ICRC : Sri Lanka: ever more sick and wounded evacuated from conflict area to hospital

Since 10 February the ICRC has evacuated thousands of people from conflict-weary northern Sri Lanka to Trincomalee district for medical treatment. Martin Hermann, an ICRC surgeon, speaks about the evacuated patients and his work.

Why is the ICRC evacuating civilians out of the Vanni?

As fighting between Sri Lankan government forces and the Liberation Tigers of Tamil Eelam (LTTE) continues, sick and wounded people continue to arrive at a makeshift health facility in Putumattalan, on the northern Sri Lanka coast. Because of the lack of properly functioning medical facilities in the conflict area, the ICRC has evacuated over 6,600 people – the sick and wounded and their attendants – to Trincomalee district by sea since 10 February. Upon arrival, patients are transferred to hospital for treatment. In Trincomalee Hospital, Ministry of Health staff and an ICRC medical team, consisting of a surgeon (myself), an anaesthetist and a nurse, have treated over 1,900 patients since the first sea evacuation took place.

How would you describe the condition of the patients evacuated from Putumattalan?

Their medical condition is often extremely serious. The Ministry of Health staff working in Putumattalan are very resourceful – given the difficult environment they have to work in, they do a tremendous job. However, because of the number of people requiring medical care in the conflict area and shortages in medical supplies, many patients arrive in Trincomalee in a state of utter exhaustion, dehydrated and very often too weak to move. After they have been examined, had something to eat and drink, and caught up on some sleep, most start to feel better. Some even start smiling. They may be worried about their medical predicament and their future, but they are relieved to have left the conflict behind.

What kinds of injury do you see in patients evacuated from Putumattalan?

Many patients need to have a limb amputated because of a shrapnel injury. We also treat injuries to other parts of the body, sometimes to remove shrapnel. I have seen many patients with heavily infected wounds, sometimes in the area where the amputation is required. Infections set in rapidly when a wound is not treated with antibiotics or a dressing cannot be changed. On some patients arriving here, strips of sarong or tee-shirts have been used instead of dressings. Pieces of wood are often used as splinters to immobilize a fracture and spare the person a lot of pain. Amputees will need physiotherapy and prosthetic work if they are to regain the use of their limb. Skilled personnel and suitable facilities are required for longer-term treatment of this kind.

Given the large numbers of sick and wounded people in Putumattalan at the moment, how are patients selected for medical evacuation?

Because of the limited space available on the ferry chartered by the ICRC, there is no way to avoid selecting patients based on need. Patients are selected for evacuation on the advice of medical professionals who work in Putumattalan. Every evacuation is carried out with the agreement of the local authorities. The ICRC is not involved in the selection process. After patients board our ferry and arrive in Trincomalee or, as has been the case in recent days, in Pulmoddai, health facilities take over from the ICRC. They set priorities for treatment based on the degree of medical emergency.

How different are procedures for patients arriving from a conflict area from those for other patients?

The type of injuries is different. Wounds are highly contaminated with every kind of germ you find on the ground. Huge amounts of soft tissue are likely to have been destroyed, for example by shrapnel. The blood supply to the affected location may have been interrupted. To treat someone with such a wound, the first step is to cut out a lot of dead tissue to prevent infection. For many patients evacuated from Putumattalan, we have to cut out dead tissue, clean the injury, help with the healing process and sometimes do skin grafts to close a very large wound. We also immobilize fractures. Time is of the essence in treating these injuries. If the correct surgical procedures and treatment are carried out in time, the chances of the wound healing quickly improve drastically. It can be a matter of losing or saving a limb.

How is your working relationship with the medical staff at Trincomalee Hospital?

The medical staff at Trincomalee Hospital are extremely dedicated. They are now in a situation where they have to treat patients suffering from unconventional injuries. This is where the ICRC’s special expertise and support are a concrete advantage, which the Trincomalee staff appreciate. We complement each other. We have a very good working relationship.

Why did you make the transition from a general surgeon to a “humanitarian” surgeon?

Although I’m a general surgeon I also have orthopaedic skills, which were useful when I was working for various NGOs providing surgery in hospitals for victims of armed conflict and other violence in countries such as Nigeria and Afghanistan. In 2007, I did a mission with the German Red Cross and the ICRC in Puthukkudiyiruppu, which influenced my decision to come back to Sri Lanka with the ICRC.