Right to Health of Internally Displaced Persons - IDP SriLanka

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RIGHT TO HEAL H OF 

INTERNALLY DISPLACED PERSONS 

National Protection and Durable Solutions for 

Internally Displaced Persons Project 

Human Rights Commission of Sri Lanka

“Right to Health” 

of Internally Displaced Persons 

NATIONAL PROTECTION AND DURABLE SOLUTIONS FOR 

INTERNALLY DISPLACED PERSONS PROJECT 

HUMAN RIGHTS COMMISSION OF SRI LANKA 

No: 65/1, Muththaiyahpillai Avenue, Ward Place, Colombo 07. 

Tele: 011 2662587, 2681734 Fax : 011 2688145 

E-mail: hrccidp@sltnet.lk Web : www.idpsrilanka.lk

Title 

Author 

First Edition 

: “Right to Health” of Internally 

Displaced Persons 

: National Protection and Durable Solutions for 


Human Rights Commission of Sri Lanka 

: 2009 March 

Published by 

Funded by 

Printed by 

Cover Designs by 

Cover Photo 

: National Protection and Durable Solutions for 



: UNHCR 

: V & U Printers 

: National Protection and Durable Solution for 



: http://www.flickr.com/photos/ifrc/2382535600/ 

ISBN Number : 978-955-8929-12-4 

02

PREFACE 

E 

Due to the prolonged war, many people were displaced and living in 

Welfare Centres, Relocation Villages, Resettlement Villages and with 

friends and relatives. The plight of these IDPs was more intensified with 

the health condition. 

National Protection and Durable Solutions for Internally Displaced 

Persons Project of the Human Rights Commission of Sri Lanka 

established in the year 2002 with the mandate of protection and 

promotion of the rights of IDPs, conducted this study on “Right to Health 

of IDPs” and has made recommendations to address those issues. 

The Study does not focus its attention to the health issues in the other 

areas of the country and it is believed that there may be areas with similar 

health conditions. The situation of IDPs who were displaced due to the 

Wanni humanitarian operations, has not been considered, since the study 

was at the final stages of completion when the displacements began. 

It is a pleasure to acknowledge the assistance provided by Ms. Danitha 

Lanka Vitharana (L.L.B, Attorney At Law) former Legal Officer of the 

Project, for carrying out the study with so much enthusiasm. I am most 

thankful to the Project staff who worked hard to analyze the situation in 

the regions and to all others who rendered their kind support to conduct 

this study. 

Mr. Senaka Dissanayake 

Programme Manager 

NPDS for IDPs Project, 

Human Rights Commission of Sri Lanka, 

No: 65/1, MuttiahpillaiAvenue, 

Ward Place, 

Colombo 07. 

27th March 2009. 

03

BH 

CD & MH 

CD 

CEDAW 

CERD 

CRC 

DDHS 

DGH 

DH 

DPDHS 

DS 

FHB 

GH 

GLs 

GPID 

ICESCR 

ICU 

IDPs 

LTTE 

MDGs 

MH 

MOH 

MPCS 

NDRSC 

NGOs 

NPDS for IDPs 

Project of 

HRCSL 

OPD 

PDHS 

PGH 

PHI 

ABBRIVIATIONS 

B I A I - Base Hospitals 

- Central Dispensaries & Maternity Homes 

- Central Dispensaries 

- Convention on the Elimination of All Forms of 

Discrimination Against Women 

- Convention on the Elimination of All Forms of 

Racial Discrimination 

- Convention on the Rights of the Child 

- Divisional Directors of Health Services 

- District General Hospital 

- District Hospitals 

- Deputy Provincial Director of Health Service 

- Divisional Secretary 

- Family Health Bureau 

- General Hospitals 

- Provisional guidelines for emergency management 

of public health problems of the IDPs” 

