"What we are hearing this week about the extent of the health crisis among displaced people in the Vanni districts is both deeply upsetting and compels us to say with an even greater sense of urgency that this suffering must stop," says Jack Arthey, Head of Christian Aid's South East Asia Team, who visits Sri Lanka regularly.

Some 700,000 of Sri Lanka's one million internal refugees live in the Jaffna peninsula and the northern Vanni districts, their lives torn apart because of the on-going civil war between the government and the Liberation Tigers of Tamil Eelam (LTTE). Information on the health care situation and the welfare of refugees is constantly disputed and manipulated by both sides, a situation made possible because access to the north is severely restricted by the government.

Evidence received by Christian Aid this week shows the health care situation in the northern Vanni districts has reached critical proportions. There is a high incidence of diseases such as malaria, typhoid and scabies in nutrition centres. Where they exist, hospitals staffed by one doctor are often seeing 1,200 patients a day.

"Essential drugs are often outdated, or old stock and ineffective, as medicines and other items are restricted or banned under a government embargo on certain goods to the north," says Jack Arthey. "Worm infection and anaemia are common among the pregnant women. Maternity clinics are few, the roads poor and virtually no available means of transport."

CA supports the work of seven non-governmental organisations providing materials to build temporary homes. They also run nutrition centres for mothers and children. Emaciated mothers and children are referred by hospital staff to these and other over-stretched nutrition centres. Mothers report that their children are developing night blindnesses through lack of vitamin A and need to be watched over continually to prevent them from knocking into objects and hurting themselves. There is a lack of vitamin A tablets in the hospitals.