In 1995 since the resumption of Eelam war III the Government of Sri Lanka forbade NGOs from distributing food, and with the exception of ICRC, distributing medicines. Stringent controls have been imposed on the ICRC also in the medicines they provide.

Thus the government took upon itself the full responsibility of the distribution of food and medicines to the war torn districts of the Vanni (Mullaitivu, Kilinochi and Mannar ). But, Instead of providing, the government has pursued a policy of deprivation.

It does not allow any outsiders to visit the area so that this information is not disseminated.

It imposes severe controls on the NGOs which are allowed to work there. For instance, the NGO personnel are not allowed to carry cameras or even film rolls.

Given below is a brief description of the health and nutrition problem which has now loomed large to crisis proportions.

HEALTH

(A) Health Services
The Vanni districts have only one district hospital in Mallavi, whereas according to Health Ministry specifications, they should have four Base Hospitals (one per 100,000) one district hospital (one per 50,000) and a central dispensary and maternity ward for every 20,000 people.

For instance Mullaitivu district itself has a population of 233,000 (the government has repeatedly disputed this figure which was compiled after an extensive census taken by the Mullaitivu government agent in October 1997) out of which only 108,321 are the local population. Out of 233,000 in Mullaitivu district, only 90,709 are not displaced. Therefore, the health services are woefully inadequate especially to serve the most vulnerable segment of the population, the displaced families. Given below is the available medical staff, of doctors and registered medical practitioners (RMP- who are not doctors), serving in the district hospital and central dispensaries.

The lack of staff, the blockade on medicines, sudden increase in the population leading to the outbreak of diseases, the extremely restricted permission on malathion (a spray used for mosquitoes), the clearing of dense forests for resettling people which has brought upon the population a variety of unidentified fevers, all have further exarcebated the health problem.

(b) Diseases

- Malaria
OPD attendance in Mullaitivu district in 1997 was 727,103. Out of this 339,843 people were treated for clinical malaria. Facilities are minimal for taking blood tests on patients, instead the doctors say they guess from symptoms and treat the patients straight away with very strong drugs. Blood films were taken for a small sample of 36,515 fever patients, of whom 16,936 were identified positive for malaria. Of these, 3239 were identified as having cerebral (brain) malaria .

Every person in the district have contracted malaria at least twice. It is normal to meet people who have got malaria 7-9 times, since they were displaced to the Vanni. This chronic outbreak of malaria has brought other complications related to reduction in disease resistance, brain hemorrhage, and an outbreak of tuberculosis. In 1997 approximately 1200 patients were diagnosed as having TB.

The government sends restricted quantities of sugar coated chloroquin for malaria, which is ineffective. The government also sends outdated (expired) medicines. For instance, the stock sent to the Medical Officer of Health of Mullaitivu in October 1997 was seen to be expiring in November and December 1997 and  January 1998. The doctors, seeing that the medicines used are not effective, prescribe Quinine - a drug no longer used anywhere else. Patients need to consume high protein diet when using chloroquin. But the poor take it on empty stomachs and have suffered hallucination, dizziness, fainting and inertia.

In the activities of malaria prevention, the health authorities are mounting a campaign to clear over growth around settlement schemes. Malathion is sent only in restricted quantities that they are able to spray sections of the region in rotation. So that this exercise is only temporary relief.

- Other diseases
Typhoid has become rampant. The government sends chloramphenicol and quadril for treating typhoid. Chloramphenicol is no longer used in other parts of the world because of its serious (sometimes fatal) side effects. The MOH in Mullaitivu is concerned about the usage of this drug.

Rabies is prevalent due to lack of medicines.
Rabies has become another fatal disease due to the increase in the population of stray dogs and the lack of medicine (which is very expensive even in the South). Strychnine, a poison used for killing stray dogs is banned. The only means available for the medical staff is to beat the dogs to death which they are reluctant to do. Recently after much pressure exerted by the district medical personnel, the government has allowed only 200 g of Strychnine.

(c) Pregnancy and child birth
Worm infection and anemia have been identified as common afflictions for pregnant women. Iron tablets (which is very cheap) is also in short supply. The mothers are afflicted with malaria too during pregnancy. The maternity clinics are far apart. The conditions of the roads are extremely poor and transport is next to nil. Harrowing tales of women dying at childbirth due to lack of transport services are common. The MOH lacks personnel to do a survey of deaths during pregnancy but surmises that these incidents are high.

NUTRITION
Since the government disputes the population figures provided by its own government agent, it provides dry rations to only half of the displaced population. Having no choice the government agent distributes it among the whole of the displaced population. As a result, a displaced family receives only Rs 315/- worth of food per month which distribution is also very irregular. Employment avenues were already inadequate in Mullaitivu, and the arrival of displaced population has affected the prospects of even the local labour. So that labourers in the agriculture and fisheries sector have been severely affected. The result is massive starvation.

Most children in the area are malnourished. A survey done by the midwives indicate that out of a random sample of 16,767 children under 5, those who were normal were only 4863. 6371 children were found to be afflicted with third degree malnutrition, 3186 children with second degree and 2347 with first degree malnutrition. Malnutrition is caused by lack of food, is compounded by diseases such as malaria, bronchial diseases, worm infestations, etc. Particular areas have shown even higher percentage of malnutrition. For instance, in a division called Puthvedduvan in Mullaitivu district (population 1900 families), out of 121 children picked out by random sampling, 56 were seen to be suffering from third degree malnutrition.

Emaciated looking mothers and children, referred by the hospital staff, flock nutrition centers run by NGOs where wet feeding is implemented. The organizations are unable to cater to the demand. Mothers report that their children have developed night blindness and need constant supervision to prevent them from knocking into objects and hurting themselves after dark. There is shortage of vitamin A tablets in hospitals which is essential for treating night blindness. The minutes of education department meetings of principals reveal that 3 - 7 students faint in hunger in schools on a daily basis. The principals have also reported that sometimes they are forced to close schools by 10 am because the students cannot cope with schooling without food.

EDUCATION FACILITIES
To highlight drawbacks of the education facilities, one could look at the conditions of schools in Thunukkai, one divisional secretary’s division in Mullaitivu district. The present facilities were barely able to cope with about 2300 students before the displacement of 1995. Now they have to serve 8571 children. Students study under trees. The schools need 313 teachers but have only 128. So the department is forced to employ 106 volunteer teachers with an allowance of Rs 500 per month, which money is collected from the displaced population at Rs 10 per month.

In villages and settlement schemes mothers recount humiliations their children suffer at school because they could not make necessary payments to school or that they did not possess exercise books and pencils. Roughly 20,000 children in the district are unable to attend schools.

Recently teachers did a survey of the standard of education in the Thunukkai division and found that 210 students attending the classes between year 4 and year 8 did not know to read and write.