On this, the inaugural “World Humanitarian Day”, Tamils Rehabilitation Organization (TRO) honors the memory of humanitarian workers throughout the world who have laid down their lives in selfless service to those affected by war or natural disaster. Humanitarian workers in Sri Lanka, and TRO staff in particular, have been the frequent target of violence. Sri Lanka continues to be one of the most dangerous places in the world for humanitarian workers and with over one hundred having been killed since 2005 (Action Contre La Faim 17, TRO 7, etc).

We also wish to draw attention to those humanitarian workers who courageously continue to work in dangerous conditions risking death, injury, rape, torture and disappearance. The local staff of UN Agencies, international and national NGOs, and Community Based Organizations (CBOs) in Sri Lanka deserve special mention especially those who continued to assist the 330,000 IDPs in the Vanni after the UN and international NGOs deserted the people and left the area in September 2008.

During this period, September 2008 to May 2009, thirty-six (36) humanitarian workers were killed by aerial bombardment and artillery shelling in the so called ‘safe zones’.  Of these, 19 were TRO staff and the other 17 were local staff of the ICRC, international and national NGOs, CBOs and volunteer medical staff in the makeshift hospitals.

Many of these deaths occurred in the final days of the military onslaught into the ‘safe zone’ and as a result the details are only now filtering out. The difficulty in getting accurate information has been due to the lack of access to the concentration camps in the North of Sri Lanka where most of the survivors from the ‘safe zone’ are imprisoned by the Government of Sri Lanka (GoSL).

Current Situation in the Concentration Camps

Over 280,000 Tamil civilians who survived the Sri Lanka Armed Forces military onslaught into the so called ‘safe zone’ are now being kept as prisoners in the concentration camps in the North of Sri Lanka. The GoSL is committing widespread violations of International Human Rights Law and the Guiding Principles on Internal Displacement in the management of the concentration camps.

The GoSL has limited access to the camps by international humanitarian organizations and the ICRC and has prevented the Tamil Diaspora and TRO from formally participating in the humanitarian response to the crisis. This is in contrast to the response to the 2004 tsunami, during which a similar number of persons were displaced. At that time, the Tamil Diaspora, international humanitarian agencies and numerous others were allowed full and free access and were able to adequately serve the needs of the IDPs. In contrast to that response the GoSL in this case failed to adequately plan for the arrival of these persons though it knew that approximately 330,000 persons were in the Vanni and would need to be cared for after hostilities ceased. The GoSL restriction of access and freedom of movement have also severely hampered the humanitarian response to this crisis.

The Tamil Diaspora and TRO are ready, willing and able to assist those imprisoned in the camps if allowed to do so by the GoSL. The camps are overcrowded and badly planned with inadequate water and sanitation infrastructure and are prone to flooding - a major concern given the recent flooding and the fast approaching monsoon season. There are continuing outbreaks of contagious diseases with health officials recording thousands of cases of diarrhea, hepatitis, dysentery, and chickenpox. Additionally, there are approximately 35,000-50,000 children (estimates vary as the GoSL has yet to compile or publish registration lists) in the camps and according to a study by the Sri Lanka Medical Research Institute 46.9% of these children are underweight, 35.6% exhibit wasting (low weight for height) and 30% are stunted (low height for age).

There are also confirmed reports of arbitrary arrest and detention, enforced disappearances, abductions, torture and other violations of international human rights and humanitarian law in the treatment of the detainees in the concentration camps.

Issues and recommendations:

•  The concentration camps are places of mass arbitrary detention where a group of people are being imprisoned, indefinitely, without trial or any charges being filed, based solely on their ethnic identity, being Tamil, and the fact that they formerly resided in territory controlled by the LTTE.

