Sri Lanka 17 years of humanitarian actions Report Released by Médecins Sans Frontières in june 2003 Document en provenance du site internet de Médecins Sans Frontières http://www.msf.fr Tous droits de reproduction et/ou de diffusion, totale ou partielle, sous quelque forme que ce soit, réservés pour tous pays, sauf autorisation préalable et écrite de l’auteur et/ou de Médecins Sans Frontières et/ou de la publication d’origine. Toute mise en réseau, même partielle, interdite. Sri Lanka : 17 years of humanitarian actions the french section of Médecins Sans Frontières close all its projects in Sri Lanka. contents Background & context page 3 With the hope of lasting peace, the situation This document was inspired by a simple is slowly changing in the northern and eas- idea: how to mark the end of our missions 17 years of MSF programmes page 5 tern areas of Sri Lanka. The health system in after 17 years in this unique region of the these former zones of conflict is being resto- world. Trincomalee page 6 red and doctors and nurses are returning to We wanted to put something down in writ- take up long vacant positions. After suffering ting and to thank those who were there and Jaffna & Point Pedro page 8 the consequences of the conflict, the popula- contributed to the programmes. tions are also returning to their villages in But we also wanted to share the experience Batticaloa page 11 the hope of building a new life. with those who did not necessarily partici- pate. Vavaniya page 17 Outside the zones of conflict, the Sri-Lankan So we decided to set about gathering the health system has always been highly develo- experiences and memories of those who Madhu page 18 ped and effective, with competent staff. Most were in Sri Lanka, as a way of helping others importantly the health system is free of char- to understand what it was like. Personnal memories page 20 ge and therefore accessible to the poorest There are no analyses, no comments, no cri- members of society. What could be better ticisms… We have compiled this account of Human resources page 25 than applying this system throughout Sri facts and emotions experienced by all those Lanka, to all Sri-Lankans? The reasons for working in Sri Lanka and have published Thanks page 26 MSF’s presence in the areas isolated by the without commentaries. conflict no longer exist. MSF France has the- We would like to thank all those who contri- refore decided to close its programmes by the buted to this document, near or far, directly end of June 2003 but MSF Holland continues and indirectly. to support the obstetrical and gynaecological Many thanks to all institutional donors who services in the hospital of Puthukkudiyiruppu. help to finance the mission. Photos : MSF-Holland is also training the hospital Front and back pages : D.Lefèvre - P. 3 : D.Lefèvre - P. 4 : E.Bouvet - P.5 : D.Lefèvre - P.6 : Y.de volunteers there. A new programme in the Our apologies to those who we were unable Fareins - P. 7 : D.Lefèvre, MSF - P. 8 : MSF - P. 9 : D. hospital of Mullaitivu will start soon. In to include, because of time or distance. Lefèvre, MSF - P.10 : MSF, D. Lefèvre - P. 11 : D. Lefèvre, S.Crisan/MSF - P. 12 : MSF - P. 13 : G. Vavuniya, near the former front-line, MSF- We also apologise to any of the national staff Myers/MSF, MSF - P. 14 : MSF, S.Crisan/MSF - P. 15 : Holland is running a community-based and volunteers whose names may have been MSF - P.16 : MSF, Y.de Fareins - P. 17 : MSF - P. 18 : psychosocial project focusing on war trauma. forgotten at the end of the document. C. Perera/Gamma - P. 19 : D. Lefèvre - P. 20 : MSF - P. 21 : MSF - P. 22 : E. Bouvet - P. 23 : MSF - P. 24 : MSF. We would particularly like to thank the Front page: Rédacteur en chef: Anne Fouchard national professionals without whom our Patients waiting for consulta- Rédaction: Isabelle Ferry 17 years of work would not have been pos- tions. Trincomalee hospital. Co-rédaction: Remi Vallet 1997. Graphisme et fabrication: TC graphite sible. Réalisation: juin 2003 Back page: Translation: C.Serraf, L. Brumer, D.Chanley Tamil family waiting for the SLA to release their sons. Many thanks to evryone who contribuated to this Point Pedro 1997. brochure: Arnaud L., Anouck S., Anoulack P., Diana T., Guillermo B., Karine P., Kate D., Sean H., Stéphanie P. and especially Chris B. et Yves C. 2 two a k n a L ri S Welcome to Paradise ! Facts and figures Sri Lanka, surrounded by the Indian the British, after independence they were toward peace have followed. Air and road Official name: Ocean, is an island paradise just 50 km off marginalized. In 1956, Sinhalese was pro- links between the Jaffna peninsula and the Democratic