Ramachandra is18 years old. She was wounded on Jan. 8 during the conflict in northern Sri Lanka, and underwent amputations at a hospital in the Vanni. She was evacuated by ambulance to the main hospital in the northern Sri Lankan town of Vavuniya  eight days later. The young woman is missing her left hand and left leg, and half of her right foot. Without post-operative care and physiotherapy she could remain bed ridden for the rest of her life. Ramachandra is currently hospitalized in the Pompaimadhu Ayurvedic Hospital close to Vavuniya. Unlike other hospitals in the area, which are flooded with patients, the Pompaimadhu Hospital appears like a small haven: no wounded patients lying on mats on the floor, no ambulance traffic jams at the hospital entrance. Lots of wheel chairs and crutches donated by Handicap International are placed alongside the beds. At least 30 patients in the hospital have one or more amputations, whilst another 25 people are paralyzed. Up to 200 patients receive post-operative care here, including small surgery and physiotherapy. “As the Vavuniya Hospital was overcrowded, the Ministry of Health established a post-operative care unit in the Ayurvedic Hospital, which MSF [Médecins Sans Frontières] has been supporting since the beginning of May,” says a doctor who is part of the MSF emergency team in Sri Lanka. “It’s a separate space where war wounded patients receive the complete medical care they need, from small surgery or daily dressings, up to rehabilitation.” The physiotherapist attaches Ramachandra’s wrist to a crutch with bandages and she slowly stands up and begins to walk. MSF, Ministry of Health doctors and nurses and Red Cross Society volunteers quietly move from patient to patient housed under six temporary structures. Most of the patients have several dressings that need to be changed regularly. In a small room in the hospital, MSF surgeons and anesthetists carry out surgical procedures such as skin grafts and wound closures. An old woman tries to stand up with crutches by herself and falls down, breaking into tears. Emotionally exhausted, the patients have to mobilize enormous energy just to try to walk again. On the next bed, chatter has begun between teenage girls. Among them is Agantha, 17, who has had both legs amputated above the knee. Another patient, a 14-year-old girl, smiles as the physiotherapist urges her to walk. “In one month she will walk,” announces the physiotherapist, pushing on very frail girl’s knees to help her get on her feet from a wheel chair. She keeps her smile throughout the exercise, but after the physiotherapist has gone she cries and complains about the pain, her distraught mother looking on. “It’s the first time she’s standing up in five months,” explains the physiotherapist. “There are thousands of patients like her, either in the hospitals or in the camps, who need post-operative care and physiotherapy.”

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