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Selected Writings by Dharmeratnam Sivaram (Taraki)
LTTE has own 'medical corps'
6 October 1996
Taking care of the wounded in battle is a key element in sustaining the morale of an army or any organised fighting force.
If soldiers in the field feel that they will not get adequate medical attention they may be less ready to fight resolutely. The sight of their injured but unattended brothers in arms can dampen the fighting spirit of men in battle. (There are rare instances of wounded soldiers killing themselves. Medieval Tamil grammars describe a codified form of martial suicide called Pun Kiliththu Mudiyum Maram whereby a wounded soldier would kill himself by tearing his wound apart to “attain the glory of the warrior’s heaven”. )
Modern states became increasingly aware of this when rules and methods of raising and deploying mass armies were standardized in western Europe in the latter half of the eighteenth century.
However this awareness found expression formally only when the
the Geneva Conventions were adopted in 1949. (Sri Lanka signed it in 1959)
“At all times, and particularly after an engagement, parties to a conflict must immediately take all possible measures to search for and collect the wounded, sick and shipwrecked to protect them against pillage and ill-treatment and ensure their adequate care as well as to search for the dead and prevent their being despoiled” (1-15, 2-18, 4-16)
It is relevant to note here that many wars in the post-cold war world are being waged by parties which are not signatory to the Geneva Conventions and hence are not bound formally to observe the norms relating to the dead and wounded of their opponents.
(The massacre at Mullaithivu is a very good illustration of this developing situation in the new world order.)
Although this may be the case with regard to conflicts between states and “non-state’ armed forces, caring for the wounded and removing the dead are of central concern to even those who may not be party to the Geneva Conventions if their aim is to have a modern efficient, and hence significantly literate, fighting force.
Caring for the wounded is not merely important for morale but is necessary for replenishing one’s troops, particularly when one’s recruitment base is limited.
The army, which is more than hundred thousand strong, has two regiments of medical corps - one volunteer and one regular. These constitute the Directorate of Medical Services which comes under the Adjutant General. Brig. (Dr) L. R Navaratne is the director while his predecessor Major General (Dr) C. Thurairajah is consultant. The total strength of the DMS is not more than two thousand. There are also civilian doctors who are seconded to the medical corps. Last week it was clear that the DMS was under some strain in coping with the wounded from Kilinochchi. The President herself had to appeal for blood donations. Normal surgical operations at the national hospital had to be postponed due to lack of blood.
The question here is - if the army, which has a regular medical corps with the full backing of the state’s medical system, sometimes finds itself in difficulty when casualties are exceptionally high, then how does the LTTE handle situations where it has to deal with hundreds of injured cadres within a short space and time ?
(The “expalantion’ heard recently in the government media that the Tigers are giving cyanide to their wounded cadres is nothing but scatterbrained psy-ops.)
The question is especially relevant in the context of the government’s claim that with the capture of Kilinochchi the Tigers have been denied all major hospitals in the north. The implication here being that the LTTE cannot , in the future, engage in major confrontations in which it would have to take a large number of casualties.
Even a brief perusal of the manner in which the LTTE has handled the matter will show that this argument is not quite sound as it may appear to be.
Until 1991 the Tigers had unhindered access to the hospitals of South India. The LTTE had to only have first aid or the basic paramedical facilities to keep seriously wounded cadres alive until they were taken across the Palk Strait. In fact this is how Seelan (Charles Antony) survived the gun shot injury which he recieved in the attack on the Chavakachcheri Police station in 1982. He, who otherwise would have died due to excessive bleeding or become lame for good, was operated on a few days after the incident in Tamil Nadu and later underwent physiotherapy until he could walk about. It should be noted here that it is Seelan who helped Prabhaharan save the LTTE from oblivion.
But Sathiyanathan, the LTTE’s first martyr, who was wounded in an army cordon in Jaffna died in Madurai while being treated at a hospital there.
Even when the LTTE took on the Indian army it was able to take its wounded cadres to Tamil Nadu for treatment. It also brought enough medical supplies from there to keep its paramedics well equipped.
But all this changed after Rajiv’s assasination. Medical supplies were largely cut off and hospital facilities were completely denied in Tamil Nadu and other parts of India.
Yet the LTTE undertook the attack on the Elephant Pass camp in which a very large number were wounded. All were treated in Field Medical Stations and the more serious cases were sent off for surgery in hospitals in the peninsula and in the jungles of Vanni.
The amount of medical supplies such as saline, Gelefundin solution, pressure bandages etc,. which the medical units of the LTTE had at their disposal in the Field Medical Stations (FMS) and the number of doctors and other medical personnel who were working in the rear was a clear indication that the Tigers had developed at least a rudimentary medical corps by that time.
Taking care of a large number of wounded also means the efficient accumulation, storage and distribution of blood for transfusion.
The LTTE’s “medical corps’ seems to resolve part of the problem arising from the need for a large amount of blood in emergencies by the precise knowledge it has of the blood group and the medical status of each cadre in the field which enables on the spot donations and transfusion in the FMS or in the rear.
In fact, no sooner than the Elephant Pass battle was over the army began a major operation towards the 1-4 base area in the Manalaaru sector. The LTTE again suffered heavy casualies trying to stall this thrust. Yet it was able to meet the situation without much of a crisis.
The LTTE had to cope, on its own, with a large number of wounded in the following engagements since 1991 - Kattaikaadu, Idaikaadu, the expansion of the Palaly FDL towards Tellipalai in 1992, Pooneryn, Operation Yal Devi, Tiger leap, Weli Oya (the aborted attack last year), Riviresa I, Mullaithivu and Sath Jaya.
By 1994, the LTTE’s medical system had programs for rehabilitation, counselling and physiotherapy. There was also a section for Jaipur legs.
The main part of these programs was run at Sankuveli in Valigamam until July 1995. The majority of the cadres in these programs were redeployed in logistics, administration, internal intelligence etc., (Some of them were escorts to visitors during the peace talks last year)
In 1993, the Tigers established their own “Medical College’.
Dr. Jayakularajah (Prabharan’s old friend from Thirukovil in the Ampara district) was made honorary head of the institution . He, however, relinquished his position last year.
A senior member from the east is the current head of the “college’. The LTTE’s doctors are all cyanide carrying members of the organisation. Two large underground hospitals were constructed in Mullaithivu with concrete and steel as early as 1990. Another one with three stories was abandoned in Jaffna during Op. Riviresa I.
It is understood that a big underground storage structure northeast of Mullaithivu was converted into a hospital early this year. But the fact that the LTTE has been able to take care of its wounded both at Mullaithivu and Kilinochchi even after the last major government medical facility in the north fell to the army, leads one to presume that it may have more such underground hospitals.
And finally a case in point.
The Tigers took a very large number casualties in the Mullaithivu assault.
But the only visible indication of this, after the conclusion of the Op. Unceasing Waves, was the LTTE’s announcement in the Vanni that each household should give a bunch of Thambili for the wounded.