Sri Lankan government accused of using healthcare as a weapon of war crime strategy

The Sri Lankan government has been accused of using healthcare as a weapon of war crime strategy. “The health care – a strategy of using people’s need for health care as a weapon against them by violently depriving them of it- has translated into hundreds of health workers killed, hundreds more incarcerated tortured, and hundreds of health facilities deliberately and systematically attacked” said the Tamil Physicians Forum in a preliminary report released couple of days ago.

The Forum has also accused the international community of a desperate silence and of failing to protect the thousands of civilians under international humanitarian and human rights law.

The weaponisation of health care in Sri Lankan context, as the Forum identifies, was conducted in following context: 1.Targeting Health Care workers 2. Attacking Health Care facility 3. Criminalizing Medical Neutralist 4. Exodus of Health Care Workers 5. Violating international Law 6. Be-signing Medicine 7.Misuse of Public Health Resources 8. Deployed Military intelligence in Health work 9.Putting Military agenda in Health 10. Lack of Medico legal Service 11. Restricting the Health facilities.

The full report is available below:

The conflict in Sri Lanka presents new and unprecedented challenges that undermine the principles and practice of medical neutrality with direct and repeated targeting of health workers, health facilities, and became the most dangerous place on earth for health –care provides. The health care – a strategy of using people’s need for health care as a weapon against them by violently depriving them of it- has translated into hundreds of health workers killed, hundreds more incarcerated tortured, and hundreds of health facilities deliberately and systematically attacked. Evidence shows use of this strategy on an unprecedented scale by the Sri Lanka Government and allied forces, in what human rights organization described as a war crime strategy, although all parties seem to have committed violators. Attacks on health care have sparked a large scale exodus of experienced health workers. Formidable challenges face health workers who have stayed behind and with no health care a major factor in the flight of refugees, the effect extends well beyond Sri Lanka. The international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences. There have been repudiated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality conflict. In this Health Policy analysis, the situation of health workers, facing such systematic and serious violations of international humanitarian law. We describe the tremendous pressures that health workers have been under and continue to endure, and the remarkable resilience and resourcefulness they have displayed in response to this crisis. We propose policy imperatives to protect and support health working in around conflict zones.

Health workers under attack

The idea of weaponisation of health care to capture the phenomenon of large scale use of violence to restrict or deny access in care as a weapon of war. Weaponisation is multi-dimensional and includes practices such as attacking health care facilities, targeting health workers, obliterating medical naturality, and be-singing medicine. Though large-scale violations of international humanitarian laws, weaponisation of health care amounts to what has been called a “war-come strategy”. Weaponisation of health care in the Sri Lankan conflicts was manifested most notably in the targeting of health workers and facilities during the period of 2008 – 2009. The historical context is important to understand.

Global context: protection of health workers under international humanitarian law.

The imperative for unobstructed humanitarian aid during armed conflicts is well established. The importance of allowing health workers to treat suck and wounded combatants led to the creation of the International Committee of the Red Cross (ICRC) in 1863 and drove the development of the humanitarian principles of impartiality, independence and mentality underlying the first international humanitarian law in 1864. The four Geneva Conventions codified in 1949, define the obligations of nation stated engaged in armed against civilian populations, established district protections for health and humanitarian workers who provide and to wounded combatants of any side and the civilian populations. These protections under International humanitarian law confer treaty obligations on all signatory nations. Every country in the world has signed and ratified the 1949 Geneva Conventions, however, not all nation states have signed or ratified the Additional Protocols in the Geneva Conventions that expand and clarify the protections for medical and humanitarian personnel and civilian populations. These protections are recognized as a matter of customary international humanitarian law, which means even governments that have not ratified the relevant treaties are required to respect them. Finally, recognition by UN rights bodies that international human rights law and International humanitarian law provide for access to health care in war time is increasing.

The ability of people in need to access health care depends on state and non-state armed groups respecting international humanitarian law provisions that protect health workers. Yet several of today’s armed conflicts and resultant humanitarian crises are taking place in settings in which both state and not state armed groups have shown disregard for the safety and lives of health workers, frequently violating applicable international humanitarian law with impunity.

Tamil Physicians forum is  seeking litigation measures for massacre in Northern Sri Lanka during the period of 2008 -2009. This complex political emergency undermined to recognize Tamil Civilian Causality.

Weaponization of Health care by the Sri Lankan government had eliminated not only Tamil Eelam Health system and Health family but also had led to massive civilian causality.

The weaponization of health care in Sri Lankan context shall be analysed in following context:

1. Targeting Health Care workers

Health Care workers were kidnapped and arrested and killed.   It has happened heavily during the period of 2008 to 2009. Further more than 2000. Health care workers from Tamil Eelam Health Services were in the list of missing, death and arrested. These workers had done marvelous work during tsunami. Further Psychosocial Team which worked with counseling and landmine awareness were also missing.

