Sri Lanka

Sri Lanka’s eastern coast has been devastated by the 2004 Tsunami and by the ongoing conflict between the government and the Liberation Tigers of Tamil Eelam (LTTE). While the conflict in the east has waned, thousands of Internally Displaced Persons (IDPs) are returning home to the districts of Ampara and Batticaloa without access to services or infrastructure. Targeting with these returning communities, our supported programs provide integrated psychosocial health, community health education and primary health care programs specifically designed for newly returned IDPs. At the same time, in the north of the country, where fighting has just ended, there is a humanitarian crisis as more than 250,000 IDPs live in gravely concerning conditions. MAC is investigating how to support these displaced and traumatized communities in the northern districts of Vavuniya and Mannar, including the world’s largest IDP camp, Menik Farm.

Where: Ampara & Batticaloa Districts
People Impacted: 59,700

Context

Sri Lankans have been buffeted by the 2004 Tsunami and the lengthy conflict between the government and the Liberation Tigers of Tamil Eelam (LTTE), which killed over 70,000 and displaced over one million people at the height of the fighting¹. The conflict recently ended but during its height communities in and around combat zones had virtually no access to medical or sanitation services. The most pressing humanitarian situation in Sri Lanka is in the districts of Vavuniya and Mannar, where 250,000 of displaced people, long trapped between government and LTTE fighting, live in desperate conditions. Among these IDP camps is the world’s largest IDP camp, Menik Farm, where 125,000 IDPs have been placed by the Sri Lankan government. Meanwhile, thousands of Internally Displaced Persons (IDPs) who fled earlier fighting are returning home to the eastern districts of Ampara and Batticaloa. The island, with its relatively high income and education levels, represents three developmental stages at once: humanitarian crisis in the north, post-crisis transition in the east, and stability and development in the west.

Primary Health
In Batticaloa District, an estimated 45,000 people have recently returned from displacement to be greeted by poor access to public services, very little post-tsunami reconstruction and an uncertain future. MAC supports a program providing three mobile clinics for returning IDPs as a temporary reinforcement of the primary health care system. The program also promotes hygiene through health education, and strengthens the capacities of Sri Lanka’s national medical staff.

The mobile clinics:

Provide primary health care to IDPs who are returning to their homes but who face a lack of services and infrastructure.
Are flexible, allowing for returning residents’ movement and ensuring constant care for patients with chronic diseases, pregnant women and young children.
Assist Batticaloa’s District Public Health Services (DPHS) as it trains Sri Lankan health personnel and rebuild health services and infrastructure in areas previously affected by internal conflict and the 2004 tsunami.

Our grantee’s intention is to transition the provision of health care in Batticaloa to the local health authorities but, faced with exorbitant needs in the region due to renewed political tensions, the local health authorities have yet to recover the capacity to deliver quality primary health care. The Sri Lankan Ministry of Health has requested that medical support continue until it is capable of handling full responsibility for these communities. Given the ongoing needs of the returning IDPs and our commitment to continuous, sustainable health care coverage for local communities, MAC is seeking to continue its support of this program until a smooth transition is possible.

Psychosocial Health
Sri Lanka has one of the highest suicide rates in the world and an estimated 3% of the general population suffers from mental health problems, with that percentage much higher amongst the IDP and tsunami-affected populations which have endured prolonged traumatic stress². Since 2007, we have worked with the people of Thirukkovil, a village of 30,000 in Ampara District, on a psychosocial health program that rebuilds communal ties and supports community members affected by the conflict and the tsunami. Here we built a Community Center to meet the needs of the 6,000 residents of the Vinyagapuram neighborhood, who struggle with alcoholism, high school drop-out rates, suicide, and domestic violence. The goal is to rebuild Thirukkovil’s social cohesion so that affected populations can once more find their place within the community; the hope is that the community itself, through a new community-based organization supported by us, will have autonomous managerial and financial control of the Center at the end of the program.

This Center, which includes classrooms, a library, computer rooms, individual counseling rooms and performance spaces, offers a safe place to come during the day for children who are at risk of being forcefully recruited by rebel troops. Relaxation and meditation sessions are just some of the activities available to help reduce stress among these children.

The Center, which is used by 60 to 80 people every day and whose staff has counseled over 1,000 families in 2008, also provides:

Classes for 17-30 year olds, (e.g., English, computers)
Health education workshops run by local staff on health and hygiene
Individual and family counseling sessions, including house calls
Discussion groups are regularly held for various groups, including women and parents who wish to receive support in raising their children.

Transition to local hands: As the program reaches its end, the management of the Center is being handed over to the local community to ensure that the Center continues to thrive as a communal resource. The transition process began in 2008 when local staff members began attending psychosocial support and organizational management training sessions. A new community-based organization, which includes representatives of the local authorities and community, is currently being developed. Given the limited financial capacity of the Sri Lankan health authorities, income generation activities, such as charging for English classes, Internet access, and room rentals, are currently under consideration to ensure the autonomy and viability of the Center.
Using the successful Thirukkovil Community Center as a model, MAC has expanded its support to a second psychosocial health program into nearby Batticaloa District. When completed, five small, satellite Community Centers will complement the mobile health clinics already working with these same communities.

Community Health Education
Our grantee’s community health educators organize free, public health workshops that are integrated into the Community Center. With a culturally sensitive and preventive approach, workshops emphasize personal hygiene, vaccination, prenatal and postnatal care, HIV/AIDS prevention, and mental health.