✦ This illegal mass detention is thus discrimination and is prohibited in International Human Rights Law, the International Covenant on Civil and Political Rights (ICCPR: Articles 9 & 12), and by the Guiding Principles on Internal Displacement (Principles 12 & 14)

✦ These violations should cease immediately and the detainees must be allowed to have freedom of movement out of the camps to places of their choice - be it their original places of habitation or to the homes of friends and family. If they choose to stay in the camps they must be allowed to have freedom of movement into and out of the camp.

•  Denial of unfettered humanitarian access by the humanitarian community and and free access by the media and family members. (Principle 25 of the Guiding Principles on Internal Displacement)

✦ Humanitarian agencies and humanitarian assistance of all types must have complete and unrestricted access to the camps so as to be able to better serve the needs of the internees.

✦ The GoSL has also not allowed the media, international humanitarian organizations and family members to communicate with the internees in private so that they can freely speak their minds and convey what they have witnessed over the past 18 months.

•  Independent monitors, ideally from the Office of the High Commissioner for Human Rights (OHCHR) are desperately needed to prevent further human rights abuses from occurring, these include: arbitrary arrest and detention, enforced disappearances, abductions, torture and other abuses of the detainees human rights.

TRO calls on the international community and the Tamil Diaspora to pressure the GoSL to immediately allow freedom of movement to the IDP Detainees and unfettered humanitarian access to the camps.

TRO, in Sri Lanka and internationally, have had extensive experience with IDP camp management, resettlement and demining over the past 24 years. During the exodus from Jaffna, after the 2004 tsunami, and during the past 18 months TRO cared for hundreds of thousands of IDPs building shelters, providing food, water, sanitation, primary healthcare and development. Currently, TRO and the Tamil Diaspora, despite attempts by the GoSL to limit our engagement, are providing large amounts of funds to international and local NGOs working with those affected by the war. We urge the GoSL to de-politicize humanitarian assistance and development and utilize the vast wealth of knowledge and resources that TRO and the Tamil Diaspora are able to mobilize. If there is to be a just, sustainable peace on the island the depoliticization of humanitarian assistance, resettlement and development is an important first step.    Click here to PDF version

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Any health system would have difficulties responding to the needs of over 260,000 people who recently came out of a war zone. Facilities in the Sri Lankan camps for internally displaced people (IDPs) are overstretched. People sometimes wait days before they can see a doctor for treatment. At night, non-medical people decide who gets referred to a hospital and who doesn’t. Although the war has ended, suffering for Sri Lankans continues.

For the past three months, Ati* has been living in a camp in Manik Farm with her husband and three children. Two weeks ago, her five-year-old son had a fever and was barely responding. She carried him to the clinic in the camp at 5 a.m. and waited to see a doctor until 6 p.m. Like many others that day, she did not get to see a doctor and returned to her tent with her sick child and no treatment. She went back the next day and again failed to see a doctor after waiting for another 13 hours. It wasn’t until the third day that she finally managed to see a doctor who gave her some antibiotics.

300 patients a day

Even though medical services are gradually expanding in those camps with Ministry of Health clinics, and medical staff doing what they can in all the camps, the needs remain vast and facilities are overstretched. Some doctors are seeing 200 to 300 patients a day; there is little capacity to carry out tests or follow up with patients; and only the most urgent cases get transferred to hospitals outside the camps.

Maruthani,* a 24-year-old woman, arrived in Manik Farm at the end of May. She is badly disfigured from a bomb shell fragment that cut her lips, cheeks, and chin during the conflict. Her mouth is always open, and her tongue is badly affected; she can barely drink and cannot speak. She is in need of reconstructive surgery—something impossible to get inside the camp. When her wounds became infected, she went, in pain, to the clinic in the camp. There they were unable to do anything for her and she was not transferred to a hospital outside the camp because she was not considered to be an emergency case. She spends her days lying in the sand outside her tent, waiting for the day to pass.