- Guiding Principles on Internal Displacement 

- International Covenant on Economic, Social and 

Cultural Rights 

- Intensive Care Units 

- Internally Displaced Persons 

- Liberation Tigers of Tamil Eelam 

- Millennium Development Goals 

- Maternity Homes 

- Medical Officer of Health 

- Multi Purpose Cooperating Societies 

- National Disaster Relief Service Center 

- Non Governmental Organizations 

- National Protection and Durable Solutions for 

Internally Displaced Persons Project of 


- Out Patient Division 

- Provincial Director of Health Service 

- Provincial General Hospital 

- Public Health Inspector 

04

PHM 

PHNS 

PHS 

PU 

RDHS 

RE 

RGD 

RH 

RLVs 

SPHM 

SPHM 

TB 

TH 

UDHR 

UNCESCR 

Rights 

UNHCR 

UNICEF 

WC 

WFP 

WHO 

- Public Health Midwife 

- Public Health Nursing Sister 

- Public Health Service 

- Peripheral Unit 

- Regional Director of Health Service 

- Regional Epidemiologist 

- Register General Department 

- Rural Hospitals 

- Relocated Villages 

- Supervising Public Health Inspector 

- Supervising Public Health Midwife 

- Tuberculosis 

- Teaching Hospitals 

- Universal Declaration of Human Rights 

- UN Committee on Economic &Social & Cultural 

- United Nation's High Commissioner for Refugees 

- United Nations' Children Fund 

- Welfare Center 

- World Food Programme 

- World Health Organization 

05

Table of Contents 

n t 1. Executive Summery................................................................... 08 

2. Introduction............................................................................... 12 

3. Universal Human Rights Norms on “Right to Health”............ 16 

4. Justiciability of Right to Health in Sri Lanka........................... 22 

4.1 A Constitutional Right............................................... 22 

4.2 A Statutory right........................................................ 23 

5. Do the Health Rights of the IDPs Require a Special Attention. 26 

6. General Curative health situation of the districts...................... 32 

6.1. Analysis on General Curative Health Sector 

of the Districts............................................................ 36 

7. Health Issues of Internally Displaced Persons........................... 40 

7.1. Access to health clinics.............................................. 40 

7.2. Public Health Services............................................... 42 

7.3. Shelter, water, sanitation and hygiene and disease 

Prevalence.................................................................. 45 

7.4. Adequate Food Supply and Nutrition........................ 54 

7.5. Nutrition status of more vulnerable groups............... 57 

7.6. Risk of HIV infections............................................... 61 

7.7. Mental health of IDPs................................................ 61 

7.8. Addressing similar issues differently-unequal 

responses to different types of displacements............ 62 

7.9. Security problems...................................................... 64 

7.10. Role of health professionals..................................... 65 

8. Conclusion................................................................................. 68 

9. Recommendations..................................................................... 70 

Annexures.................................................................................. 76 

06

“Right to Health” of Internally Displaced Persons 

1. Executive Summar y 

Healthy population is very much imperative for a country because it 

increases the capacities of human resources of the country. Owing to the 

“welfare state concept” developed during the first decades of 20th 

century, Sri Lanka possesses a developed healthcare system comparing 

to other developing countries. However prolonged conflict situation in 

the country has caused the health system of the conflict affected areas to 

be broken down despite the several steps by the health authorities and 

other agencies. Meanwhile, post disaster situation urges special attention 

on health of those displaced people, especially on community health. 

There are about 225 000 internally displaced people(IDPs) are living in 

the selected six districts for the study, namely Trinvcomalee, Batticaloa, 

Vavuniya, Mannar, Anuradhapura and Puttalam. This selected sample 

represents nearly 50 percent of conflict affected IDPs in Sri Lanka. 

The right of everyone to the enjoyment of the highest attainable standard 

of physical and mental health has been recognized by many universal 

human rights instruments and this comprises the right to adequate 

standard of living. There are avenues in Sri Lankan fundamental rights 

field too, to identify the Right to Health as a right, though it is not directly 

stipulated in the Constitution as a right. In addition, the statutes like 

Penal Code, Food Act, Health Service Act and provincial statues on 

health service have specifically laid down provisions to maintain and 

preserve public health. IDPs too, entitled to these constitutional and 

statutory rights, with no distinctions to their status as IDPs. In addition to 

this general legal framework, Principle 18 & 19 of the Guiding 

Principles on Internal Displacement (GPID) and the Humanitarian 

Charter and Minimum Standards in Disaster Response of the Sphere 

Project stipulate the means and ways of protecting displaced person's 

health rights in detail. 

