Hans van de Weerd, General Director of Médecins Sans Frontières (MSF) Holland, has recently returned from Sri Lanka. Here we ask him about the situation in the northern district of Vavuniya, where there are over 260,000 displaced people as a result of the now ended war between the Sri Lankan army and the Liberation Tigers of Tamil Eelam.

What is the situation in the camps in Vavuniya?

"More than 260,000 displaced people are living in Vavuniya, spread out over many different camps, where they still don't have freedom of movement. They are not allowed to leave the camps and are not allowed to possess phones. The size of the camps differ from a few thousand to more than 60,000 people. The conditions vary immensely from one camp to another: in some, the water supply is a problem, in others, the delay in the distribution of food rations is the biggest concern.

"Overall, there is a concerning shortage of medical staff inside the camps and MSF staff still hear stories of people who say it has taken them days to see a doctor. The doctors and nurses of the Minister of Health are working very hard, but with these numbers of people the needs are enormous. There are many people with injuries and amputations and there is a huge need for physiotherapy. Often patients get discharged from overcrowded hospitals and sent to the camps where they do not receive the post-operative care they need, such as physiotherapy.

"Furthermore, in most of the camps, there are no adequate health services functioning at night, so it is down to the soldiers at the gates to judge whether a patient is ill enough to need to go to a hospital outside the camps.

"Mental health problems are another important issue for the people living in the camps, as during the conflict they went through traumatic experiences, many of them have lost loved ones or/and have been injured. Added to this, they are now in a situation where it is difficult to rebuild a normal life. People are living in crowded tents, there are very few jobs inside the camps, there is nowhere to go and very little to do other than wander from one food or item distribution, organised by either the government or humanitarian organisations, to the next. In many camps, people cannot cook for themselves but have to rely on communal kitchens, parents worry about their children missing out on their education and the uncertainty about when they will be able to leave or get together with their relatives is a cause of great anxiety."

Apparently people in the camps are not free to leave. Why does MSF work there?

"MSF is working for the people in the camps, where freedom of movement is severely restricted, according to the government because of the concern about the presence of former fighters among the civilians. There are provisions under international law for such restrictions in states of emergency, which the Sri Lankan parliament has declared, but they are meant to be of limited duration.

"Of course, MSF is deeply concerned that the longer these conditions exist, the more difficult life becomes for those who are living in the camps, particularly as they have experienced extremely traumatic events and many are still not sure where their families are or what has happened to them. To date, there has been no clear, systematic release of anyone from the camps, with the exception of children under 10 and adults over 60 who have relatives outside the camps. With the rainy season coming up, MSF is also concerned about any acute needs that could arise in the camps.

"It is true that the government has made an effort to set up the camps and ensure that assistance is provided. However, health care services, for example, are still not at the level we would hope to see. MSF has offered to the authorities its assistance in helping expand the existing services. MSF is of the opinion that the government has an obligation to release civilians and ensure that adequate assistance is provided."

What is MSF doing in Vavuniya?

"In 11 of the camps, MSF delivers high energy porridge to supplement the diets of particularly vulnerable people like children under 5, pregnant and lactating women and the elderly. In total, MSF is giving out each day more than 23,000 meals to these people and makes sure that sick people and malnourished children will be referred to clinics and special treatment centres for malnourished children.

"In May, MSF set up a 150 bed hospital outside the camps of Menik Farm with two operating rooms and an intensive care unit. Since the opening, over a thousand medical and surgical patients were admitted. People are referred there by the Ministry of Health staff in the camps. We are mostly treating conflict related injuries, respiratory tract infections and paediatric cases. Maternity services have also recently started. We continue to support the Ministry of Health General Vavuniya hospital with MSF staff doing surgery, nursing and physiotherapy.

"Nine nutritional assistants work alongside ministry of health staff in the nutrition department of the paediatric ward and a Mental Health officer is assisting a local NGO with training their counsellors to provide mental health to the patients in the hospital. A team of about 135 caretakers help patients with day to day activities like eating and bathing and some of them are also being trained in physiotherapy and doing wound-dressings. MSF also distributed clothes, towels, water bottles, money, mats, pillows and bedsheets to more than 10,000 patients as most of them arrived with only their clothes on.

"In the Ministry of Health Pompaimadhu hospital, MSF staff are taking care of 180 wounded patients, many with amputations. Fifty of them have spinal cord injuries. The main activities are dressings, physiotherapy and surgery.

"We are in a process of negotiations with the authorities to start a programme of orthopaedic and reconstructive surgery in the hospital of Vavuniya."

What restrictions do you face in your work?

"The process to issue visas for international staff is lengthy and very bureaucratic and this has hampered our work. Also the teams having to enter the camps on a daily basis for the feeding activities are often hindered by unclear procedures, which sometimes delays the work by hours or days.

"MSF is not allowed to enter camps where we do not work and we have not been able to carry out an independent assessment of the needs of the displaced people in the camps.

"MSF has the capacity to scale up activities and provide medical and mental health care for the people inside the camps. So far, the authorities have not accepted this proposal for assistance."