sri lanka v. ang

27 Pages·2003·1.92 MB·English

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

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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.
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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.
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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
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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
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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
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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
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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.
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