Socialist the coast of India. Marco Polo once said of claimed the country’s sole official language rest of the island have been reopened. The Republic of Sri Lanka this island, 430 km long and 225 km wide, causing anger amongst the Tamil commu- disarmament process has begun and the >Land area:65,610 sq that it was the most pleasant island of its nity. In 1972, the rebellion army, the Tamil two sides have exchanged prisoners of km. 1,340 km of coastline size. All the guidebooks acclaim the treasu- New Tigers (TNT) was founded by war. On a political level, the Tamil Tigers >Capital city:Colombo res of this island the size of Ireland: the Vellupillai Prabhakaran, who later formed have abandoned their claim for an inde- >National holiday: fine architecture, archaeological treasures, the Liberation Tigers of Tamil Eelam pendent state, and the government accep- 4th February (celebra- mysterious traditional dances, sandy bea- (LTTE) in 1976. These movements called ted, in an agreement signed in December ting the country’s inde- ches lined with palm trees, tea plantations for an independent constitution for the 2002, the principle of autonomy in the pendence in 1948) as far as the eye can see, topical forests, an provinces of the north and east of Sri northern and eastern regions. New rounds >Population:19 576 783 abundance of wild fauna, and above all, the Lanka. Violent confrontations began, trig- of talks were due to take place in Japan on >Sinhalese:74% friendly and welcoming people. Twenty gered notably with the TNT assassinating 9th– 10th of June. But LTTE decided to Tamils:18%, Moor:7% years of civil war have not put off holiday- the mayor of Jaffna, a town in the heart of boycott them. Although tensions still sub- other:Burgher,Vedda, makers: in 2000, when clashes between the the Tamil peninsula in the country’s north. sist, hope has returned to Sri Lanka. Malay:1% army and Tamil rebels claimed 4000 lives, >Religions: the island’s southern beaches were visited However, it was not until 1983 that the Buddhist:70% by over 400,000 overseas tourists. civil war really began. Thirteen Sri Lankan Hindu:15% Muslim:7% army soldiers were killed in an LTTE Christian:7%. ambush. Riots broke out at the soldiers’ A COVETED ISLAND funeral in the capital Colombo and 3000 The natural beauty and riches of Sri Lanka Tamils were killed, meanwhile in the have long been coveted. Under Indian north the army launched massive retalia- influence between the 14th and 16th cen- tion strikes around Jaffna. 20 years of turies, the island later became a conflict have left more than 60,000 dead Portuguese colony in the 16th century. It and hundreds of thousands of people refu- then fell into the hands of the Dutch in the gees or missing. 17th century before coming under British control in 1796, which lasted 152 years. In 1948, the island of Ceylon finally gained HOPE OF PEACE its independence, but it was not until 1972 After three failed rounds of peace negotia- that the island was renamed Sri Lanka tions, the current talks seem to be promi- under the new constitution. sing. In February 2002, the government (whose president Chandrika Kumaratunga This new constitution, which made is from the People’s Alliance and whose Buddhism the national religion, stirred prime minister Ranil Wickremasinghe is tensions between the Sinhalese communi- from the opposing United National Party) ty (mainly Buddhist) and the Tamils signed a permanent ceasefire with the (mostly Hindu). Although the Tamils held Tamil Tigers which paved the way for new most of the administrative positions under peace talks. Since then further steps 3 three Médecins Sans Frontières in Sri Lanka War Timeline >1972 New constitution. Buddhism becomes the State religion. Birth of the Tamil New Tigers (TNT),Tamil armed rebel movement. > 1976 The TNT becomes the LTTE (Liberation Tigers of Tamil Eelam). > 1982 Tamil party boycotts presidential elections. > 1983 Civil war begins. > 1985 First peace negotiations collapse. > 1987 Armed military offensive. The LTTE ON BOTH SIDES In the zones under LTTE control and the retreats to the Jaffna OF THE FRONT LINE so-called “grey zones” (those controlled peninsula. Deployment MSF set up missions both in towns under by the army but with pockets of LTTE of an Indian peacekee- Since 1986 Médecins Sans Frontières has government control and in zones held by resistance) MSF endeavoured to provide ping force. been working in Sri Lanka pursuing the the LTTE. We worked in public hospitals access to care for people in vulnerable > 1987-1990 Repeated LTTE attacks same objective: providing assistance to (some in the hands of the government