In order to provide access to primary health care and referral specialist services for isolated populations in parts of Mullaitivu District, MSF began a mobile clinic project in December 2010. Throughout 2011, mobile clinics conducted 200 primary health care 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.Numerous communities in areas affected by the fighting witnessed deeply traumatic events during the last phase of the civil war. While the physical scars may have healed for many, considerable mental health care needs remain. Many people 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. MSF worked 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 money and public transportation, mobile mental health teams had to travel to very remote areas to reach patients.From February 2011 to July 2012, MSF provided 4,629 counseling and group support sessions for individuals suffering from psychological and psychiatric disorders, targeting children, women, the elderly, and disabled. A psychiatrist also provided medical follow-up for patients diagnosed with post-traumatic stress disorder, depression, psychosis, or epilepsy.The community outreach program conducted group counseling sessions for students in the region and provided training for teachers to identify children with mental health conditions. “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.” From 2006 to 2011, MSF provided support at Point Pedro Hospital’s emergency unit and assisted with maternal health care, 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 more than 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. In 2011, MSF carried out around 5,000 consultations in the emergency unit, performed 1,004 major surgeries, delivered 329 babies, and provided antenatal care to 2,295 women. Doctors Without Borders/Médecins Sans Frontières (MSF) announced that it has handed over its last remaining project in Sri Lanka—a mental health program in Mullaitivu District—to World Vision, an established international NGO with a long-term operational plan for the north of the country. This handover follows a progressive transfer of medical activities to the Sri Lankan Ministry of Health over 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 health care during the resettlement period for the internally displaced people,” said Marie Ouannes, MSF’s program manager for Sri Lanka. Other key objectives of the project included establishing an efficient referral system within local health structures for those in need of treatment and building a pool of trained local counselors and community support officers.“While not in the acute post-conflict phase, mental health needs in the area are still significant, despite the war having ended more than three years ago,” said MSF psychologist Gaia Quaranta. “Specialized skills and a long-term approach to community rehabilitation is required to address these issues, which is why we call on other organizations with a long-term future presence in the area to continue providing mental health care support for local communities.”In recent years, nongovernmental organizations have been granted greater access to areas that were most affected by the fighting. Infrastructure and health facilities have improved, as well.“As a medical humanitarian organization specializing 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.
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