Some emergency cases are referred by the Ministry of Health staff to the MSF hospital outside Manik Farm, where MSF medical teams are mostly treating patients for conflict-related trauma, respiratory tract infections and skin diseases. Problems come at night. “In many camps, if someone gets sick at night, they have to rely on the soldier at the camp gate to make the decision on whether they get referred to a hospital or not,” said Karline Kleijer, MSF emergency coordinator. “This works for those who are obviously ill, in convulsions, or with a bleeding wound. But when it is a dehydrated child with a fever, the average soldier will not see that they are in urgent need of medical attention because they are not easy things to diagnose.”

Breakfast at night

Another concern for those in the camps is access to clean water and food. In most camps, people do not cook for themselves but rely on community kitchens and rations distributed daily by the government or nongovernmental organizations (NGOs). “Sometimes, especially in the newer camps, the food doesn’t get delivered until late in the evening and the first meal of the day is at 10 o’clock at night,” said an MSF aid worker. Every day, MSF distributes high-energy porridge to 23,000 children under five, pregnant and lactating women, and people over 60 in 11 of the camps. “It is difficult for our staff to turn people away when they do not fit into our target group,” she said.

Outside of the camps, hundreds of people are still hospitalized, receiving treatment for injuries they incurred during the conflict. Working with Ministry of Health staff in Pompaimadhu hospital, MSF is treating 180 patients with spinal cord injuries, fractures that did not heal, and infected wounds. The MSF surgeon does an average of 16 to 20 surgeries a week and physiotherapy is a big component of the program. “To see someone walk again thanks to the physiotherapy is amazing,” said MSF surgeon Tim Pruchnic.

Traumatized with no support

Traumatized by what they experienced during the conflict, many of the patients in hospital are struggling to cope with their grief and worry about their future and the fate of their loved ones. “A young mother admitted to Pompaimadhu hospital has lost her husband, her parents, her sister, her sister’s husband and children,” said an MSF worker. “She is alone now in the hospital, recovering from her injuries; she is the sole survivor of her family and she is pregnant. She feels very lonely and is still in shock. It has only been two-and-a-half months since she lost everything and everyone. She worries about how she will cope as a single mother. As long as she stays in Pompaimadhu, she can get help, but when she is discharged to the camps she will no longer get any support.”

In the camps, people are dealing with the trauma they experienced during the conflict, and it is difficult to rebuild any semblance of a normal life. There are very few job opportunities inside the camps. People are not allowed to leave the camps, and parents worry about their children’s education. People have difficulties searching for relatives, making plans, or taking control of their futures. With nowhere to go, there is little to do other than walk from one distribution to another. The uncertainty of how long they have to remain in the camps is difficult to live with. Therefore, there is a huge need for psychological support for people living in the camps and currently none is provided.

MSF ready to start

In addition to the high-energy porridge the MSF teams cook and distribute in the camps, MSF has the capacity to scale up activities and provide medical support to the Ministry of Health staff inside the camps. “We have two whiteboards in our office,” said Kleijer, the MSF emergency coordinator. “One with a list of planned activities for the coming weeks—supplementary feeding, surgery, etc. And another is a list of activities waiting for approval, including mental health, basic health care, and physiotherapy in the camps. We are ready to start!”

MSF continues to pursue discussions with the authorities in Colombo.*Name has been changed

When the cameras came, everyone came to the edges of the IDP camp. One hand on the hot metal of a barbed wire fence, the emptiness in their eyes was captured in images flashed around the world as the military campaign of the Government of Sri Lanka came to end.

The cameras are gone now, but the people remain. Nearly 300,000 civilians who have lived through 30 years of civil war between the Sri Lankan government and the separatist Liberation Tigers of Tamil Eelam (the LTTE). Most recently they have fled conflict zones in the NorthEast, where they faced daily shelling, even in designated “safe zones”. In search of safety, they traveled on foot for days, a few meager belongings piled atop their heads, gingerly stepping over dead bodies strewn across the dirt roads. Some pleaded with relatives, neighbors who made the difficult choice to stay, rather than face the misery of what quickly became overcrowded “internment camps”.

