The war in Sri Lanka has ended but the suffering continues

Any health system would have difficulties responding to the needs of over 260,000 people who recently came out of a war zone. And so, facilities in the Sri Lankan IDP camps are overstretched. People sometimes need to wait days before they can see a doctor for treatment and at night non-medical people decide who gets referred to a hospital and who does not. The suffering continues.

For the past three months, Ati* has been living in a camp in Menik farm with her husband and three children. Two weeks ago, her five year old son had a fever and was barely responding. She carried him to the clinic in the camp at 5am and queued to see a doctor until 6pm. Like many others that day, she did not get to see a doctor and returned to her tent with her sick child and no treatment. She went back the next day and again failed to see a doctor after waiting for another 13 hours. It wasn't until the third day that she finally managed to see a doctor who gave her some antibiotics.

300 patients a day
Even if the services are gradually expanding in the camps with Ministry of Health clinics in all the camps and the medical staff doing what they can, the needs are vast and the facilities are overstretched. Some doctors are seeing 200 to 300 patients a day, there is little capacity to carry out tests or follow up patients and only the most urgent cases get transferred to hospitals outside the camps. Maruthani,* a 24 year old woman, arrived in Menik Farm at the end of May and is badly disfigured since a fragment of bomb shell cut her lips, cheeks and chin during the conflict. Her mouth is always open, her tongue is badly affected, she can barely drink and cannot speak. She is in need of reconstructive surgery, something impossible to get inside the camp. When her wounds became infected, she went, in pain, to the clinic in the camp. There they were unable to do anything for her and she was not transferred to a hospital outside the camp because she was not considered to be an emergency case. She spends her days lying in the sand outside her tent, waiting for the day to pass.
Some emergency cases in the camps are referred by the Ministry of Health staff to the MSF hospital outside Menik Farm where MSF medical teams are mostly treating patients for conflict related trauma, respiratory tract infections and skin diseases. The problem comes at night.
“In many camps if someone gets sick at night they have to rely on the soldier at the gate of the camp to take the decision on whether they get referred to a hospital or not”, explains Karline Kleijer, MSF emergency coordinator. “This works for those who are obviously ill, fitting or with a bleeding wound, but when it is a dehydrated child with a fever, the average soldier will not see that they are in urgent need of medical attention because they are not easy things to diagnose.”

Breakfast at night
Another concern for those in the camps is access to clean water and food. In most camps people do not cook for themselves but rely on community kitchens and rations distributed daily by the government or NGOs.
“Sometimes, especially in the newer camps, the food doesn't get delivered until late in the evening and the first meal of the day is at ten o'clock at night”, says an MSF aid worker. Every day MSF distributes high energy porridge to 23,000 children under five, pregnant and lactating women and people over 60 in 11 of the camps. “It is difficult for our staff to turn people away when they do not fit into our target group."
Outside of the camps, hundreds of people are still hospitalised receiving treatment for injuries they incurred during the conflict. Working with Ministry of Health staff in Pompaimadhu hospital, MSF is treating 180 patients with spinal cord injuries, fractures that did not heal and infected wounds. The MSF surgeon does an average of 16 to 20 surgeries a week and physiotherapy is a big component of the programme.
“To see someone walk again thanks to the physiotherapy is amazing” says MSF surgeon Tim Pruchnic.

Traumatised
Traumatised by what they experienced during the conflict, many of the patients in hospital are struggling to cope with their grief and worry about their future and the fate of their loved ones.
“A young mother admitted in Pompaimadhu has lost her husband, her parents, her sister, her sister's husband and children”, remembered an MSF worker. “She is alone now in Pompaimadhu hospital recovering from her injuries, she is the sole survivor of her family and she is pregnant. She feels very lonely and is still in shock, it has only been two and a half months since she lost everything and everyone. She worries about how she will cope as a single mother. As long as she stays in Pompaimadhu she can get help, but when she is discharged to the camps she will no longer get any support.”
In the camps, people are dealing with the trauma experienced in the conflict and it is difficult to rebuild any semblance of a normal life. There are very few job opportunities inside the camps, the people are not allowed to leave the camps and parents worry about their children's education. People have difficulties to search for relatives, make plans or take control of their own future. With nowhere to go there is little to do other than walk from one distribution to another. The uncertainty of how long they have to remain in the camps is difficult to live with. There is therefore a huge need for psychological support for people living in the camps and currently none is provided.

Ready to start
In addition to the high energy porridge the MSF teams cook and distribute in the camps, MSF has the capacity to scale up activities and provide medical support to the Ministry of Health staff inside the camps.
“We have two whiteboards in our office,” explained Karline. “One with a list of planned activities for the coming weeks: supplementary feeding, surgery, etc. And another is a list of activities waiting for approval, including mental health, basic health care and physiotherapy in the camps… We are ready to start!”

MSF continues to pursue discussions with the authorities in Colombo.

