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Sri Lanka's Genocidal War - '95 to '01
Health Crisis in the Vanni Districts says Asian Human Rights Commission...
The
National Peace Council Reported in Human Rights Solidarity (the Asian
Human Rights Commission Newsletter) on March/April 1998...
"There has been an economic blockade in the Northern Province in Sri Lanka ever since 1990. In 1995 since the resumption of the Eelam war, the government of Sri Lanka has forbidden non governmental organisations (NGOs) from distributing food and, with the exception of the International Committee of the Red Cross (ICRC), distributing medicine.
Stringent controls have also been imposed on the ICRC in the medicines they can provide. Thus, the government took upon itself the full responsibility of the distribution of food and medicine to the war-torn districts of the Vanni (Mullaitivu, Kilinochi and Mannar). Instead of providing for its people, the government has pursued a policy of deprivation. It does not allow any outsiders to visit the area so that this information is not disseminated. It imposes severe controls on the NGOs that are allowed to work there. For instance, NGO personnel are not allowed to carry cameras or even rolls of film. A brief description of the health and nutrition problems that have now loomed close to crisis proportions is provided below.
Inadequate Health Service
The Vanni districts have only one district hospital in Mallavi whereas, according to Ministry of Health specifications, there should be four base hospitals (one for every 100,000 people), one district hospital for every 50,000 people and a central dispensary and maternity ward for every 20,000 people. For instance, Mullaitivu District itself has a population of 233,000 (the government has repeatedly disputed this figure that was compiled after an extensive census taken by a Mullaitivu government agent in October 1 1997) of which only
108,321 are members of the local population. Of the 233,000 people in Mullaitivu District, only 90,709 are not displaced. Therefore, the health services are woefully inadequate, especially to serve the most vulnerable segment of the population - the displaced families. The table on the next page shoals the available medical staff of doctors and registered medical practitioners (RMPs), who are not fully fledged doctors, serving in the district hospital and central dispensaries.
According to Health Ministry specifications, there should be a midwife for every 2,500 people and a public health inspector (PHI) for every 8,000 people. The number of staff in these fields is also grossly inadequate. Taking the district of Mullaitivu as an example, for a population of more than 200,000, there is only one PHI and 11 midwives.
Hospitals Patients seen per day Staff in Outpatient Department Mallavi 100-1200 1 Doctor, 2 RMPs Puthukudiyiruppu 1200 3 RMPs Muthaiyankaddu 500 1 RMP Naddankandal 500 1 RMP Mulliyavalai 400-500 1 RMP Thunnukkai 500 1 RMP Adding to the problem of a lack of staff is the blockade on medicine; the sudden increase in the population leading to the outbreak of diseases, such as malaria; the extremely restricted permission on malathion (a spray used for mosquitoes), and the clearance of dense forests for resettling people that has brought upon the population a variety of unidentified fever symptoms - all of these have further exacerbated the health problem.
Spread of Diseases - Malaria
The number of people visiting the outpatient department (OPI)) in Mullaitivu District in 1997 was 727,103. Out of this, 339,843 people were treated for clinical malaria. Facilities are minimal for taking blood tests on patients. Instead, the doctors say they guess from the symptoms and treat the patients immediately with very strong drugs. Nevertheless, blood film was taken for a small sample of 36,515 fever patients. Of these, 16,936 were identified positive for malaria with 3,239 of them identified as having cerebral malaria that brings on certain damage to the brain.
Every other person one meek the district will have contracted malaria at least twice. It is normal to meet people who have had malaria seven to nine times since they were displaced to the Vanni. This chronic outbreak of malaria has brought other complications related to a reduced resistance to diseases, like brain haemorrhages and an outbreak of tuberculosis. In 1997, about 1,200 patients were diagnosed as having TB.
The government sends restricted quantities of sugar-coated chloroquin for malaria. But according to recent medical journals, this is being discouraged as it is ineffective to treat the disease. The government sends old medicine too. For instance, the stock sent to the medical officer of health (MOM) of Mullaitivu in October 1997 had expiration dates of November 1997, December 1997 and January 1998. The doctors, seeing that the medicines used are not effective, prescribe quinine too. Quinine, however, is a long outdated duly.
Patients need to consume a highprotein diet when using chloroquin. The poor, however, take it on empty stomachs and have suffered hallucinations, dizziness, fainting and inertia.
