Sri Lanka: A Day Among the War-wounded

In five days, from May 16 to 20, 77,000 people emerged from the former conflict zone in northern Sri Lanka arriving in the Vavuniya district. Many of them needing urgent medical care. MSF teams have been providing medical services day and night at different locations in the district, from the checkpoint close to the former frontline to the hospital in the city of Vavuniya.

Since May 16, roughly 10,000 people per day passed through the Omanthai checkpoint, close to the former front line, before arriving in Vavuniya. A four-person MSF team was able to go to Omanthai to identify the wounded and sick who needed to be transferred to the hospital, stabilise patients for transfer, and provide as much on the spot medical care as possible.

It's the 20th of May, and Jean-Paul an MSF surgeon who has just arrived to help the team in Omanthai finds a 13-year-old girl with shrapnel embedded in her back. He tells her not to move as he tries to take the shrapnel out.

“We treat as many people as we can directly on site because the hospital is more than full,” explains Alexa, a Dutch doctor working at Omanthai. “It is always a difficult decision to take: treat on site or let them go to the (internally displaced persons) camps, with the follow up that can be provided there, or send them to the hospital, where there are already four patients to a bed.”

An average of 20 wounded people per day are referred to the hospital, whilst around 150 patients a day are treated by a 3 person MSF medical team in the onsite clinic at Omanthai. “One of us goes through the long lines of people and sends to the clinic those who need the most medical care,” Alexa continues. “A large majority, among the last of the people that came out of the conflict zone, have wounds or scars from bullets and shelling. Many  people had surgical procedures in the conflict zone. Some wounds are old  and have healed, but others are bleeding -- either because the wound is  recent or because it has reopened. ”

In the emergency room in Vavuniya Hospital, moving around is difficult since people are everywhere. The hospital has 400 beds, but over 1,900 patients are presently packed into the hospital. MSF teams are supporting ministry of health staff to help treat the sick and wounded.

“I’ve been doing around 30 surgical procedures per day over the last few　days,” said Matthew, one of four MSF surgeons working in Vavuniya　Hospital.  “Normally, I would do five. We sometimes work together on the same  patient;  one is amputating the leg and the other is amputating the arm. Or one is  taking care of wounds in a foot and the others are treating chest wounds.  The majority of the injuries are relatively mild, but we see lots of them on the same patients – something like twenty mild injuries for one person, caused by a bomb blast.”

The immediate priority for MSF is to treat the sick and wounded coming out of the former war zone. In addition to providing support to Vavuniya　Hospital, teams have set up post –operative care in the Pompaimadhu　Ayurvedic Hospital to help with the follow up of patients, MSF has also　just set up a 100 bed field hospital with surgical capacity outside Manik　Farm to provide emergency care to patients from surrounding camps which　
hold approximately 160,000 people.