Over the last 36 hours Médecins Sans Frontières (MSF) surgeons alongside Ministry of Health staff, have been working around the clock to treat more than 400 war wounded patients that have arrived in Vavuniya hospital, in the government controlled area in northern Sri Lanka. This number represents almost double the number of patients that were normally admitted to hospital in the space of a week. The injuries are mostly caused by shrapnel and landmines. Busloads of patients are arriving from the conflict zone to the hospital and the government-run camps in Vavuniya. “The buses are still coming and they’re actually unloading dead bodies, at times, as some wounded people died on the way,” says Karen Stewart, MSF mental health officer working in Vavuniya. More than 30 wounded people died on their way to the hospital on Monday, April 20. In the last days, between 25,000 - 40,000 people are reported to have now left the conflict area, known as the Vanni, but tens of thousands remain trapped in the middle of fighting between government forces and the Liberation Tigers of Tamil Eelam (LTTE). "Almost everyone has left someone behind in the conflict area,” explains Stewart. “Sometimes you can even hear the shelling from Vavuniya so they know what’s happening in the Vanni. Probably 85% of the people I’ve talked to have witnessed horrific things, like being in a bunker, and suddenly a shell goes and it’s killed half the people in the bunker. Someone else I spoke to told me how she went out to find some water and when she came back everyone in her bunker was dead.” Despite the efforts of MSF and Ministry of Health staff, the hospital in Vavuniya is completely overwhelmed. In the month of March alone, 90 per cent of the 800 surgical operations carried out by the MSF and Ministry of Health surgeons there were for people wounded by bullets or shelling. There are over 1,200 patients and the bed capacity is just over 400. “It’s chaotic,” says Stewart. “The beds have been pushed together so it’s like one massive bed. Instead of having one person per bed, you have two. It’s just like one huge bed across the ward. Then there’s a whole other layer on the ground, we have people under every bed, so that’s double capacity. You also have a lot of people who are outside, in the walkways, lying on mats.” People arriving from the war zone are put into temporary government-run camps in Vavuniya which are fast reaching maximum capacity. Families are cramped together, in some cases an entire family has to live in the space of a sofa. There is no freedom of movement in between the camps, and only a minority have been able to find out any information about their loved ones who might be in other camps. “This is one of the biggest causes of mental health distress," says Stewart, a mental health specialist. "They arrive, wounded, lost and skinny and then they are put in a camp where they can’t leave and they can’t call their family. They have no communication, they have nothing. There can be a husband and wife in two separate camps and they would never know.” MSF calls on all parties to the conflict to allow independent humanitarian agencies to provide medical aid to the wounded in the Vanni, and to help evacuate the wounded to hospitals. Tens of thousands of civilians remain trapped in the war zone. It lies within the responsibility of both parties to find a solution for the civilians to be safe and to have access to medical care.