Each internally displaced person is interviewed as they enter, they cover their faces to protect from dust, smoke from one collective stove, and the pervasive, overwhelming, stench. Some do not enter: young men (husbands and fathers) suspected of being “terrorist supporters” are taken to detention centers with little to no access to the outside world.

Pregnant women left behind in the overcrowded camps often have to care for young children who cannot accompany them on the journey to the closest hospital, where thousands of patients wait for the services of a handful of doctors, working in a half-shelled hospital with only 300 beds. Newborns are brought back to an inhospitable environment, where breastfeeding must be done in public under the gaze of loitering soldiers, and children become among those most vulnerable to the spread of infectious diseases such as chicken pox and hepatitis. Nearly half of some camps are recent amputee victims. They sit together in the tiny pockets of available shade. Children look for a place to play, carefully avoiding the women wandering aimlessly around the camps, suffering from severe psychiatric breakdowns.

And of all this misery, a lucrative trade has emerged. Liquor, groceries, can be purchased by those able to access remittances from abroad, the entire transaction going through the military or others in a position to profit from suffering. Perhaps what has made these camps the “worst place in the world” (http://humanitarianrelief.change.org/blog/view/wednesday_award_for_the_worst_place_in_the_world_12)  is the continued silence. The silence of the international community, the silence of intimidated journalists and humanitarian workers, and the silence of the civilians. The hunger has weakened their bodies, the trauma has silenced their minds, the fear has prevented questions, and the fatigue has made it impossible to hope for help.

Nimmi Gowrinathan is the Director of South Asia Programs at Operation USA (www.opusa.org), and a PhD candidate in the Department of Political Science at UCLA.

Dr V Shanmugarajah said he feared many more may have been killed since some bodies were being buried on the spot without being brought to the makeshift hospital he runs.

Shanmugarajah described seeing shells fly through the air, with some falling close to the hospital, forcing many to flee to bunkers for shelter.

The government vowed two weeks ago to cease firing heavy weapons into the tiny coastal strip that remained under LTTE control in an effort to avoid civilian casualties. However, medical officials in the area have reported that air strikes and artillery attacks have continued unabated, despite the presence of an estimated 150,000 ethnic Tamil civilians in the Save Zone.

Patients, medical staff, aid workers, and other witnesses have provided Human Rights Watch with information about at least 30 attacks on permanent and makeshift hospitals in the combat area since December 2008. One of the deadliest took place on May 2, when artillery shells struck Mullaivaikal hospital in the government-declared “no-fire zone,” killing 68 persons and wounding 87

About 87 people were injured. Another 27 people reportedly died on Friday. The army has denied bombing the hospital, saying that Tamil Tiger rebels carried out suicide attacks.

A spokesman for the Sri Lankan army said that although soldiers had heard explosions in the area, they had not fired any shells.

The army had not used heavy weapons for some days, he said, since the government announced on Monday that it was halting its use of heavy weapons in the conflict zone

The artillery attacks came amid growing international concerns over the fate of the estimated 50,000 civilians trapped in the war zone, following a U.N. report that nearly 6,500 civilians were killed in the last three months.

International pressure has grown for a cease-fire between the government forces and Tamil rebels to protect the trapped civilians.

The government has rejected calls for a cease-fire, saying its troops are on the verge of ending the quarter-century civil war

The so-called ‘safe zone’ now consists of their main villages: Mullivaikal, Valiaganmadam, Vattuvahal. There are approximately 125,000 - 140,000 civilians in the area.

The Government had maintained for weeks that there were fewer than 50,000 civilians in the area where the army has pinned down the last of the Tigers.

It insisted that UN and Red Cross estimates of 100,000 to 150,000 civilians in the zone were exaggerated — and prepared internment camps to screen non-combatants based on its own figures.

The army now says that it has rescued 103,000 civilians from the area since Monday — on top of 70,000 already in the camps — and estimates that there are up to 20,000 still inside the zone