During the five days from May 16 to 20, 77,000 people emerged from the recent conflict zone in northern Sri Lanka, arriving in the Vavuniya area. Many of them needed urgent medical care. MSF teams have been providing medical services day and night at different locations — from the checkpoint close to the former frontline, to the hospital in the city of Vavuniya. Roughly 10,000 people per day passed through the Omanthai checkpoint, where a four-person MSF team identified the wounded and sick who needed to be transferred to the hospital, stabilized patients for transfer, and provided as much on-the-spot medical care as possible. It's the 20th of May in Omanthai, and MSF surgeon Jean-Paul Dixmeras finds a 13-year-old girl with shrapnel embedded in her back. He tells her not to move as he tries to take out the shrapnel. “We treat as many people as we can directly on site because the hospital is more than full,” explains Alexa ter Horst, a Dutch doctor also working at Omanthai. “It is always a difficult decision to take: treat on site or let them go to the (internally displaced persons) camps, with the follow-up that can be provided there, or send them to the hospital, where there are already four patients to a bed.” MSF refers an average of 20 wounded people per day to the hospital, while a medical of three treat around 150 patients a day in the onsite clinic at Omanthai. “One of us goes through the long lines of people and sends to the clinic those who need the most medical care,” ter Horst continues. “A large majority, among the last of the people that came out of the conflict zone, have wounds or scars from bullets and shelling. Many people had surgical procedures in the conflict zone. Some wounds are old and have healed, but others are bleeding — either because the wound is recent or because it has reopened.” In the emergency room in Vavuniya Hospital, moving around is difficult since people are everywhere. The hospital has 400 beds, but over 1,900 patients are packed into the hospital. MSF teams support ministry of health staff to help treat the sick and wounded. “I’ve been doing around 30 surgical procedures per day over the last few days,” says Matthew Deeter, one of four MSF surgeons working in Vavuniya Hospital. “Normally, I would do five. We sometimes work together on the same patient; one is amputating the leg and the other is amputating the arm. Or one is taking care of wounds in a foot and the others are treating chest wounds. The majority of the injuries are relatively mild, but we see lots of them on the same patients — something like 20 mild injuries for one person, caused by a bomb blast.” The immediate priority for MSF is to treat the sick and wounded coming out of the former war zone. In addition to providing support to Vavuniya Hospital, teams have set up post-operative care in the Pompaimadhu Ayurvedic Hospital to help with the follow-up of patients. MSF has also just set up a 100-bed field hospital with surgical capacity outside Manik Farm to provide emergency care to patients from surrounding camps which hold approximately 160,000 people.