In the activities of malaria prevention, the health authorities are mounting a campaign to clear overgrowth around settlement schemes.
Malathion is sent only in restricted quantities so they are only able to spray sections of the region in rotation. Thus, this exercise only provides temporary relief.
Other diseases
Typhoid has become rampant due to malarial infection. The government sends chloramphenicol and quadril for treating typhoid. But medical personnel report that chloramphenicol is not used now in other parts of the world because of certain side effects; instead, bactrim is prescribed. The MOH in Mullaitivu is concerned about the usage of this drug. Meanwhile, scabies is prevalent due to a lack of medicine for treatment.
Rabies has become another fatal disease due to the increase in the population of stray dogs and a lack of medicine, which is very expensive, even in the South. Stichneeds, a poison used for killing stray dogs, is banned. The only means available for the medical staffis to heat the dogs to death, which they are reluctant to do. Recently, after much pressure was exerted by the district medical personnel, the government has allowed the use of 200 grams of stichneeds.
Pregnancy and Childbirth
Worm infection and anaemia have been identified as common afflictions for pregnant women. There is a severe shortage of iron tablets. The mothers are afflicted with malaria too during pregnancy. In addition, the maternity clinics are far apart. The conditions of the roads are extremely poor, and transport is next to nil. It is common to hear harrowing tales of women dying at childbirth due to a lack of transport services. The MOH lacks personnel to do a survey of deaths during pregnancy but surmises that these incidents are high.
Serious Malnutrition
Since the government disputes the population figures provided by its own government agent, it provides dry rations to only half of the displaced population. Having no choice, the government agent distributes it among the whole of the displaced population. As a result, a displaced family receives only Rs315 (about US$6.30) worth of food per month, and distribution is very irregular. Job opportunities are already inadequate in Mullaitivu, and the arrival of the displaced population has affected even the prospects of local labour with labourers in the agriculture and fisheries sector being severely affected. As a result, starvation has become a normal occurrence.
It is calculated that third-degree malnutrition among children, beyond which level the child develops an extended stomach, an expanded liver and a skinny frame, is around 40 percent in the district. A survey by the midwives indicated that only 4,863 children under 5 years old, out of a random sample of 16,767, were normal. There were 6,371 children found to be afflicted with third-degree rnalnutrition 3,186 with second degree and 2,347 with first-degree malnutrition. Malnutrition is caused, first, by diseases such as malaria and bronchial diseases, secondly, by worm infestations and, thirdly, by a lack of food. There are particular areas that have shown even higher percentages of malnutrition. For instance, in a division called Puthvedduvan in Mullaitivu District (a population of 1,900 families), 56 out of 121 children picked by random sampling were suffering from third-degree malnutrition.
Emaciated-looking mothers and children, referred by the hospital staff, flock to nutrition centres run by NGOs where wet feeding is implemented. However the NGOs are unable to cater to the demand. Mothers report that their children have developed night blindness and need constant supervision to prevent them from knocking into objects and hurting themselves after dark. There is a lack of vitamin A tablets in hospitals, which is essential for treating night blindness. The minutes of Education Department meetings of principals reveal that three to seven students faint because of hunger in schools on a daily basis. The principals have also reported that sometimes they are forced to close the schools by l 0 a.m. because the students cannot cope with schooling without folded.
Poor Education Facilities
To highlight the drawbacks of the education facilities, one can look at the conditions of schools in
Thunukkai, a divisional secretary's division in Mullaitivu District. The present facilities were barely able to cope with about 2,300 students before the displacement of 1995. Now they have to serve 8,571 children. Students have to study under trees. The schools need 313 teachers but have only 128. The Education Department is thus forced to employ 106 volunteer teachers with an allowance of Rs.500 (US$ 10) per mouth, which is collected from the displaced population.
In village and settlement schemes, mothers recount the humiliation their children received at school because they could not make the necessary payments to the school or they did not possess exercise books and pencils. About 20,000 children in the district are unable to attend school.
Recently teachers did a survey of the standard of education in Thunokkai Division and found 210 students attending the classes between year four and year eight do not know how to read and write.
Actions Needed
Given the situation in the Vanni, we request people concerned with human rights and humanitarian issues to expose this and bring pressure can the government of Sri Lanka to immediately rectify the problems cited."
