As fighting raged earlier this year between the Sri Lankan military and the Liberation Tigers of Tamil Eelam in northeastern Sri Lanka, tens of thousands of civilians were trapped for months in a war zone with no aid and limited medical care. A few months before the final phase of the country's decades-long civil war, humanitarian aid agencies, including MSF, had to leave the areas most affected by the fighting, at the request of the government. Only the International Committee of Red Cross (ICRC) could continue some crucial medical assistance, evacuating some of the wounded to Ministry of Health hospitals.

In April, thousands of people managed to escape the war zone, many needing health care because of severe shrapnel, gunshot, or landmine injuries. From February to the end of June, almost 4,000 war wounded had major surgical interventions in Vavuniya hospital where an MSF team worked there. The other referral hospitals in the region had also to cope with at least double, or triple, the number of patients they had the capacity for.

In government-run camps held up to 280 000 displaced people, patients needing hospitalisation were referred to hospitals outside the camp, including the MSF structure. MSF also treated over 500 trauma cases related to the conflict in MSF Menick Farm hospital; over 200 of them needed surgery.

The release of people held in the camps has slowly started since August and families have been gradually leaving for their home. Still many displaced are living with host families in Vavuniya and tens of thousands remain in camps opened since December 2008. MSF works with the Ministry of Health to support the population by providing physical rehabilitation, including reconstructive surgery, and psychological care, in Vavuniya or areas of resettlement.

Approximately 260,000 people have fled the conflict area of Vanni, in northern Sri Lanka. Most have settled temporarily in Vavuniya district, and are in need of urgent medical care. [Sri Lanka 2009 ? Anne Yzebe / MSF]

MSF nurse, Mireille, attends to a patient in the MSF field hospital near Manic Farm. [Sri Lanka 2009 ? Anne Yzebe / MSF]