Mr T Ambalavanar and Mrs C Ambalavanar both surgeons from Jaffna recently visited the UK and frankly spoke of the situation facing the Health care system in Jaffna and the difficulties they face even after 4 years of "liberation." I will not go into these details as I am sure many of you are aware of this. There is a full report by Dr N. Sivarajah of Jaffna University on Health and War available at the website http://www.tamilrights.org/reports/1997r/warhealthjaf.htm

These restrictions and the economic embargo have continued since 1990. This year is the 50th anniversary of the Universal Declaration of Human Rights as well as the 50th year of Independence of Sri Lanka. Although these two significant milestones in history have been reached, the Sri Lankan government continues to use food and medicines as weapons of war. This contravenes many of the articles in the Geneva Convention of 1949, including the articles of the Geneva Convention governing the treatment of civilians during wartime to which Sri Lanka is a signatory.

In an Editorial in the BMJ (1997;315:1393 -1394; 29 November) titled "Embargoes that endanger health, Doctors should oppose them" Mr T Delamothe wrote the following:

"But a war of sorts is raging, as Leon Eisenberg has recently argued in the New England Journal of Medicine. "The Cuban and Iraqi instances make it abundantly clear that economic sanctions are, at their core, a war against public health. Our professional ethic demands the defence of public health. Thus, as physicians, we have a moral imperative to call for the end of sanctions." Neither individually nor collectively can doctors let themselves off the hook, however messy the issues. They are obliged to use their skills to improve and protect people's health, wherever they are. Doctors should therefore oppose economic embargoes, sanctions, and blockades wherever these are likely to endanger health. Last month the governing council of the American Public Health Association urged that essential humanitarian goods should be exempted from embargoes and that the health and wellbeing of embargoed populations should be aggressively monitored.

As well as individual action, doctors can apply pressure on governments through their professional organisations. International bodies could pack the greatest punch of all: if ever an issue deserved to be taken up by the World Health Organisation and the World Medical Association then this is one."

I am therefore requesting all Tamils and non-Tamils who are in the medical profession to take heed of Mr Delamothe�s words and support the enclosed appeal which will be sent as an open letter to the following organisations World Medical Association, Commonwealth Medical Association, British Medical Association, Sri Lankan Medical Association and the United Nations as well as the British Medical Journal.

As many of us have commitments we do not have the time to spare to go to Jaffna, Vanni or the East to serve our people. Placing our signature to put pressure on the Sri Lankan government is a small step in highlighting the plight of our people. This appeal has not been sponsored by any organisation. It is up to each individual to make up his or her mind to support this without other issues clouding it.

I would appeal to you to make copies of this e-mail and send it to other health professionals to also support this.

If you wish to sign this appeal send a note to [email protected], no later than 12th November 1998.

Thank You.

The Sri Lankan Government has imposed an economic embargo on the Tamil homeland in the North and East of the island since 1990. This embargo includes items of food and medicines. It has also restricted and controls the flow of basic food items to the population in the North and East who are dependent on this supply. It also restricts the work of NGO�s who undertake humanitarian work in these areas.

This has resulted in a rise in serious infectious diseases, infant and mortality rates, nutritional deficiencies among pregnant women and young children, and other treatable conditions for which neither the right drugs nor operations are available. This situation prevails in the North and East today.

The government "liberated" the Jaffna Peninsula 4 years ago but continues to tightly control the access and transport of food and medicines to Jaffna which is under military control. The government run Jaffna Teaching Hospital is today in a much worse situation as compared with 1995 before the government took control. There is a shortage of trained experienced staff, a lack of medicines and medical equipment to treat patients. It remains the only functioning hospital in the Peninsula.

We the undersigned uphold the resolution passed in 1997 by the World Medical Association at its 49th general assembly which stated that:

"Recognising that all people have the right to preservation of health and that the Geneva convention (article 23, number IV, 1949) requires the free passage of medical supplies intended for civilians, the World Medical Association urges national medical associations to ensure that governments employing economic sanctions against other states respect the agreed exemptions for medicines, medical supplies, and basic food items."

We the undersigned urge the World Medical Association, Commonwealth Medical Association, British Medical Association, Sri Lankan Medical Association and the United Nations to call upon the Sri Lankan Government to:

1. Lift the economic embargo as well as military impediments that exist for the transport of food and medicines to the Tamil areas in the North East of Sri Lanka.

2. Stop the use of food and medicines as a weapon of war causing untold misery, hardship and ill health of the Tamil people.

This embargo violates the most basic international charters and conventions governing human rights, including the articles of the Geneva Convention governing the treatment of civilians during wartime. The Sri Lankan government is using the barbarous tactics of earlier wars of "If all else fails you can starve your enemy out. Or let disease, unchecked, take its toll."

As health professionals our professional ethic demands the defence of public health. Thus, as physicians, dentists and nurses we have a moral imperative to call for the end of this embargo which endangers the health of the people in the North and East of Sri Lanka.

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