By Feizal Samath
When Tamil rebels like other residents in the war-torn north used bandages to tie up wounds, the government banned the item from the peninsula. Residents then turned to sanitary pads, as they are a good absorbent. Fearing the rebels would do the same, the government banned this too.
"Are they worried about Mrs Prabhakaran (wife of LTTE leader Velupillai Prabhakaran)?" asked a highly frustrated doctor from Jaffna town last week.
Jaffna, is suffering from a shortage of much-needed medical drugs and medical staff even though the government in mid-January lifted an embargo on food, medicines and general goods to LTTE-controlled areas in the Wanni region where Prabhakaran and his fighters are based. There are restrictions only on seven items now suspected of being used by the rebels as war material.
The relaxation is part of goodwill measures aimed at laying the groundwork for peace talks starting probably in May between the government and the LTTE.
But while all other areas where there is some rebel activity have been spared the economic embargo since mid-January, Jaffna, struggling for years without sufficient medicines due to restricted supply and a ban, doesn't figure at all in this equation. Restrictions on medicines still apply to the peninsula, home to 500,000.
"The government says more than 90 percent of the peninsula is under the control of government forces. Then why is permission needed to bring goods into an area that is run by the government?" asked Dr N. Sivarajah, head of the Department of Community Medicine at the Jaffna University. Military sources say the reason for the restriction is because supplies still reach the rebels through residents.
Sivarajah and other top medical specialists from the war-ravaged town gathered in Colombo 10 days ago for a seminar focusing on the crisis related to medical supplies to Jaffna at a time when restrictions on food and medicines have been lifted in LTTE-controlled areas. Speakers said badly-needed drugs were not available and - unlike other parts of Sri Lanka - hospitals had no way of sending a vehicle across to another hospital outside the region, to borrow supplies, as there is no road access to Jaffna.
Since the mid-1990s, road links between Jaffna and the rest of the south have been closed due to fighting between government and rebel forces with access to the region only through sea or air. Civilian flights are run only by the Air Force while passenger ferries to Jaffna are restricted to two sailings a week. If Jaffna hospitals are short of life-saving medicines, they have to borrow it from the army hospital in the region or are forced to see the patient suffer more and even die.
"In 2000, three patients died due to unbearable pain as there was a shortage of painkillers," said Dr. M. Ambalavanar, a general surgeon at Jaffna's main Teaching Hospital. "Last year, I had to send patients (suffering from fractures) home with cardboard splinters as there was no plaster of Paris available for a week."
The seminar was told that once, when medical authorities made a request for 14,400 sanitary pads for a specified period, only 1,500 were approved by the Defence Ministry whose health committee reviews all requests for medical supplies to the north. Kethesh Loganathan, an analyst at the Centre for Policy Alternatives (CPA), said there was no government explanation as to why the embargo still remains in Jaffna. "Military spokesmen at the seminar were also unable to give a proper explanation."
Since 1987, the government has enforced an economic embargo, starting off with a few items which it feared would reach the LTTE and later expanding it to even drugs including aspirin. "I can't understand why the government bans a box of aspirin when the government has not been able to stop the LTTE acquiring surface-to-air missiles, rocket launchers, tanks and other war material," said Dayala Deva, a pharmacologist and former director of the International Federation of the Red Cross (IFRC) who conducted a survey last September on the prohibition on and restriction of medicines to Jaffna.
Even to get drugs that are normally allowed into the peninsula is a laborious and time-consuming procedure and often, once permission is obtained to transport a certain amount of drugs, these are not available in the government medical stores in Colombo.
Jaffna health authorities have appointed coordinators in Colombo to handle the paperwork.
"Drugs and medicines are given to state hospitals after each hospital lists out its needs. Often the supply doesn't match the need. In Jaffna's case even the little supply we get can diminish as there have been times when stocks set aside for Jaffna have been given to other hospitals due to procedural delays in Jaffna getting permission," said Deva.
He said that 20 percent of the medical items sent to Jaffna have a short expiry date. Packages are sent by ship and examined and re-examined by security authorities so much so that when they reach their destination nearly 15 percent of the items are either pilfered or damaged. Environmental conditions like high temperatures and exposure to sunlight reduce the effectiveness of the drugs.
Deva's study showed that last year 21 medical items including X-ray developers, eye drops, some types of bandages, surgical blades, skin cream and hydrogen peroxide were banned while 42 items were restricted to between 25 percent and 50 percent of needs.
These included X-ray film, anti-venom serum injections, oxygen cylinders, oral penicillin tablets, vitamin A and D capsules, folic acid tablets, surgical spirits, sanitary pads and dextrose among others.
Family planning drugs have not been spared. Sivarajah says there is a shortage of contraceptives and some of the loops prescribed by him for women have an old expiry date.
"I was forced to use them but now we have stopped." Malnutrition in children and anaemia among pregnant mothers are on the rise in Jaffna.
However, drugs are not the only problem. There is an acute shortage of medical staff while facilities at hospitals in the peninsula are archaic and not updated for years.
Facilities at the operating theatres are appalling, according to doctors, forcing patients to be transferred by ship to other hospitals out of Jaffna. Transferred patients may have to wait for days or weeks as residents must get a government permit to leave though space on board a ship or plane is now instantly available.
Hospitals in Jaffna, like many other buildings, have the scars of the war and even though crumbling, are rarely repaired. Budget cuts on health services across the island have further compounded the problem.
Deva and other doctors at the seminar urged government authorities to lift restrictions on all types of drugs and medicines and do away with the need for Defence Ministry permission for these items, particularly now in view of the forthcoming peace talks.
While hospitals in Jaffna are struggling for much-needed supplies, some private pharmacies are able to get banned drugs and sell them at high prices. In March last year, there was a shortage of an analgesic injection banned by the Defence Ministry.
But a local politician there somehow got government permission for 100,000 such injections which were then sold in private pharmacies in Jaffna, at 80 rupees compared to a mere 10 rupees in Colombo!