situations, including many displaced peo- against Indian soldiers. populations directly victim of or isolated by others controlled by the Tigers – like ple. At Madhu and in the entire Jaffna The latter take revenge the conflict, while denouncing violations of Trincomalee, Point Pedro, Jaffna and peninsula, as well as around Batticaloa, we on the civilian popula- human rights and humanitarian rights. Batticaloa) to help make up for the lack of provided food and medical assistance, and tion. Tamil specialist doctors (many of whom set up epidemiological prevention pro- > 1990 Retreat of Indian troops. With these principles in mind, MSF set up had chosen exile to flee the conflict) as grammes and vaccination campaigns. > 1991 two types of programmes. The first set well as a lack of material resources. MSF LTTE assassinates Rajiv about to help existing health facilities to provided surgeons, anaesthetists, mid- Finally, making the most of our presence Gandhi,the Indian ensure essential services were provided in wives, nurses, and even paediatricians, on both sides of the frontline, MSF prime minister.s the large hospitals situated in the zones of gynaecologists, obstetricians, in addition transported many patients in need of > 1993 conflict. Surgery was the main activity in to the usual administrators and techni- emergency medical care to appropriate The President, Premadasa,is killed by this civil war context: over the 17 years, cians. We used our status as an internatio- facilities. a bomb. nearly 260 expatriate surgeons have wor- nal non-governmental organisation to > 1994 ked in the operating theatres of Sri Lanka. convince the ministry of health to allocate Again, our status as and an independent Chandrika Kumaratunga, The second type of programme involved the resources needed, and the ministry of NGO often enabled us to get past check- elected president, setting up mobile clinics to provide the iso- defence to allow us access to the regions points and zones of fighting which pre- re-opens peace negotia- tions. lated population with access to care. affected by conflict. vented patients from getting to hospital. 4 four a k n a L ri S 17 years of MSF programmes in a country at war War Timeline 1988 hospital. Batticaloa carries out 3,400 ope- > 1995 the majority of doctors in the north and rations a year (of which 20% war surgery). Peace negotiations fail, LTTE renews bomb east of Sri Lanka leave the country to esca- In Vavuniya, a team covers the surgical attacks. Army launch pe the fighting. 50 MSF surgeons, and as and anaesthetic needs (2,200 operations a military offensive in the many anaesthetists, work in turns in the year). In 1996 Jaffna hospital is partially north:LTTE troops leave four hospitals in war zones: Trincomalee, destroyed. One year later, MSF obtains Jaffna. Mannar, Point Pedro and Batticaloa. First authorisation to work there and carries > 1996 Bomb explodes in mobile clinics in Batticaloa. out over 8,500 surgical operations. Colombo. Nationwide state of emergency declared. 1989-1991 1998-2000 > 1997 brief period of calm, then renewed fighting Supplying drugs and materials remains Major new military offensive against the resulting in a flood of wounded arriving in difficult. Activities are set up to improve LTTE. Point Pedro. Seven missions in total, surgery conditions (hygiene, asepsis, steri- > 1999 including four surgical. First mobile cli- lisation, post-operative care etc.). At the Wounded in an attack, nics in Mannar. end of 1999 emergency interventions Chandrika Kumaratunga increase, MSF therefore increases it teams. is re-elected president. After the bombing of Madhu church, MSF > 2000 1992-1994 Tigers make new re-opens its surgical activities in Vavuniya. breacktrough. in the IDP camp in Madhu, four people per- In Batticaloa, surgery conditions improve > Décembre 2001 form minor surgery and evacuate patients with the renovation of the operating thea- New government. that require more complex surgery. New tres and the burn victims ward in the > Février 2002 surgery and obstetrics programme in surgical department. In 2000, 13,354 Cease-fire signed,a Kilinochchi (October 94). First mobile cli- patients were admitted for surgery: pre-requisite for peace- negotiations. Norway nics in Madhu. 