Being a devolved subject under the 13th Amendment, “Health” comes 

under the purview of both central and provincial council but 

considerable powers have been conferred to the provinces regarding 

preventive health and curative health sectors. Analyzing the general 

08

curative health sector in the selected districts, the lack of medical 

infrastructure and human resources have caused to minimize the service 

given to the public despite of several steps by government to improve the 

status of the health institutions. Especially, lack of psychiatrists and 

counselors to deal with the mentally depressed people in those areas is 

remarkable. Regarding the access to curative health care of IDPs 

sometimes due to unavailability of transport facility to the closest health 

institution, they have to walk more than 10 Km while they are not 

physically well enough. Some mobile clinics stop their visits to IDP 

locations soon after the resettlement or relocation underwent. 

Regarding the preventive health sector, the duty is upon relevant 

provincial councils to preserve the public health as per 13th Amendment 

to the Constitution. However some administrative issues in preventive 

health sector have resulted in public health of the IDPs to be less-touched 

and sometimes they were refused to be given services. Disability of the 

host district health authorities to meet the heath needs of the both IDPs 

and host community, consequent to a displacement, has caused some 

issues to be raised in relation to allocation of health infrastructure and 

human resources. Unavailability of uniform system in allocating 

community health workers has originated some anomalies in the field 

and it has caused overload of works to some health workers. The 

available living standards, especially regarding water, shelter, sanitation 

and hygiene issues to some sets of IDPs is also questionable because 

there is a lack of services providing by the relevant local authorities and 

also lack of supervision by the health authorities in that regard. Though 

the health authorities were able to control out-break of diseases after a 

disaster, some ad-hoc cases were reported due to the inaction or improper 

management of the diseases by the health worker and also due to 

unhealthy practices of IDPs. 

Regarding the nutritional status of the IDPs, the available dry ration 

package is considered as not sufficient, especially to those depending 

only on it such as Child headed families, and women headed families. In 

addition, irregularities in issuing dry ration and problems regarding low 

quality of dry ration given to IDPs also reported. In such a backdrop, the 

nutritional status of extremely vulnerable groups such as pregnant and 

lactating mothers, infants and children has gone down and the security 

problems and lack of livelihood opportunities have enlarged the plight. 

09

Concerning all health aspects of the conflict affected internally displaced 

people, a sort of unequal responses has been given to Tsunami IDPs visà-vis 

other IDPs. The way of addressing health hazards consequent to the 

tsunami disaster, is not carrying out in relation to conflict affected IDPs 

though the outcomes are similar. At the same time, having experienced 

sudden displacements due to unavoidable reasons several times in the 

country, health authorities have to develop the system to handle health 

hazards after displacements, in a uniform way. 

Therefore, following recommendations were made to tackle those 

problems. 

Improving health related infrastructure in hospitals. 

Proper management of human recourses in health sector. 

Special health measures/mechanisms to deal with 

displacement. 

Addressing health concerns in planning resettlement / 

relocation of IDPs. 

The quantity and nutrition status of dry ration to be increased. 

Inclusion of Right to health in the Constitution. 

Development of the medical record system. 

Promote health education and community involvement in 

health concerns among IDPs. 

Those recommendations should be implemented giving paramount 

importance to the areas where there is frequent displacements and where 

the bulk of displaced people living. Accomplishment of them is to be 

carried out with the cooperation of Ministry of Health Care and Nutrition 

with the participation of relevant provincial councils, local authorities 

and other disaster related Ministries. 

10

Introduction 

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2. Introduction 

t o n 

Healthy mankind is a great treasure for the society since it reduces the 

social cost and increases the development. Rights perspectives of health 

tracks beyond the ancient monarchy period where it was considered as a 

duty of the king to control the epidemics like leprosy and they have built 

and maintained a system of hospital in the country. In the present globe, 

right to health is considered as a social and economic right to which a 

heavy weight is given in many universal human rights instruments. 

