Immense Surgical and Mental Health Needs in Sri Lanka's Conflict Area

During the first two weeks of March, relatively few people seem to have been able to flee from the conflict-affected Vanni area in northern Sri Lanka. Communication with people inside the Vanni remains incredibly difficult, but accounts given by people who have managed to escape in recent days confirm that civilians remain trapped by the conflict and that it is practically impossible for them to leave as they risk being shot at.

A Doctors Without Borders/Médecins Sans Frontières (MSF) team continues to work at the government hospital in Vavuniya, just outside the Vanni, focusing on surgery and providing laboratory support.

The civilian population in the Vanni are suffering heavily as a result of the violence. Out of the 953 admissions of wounded and sick people evacuated from the Vanni between February 11 and March 8, 584 required surgery. The majority of the surgical cases—92 percent—are directly related to violence, with wounds predominantly caused by shrapnel and gunfire.

MSF remains extremely worried about the situation for approximately 150,000 civilians still trapped in the Vanni.

Crowded—and Isolated—in the camps

The 33,896 people who managed to flee the Vanni in the first two months of 2009 are living in 13 camps in Vavuniya, and 3,000 people are living in temporary settlements in the Jaffna area on the northern tip of Sri Lanka.

The camps in Vavuniya are enclosed areas that usually include a community building such as a school or university campus. People are living in tents, often with two or three families per tent, or in public buildings. The camps are very crowded; there can be 600 people living in a large basketball court. People are surrounded by barbed wire and are not allowed to leave or communicate with people from other camps. They are not allowed to receive visitors and it is common for families to be split between several camps, with a man in one camp and his wife in another.

In each of the camps, people are not able to cook for themselves and must rely on community kitchens. The government provides health services in the camps, and if need be, refers patients to the hospital.

MSF runs a supplementary feeding program in ten of the 13 camps for children under five and for pregnant and lactating women. Supplementary feeding mixtures are prepared and distributed by MSF teams daily.

Mounting Mental Health Concerns

Many people in the camps are experiencing acute mental health distress, which is not being addressed. People are hugely affected by the trauma they experienced in the Vanni and during their flight. Many have lost relatives or even their entire families. They have no contact with their loved ones still inside the Vanni and often don’t even know whether those they left behind are still alive. Whenever there are new arrivals, people crowd around them to see whether they can find their loved ones amongst them.

Some people have been living in the camps for months. Before they were able to leave the Vanni, many had already moved five or six times in search of safety. In the camps, they have no jobs, no schools to go to, and there is literally nothing for them to do except to wait. They have lost all autonomy. Their lives are on hold and they live in constant fear about the safety of their loved ones.

MSF is prepared to provide independent and confidential mental health services to inhabitants of the camps, and is currently negotiating with the Sri Lankan authorities about this.