5000 operations were carried out, inclu- acts as mediator. ding 1,200 major operations (one out of are sent on short-term missions. In 2001, > Septembre 2002 five for war injuries). In January 2000, of the 24,067 patients admitted to the 1stround of negotiations 1995-1997 MSF re-opens its activities in Point Pedro. three surgical wards of Batticaloa, in Thailand. Road and violence escalates. It becomes more and A further surgeon and anaesthetist are Vavuniya and Point Pedro, 8,900 were air liaisons are re-opened between more difficult to provide assistance to the sent. operated, including 2.5% war wounded Jaffna peninsula and civilian population. ‘Strategic’ drugs (far less than previous years). the rest of Sri Lanka. (anaesthetics, analgesics) and medical > Juin 2003 2001-2002 materials must be submitted for authorisa- Negotiations are due to tion before being transported to conflict The effort put into improving working 2003 be held in Japan as well as a meeting with donor areas. In Kilinochchi, an LTTE town, the conditions and the case management of With the hope of lasting peace, the health countries for the recons- government refuses us authorisation to patients begin to show. In Batticaloa a pain facilities of the north and east of the island truction of Sri Lanka. open a surgical programme. The fighting management programme is set up for are functioning relatively well again. The LTTE boycott. around Jaffna pushes the populations major burn victims and patients in post- war surgery programmes are no longer jus- towards the east: Point Pedro hospital operative care. Specialised surgeons tified. Médecins Sans Frontières is closing becomes the only accessible surgical (orthopaedic surgeons, plastic surgeons) its programmes and leaving the country. 5 five In the beginning, there was Trinco After an initial evaluation mission in 1983 zone of Trincomalee is off limits to forei- permanently in the Trincomalee district. (which did not lead to an intervention), gners. Following our evaluation mission, Alain Rouvillois has replaced the former Personal MSF first began working in Sri Lanka in the ministries of Health and Rehabilitation coordinator Joaquim Miro. An ophthalmo- Memories 1987 with a surgical programme in the have offered to collaborate with us on an logist will soon join the surgical team. The eastern town of Trincomalee. assistance programme for the displaced conflict seems to have intensified over the people around Tincomalee. A surgical past few weeks. We are currently looking “I spent around a year in Below are extracts from Messages Sans team could work in the hospital and ano- at the possibility of setting up a mission in Trinco. The anaesthetists Frontières at the time. ther team could work in the camps and another district of Sri Lanka. called it the ‘Club Med’ mis- isolated villages. The board has accepted sion where they particularly enjoyed the ‘anaesthetist’s this new programme and we have begun beach’. MESSAGES NO. 4 -SEPTEMBER 1986 setting up a surgical team. MESSAGES NO. 12 - APRIL 1987 Joking aside,a few days Françoise Body and Antoine Crouan On Friday 17 April, 10 km from after I arrived two members recently went on an evaluation mission Trincomalee in the northeast of the island, of the house staff were arrested by the army in a following the deteriorating situation in the MESSAGES NO. 6 - 31 OCTOBER 1986 an armed group massacred 120 people and morning raid after a public northern and eastern areas of Sri Lanka. A new programme has just been opened in left around 50 injured. The Médecins Sans denunciation of Tamil sup- The conflict has divided the two ethnic Sri Lanka. An evaluation mission was Frontières team operated on the injured porters in the town centre. For several weeks I met with communities; the Singhalese (12 million) conducted in August 1986 in the north for 48 hours non-stop. the military chief in the and the Tamils (3 million). Tamil guerrilla and eastern zones of the island where zone,asking to visit and armies have been operating in the north Tamil guerrilla forces are fighting govern- talk to our arrested staff. and east of the country since 1982, ment forces. I wanted to be sure they were not being treated demanding full independence for this part The minister of health has accepted a badly and had not been of the island: violent clashes have conti- medical-surgical assistance programme for “I remember a bomb that exploded at the Trinco mar- ket in the middle of summer, 1989. It was devastating; deported to another camp. nued since. the displaced civilian population in the the mutilated bodies, the injured taken to hospital. The day they were both MSF had sent a team to Sri Lanka in 1983 district of Tincomalee in the northeast of The horror… We were worried that some of the team released,the entire MSF might have been caught in the explosion.” house in Trinco celebrated. to evaluate the medical needs of a group of Sri Lanka. displaced Tamils in the north of the coun- The programme is currently being set up. Anne-Marie Gloaguen, nurse in Trinco That same year