Right to health is not a right to be healthy but it is a right to the enjoyment 

of other connected facilities and conditions that are necessary for good 

health. The scope of the right to health can be identified by giving a 

closer look at two basic components of this right: 

Matters related to health care 

Matters related to general living conditions affecting health, 

such as safe water, food, sanitation and shelter. 

Therefore it is understood that right to health should encompass both 

these components to make it effective and thereby it will facilitate to 

achieve ones' right to life with dignity. 

In Sri Lanka, Ministry of Health Care & Nutrition with the help of 

1 

Provincial Health Sectors provide preventive, curative and 

rehabilitative health care facilities to the public and private sector also 

provides curative health care to the people. Interestingly Sri Lankan 

health situation was commended as follows by British Medical 

Association in their Article of THE RIGHT TO HEALTH: A TOOLKIT 

2 

FOR HEALTH PROFESSIONALS . 

1As per 13th amendment to the Constitution of Sri Lanka- This will be discussed latter in 

the study 

2 Judith Asher, Danielle Hamm, BMA House, Tavistock Square, London, WC1H 9JP, 

September 2007. 

12

“Despite its status as a 'less-developed' country, Sri Lanka has 

achieved impressive results in health, nutrition and family 

planning with levels of public health expenditure lower than 

countries with similar incomes whose health outcomes are 

considerably worse. Current life expectancy is 73 years, 

compared to a regional average of only 61 years, infant 

mortality is around 16 per 1,000 births, fertility is near 

replacement level, and the population growth rate is less than 1 

percent a year and falling. The maternal mortality ratio, at 30 

deaths per 100,000 live births, is well below that of countries 

with similar levels of per capita income”. 

This illustration is true as long as the overall condition of the health in the 

whole country is considered. But in district wise and segment wise, the 

situation of health condition is different, sometimes very much worse. 

This difference can be seen among the rural population, estate 

population in the up-country and also among internally displaced 

persons (IDPs). 

The purpose of this study is to assess the “Right to Heath of the IDPs” and 

address the issues raised therewith. In this regard, the health situation in 

six Districts of Sri Lanka, namely Batticaloa and Trincomalee in the 

Eastern Province, Mannar and Vavuniya in the Northern Province, 

Puttalam in North Western Province and Anuradhapura in North Central 

Province were identified. This sample was selected for the research 

because they are often affected by the conflict and access to relevant 

information is comparatively trouble-free in these districts than the other 

conflict affected areas. As for Puttalam, though it is somewhat far from 

the conflict, many IDPs have been relocated within that district and 

selected therefore. The total IDP population in these districts is 224,818 

and they represent more than 50 percent of the total Sri Lankan conflict 

affected IDP population. However, the limitation of this study is that the 

unavailability of the facts and problems faced by displaced persons in the 

district like Jaffna, Mulathivu, Kilinochchi and Ampara where the 

condition of health and living standards are sometimes more aggregative 

than the selected sample and access to information is also comparatively 

13

trouble-free in these districts than the other conflict affected areas.As for 

Puttalam, though it is somewhat far from the conflict, many IDPs have 

been relocated within that district and selected therefore. The total IDP 

population in these districts is 224,818 and they represent more than 50 

3 

percent of the total Sri Lankan conflict affected IDP population . 

However, the limitation of this study is that the unavailability of the facts 

and problems faced by displaced persons in the district like Jaffna, 

Mulathivu, Kilinochchi and Ampara where the condition of health and 

living standards are sometimes more aggregative than the selected 

sample and access to information is also comparatively cumbersome. 

Therefore when the authorities take decisions to facilitate health of 

displaced persons in selected districts, the persons in other conflict 

affected districts should also be benefited from such a decision. 

