quantities approved by the Ministry of Defence in Colombo are taken to the border, soldiers there have refused to allow them through. Consequently, there is a lack of drugs to treat even the simplest injuries and illnesses, health workers say.

MSF, winner of last year's Nobel Peace Prize, has repeatedly protested the seriousness of the drugs shortage in the northern Vanni region of the island. On two occasions when MSF tried to take drugs Mallavi hospital in Mullaitivu district, it was prevented by the security forces. "The shortage of medications has become so critical that patients are being turned away from hospitals and clinics without receiving the necessary treatment", said Isabel Simpson of MSF (Holland), Head of Mission in Sri Lanka.

In another instance, the Ministry of Defence has been delaying granting permission for three of the ambulances donated by the UNICEF in May 2000, to help medical authorities in the Vanni region. These were donated to transport serious cases that cannot be treated in the region to hospitals in government-held areas. "The numbers of ambulances [in the Vanni] are not enough to deal with the numerous patients admitted with serious injuries, and the existing vehicles are in a bad condition with inadequate facilities on board to transfer patients", according to an MSF. "There is also the restriction on fuel, which limits the usage of ambulances." There are many reported incidents of children and the elderly dying after reaching help too late, or not at all.

In May 2000, the surgery of the Mallavi hospital and two branches of Mullaitivu hospital were closed due to the shortage of medical equipment. As a result, medical staff were unable to help the massive number of patients who arrive each month, including many wounded in airstrikes and shelling. The frustration saps staff morale. Some choose to transfer out of these areas, adding to the existing staff shortage problem. Tamil areas under the control of the Sri Lanka Army also struggle to get supplies o drugs and equipment, even though they are not subject to the embargo. According to a recent report, the Jaffna Teaching Hospital, the largest civilian hospital outside Colombo, received only a third of the quota for surgical equipment and continues not to receive the allowed monthly quota of drugs.

Some of the hospitals in the North and East have been damaged or destroyed by aerial attacks, such as the one in Kilinochi district, which took several direct hits in 1996, and almost all the other need upgrades to equipment and facilities. Hospital authorities protest that the government routinely diverts allocated funding to other areas. For example, in 1998, a sum of 3.5 million rupees that was supposed to help rehabilitate hospitals in the North and East was channelled to the Mini-stry of Defence, they say. As a result, some of the hospitals fail to reach the proper hygiene standards and in bittier irony become breeding grounds for infectious diseases. While, with little state funding forthcoming, many hospitals and other medical establishments continue their slide into disrepair, there is little good news regarding new hospitals either. In March this year the Government Agent of Trincomalee- held by the Army - blocked the construction work of an Ayurvedic Hospital due to pressure from Buddhist organisations.

Efforts of international aid workers are also frustrated. In October 1997, Sri Lankan government reportedly broke its pledge to UNICEF to observe a temporary truce to facilitate a vaccination programme for children that the agency had organised. According to aid agency staff, the Air Force dropped bombs at one of the hospital that was designated a vaccination centre. In other Tamil areas such as Mallavi and Mankulam, where mothers had gathered with their children for the vaccination, the army reportedly had carried out artillery attacks; forcing them to flee and none of the children in these areas were immunised as a result.

With the continuing shortage in water purification tablets, which are one of the restricted items to the North and East of the country, the drinking water in some of these areas has become contaminated and acts as a prime conduit for diseases. The poor quality drinking water, along with falling levels of maternal nutrition, has led to numerous cases of low-birth-weight babies. Inadequate medical facilities have further contrived to increase the mortality rate in these infants, according to local government officials.

The severe shortage of qualified paediatricians in the Tamil areas exacerbates problems. The shortage is caused on one hand by the inherent risks associated with living in these areas and on the other by the ever-falling numbers of students graduating from the medical faculties. Many of those who do finally graduate continue to leave the area for better pastures, given the sheer lack of medicine, facilities and funding they would have to cope with.

In a relatively new development, the anti-personnel mines left by retreating Sri Lankan soldiers has become a further cause for people needing medical treatment. Displaced civilians returning to their homes have often triggered mines laid in their property. The-re have also been many reported incidents of land mine explosions in school playgrounds. Consequently, many children have lost limbs. With leather - one of the restricted items - which is used to make artificial limbs being in short supply, few victims are the recipients of these. In August 2000, the Tamils Rehabilitation Organisation launch-ed the "Venn Pura"(White Dove) programme specifically to deal with landmine victims.

"The [government is responsible for the] most egregious violations include denials of food and medicine or medical supplies, especially for children", according to Prof. Jordan J Paust in an essay published in Vanderbilt Journal of Transnational Law (May 1998). The government argues that it needs to maintain its economic embargo to prevent supplies reaching the guerrillas of the Liberation Tigers of Tamil Eelam (LTTE). However aid workers say the Tigers bring in all they need via their shipping fleet. One aid worker says during the two years she was in the Vanni since 1996, LTTE fighters were never brought to civilian hospitals. The government estimates there are 4000 Tamil guerrillas, but over half a million people in the areas not controlled by the SLA live under the embargo.

Courtesy: TamilGuardian, November 04, 2000