2. Attacking Health Care facility

Sri Lankan Military operation was always targeting first the public Hospitals. Chest Hospital KKS, DH, Chavakachcheri. DH Tellippallai, GH Kilinochchi had severely damaged and made exodus. TH, Jaffna was targeted in 1987 from Jaffna fort during Indian Peace Keeping Force (IPKF) Operation in Oct 1987 and Sri Lankan “Suriyakathir” Operation during 1995. This weaponization phenomena continued in Vanni in 2006 to 2009  from Mannar Pallamadu hospital, Kilinochchi Hospital, Puthukudiyiruppu Hospital and lasted to Mullivakal Temporary Health shelter.

3. Criminalizing Medical Neutralist

Helping the people in affected area can be penalized according to Sri Lankan Law and it has happened.

Medical Neutralists’ were punished including doctors, pharmacist.  And some were killed. Some were turned out to be a witness for falsification of crime. Some doctors were arrested and make to write false statements and books.

4. Exodus of Health Care Workers

 Direct and indirect threat has been made the health care workers to more out of   the conflict zone. Most of the Tamil doctors and medical technical officer     have migrated. Further government had noticed to move out of the conflict   zone in 2008. And it had made Humanitarian agency to vacate the Vanni. It is one of   the reasons for death of 140,000 people in Vanni with severe causalities.

5. Violating international Law

Food, water, clean air, medicines were intensively limited during the period of 2008-2009. Safety zone which was declared by the Sri Lankan government also targeted by Sri Lankan security forces.

Hospital Centred Victimization was done by Sri Lankan government security forces. The conflict has shown large scale aerial bombing of civilian areas, committed by the Sri Lankan government. The pattern of government attacks on Civilian areas suggested that the government targeted all civilians, including those providing medical care, people living in opposition controlled areas and hence as legitimate military targets. But, as international humanitarian law makes clear, even that designation is no justification for the Sri Lankan Government war crime of deliberately bombing civilian homes, attacking infrastructure vital to civilian habitat, hospitals markets; and forcing the displacement of total population exodus. Prisoners were injected with unknown injection without their consent. This has caused premature deaths with cancer and unknown diagnosis.

6. Be-signing Medicine

Medicines were restricted to public from 1990 in Vanni.

MSF and ICRC provided limited supply of drugs after security clearance. Severe shortage and scarcity of medicines occurred during the period of 2008-2009 in Vanni.

7. Misuse of Public Health Resources

Resource donated for public were taken by the defence forces and the humanitarian aids were diverted to Military hospitals.

8. Deployed Military intelligence in Health work

Few doctors and health assistance were deployed by the government intelligent agents to support their military operation by various means including, identifying Tiger leaders and their operation. Further these deployed defence medicals agents witnessed the war as supporting the government and denying that anything had happened to public.

9. Putting Military agenda in Health

Forced sterilization was done by the health authorities by the order of a Military governor. Health projects were diverted to military or defence agent including GFATM Projects.

ICRC humanitarian work shops were used to hide the medico legal procedure for Victims by the military activities against the civilians.

10. Lack of Medico legal Service

Medico legal Services were not done to about 250,000 Tamil victims medico legal procedures not identified. Among them about 100,000 victims were injured and recovered and but 140,000 were had injured  and succumbed to death.

11. Restricting the Health facilities

Health Care facilities were restricted to Tamil people during the period of 1990 to 2009. UNICEF ICRC and MSF were the only INGOS which supported to provide the minimum health care facilities.

Tamil employees of the Sri Lankan Health Ministry were in uncontrolled area worked with the high Defence Ministry Restriction during the period of January 2009 to August 2009. Most of the people were detained in concentrated camps and healthcare facilities also restricted. These were the modern Hilter’s concentrated camps.

12. Encroaching Hospitals, hospital lands for military purpose.

Chest Hospital, KKS which was a 110 beds strength has been captured by the SL Forces in 1990 and it was occupied by them. After 2009 the hospital buildings were demolished and land is occupied by the military forces. There is a military operation is going on in K.K.S now from the   3^rd week of March 2017 by the Sri Lankan Security Forces. These forces are going to be deployed as Peace Keeping Forces in Mali in short period by UN. But this exercising area is belonging to Chest hospital. Jaffna district people are suffering from H₁N₁ influenza epidemic due to lack of functioning Chest Hospital. WHO should identified this as a weaponization Health hazard and which leads to lack of isolation hospital for the public.

A Land allocated for Teaching Hospital Jaffna to Build Pediatric Hospital is also occupied by the Military Forces in Jaffna City. It hurdles to build a Pediatric Hospital in Jaffna which is planned to build.