International medical humanitarian organisation Médecins Sans Frontières (MSF) has handed over its last remaining activities in Mullaitivu district, Sri Lanka, having first worked in the country in 1986.  

The handover of the mental health programme in August 2012 to an established international NGO with a long-term operational plan for the north of the country follows a progressive transfer of medical activities to the Ministry of Health during the last 18 months.

“The District General Hospital of Mullaitivu was almost non-functioning back in 2010 when MSF decided to provide support to enhance access to healthcare during the resettlement period for the internally displaced people,” said Marie Ouannes, MSF programme manager for Sri Lanka .

“The partnership with the Ministry of Health teams, either in Colombo or at provincial level, led to much better access to health facilities for communities in Mullaitivu district. In terms of human resources, the government is also scaling up staff in these structures, which means MSF can now reallocate these resources to emergency contexts where medical services and facilities are in shorter supply.”  

Gradual handover

From 2006 to 2011, MSF provided support at Point Pedro Hospital’s emergency unit as well as assisting in maternal healthcare, surgery and infection control. These activities were handed over successfully to the Ministry of Health in December last year.

In 2011, MSF staff performed 1,720 major operations and over 6,900 emergency consultations, approximately 5,300 women received antenatal care, and 929 births were assisted.

In 2012, MSF gradually handed over its responsibilities in the 80-bed Mullaitivu Hospital to the Ministry of Health. During 2011, around 5,000 consultations took place in the emergency unit, MSF surgeons performed 1,004 major surgeries, 329 babies were delivered and 2,295 women received antenatal care.

In order to provide access to primary healthcare and referral specialist services for isolated populations in parts of Mullaitivu district at the time, MSF began a mobile clinic project in December 2010. Throughout 2011, mobile clinics conducted 200 primary healthcare consultations at five different sites per week, or 11,524 for the entire year, mostly in Puthukkudiyiruppu division.

MSF also developed Mullaitivu Hospital’s electricity, water and sanitation systems to ensure sustainability in the future, and provided significant assistance to develop the health structure’s laboratory service.

Mental health needs

Numerous communities in areas affected by the fighting witnessed deeply traumatic events that took place during the last phase of the civil war. While the physical scars may have healed for many, considerable mental healthcare needs remain. Many lost everything during the war and face new difficulties in the resettlement process.

Drawing on extensive experience of working in conflict and post-conflict settings, MSF launched mental health activities in 2009, in collaboration with the Ministry of Health and the College of Psychiatrists, first in Menik Farm – a camp for hundreds of thousands of people displaced by the war – and later in eight different sites in Mullaitivu district, including inside a specially built structure on the grounds of Mullaitivu Hospital.

As many sick people were unable to travel to health facilities due to a lack of public transport and money, mobile mental health teams had to travel to very remote areas to reach patients.

Between February 2011 and July 2012, MSF provided 4,629 counseling and group support sessions for identified vulnerable individuals suffering from psychological and psychiatric disorders, targeting children, women, the elderly and disabled. A psychiatrist also provided medical follow-up of diagnosed patients with post traumatic stress disorder, depression, psychosis and epilepsy.

The community outreach programme conducted group counselling sessions for pupils in schools in the region and provided training for teachers to identify children with mental health conditions.

Other key objectives of the project included establishing an efficient referral system within local health structures for those in need of treatment, as well as building a pool of trained local counsellors and community support officers.

Continuous monitoring

In August 2012, MSF handed over its mental health programme - its last remaining activity in the country – to World Vision.

“While not in the acute post-conflict phase, mental health needs in the Vanni are still significant, despite the war having ended more than three years ago,” said MSF psychologist Gaia Quaranta.

“Specialised skills and a long-term approach to community rehabilitation is required to address these issues, which is why we call on other organisations with a long-term future presence in the area to continue providing mental health care support for local communities.”   

In recent years, in addition to improvements in infrastructure and health facilities, access to the affected areas has improved for non-government organisations.

“As a medical humanitarian organisation specialising in emergencies, MSF must allocate our limited resources to where the health needs of neglected populations are greatest,” said Marie Ouannes.

“In the north of Sri Lanka, other actors that are better suited to a long-term recovery process are now able to reach the populations in need of care.”

MSF will continue to monitor the situation in Sri Lanka and stands ready to return to the country to provide emergency medical support if the need arises.