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Sri Lanka: organizing medical evacuations by sea

26-02-2009 Interview

People fleeing hostilities in the Vanni continue to arrive in Putumattalan, on Sri Lanka's north-eastern coast. Since 10 February, the ICRC has evacuated nearly 2,000 patients and relatives by sea for medical treatment. The evacuations continue, with the support of both parties to the conflict.

 Morven Murchison coordinates the ICRC's health activities in Sri Lanka. She took part in several recent evacuations. In this interview she speaks about the needs of the displaced population in the Vanni.  

 What is the humanitarian situation in the Vanni, and in Putumattalan in particular?  

Thousands of displaced civilians are currently seeking safety, food, water and medical care. Entire families have moved and are still moving towards the coast to escape the fighting. They hope to find something to eat – fish, for example. However, because there is not enough drinking water in the Putumattalan area, they end up moving back inland in search of water. The lack of clean water is a major humanitarian concern: the population on the coast has increased tremendously over recent weeks and the wells in Putumattalan cannot provide enough water for everyone to drink, wash and cook.

As the fighting continues, the area in which most displaced people are located gets smaller by the day. The area in and around Putumattalan is not safe at the moment. Naturally, people look for safe areas and find themselves forced to compete for space with tractors, bullock carts and domestic animals. They dig trenches to protect themselves and remain in them most of the time. They come out only when it is safe for them to do so.

In such difficult conditions, there is also a great sense of community. Food is scarce, but many share whatever they have. The last time I was in Putumattalan someone brought a small basket of fish from the sea, which was immediately shared among the 70 or so people who were there.

 Are there medical facilities that can treat the sick and wounded in the Vanni?  

As far as we can tell, none of the conventional medical facilities that used to treat the sick and wounded are functioning anymore. There are only a few makeshift medical points left. Owing to security constraints, pregnant women are opting to have their babies wherever they happen to be. The sick and wounded arrive in Putumattalan on a daily basis. To cope with the influx, local people have helped set up a makeshift medical facility in a community centre and school. Even there, some patients are sheltered only by tarpaulins.

The shortage of some medical supplies remains an issue. Many patients transferred from Putumattalan to Trincomalee Hospital have wound infections due to inadequate sanitation and a lack of antibiotics. A few Ministry of Health staff are on the ground doing what they can. They are master improvisers, using bed sheets for bandages and hanging saline drips from tree branches above patients. In the shade of another tree, dead bodies are stored until they are claimed by loved ones. Any unclaimed bodies are buried on the spot.

 Are there concerns that there could be an outbreak of disease in Putumattalan?  

The risk of an outbreak is very high given most people's living conditions, the lack of water and the lack of proper sanitation.

There are no proper latrines or pits in the area where most displaced people are. There are reports of an increase in the number of cases of communicable disease s, including diarrhoea and respiratory infections. We are very concerned about the possibility of a serious outbreak of disease.



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 The evacuations by sea of sick and wounded people and their families carried out by the ICRC since 10 February have taken place under difficult conditions. They have been possible only because of the ICRC's neutral and independent status and the active support of both parties to the conflict.  

 Linh Schroeder coordinates all field operations for the ICRC in Sri Lanka and has played a key role in organizing the evacuations. She explains what the ICRC is able to achieve because of its neutral and independent status.  

 How does an ICRC sea evacuation get organized?  

The ICRC carries out its work in the Vanni, now as ever, as a neutral and independent intermediary with the full support of the parties to the conflict. We have a long history of facilitating the safe movement of civilians and humanitarian aid by road between government-controlled and LTTE-held areas. We have been able to perform this task only through the active support of the parties.

The military and humanitarian situations in the Vanni have obviously changed in recent weeks, but our working procedures remain the same. To evacuate the sick and wounded by ferry, we must first obtain the agreement of the parties. Bringing a boat into a conflict area is a delicate undertaking which we will become involved in only if both sides provide us with the necessary security assu rances. They do so because of the neutral and independent nature of our humanitarian work. Only when the safety of our staff and of the vessel and passengers have been guaranteed can a sea evacuation take place. In practical terms, this means that there must be respect for the ICRC's independence and its humanitarian role as well as agreement on such matters as the timing and route of the operation.

 With whom does the ICRC negotiate?  

In addition to obtaining guarantees of safe passage from both parties, the ICRC maintains contact with all military and civilian authorities, including those of the LTTE, that may be involved in or affected by the evacuations. We are therefore in constant discussion with the Sri Lanka Security Forces, which control the area in which our ferry navigates, the Sri Lanka Navy in Trincomalee, which disembarks the patients, and Ministry of Health staff, who take care of incoming patients at Trincomalee Hospital.

Practical issues have also had to be taken into account. First of all, we had to find a vessel that was suitable for transporting patients, some of whom are in critical condition. In particular, we needed a large vessel that we could bring patients to on small fishing boats. The Green Ocean , a ferry that usually operates between Trincomalee and Jaffna, is the best option available at the moment. ICRC medical evacuations are scheduled carefully and in discussion with the civilian authorities, in order to minimize the impact of the disruption in the ferry service for the Jaffna population.

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