our ambu- from February to August 1989. try. At the time, several Ceylonese organi- Joaquim Miro and Anne-Françoise lance was attacked by the sations were providing assistance to the Basquin are heading the coordination army on the road to Madhu. The teams were population there: MSF was not present. team. A surgical team should soon join the very shaken and our pro- The current situation means it is difficult first medical team. This surgical team will grammes were disrupted. for the civilian population to move about work in the district hospital, which is the We remained on stand-by for about three weeks,tur- the country, isolating them. MSF has the- only reference facility for the population ning things over in our refore sent an evaluation mission to the of 250,000 people. minds and discussing our district of Trincomalee in eastern Sri The violence is intensifying in this strate- motivation behind working Lanka. gic region. with MSF and at what point the risks become too great.” Of the 250,000 inhabitants in this district, 50,000 are internally displaced people. Ariane Betz,anaesthetist Several villages have been destroyed both MESSAGES NO. 10 -FEBRUARY 1987 nurse in Trinco,and then by resistance movements and by govern- Médecins Sans Frontières is sending more Monaregala,from March 1991 to May 1992. ment forces. Like Jaffna and Batticaloa, the volunteers. Nine people are now working 6 six a Trinco nk a L ri S My best mission Elisabeth Szumilin, now doctor with the evacuate two children: one was suffering medical department at headquarters in Paris, from severe de-hydration, the other had describes her second mission with MSF. It pneumonia with respiratory distress – all was in 1987-1988 in Trincomalee… that on a bicycle … We finally re-started working, along the same lines as before. I have very good memories of Sri Lanka. It From top to buttom: - Elisabeth Szumilin (doctor) and was my best mission. Master Léo (her translator) in consul- Although hard to believe, for 15 months MY LEAST PLEASANT SOUVENIRS? tation. Trincomalee district. 1987. I got up at 5.30am every morning, to get One day I was unable to save a mother’s - Hospital ward. - Queueing for consultations. Mobile the 6am boat. I don’t think we (Gigi, the fourth and last living son. He had attemp- clinics .Trincomalee. 1987. nurse and I) ever missed that boat. ted suicide by swallowing poison. I still I suspect that the captain may have ask myself today if I could have done delayed the departure a bit if he didn’t see more…. The anaesthetist was very sup- memories of the mission. It meant that we us at six o’clock sharp half asleep at the portive and spent a lot of time with me were accepted and respected by both par- front of the boat: what had become ‘our’ explaining that I had done everything pos- ties and thus able to work. spot (inside the smell of diesel could make sible. even a Parisian throw up). The neutrality was not a hoax. For me After the army attacked a camp, the Tigers there was no difference between a Tamil As soon as the villagers realized that they ‘strongly encouraged’ us to come and patient and a Singhalese patient. I refused could count on us at the time we had photograph the massacre: we saw only to learn either of the languages! It would arranged, they used to come. Sometimes women, children and elderly Tamils burnt have been seen as taking sides, or I would there were so many of them we could only in their homes. We found ourselves in the have had to learn both languages simulta- treat the most urgent cases. middle of the attack on the camp. After neously! I was terrified that I may have to ‘operate’ several hours, when the fighting had finis- in the jungle. In the evening, or at night, hed, we came out of the house where we To mark our neutrality, we also worked in after work, we would go and help the sur- were hiding and tried to go into the camp Singhalese facilities and supplied them gical team ‘hold the retractors’. I wanted to to offer our help to any wounded military. with drugs. Despite the fact that they had learn in case I came across an emergency They declined our help. But I still think far fewer needs, I carried out consultations in an isolated zone. The surgical team was that it was thanks to these ‘small gestures’ with them. great. I learnt a lot from them. that we were authorized to access the The army knew we supplied medication to One day the Tigers attacked Trincomalee. zones outside government control and the Tamils. I used to hand them to one My superiors forbade me to return! I still thus provide assistance to Tamil popula- person only, always the same: a second haven’t forgiven them !!! So I