*name has been changed

http://www.msf.org/msfinternational/invoke.cfm?objectid=12EEE5AE-15C5-F00A-259ECDF0EB7BAAFF&component=toolkit.article&method=full_html

AAAS Satellite Image Analysis Points to New Graves, Shelling, and Human Displacement in Sri Lanka

Beside a green lagoon on Sri Lanka's northeastern coast, on a sandy spit of land less than 8 miles long, violence reportedly erupted 9-10 May as military soldiers clashed with rebel Tamil Tigers.

Now, a detailed AAAS assessment of high-resolution satellite images seems to confirm descriptions of intense fighting within Sri Lanka's "no-fire zone"—revealing a landscape scarred by freshly dug graves and artillery explosions.
At one gravesite, for example, an estimated 342 new graves appeared in satellite images after violence erupted in May, said Lars Bromley of the AAAS Science and Human Rights Program. Thousands of refugee shelters vanished, while dozens of permanent structures were damaged and the region was riddled by shelling, said Bromley, director of the Geospatial Technologies and Human Rights project at AAAS.

"The narrow peninsula that makes up the civilian safety zone in Sri Lanka clearly has undergone very dramatic physical changes," Bromley confirmed. "By comparing before-and-after satellite images, we were able to see a significant movement of the region's human population, suggesting widespread displacement, based on changes to structures. We also identified many crater-like features consistent with shelling, a major gravesite expansion, and numerous suspected mortar sites."

 
 
 
 

By 6 May 2009, numberous probable internally

displaced persons structures are present in this

image, along with a graveyard (outlined in red),

containing an estimated 195 burials.

Shortly after the clash between the Sri Lankan military and rebels with the Liberation Tigers of Tamil Eelam (LTTE), the New York Times filed this report: "A government doctor said at least 378 civilians—and perhaps as many as 1,000—had been killed and more than 1,100 wounded on Saturday and Sunday during intensive shelling of the combat zone on Sri Lanka's northeastern coast."

The Defense Ministry of Sri Lanka issued a statement contending that rebels were "bombarding their own civilians." Other sources have accused the government of shelling the civilian-populated region, which was declared a no-fire zone on 12 February. Journalists meanwhile reported being banned or ejected from the region.

By 10 May 2009, the graveyard in this image,

outlined in red, has expanded substantially,

compared with the earlier, 6 May image above.

Bromley compared six images, spanning dates from 9 May 2005 through 24 May 2009, captured by multiple satellites, including DigitalGlobe's QuickBird and WorldView satellites; and GeoEye's Ikonos and GeoEye-1 satellites.

The AAAS analysis, requested by Human Rights Watch and Amnesty International USA, was conducted as part of broader AAAS research funded by the John D. and Catherine T. MacArthur Foundation.
When compared with a 6 May satellite image, a 10 May image reveals "the obvious removal of thousands of likely [internally displaced persons, or IDP] structures," the AAAS report states. "Overall, the area appears to have been swept relatively clean."

By 24 May 2009, an area across the street from the

original graveyard in this image has been cleared

and is also being used for burials. AAAS analysis

suggested that 342 new graves were dug at this site

in Sri Lanka's "no-fire zone" following the 9-10 May

episode of renewed fighting.

http://www.aaas.org/news/releases/2009/0812sri_lanka.shtml

Assistant Secretary Blake and Chargé d'Affaires Moore Discuss the Humanitarian Situation and Prospects for Political Reconciliation in Sri Lanka with Tamil Diaspora Groups

Assistant Secretary of State for South and Central Asian Affairs Robert Blake and U.S. Chargé d’Affaires in Sri Lanka James Moore met with 16 representatives of U.S.-based organizations representing members of the Tamil diaspora to discuss the humanitarian situation in Sri Lanka and prospects for political reconciliation on August 11.

Assistant Secretary Blake and Chargé Moore welcomed the opportunity to listen to the concerns and perspectives of the American Tamil diaspora community and to share the steps the United States is taking to address the humanitarian crisis. The United States has provided $56 million in humanitarian assistance in 2009. While the Government of Sri Lanka has made some progress easing camp congestion, registering IDPs, and expanding access by humanitarian organizations, much remains to be done, Assistant Secretary Blake and Chargé Moore said. The United States is urging the safe and speedy return of IDPs, continued access for international humanitarian organizations, and the registration and provision of national identification cards to IDPs, to help promote freedom of movement.
Assistant Secretary Blake and Chargé Moore underscored the importance of political reconciliation. The U.S. has stressed to the government that to achieve a lasting peace, it must promote justice and political reconciliation for all parties, dialogue with all parties, including Tamils inside and outside Sri Lanka on new mechanisms for devolving power, and improve human rights. Assistant Secretary Blake and Chargé Moore recommended that the Government of Sri Lanka and the American Tamil diaspora community seek opportunities to engage one another on political reconciliation and the reconstruction of Sri Lanka.
Assistant Secretary Blake and Chargé Moore concluded by saying that they would like to continue the dialogue with the diaspora community and urged participants to continue to share feedback.
The discussion took place at the State Department with Chargé Moore through a digital video conference at the U.S. Embassy in Colombo.


http://www.state.gov/r/pa/prs/ps/2009/aug/127195.htm