The emergency medical aid organisation Médecins Sans Frontières today expressed its deep concern about the humanitarian situation in Sri Lanka. The recent outbreak of major fighting in Sri Lanka has caused civilian casualties and further hardships for the population in the contested northern areas.

MSF has called on the warring parties to respect international humanitarian law and stop indiscriminate attacks that are injuring and killing civilians. The parties should also guarantee front-line passage for relief goods and access for other humanitarian agencies.

"MSF field workers near the combat zone have already come across sad evidence of the indiscriminate use of force," said Operational Director Marcel van Soest. "Both the Sri Lankan army and the Tamil Tigers must respect the right of civilians not to be targets of attack." On November 3, shells hit the village of Paliyady in Mullaitivu District.

MSF health workers at Mallavi Hospital treated three children with minor shrapnel wounds who were injured on their way home from school, and a 63-year-old man with severe injuries to both legs, resulting in an emergency amputation. The same area was bombed that evening by a Sri Lankan Air Force jet. Eleven seriously injured people were taken to Mallavi Hospital - of these, six died on arrival and a seventh following several hours of extensive surgery. Four casualties remain in Mallavi Hospital in a stable condition.

MSF teams in Mallavi and Puthukkuydiyiruppu are isolated from the south of the country, but they can still accomplish some work. It is unclear how long the teams can continue with their existing supplies. Says van Soest, "We are concerned that should fighting continue for an extended period, the civilian population in the affected areas is likely to face severe shortages of food and essential medical supplies. It is necessary that both sides take steps to ensure the open flow of humanitarian assistance to the civilian population." MSF has been working in Sri Lanka since 1986. MSF has a program in the Mallavi hospital (Surgery, Paediatrics, Gynaecology, and lab research) and a malaria program in Puthukkuydiyiruppu.

Furthermore teams operate in Batticaloa (Surgery, Mobile clinics, rehabilitation of the hospital), Vavuniya/Murunkan (Murunkan hospital and mobile clinics) and Jaffna Teaching Hospital (Paediatrics, Maternity, Sterilisation & Hygienne in OT). There are a total of 31 MSF volunteers in Sri Lanka.