ended up tions who had no access to health care year medical student who had joined the staying longer. As I was convinced that because they did not dare approach the Tigers. The young man was killed. One of there were still many needs in the area, I checkpoints. our young civilian volunteers was also set out on another evaluation mission, on killed, and many others besides: the chief a bicycle (because of the remote controlled of the Singhalese military, who we were mines. It was safe on a bicycle, unless WORKING ON BOTH SIDES very fond of, was killed in a suicide attack someone really had it in for you). In the The neutrality of the teams I worked with in Colombo. He was curious about us, first village we visited, we urgently had to is one of the reasons I have such good about our culture…. 7 seven Jaffna and Point Pedro, in the heart of the peninsula Jaffna peninsula, home of the Tamil Tigers, In the summer of 1995, the army launched still made the delivery of supplies very dif- lies off the north of Sri Lanka. Its former a major military operation called “bond en ficult. Jaffna hospital was back in service Personal population of 1 million inhabitants has hal- avant” to regain control of the peninsula. with 600 beds, but most of the wards were Memories ved to 500,000 as a result of the conflict. The town of Jaffna was the first to fall. still in need of specialist doctors. MSF The peninsula is linked to the rest of Sri Within a few weeks, hundreds of people stepped in at the request of the Sri Lankan Lanka by two bridges which were often clo- died in the offensive, many of them civi- Ministry of Health, and provided the Opening of Point Pedro sed during periods of fighting. As it was lians. The Sri Lankan army seemed to be human resources needed in general surge- The escalating fighting on therefore rarely accessible by road, the trying to crush the Tamil army forces to ry, paediatrics and obstetrics-gynaecology. Jaffna peninsula in northern MSF teams used to take the ICRC boat force their leaders back to the negotiating Sri Lanka has resulted in from Trincomalee. Army blockades com- table, rather than simply trying to conquer a massive and prolonged flood of casualties admitted pounded the difficulty of getting supplies to the LTTE stronghold. Sadly many civilians A FRAGILE RECONSTRUCTION to the hospitals of this the peninsula. This isolated zone where paid for the fighting with their lives. In PROCESS region,as well as large Médecins Sans Frontières first set up a sur- September 1995, a flood of casualties arri- In 1997, the reconstruction process on the displacements of gical programme in 1987 in Manthikai ved at the hospital in Point Pedro where peninsula was under way and nearly population. A medical-surgical team hospital, Point Pedro, was under constant the MSF team was working. Fourteen 50,000 people were able to return to the made up of 9 MSF tension. The difficulties encountered in patients with serious injuries were admit- region. MSF sent another surgeon and volunteers (surgeons,doc- providing assistance were numerous. ted on 21 September. Among them, four paediatrician to join its team in Jaffna tors and nurses) left on children died from their injuries. The next hospital, and began reconstruction of part 2 June. The government has officially authorised MSF day the situation deteriorated even more, of the hospital despite the ongoing diffi- to work in Point Pedro. The population of Jaffna has been displa- and 25 more injured arrived, mostly culties with supplies. But the Sri Lankan The various parties seem to ced many times and the peninsula’s infras- women and children. Ten of them died, government soon found the money nee- welcome our presence. tructure, particularly the health facilities, including six children under the age of ded to make the public services function Messages Sans Frontières, have suffered from the escalating violence. ten. By 4 o’clock that afternoon, 150 chil- again. After ten years, MSF finally closed 12 June 1987 The conflicts began between various Tamil dren had been hospitalised after their its surgery programmes in Jaffna and Point movements from 1983 to 1992, then flared school was bombed. Fifteen of them later Pedro hospitals. MSF continued its paedia- up between the LTTE and the Indian pea- died. trics programme in Jaffna hospital, which cekeeping force between 1987 and 1990, had just restarted after the negative results and later shifted to the LTTE and the Sri It was not until May 1996 that the army of an evaluation of the premature infants Lankan army from 1990 until 2001. finally managed to take control of most of and intensive care wards. Nearly 160,000 