Extracts from the report on Sri Lanka of the advisory panel appointed by Ban Ki Moon
The following are extracts from the Ban Ki Moon report pertaining to instances where hospitals were allegedly shelled:
On or around 19 to 21 January, SLA shells hit Vallipuram hospital, located in the first NFZ killing patients. Throughout the final stages of the war, virtually every hospital in the Vanni, whether permanent or makeshift, was hit by artillery. Particularly those which contained wounded LTTE were hit repeatedly.
87. Heavy shelling continued unabated. On 24 January, the Udayaarkaddu Hospital, also located in the NFZ and clearly marked with emblems, was hit by several shells.
4. SLA shelling of PTK (Puthukudiirippu) Hospital
90. Fighting in the area intensified as part of the expressed efforts by the 55th and 58 Divisions to capture PTK by 4 February, the day commemorating Sri Lanka’s independence. PTK hospital was the only permanent hospital left in the Vanni, and its neutrality was recognized by the Government and the LTTE. The medical staff, including five doctors, was stretched beyond its capacity, and medical supplies were very limited. The shelling in the first NFZ had marked a turning point in the conflict, and civilian casualties were rising. PTK hospital was packed with hundreds of injured civilians from the NFZ. More than 100 new patients were arriving each day, many from the NFZ. Many had severe or life-threatening injuries caused by artillery fire or burns. The casualties, many of them babies, young children and the elderly, were packed in every conceivable space – on beds, under tables, in hallways and outside in the driveway.
91. ON 29 January 2009, the two remaining United Nations international staff left for Vavuniya, without the national staff members, who were still not allowed to leave by the LTTE. The ICRC dispatched a separate convoy, which evacuated about 200 wounded patients. Immediately thereafter, in the week between 29 January and 4 February, PTK hospital was hit every day by MBRLs and other artillery, taking at least nine direct hits. A number of patients inside the hospital, most of them already injured, were killed, as were several staff members. Even the operating theatre was hit. Two ICRC international delegates were in the hospital when it was shelled on 4 February 2009. The shelling was coming from SLA positions.
92. The GPS coordinates of PTK hospital were well known to the SLA, and the hospital was clearly marked with emblems easily visible to UAVs. On 1 February 2009, the ICRC issued a public statement emphasizing that "wounded and sick people, medical personnel and medical facilities are all protected by international humanitarian law. Under no circumstance may they be directly attacked."
Sri Lankan defence secretary Gotabaya Rajapaksa tells Sky's Alex Crawfod a hospital hit by artillery fire in the rebel-controlled north was a legitimate target, after 12 were killed. This report contains images of injured people you may find distressing. [Sky News]
93. The Ministry of Human Rights and Disaster Management responded by accusing the ICRC of "either willful ignorance or naiveté." Initially, the Government denied shelling the hospital, but on 2 February 2009, the Defence Secretary gave the following statement in an interview on Skynews:
"If they (reports) are referring to the (PTK) hospital, now there shouldn’t be a hospital or anything because we withdrew that. We got all the patients to Vavuniya, out of there. So nothing should exist beyond the No Fire Zone… No hospital should operate in the area, nothing should operate. That is why we clearly gave these No Fire Zones… For the LTTE… to crush the terrorists, there is nothing called un-proportionate.
94. After the fall of Kilinochchi, PTK was a strategic stronghold in the LTTE’s fight against the SLA. As a result, the LTTE had a sizable presence in the PTK area and maintained a separate ward for wounded cadres in PTK hospital, but they were not armed. The frontline was nearby, and as the fighting in the PTK area increased, more LTTE wounded started to come into the hospital. The LTTE also fired mobile artillery from the vicinity of the hospital, but did not use the hospital for military purposes until after it was evacuated. Yet, in its eagerness to capture the area, the SLA repeatedly shelled the hospital and surrounding areas. Due to the incessant shelling, the Regional Directors of Health Services (RDHS), the United Nations, the AGA and the ICRC decided to evacuate some 300 patients in PTK hospital to Putumattalan, around 6 to 8 kilometres away, on the coastal strip next to the Nanthikadal lagoon. Ponnambalm Hospital, a private hospital used in part by the LTTE, was shelled on 6 February 2009, causing part of it to collapse.
