While Sri Lanka’s Ministry of Health has set up a system to provide initial treatment to the wounded and sick people in camps in the Vavuniya region following the conflict in the north, the needs remain immense and require around-the-clock medical presence in the camps to respond to all emergencies. Médecins Sans Frontières (MSF) has the capacity to scale up surgical and medical care for the displaced inside the camps if authorizations are provided.

An inflatable MSF field hospital is currently the closest referral hospital for the 220,000 displaced people living in Manik Farm camp in northern Sri Lanka. Along with six hospitalization tents, the hospital is equipped with two operating theatres and an intensive care room. The MSF medical team working in this hospital is currently treating war-wounded patients and patients suffering from pneumonia, other severe respiratory infections and dehydration caused primarily by diarrhea. The 100-bed facility received its first patients on May 22 and its first surgical cases on May 26.

Ambulances arrive from the five zones of Manik Farm camp bearing some of the displaced people in need of hospitalization. Around 70 patients, lie on their beds under the white tents in the MSF field hospital, just across the road from Manik Farm.

In the operating theatre, MSF surgeons are performing six to 10 minor surgical procedures everyday, on people suffering from injuries caused by shell blasts, gunshots or accidents. MSF surgeons remove dead and infected tissues from wounds – several times if necessary – to try to avoid amputations. “We have lots of infected war wounds that have been poorly treated,” describes Mike Newman, MSF surgeon. “For some wounds the treatment is coming weeks later, for others it is months later.”

In the tent full of patients, a woman with a bandage around her head waits to be examined. Selva (patient names changed) was injured in the Vanni, the former conflict zone, on May 19. Her husband and oldest daughter were also wounded. They wrapped some clothes around their wounds to stop the bleeding. The next day, they managed to reach the Omanthai crossing point to escape the fighting, where the army told them to go to the onsite clinic. But Selva refused, afraid that in her absence her family would be loaded onto a bus and taken to the camps, effectively separating them. Two days later, once in the Manik Farm camp, she sought care in the overcrowded camp hospital. It took another two days for a doctor to treat her and refer her to the MSF field hospital, by which time her wounds were infected.

Next to Selva’s bed, an 18-year-old boy has multiple injuries: three-month-old bullet wounds in his arm and shoulder and one-week-old shrapnel embedded in his knee. With a home-made bandage around his knee, Dilan walked for two days out of the battle zone before being sent to the Manik Farm camp with a dressing over his knee. Still in great pain, he went to the camp hospital, where his dressing was changed and he was given some medicine. But over the following three days he received no follow up care. Though the medicine eased the pain, an infection was spreading. Eight days after his injury, Dilan arrived at the MSF field hospital.

There are probably hundreds of people like Selva or Dilan who have not received the close medical follow up war-wounded patients require. Though Ministry of Health doctors working in the camps are doing their best to cope with the number of patients, there is a need to provide around-the-clock service which can identify, treat and refer war-wounded patients and  medical emergencies to the field hospital as quickly as possible. MSF has the capacity to scale up these services in the camps and continues to pursue discussions with the authorities in Colombo.

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