3 See theAnnexure I, Source-District Secretariats of particular districts. 

14

“Right to Health” as a 

Universal Human Right Norm 


3. “Right to Health” as a Universal Human Right Norm 

Almost all universal instruments of human rights have identified and 

expressed the values of human rights for advancing health of the people. 

Article 25 of the Universal Declaration of Human Rights (UDHR) 

enumerates that "Everyone has the right to a standard of living adequate 

for the health of himself and of his family, including food, clothing, 

housing and medical care and necessary social services". 

According to Article 12 of the International Covenant on Economic 

Social and Cultural Rights (ICESCR), the States parties recognize the 

right of everyone to the enjoyment of the highest attainable standard of 

physical and mental health. Under this Covenant States parties should 

take steps to achieve the full realization of this right by the provision for 

the reduction of the stillbirth-rate and of infant mortality and for the 

healthy development of the child; the improvement of all aspects of 

environmental and industrial hygiene; the prevention, treatment and 

control of epidemic, endemic, occupational and other diseases and the 

creation of conditions which would assure to all medical service and 

medical attention in the event of sickness. State party is also under an 

obligation to protect, respect and fulfill the right to health within their 

jurisdictions. The obligation to respect implies a duty of the state not to 

4 

violate the right to health by its actions . The obligation to protect implies 

a duty of the state to prevent violations of the right to health by others. It 

must take measures which prevent third parties from interfering with or 

5 

violating the right to health . The obligation to fulfill means that 

6 

governments must act in order to ensure those rights can be enjoyed . 

4 

The state must refrain from denying or limiting equal access for all persons, including 

prisoners, detainees, minorities, asylum seekers and illegal immigrants; the state must 

refrain from censoring, withholding or intentionally misrepresenting accurate healthrelated 

information, including sexual health education and information. Source-U.N. 

Doc. HRI\GEN\1\Rev.1 at 45 (1994) 

5 

The government must introduce and enforce appropriate controls for the marketing of 

medical equipment and medicines by third parties; the government must ensure that 

medical practitioners and other health professionals meet appropriate recognized 

standards of education, skill and ethical codes of conduct. . Source-U.N. Doc. 

HRI\GEN\1\Rev.1 at 45 (1994) 

6 

The government must focus on rectifying existing imbalances in the provision of health 

facilities, goods and services. For example, it should allocate sufficient public resources 

to the most deprived regions in the country, in particular to the poor and otherwise 

vulnerable and disadvantaged groups. The government must promote activities that 

benefit good health and ensure the dissemination of appropriate information. Source- 

U.N. Doc HRI\GEN\1\Rev.1 at 45 (1994) 

16

According to UN Committee on Economic & Social & Cultural Rights 

7 

(UNCESCR), General Comment 14 , elements for respect for right to 

health include: 

(a)Availability : functioning public health and health care facilities, 

goods, services and programmes must be available in sufficient quantity. 

(b) Accessibility: Health facilities, goods and services have to be 

accessible to everyone without discrimination, within the jurisdiction of 

the State party.Accessibility has four overlapping dimensions: 

Non-discrimination : health facilities, goods and services must 

be accessible to all, especially the most vulnerable or 

marginalized sections of the population, in law and in fact, 

without discrimination on any of the prohibited grounds. 

Physical accessibility : health facilities, goods and services must 

be within safe physical reach for all sections of the population, 

especially vulnerable or marginalized groups, such as ethnic 

minorities and indigenous populations, women, children, 

adolescents, older persons, persons with disabilities and persons 

with HIV/AIDS. Accessibility also implies that medical 

services and underlying determinants of health, such as safe and 

potable water and adequate sanitation facilities, are within safe 

physical reach, including in rural areas. 

Economic accessibility : health facilities, goods and services 

must be affordable for all. 

Information accessibility: accessibility includes the right to 

seek, receive and impart information and ideas concerning 

8 

health issues . 

7 

United Nations, 2000, Committee on Economic, Social and Cultural Rights 

(UNCESCR), General Comment No. 14 (Eleventh Session).The right to the highest 

attainable standard of health UN Document, E/C.12/2000/4. UN, Geneva. No 30 

8 

However, accessibility of information should not impair the right to have personal 

health data treated with confidentiality 

17

(c) Acceptability: All health facilities, goods and services must be 

respectful of medical ethics and culturally appropriate. 