people have been displa- the island, forcing the Tigers to retreat. ced within the zone during the various Jaffna hospital was partially destroyed in In January 1998, local elections were sup- conflicts. The entire population has been the battle of the town. It had been the posed to end military rule, paving the way isolated from the rest of the island with no second biggest university hospital in Sri for some kind of democracy. But this possibility of leaving the peninsula by Lanka with more than a thousand beds. transition was soon compromised when land. In June 1996, one year after the embargo the mayor of Jaffna was assassinated in that paralysed the population and its May the same year. For the first three health facilities had been lifted, basic food, months of the year, the situation remained A BLOODY SUMMER medicines and other medical equipment unstable, but the violence soon spiralled. From 1992 to October 1995, the Jaffna were still in short supply. The strict From December 1999 the sector known as peninsula remained under LTTE control. control held by the Ministry of Defence Elephant Pass was the scene of violent 8 eight a Jaffna & Point Pedro nk a L ri S Facts and figures ment and medicines. Goods, and more importantly people, were free to move Jaffna Programme about again. Supplies were also made pos- Surgical,paediatric and sible in zones controlled by the LTTE. obstetrics assistance MSF was able to relaunch its mobile pae- >Opened in March 1997 diatric clinics from Jaffna in three areas of > Closed in March 2003 the peninsula: Kayts Island, Tellipalai and Chankanai. The end of the embargo on > Population covered: 500,000 medical equipment enabled MSF to provi- de significantly more aid to the popula- > MSF staff 2002: 3 (2 paediatricians and tion. 1 nurse) > Local staff:4 The last programme MSF maintained on the peninsula was the epidemiological > University hospital in Jaffna:Total number of monitoring of the tens of thousands of admissions in paediatrics displaced people living in unsafe health in 2002:7,950 conditions in the camps of the region (in Tenmarachchi, east of Jaffna near Vadamarachchi, and in the Weligaman zone). Owing to the concentration of clashes between the LTTE and the army. home. These precipitated forced displace- population in certain zones, a sentinel sur- Given the threat of heavy fighting and ments back to former zones of conflict veillance system of the various IDP sites large movements of troops, 150,000 civi- resulted in many accidents caused by anti- was set up. Each week, the network of lians were left with no choice but to flee personal land mines. The surgery depart- medical students went to the field to col- their homes. MSF reopened its surgery ment performed countless amputations of lect data in order to avoid the outbreak of programme in Point Pedro hospital after lower limbs. MSF began lobbying to stop epidemics. At the same time, the teams the fighting began, sending a team and the army forcing the population to return began looking into whether the people Point Pedro Programme Surgical Assistance much needed emergency equipment. In before proper mine clearance operations could be moved to safer areas, in collabo- Jaffna, the mobile paediatric clinics, which were performed. ration with the hygiene services and other >Initially opened:1987 had been set up at the beginning of the NGOs. > Temporary closure:1997 month, were temporarily suspended At the time, the situation was unstable and In February 2002, the new government > Reopened:1999 during the fighting. The paediatrics ward gunfire was still daily occurrence. But the and the LTTE signed a definitive ceasefire > Population covered: at Jaffna hospital remained in operation, situation finally calmed, with no obvious agreement, and the peace process began. 100,000 with a further paediatrician and mid-wife fighting. It was not until December 2001 In December that year, MSF was able to > MSF staff (2002): sent to join the staff already there. that the situation became noticeably more transfer most of its activities to the hospi- 4 (1 surgeon,1 anaesthe- calm. The new government signed a cea- tal’s authorities. In 2003, MSF continued tist,1 gynaecologist-obs- sefire put forward by the LTTE, and this to provide a team of surgeons, as well as tetrician,1 nurse) TOWARDS LONG-LASTING PEACE time the two parties respected the agree- some drugs and medical equipment to the > Local Staff:3 In 2001 the army decided to send the ment. The following month, the govern- hospitals in Point Pedro and Jaffna, before population in the conquered territories ment lifted the embargo on medical equip- leaving in May. 9 nine