Immense surgical and mental health needs in Sri Lanka's conflict area

During the first two weeks of March, relatively few people seem to have been able to flee from the Vanni region in Sri Lanka. Communication with people inside the Vanni remains incredibly difficult, but the accounts given by the few who have managed to escape in recent days confirm that civilians continue to be trapped in the conflict and that it is practically impossible for them to leave as they risk getting shot. An MSF team continues to work at the government hospital in Vavuniya, focusing on surgery and laboratory support. The civilian population in the Vanni are suffering heavily as a result of the violence. Out of the 953 admissions of wounded and sick people evacuated from the Vanni between February 11 and the March 8, 584 were in need of surgery. The majority of the surgical cases (92 percent) are violence related. The wounds are predominantly caused by shrapnel and shooting. MSF remains extremely worried about the situation for approximately 150,000 civilians remaining in the Vanni. Life in the camps The 33,896 people who managed to flee in the first two months of 2009 are living in 13 camps in Vavuniya and 3,000 people living in temporary settlements in the Jaffna area. The camps in Vavuniya are enclosed areas which usually include a community building, like a school or university campus. People are living in tents, with two or three families living together, or in public buildings. The camps are very crowded: there can be 600 people living in a large basketball court. They are surrounded by barbed wire and people are not allowed to leave or communicate with people from other camps. They are not allowed to receive visitors, and it is common for families to be split between several camps, with a man in one camp and his wife in another for example. In each of the camps, people do not have the possibility of cooking for themselves, but instead have to rely on community kitchens for food. If sick, they go to the government health services of the camp and, if needed, they get referred to the hospital. MSF runs a supplementary food programme for under 5s, pregnant women and breastfeeding women in the camps. Every day an MSF team prepares the supplementary feeding mix and distributes it to the target groups in 10 of the 13 camps. Mental health problems Many people in the camps are experiencing acute mental health distress which, at present, is not being addressed. People have been very affected by the traumatic experiences they have been through, both in the Vanni and during their flight. Many have lost relatives or even entire families. They have no contact with the family or friends in the Vanni and often do not know whether those they left behind are still alive. Whenever there are new arrivals, people crowd around them to see whether they can find their loved ones amongst them. Some people have been living in the camps for months. Before they were able to leave the Vanni, many had already moved five or six different times in search of a safer place. In the camps, they have no jobs or schools. There is literally nothing for them to do except wait. They have lost all autonomy. Their lives are on hold with constant fear about the safety of their loved ones. MSF is ready to assist the population of the camps by providing independent and confidential mental health services and we are discussing access with the authorities.