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Health in crisis in NE

LTTE hospitals
The LTTE runs the Dr. Ponnampalam Memorial Hospital in Puthukudiyiruppu town in the Mullaitivu district to train 'doctors' and other categories needed for the provision of health care in the uncleared areas, according to the report.

Explaining that one could sense good governance in the district, the report states, "Severely malnourished mothers and children are institutionalised and cared for until they are well by the Tamil Rehabilitation Organization with MSF-H midwife-nurses assisting the volunteers in assessment and treatment."

"Kilinochchi district has a 'Dr. Poonampalam Memorial Hospital' run by the LTTE in Kilinochchi town as in Puthukudiyirruppu in Mullaitivu. In this district too one could see orderliness and good governance," adds the report.

An acute dearth of medical staff, many health facilities damaged or destroyed, no private health facilities, disruption of primary and preventive health care and poor tertiary health care.

These are the findings of the World Health Organization (WHO) after an in-depth study of the health needs of the north and the east of the country. The fruit of a "three-month systematic on-site assessment" as WHO Representative Dr. Kan Tun says, the report, "Health System Assessment in the North and East of Sri Lanka" dated April this year but released last week is an eye-opener on the need to get cracking and make a difference between life and death for the people of the area, who have been caught up in a conflict for the past 20 years.

Covering both the cleared and uncleared areas in the districts of Jaffna, Kilinochchi, Mannar, Mullaitivu and Vavuniya in the north and Ampara, Batticaloa and Trincomalee in the east, the report states, "Although the government health services provision and some infrastructure facilities exist in the conflict affected areas, the delivery system lacks adequate facilities in terms of infrastructure, equipment and staff or personnel at the primary care level especially the preventive side to provide adequate health services for the internally displaced persons in addition to the resident population."

The report stresses the lack of staff to ensure a proper health service. "In the north-east the absence of Medical Officers of Health (MOHs), basic facilities and support is impeding the delivery of preventive care."

The staff strength needed in all districts is 9,597 and the existing vacancies are 3,300, which excludes the teaching hospitals in the area.

Here are some of the problem areas:

* An increase in the virulent form of malaria, with more than 50% of the reported cases being in this area due to the interruption in the vector control programme. Ninety-two percent of malaria deaths too are from these districts.
* An increase in the incidence of acute respiratory infections and diarrhoeal diseases due to inadequate shelter, damage/destruction to water and sanitation systems and insanitary conditions in welfare centres
* Worsening of the maternal and child health status
* Worsening nutritional status
* High maternal mortality and infant mortality rates
* Worsening nutritional status
* Psychological trauma and insecurity
* High number of attempted suicides, alcohol abuse, domestic violence and grief
* High number of disabilities and war injuries
* Unreliable data

A pathetic indicator of the situation is the nutritional status. The report states: "Jaffna district had the lowest malnutrition level in the 1975-76 National Survey. However in a study done in Jaffna in 1992 wasting was 18.9% (Sivarajah N. 1993). The same picture was seen in a study conducted by the MSF team (David Becker and Michelle Kelly 2000). Wasting among the children of 6 to 17 months was seen to be very high at 30.7%."

Some of the immediate measures suggested by the WHO are the re-establishment of primary health care services, filling up of vacancies especially those for MOHs, starting mobile services until normal services are restored and ensuring availability of equipment and drugs. (KH)

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