Sri Lanka: MSF's constant struggle to keep surgical programme going

Place: Sri Lanka | Courtesy: Medicins sans frontiers
| Date: 19971007

The 14 year-old war between the Singhalese-dominated government of Sri Lanka and the Liberation Tigers of Tamil Eelam (LTTE), continues. MSF runs programmes in the government-held territory of Batticalao, Vavuniya, Jaffna and Mannar. Teams also run programmes in the LTTE-held territory of Mallavi and Madhu.

ne of the main problems faced by MSF in Sri Lanka today is the government's stalling technique to prevent medical materials and drugs from being supplied to the LTTE-held territory. During the recent army offensive, supplies were more limited than ever. However, at all times of the year, Colombo only allows limited supplies in because government officials argue that their opponents exaggerate the numbers of people in the area under their control and manipulate the aid. Whether or not this is true, it is certain that the government and the opponents use vastly different figures for the current population in Mallavi. Colombo estimates it at 100,000, while the Tigers talk about 800,000. MSF uses the UNDP figures which estimate that there are roughly 400,000 people currently living in the area.

The fighting between the government army and the LTTE flared up again in May during what was known as the Jaya Sikuru army offensive which aimed at securing the road from Vavuniya to Jaffna. This offensive resulted in large numbers of war-wounded being taken to Mallavi Hospital. On certain days MSF treated dozens of wounded, some of whom needed complicated surgery. Two surgical teams were present at the time, and worked together to cope with the influx of patients. During this time, MSF continually asked the military authorities for clearance for badly-needed medical supplies. According to MSF's present country Coordinator Marc Koster "The government is afraid that the Tamil Tigers will benefit from our aid, and is consequently imposing so much control that we are only just able to carry out our medical work in Mallavi."

Now that the rainy season has started, the army offensive is tailing off, and only small numbers of war wounded have been appearing in the past few weeks. The workload nevertheless remains high, since the population of approximately 400,000 people depends on the Mallavi hospital for surgical operations such as caesarean sections and appendectomies. The most serious problem facing the population today is the dire water situation. It is hoped that the rains will be plentiful this year.

The MSF project on the island of Mannar has been obstructed during the past few months by the military presence in the hospital and very close to the MSF house. The team decided to perform only emergency surgery as long as the soldiers stayed around as an army presence with the hospital compound cannot be accepted. MSF's advocacy was directed at maintaining the hospital as a neutral ground. They finally left, and normal surgical activities resumed. An estimated 9,000 displaced are still in transit camps on the island awaiting resettlement in Jaffna. 700 people are transported each week.

Following the army's summer offensive, the population in Madhu may have quadrupled and currently stands at roughly 40,000. The MSF programme has, therefore, been expanded and the team reinforced. The team works in the displaced camps in Madhu, Pallampidi and neighbouring villages. There has been a rise in malnutrition, and there are more than 200 children in MSF's supplementary feeding centre at the moment. The incidence of typhoid, hepatitis and bloody diarrhoea is also on the rise. MSF continues to work with the refugees who returned from India in 1990.

In Batticaloa, MSF continues to run the surgical and paediatric wards in the town's hospital. The team also runs a mobile clinic for the surrounding villages. There was a lot of tension in the area this summer as the LTTE regularly shelled army positions. MSF also continued to run both the surgical and anaesthetics wards of Vavuniya Hospital, which is the reference centre for the northern region. At the end of the summer, Point Pedro closed and Sri Lankan doctors are providing medical assistance to the remaining population.