Sri Lanka: Health as a Weapon of War?

by Shiamala Suntharalingam, general practicioner, London, British Medical Journal, June 8, 2009

See also 'The Human Rights to Food, Medicine and Medical Supplies, and Freedom from Arbitrary and Inhuman Detention and Controls in Sri Lanka'

shiamala@hotmail.com

In 2003 I worked as an overseas volunteer doctor for six months in the Tamil north. That is when I realised the extent of the physical and psychological trauma that the Tamil people had faced during Sri Lanka’s 30 year civil war.

Throughout the conflict successive governments have used access to medicines as a weapon of war against the Tamils who were living outside the military controlled areas in the Tamil north east of the island. The recent conflict, which began in 2006, is no different.

Since 2006 the Sri Lankan government and its armed forces have systematically blocked the provision of clean water, shelter, food, and medicines by civil organisations as well as local and international non-governmental organisations (NGOs). In 2008 all international NGOs working in the northern region of Vanni, including Médecins Sans Frontières, were ordered out. It became a war
without any witnesses.

In December 2004 the Boxing Day tsunami brought more death and destruction to people who were already recovering from war trauma. During this natural disaster the Sri Lankan authorities denied access to the north east for long term relief and rehabilitation projects by NGOs and even prevented former US president Bill Clinton from visiting the affected Tamil areas.

The current phase of the civil war in northern Sri Lanka came to an end last month. Almost 280 000 Tamil men, women, and children surrendered to the Sri Lankan military after suffering continuous war, deaths, injuries, and war related displacements for almost three years. At the moment they are all forcibly kept under the direct custody of the Sri Lankan authorities. The officials refer to these people as internally displaced persons (IDPs).

Independent reports indicate that these people are kept in overcrowded camps and are not allowed to come out or communicate with the outside world. Members of the same family are forcibly kept in different locations. Women have been separated from their families and sexually abused, according to Britain’s Channel 4 News. Children in the camps are not allowed to go to school. IDPs who are teachers are not allowed to go to work. In short there is no freedom of movement. At the moment the official pronouncement is that these people will be kept under these conditions for the next three years or so.

According to local NGOs, the sick are allowed to seek limited medical help at local hospitals under military escort. The local hospital in this particular area, Vavuniya hospital, is already poorly manned and equipped because of the war. I have heard from colleagues in the area that Tamil doctors from other regions of Sri Lanka who came forward to serve these people have been refused access.

During a lightning one-day visit last week, United Nations chief Ban Ki-moon described the camp conditions as "appalling" and pressed the Sri Lankan government to allow aid agencies more access to work inside the camps. He left without receiving any such assurance.

Severine Ramon, coordinator for Médecins Sans Frontières, said the IDPs were living in misery. "Due to unhygienic living conditions, even wounds are not healing, prolonging the agony of those living inside the camps," she is reported to have said. Many of the adults and children are malnourished due to the lack of food, and this further impedes recovery from injuries.

The safety of Liberation Tigers of Tamil Eelam (LTTE) fighters, both men and women who have surrendered and are now prisoners of war, is questionable and the Tamil diaspora fears that they will be subject to torture, disappearances, and extrajudicial killings by the Sri Lankan armed forces.

During the last three years only a handful of local doctors remained in the war zone serving almost 300 000 people. Among them, T Sathiyamoorthy, T Varatharajah, and V Shanmugarajah provided valuable services as well as maintaining contact with the media and also with NGOs such as the United Nations, informing the world about the conditions they faced. All three of these doctors have been detained by the Sri Lankan armed forces and their safety is uncertain. Another doctor, J Sivamanoharan, who provided mental health services in the war zone during the same period, was killed in the war.

The Tamil diaspora, living mainly in the West, is more than a million strong, and we are in touch with our friends, relatives, and NGO workers in Sri Lanka. Local health workers inform us that the Sri Lankan Ministry of Health is not allowing Tamil doctors to assist the injured and sick inside the camps. The Sri Lankan Medical Association has not taken any obvious action over the above critical issues. I have yet to receive a reply to my request on 22 May 2009 asking them to inquire about the wellbeing of the three doctors mentioned above and to provide much needed medical assistance to the IDPs.

At this juncture I feel helpless and utterly frustrated for my people.
*Cite this as:* *BMJ* 2009;338:b2304