• About CIVIC

    CIVIC is a Washington-based non-profit organization that believes the civilians injured and the families of those killed should be recognized and helped by the warring parties involved.

    On this blog, you will find stories from our travels around the world as we meet with civilians and military, aid organizations and government in our quest to get war victims the help they need.

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    Sarah, Executive Director

    Marla B, Managing Director

    Kristele, Field Director

    Liz, Chief Communications Officer

    Trevor, CIVIC's fellow based in Afghanistan

    Chris, CIVIC's fellow based in Pakistan

    Jon, CIVIC's US military consultant

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SRI LANKA: ‘This is too much to take. Why is the world not helping?’

Originally printed in The Guardian

May 12, 2009


Yesterday a shell was reported to have hit a temporary hospital in the so-called no-fire zone in north-east Sri Lanka, killing 47 people. Vany Kumar, 25, works at the temporary medical facility in Mullaivaikal East primary school, which is caught between government troops and the last remnants of the Tamil Tigers (LTTE). Here, in a telephone interview with the Guardian, she describes life on the front line.

This is really a disaster. I don’t know really how to explain it. At the moment, it is like hell.

Most of the time we live in the shelter. There is not enough medical equipment, so it is really difficult to treat people. Food is a problem as well. There is no food at all here, there are no vegetables and no rice, they just eat whatever they can find, that’s all. The hospital is located in a primary school so there is only one room. We just try our best to achieve what we can.

I was in the office working [when the shell hit]. It was definitely a shell, there is no doubt about that. I was about 20 metres away, and I was sure that it landed inside the hospital, so I went to the shelter. I got the news from the doctors that there were people injured and dead. There was constant shelling so I couldn’t leave the shelter.

For us, shell bombing is just a normal thing now. It is like an everyday routine. We have reached a point where it’s like death is not a problem at all. No one has any feeling here now, it’s like everyone says, “Whatever happens, it happens.” That’s it, that’s the mentality every single person has here.

The most terrible thing that I have seen was when a mother had a bullet go through her breast and she was dead and the baby was still on the other side of the breast and the baby was drinking her milk, and that really affected me. I was at that place where it happened.

There is just too much to take. Children have lost parents, parents have lost children, it’s just a common thing now.

[The shelling] is definitely coming from the government side, that can be sure, because it is only a small area on the LTTE side and from the sound and from the distance I can surely say it is from the government side.

I don’t care about the government, I don’t care about the LTTE, my concern is the civilians because through all these problems they are the people affected.

The government or the LTTE, they have got to do something, and if not, I can’t imagine what will happen next. Both parties have got to have a ceasefire. I think the international [community] has to either come into the country or get both parties to stop the fighting and start thinking about the civilians living here. Every single person living here asks why the international [community] is not doing anything.

I really want to come to the UK but I don’t know. I’m talking to you now, but maybe tomorrow I’ll be dead.

SRI LANKA: ‘We have 450 beds and now have 1,700 patients’

This article was originally printed here:  http://www.guardian.co.uk/world/2009/apr/25/sri-lanka-war

Paul McMaster works as a Médecins Sans Frontières surgeon in Vavuniya hospital. This is an excerpt from his diary:

Wednesday 4.45am Woke up and started operating. A 15-year-old boy with severe blast injuries to his abdomen. He was on his own and in shock. Surgery took about two and a half hours and he was reasonably stable. The last I heard, at least, he was stable. But our concern is what happens to him now. This is a hospital with 450 beds, three intensive care beds, and we now have 1,700 patients with up to 50 coming in a day. There are patients on the floor, in the corridors, even outside. This boy is going to be on the floor. Infection is the main worry. The wounded take days to get to us by bus and infection has often set in by the time they get here. Many of them are dying on the buses that bring them, and the bodies are taken off along with the living.

7.45am I did the rounds of the emergency department. We have cases of people with their feet blown off waiting 13 hours to go into theatre. Three-quarters of the patients we see have blast injuries.

10am We had some discussions on how to increase the flow. There are teams working around the clock. We have three surgeons: myself, a Sri Lankan surgeon and another MSF surgeon from Tampa Florida. We have put two operating tables in one theatre. Things are fairly tight and congested but we get by. There are an extremely hardworking team of Sri Lankan anaesthetists and the Sri Lankan nurses here have been working 20 hours a day.

1.45pm Went back to surgery. A head injury to a child – a boy about nine. It took about two and a half hours and went OK. The problem is the internal damage to the brain. Only the next few days will tell how bad that has been.

4pm Began work on a lower leg amputation. A man had stood on a landmine. He had been with his wife and his daughter. We will operate on the wife tonight. The child has already had some surgery to remove pieces from her arm. Technically, the surgery on the man went well, but the problem is the landmine blasted soil into his leg. There is always the fear that infection will set in.

6pm I did a series of small cases – gunshot wounds. Over the course of the day I operated on 16 patients, five of them amputations on children. These are deeply traumatised people. The children in the emergency wards see people brought in with major blast limb injuries and are just sitting silently, emotionless, in the middle of all this, so we try to treat them and move them quickly out to the surgery or the ward.

9pm Finish surgery for the day. Going to find something to eat and then get some sleep.

Friday 2.30pm I have been in the whole time and do not have the big picture, but in the last 24 hours we have seen, for the first time, fewer patients coming in. Only 44 severely wounded patients came in to the hospital yesterday, although more have come in this morning. It might be that some of the other casualties are going elsewhere, to other hospitals. We’ve sent a team on a exploratory mission to try and find out exactly what’s happening.

One of the patients I have seen is a little girl of about seven or eight who has a severe leg injury. Her elder sister is in the same bed with wounds on her arms and legs. A third sister has burns to her face. Their mother has been killed and their father is in intensive care. With the level of aftercare that we can provide at the moment he has a 50/50 chance of making it, at best.

We have done 71 major operations over the past 24 hours. A lot of the these operations have been catching up on the last few days. It has been bedlam in the hospital. But it hasn’t got worse in the last 24 hours. We are only seeing the acute casualties. There are many people who are ill, several of the injured people also have chickenpox. We are hearing reports that there have been outbreaks of chickenpox in the camps because peoples’ immune systems are so weak.

I hear that some extra nurses are being sent to the hospital. The Sri Lankan medical authorities have made a real effort to send extra staff to help out. There are simply too many people to treat them all. We are not able to save some people because we need to provide more aftercare. There are simply not enough nurses.

• Paul McMaster is a retired surgeon from Droitwich, now based in Amsterdam.