103. When the PTK hospital relocated to Putumattalan, the Government stated that "there are now no hospitals functioning in uncleared areas in the Vanni". Nonetheless, the second NFZ had three makeshift hospitals, including Putumattalan, a small clinic at Valayanmadam and a hospital in Mullivaikkal. All of their coordinates were known to the Government, and they were clearly marked with emblems. Government doctors continued providing their services there. Putumattalan hospital was severely overcrowded with hundreds of newly injured civilians. As the Government did not allow basic medical supplies into the Vanni, conditions in Putumattalan hospital were so poor that a large number of amputations were performed without anesthetic, using butcher knives rather than scalpels. Sanitary pads and cotton cloths were used as bandages, and intravenous drips were hung from the trees, with the severely-injured patients lying on the ground under them. In spite of the significant efforts of the few available doctors, many patients died due to lack of access to proper medical care, and scores of bodies were deposited in front of the hospital each day.
104. On 9 February 2009, shells fell on Putumattalan hospital, killing at least 16 patients. The shells came from SLA bases in Chalai, but subsequently shells were also fired from SLA positions across the lagoon (even though the hospital was clearly visible to the SLA based there). While some wounded LTTE cadre were treated at Putumattalan hospital, they were few in number and were kept in a separate ward. Putumattalan hospital was shelled on several occasions after that, in February and March. RPGs were fired at the hospital around 27 March killing several civilians. In addition to civilian casualties, the operating theatre, makeshift ward and roof all sustained damage.
106. The ICRC continued to play a leading role in alleviating the plight of the civilian population in the Vanni, by evacuating wounded civilians from the coastal strip by ship, starting on 10 February 2009. In total, 16 ICRC ships came to the conflict zone in the final months. The international ICRC staff that had remained in Putumattalan left on the first ship, but they returned and stayed onshore for a few hours each time the ships came back. The Government did not allow United Nations staff on the ships.
107. The LTTE issued passes for injured civilians and some of their dependents to leave the area on ICRC ships, but the wounded had to be ferried on small boats, as the ship was not allowed to come closer than a kilometer offshore. The wounded were lined up on the beach, but several times came under fire. Shells fired by the SLA sometimes fell in the sea near the ICRC ships. Around 22 April, shelling near a ship forced the captain to return to deeper waters.
110. After the SLA captured the north of the NFZ, Mullivaikkal Hospital was the only remaining hospital in the conflict zone. There were no LTTE cadre in uniform in the hospital, nor did anyone bring weapons inside. Conditions were extremely poor. The hospital had four doctors and ran two improvised operating theatres. Some of the patients, including those with serious head injuries and other obvious fatal injuries, were merely made comfortable, but no attempt could be made to save them. With few beds available, wounded patients often remained in front of the hospital, some on mats and others lying on dust and gravel, under sheets set up for shelter, cradled by their loved ones or alone. With a severe shortage of gauze or other sterile bandages, old clothes or saris were used as bandages. No gloves were available, and the conditions were grossly unhygienic, giving rise to a high risk of infections. In this hospital, amputations were also performed with butcher knives, due to the lack of surgical equipment, and amputated limbs were collected in piles. On many occasions amputations were performed to save the life of the patient, as there was simply no other way to treat wounds. Due to the severe shortage of anesthetics, the little that remained was mixed with distilled water, but many amputations were performed without anesthesia. In spite of widespread malnutrition, some people continued to donate blood, but a general shortage of blood meant that a patient’s own blood was often used, caught in a plastic bag, to be filtered through a cloth and re-transfused back into the same patient.
111. Due to the heavy shelling that hit the hospital on numerous occasions, the RDHS moved to a second location at Vellamullivaikkal. On 11 or 12 May, the second hospital was also hit by SLA shells, killing many people, although it, too, was prominently marked. The conditions in the second hospital were as poor as the first, and some of the hospital staff members were killed by SLA shelling.
119. In spite of many desperate telephone calls by the AGA and doctors to stop the shelling to allow them to attend to the wounded and dead, no reprieve was forthcoming from the SLA. After 14 May 2009, the doctors could no longer go to the hospital due to the intensity of the shelling, and it had to be closed. Dozens of patients who could not be moved were left behind. All survivors huddled together in rudimentary shelters. Cooking was impossible and leaving the shelter even for sanitary purposes meant risking one’s life. Some civilians tried to stage a mass breakout, but were shot at and shelled by the LTTE. Those who managed to escape were helped across by individual SLA soldiers.
(The above extracts are from pages 23 -26 ,pages 30 -32 , page 34 and page 36 of the report on Sri Lanka compiled by the advisory panel appointed by UN Secretary -General Ban Ki Moon)