Patients in MSF Field Hospital close to Menik Farm Photo by Anne Yzebe/MSF
What is the situation in the camps in Vavuniya?
In Vavuniya, more than 260,000 displaced people are living spread out over many different camps where they still don’t have freedom of movement. They are not allowed to leave the camps or to possess mobile phones. The populations in the camps differ from a few thousand to more than 60,000 people. Conditions vary immensely from one camp to another: in some, the water supply is a problem, in others, the delay in the distribution of food rations is the greatest concern.
Overall, there is a worrying shortage of medical staff inside the camps and MSF workers still hear from people who say they have waited for days to see a doctor. While the doctors and nurses of the Ministry of Health are working very hard, with such large numbers requiring medical attention, their task is enormous.
There are many people with injuries and amputations and there is a huge need for physiotherapy. Often, patients are discharged from overcrowded hospitals and sent to the camps where they do not receive the post-operative care they need, such as physiotherapy.
Furthermore, in most of the camps, there are no adequate health services functioning at night, so it is down to the soldiers at the gates to judge whether a patient is ill enough to need to be taken to hospital.
Mental health problems are common among the camp residents, as during the conflict they went through traumatic experiences – many of them have lost loved ones and/or have been injured. In addition to this, they are now in a situation where it is difficult to rebuild a normal life.
People are living in crowded tents, there are very few jobs available inside the camps, there is nowhere to go and very little to do other than wander between food or item distribution points, which have been organised by either the government or humanitarian organisations.
In many camps, people cannot cook for themselves and have to rely on communal kitchens. Parents worry that their children are missing out on education, and uncertainty over when they will be able to leave or see their relatives is also a cause of great anxiety.
Apparently, people in the camps are not free to leave. Why does MSF work there?
MSF is working for the people in the camps, where freedom of movement is severely restricted because according to the government, there is concern about the presence of former fighters among civilians.
While there are provisions under international law for such restrictions in a state of emergency – which the Sri Lankan parliament has declared – these are meant to be imposed for a limited duration only.
MSF is deeply concerned that the longer these conditions exist, the more difficult life becomes for those who are living in the camps, particularly as they have experienced extremely traumatic events and many are still not sure where their families are or what has happened to them.
To date, there has been no clear, systematic release of anyone from the camps, with the exception of children under 10 and adults over 60 who have relatives outside them.
With the rainy season coming up, MSF is also concerned about any acute needs that could arise in the camps.
It is true that the government has made an effort to set up the camps and ensure that assistance is provided. However, health care services, for example, are still not at the level we would hope to see.
MSF has offered the authorities its assistance in helping to expand existing services. It believes the government has an obligation to release civilians and ensure that adequate assistance is provided.
What is MSF doing in Vavuniya?
In 11 of the camps, MSF delivers high-energy porridge to supplement the diets of particularly vulnerable people, like children under five, pregnant and lactating women and the elderly. In total, MSF is giving out more than 23,000 meals each day, and making sure that sick people and malnourished children are referred to clinics and special treatment centres.
In May, MSF set up a 150-bed hospital outside the camps of Menik Farm with two operating rooms and an intensive care unit. Since its opening, over 1,000 medical and surgical patients have been admitted. People are referred there by the Ministry of Health staff in the camps. We are mostly treating conflict-related injuries, respiratory tract infections and paediatric cases.
Maternity services have also recently started. We continue to support the Ministry of Health General Vavuniya hospital with MSF staff providing surgery, nursing and physiotherapy.
Nine nutritional assistants work alongside ministry of health staff in the nutrition department of the paediatric ward and a mental health officer is assisting a local NGO to train their counsellors to provide mental health care to the hospital patients.
A team of about 135 caretakers help patients with day-to-day activities like eating and bathing and some of them are also being trained in physiotherapy and dressing of wounds. MSF has also distributed clothes, towels, water bottles, money, mats, pillows and bed sheets to more than 10,000 patients, as most of them arrived with only the clothes they were wearing.
In the Ministry of Health’s Pompaimadu hospital, MSF staff are taking care of 180 wounded patients, many of whom have had amputations. Fifty of them have spinal cord injuries. The main treatments administered are dressings, physiotherapy and surgery.
We are in a process of negotiations with the authorities to start a programme of orthopaedic and reconstructive surgery in the Vavuniya hospital.
What restrictions do you face in your work?
The process to issue visas for international staff is lengthy and highly bureaucratic and this has hampered our work. Also, the teams having to enter the camps on a daily basis to provide food are often hindered by unclear procedures which can sometimes delay work by hours or days.
MSF is not allowed to enter camps where we do not work and we have not been able to carry out an independent assessment of the needs of the displaced people in the camps.
While MSF has the capacity to scale up activities and provide medical and mental health care for the people inside the camps, so far, the authorities have not accepted this proposal for assistance.