(d) Quality : All health facilities, goods and services must also be 

scientifically and medically appropriate and of good quality. 

According to the Article 2 of the ICESCR each state party undertakes to 

take steps to the maximum of its available resources, with a view to 

achieving progressively the full realization of the recognized rights by 

all appropriate means. In General Comment No. 3 on the Nature of States 

9 

Parties Obligations , it was stipulated that States parties have a core 

obligation to ensure the satisfaction of, at the very least, minimum 

essential levels of each of the rights enunciated in the Covenant 

10 

(ICESCR), including essential primary health care . 

These obligations are further clarified by The Limburg Principles on the 

11 

Implementation of ICESCR and Maastricht Guidelines on Violations 

12 

of Economic, Social and Cultural Rights . 

9 

Committee on Economic, Social and Cultural Rights, General Comment 3, The nature 

of States parties obligations (Art. 2, para.1 of the Covenant) (Fifth session, 1990), 

Compilation of General Comments and General Recommendations Adopted by Human 

Rights Treaty Bodies, U.N. Doc. HRI\GEN\1\Rev.1 at 45 (1994). 

10 

According to the Committee's view, core obligation includes at least the following 

obligations: (a) To ensure the right of access to health facilities, goods and services on a 

non-discriminatory basis, especially for vulnerable or marginalized groups; (b) To 

ensure access to the minimum essential food which is nutritionally adequate and safe, to 

ensure freedom from hunger to everyone; (c) To ensure access to basic shelter, housing 

and sanitation, and an adequate supply of safe and potable water; (d) To provide essential 

drugs, as from time to time defined under the WHO Action Programme on Essential 

Drugs; (e) To ensure equitable distribution of all health facilities, goods and services;(f) 

To adopt and implement a national public health strategy and plan of action, on the basis 

of epidemiological evidence, addressing the health concerns of the whole population. 

11 

The Limburg Principles on the Implementation of the International Covenant on 

Economic, Social and Cultural Rights, United Nations document (UN Doc. 

E/CN.4/1987/ 17). 

12 

By the International Commission of Jurists at the Maastricht Centre for Human Rights 

and the Urban Morgan Institute for Human Rights in Maastricht, January 22-26, 1997 

18

In addition to the above, Article 12 of the Convention on the Elimination 

of All Forms of Discrimination Against Women (CEDAW) states that 

state parties shall ensure to women, appropriate services in connection 

with pregnancy, confinement and post natal period, granting free 

services where necessary, as well as adequate nutrition during pregnancy 

and lactation. Article 24 of the Convention on the Rights of the Child 

(CRC) enumerates that right of the child to the enjoyment of the highest 

attainable standard of health and to facilitate for the treatment of illness 

and rehabilitation of health and Article 5 of the Convention on the 

Elimination of All Forms of Racial Discrimination (CERD) discusses 

the importance of the right to health. Regional human rights 

13 

instruments also elaborate on the health concerns in addition to those 

universal instruments. 

The Alma-Ata Declaration on Primary Health Care of 1978(declared in 

the International Conference on Primary Health Care) also identified 

primary health care as the key to the attainment of the goal of Health for 

All. Under this declaration, State parties should recognize the essential 

role of international cooperation and comply with their commitment to 

take joint and separate action to achieve the full realization of the right to 

health. In addition, out of 8 “Millennium Development Goals” 

14 

(MDGs) , 3 goals are focused on health. While Goal 4 is to reduce child 

mortality, Goal 5 is to improve maternal health and Goal 6 is supposed to 

combat HIV/AIDS, malaria and other diseases. 

13 

Article XI of the American Declaration of the Rights and Duties of Man 

(ADHR),Article 28 of the Convention on the Protection of the Rights of All Migrant 

Workers, Chapter 12 The survival rights (economic, social and cultural rights) and 

Members of Their Families (CMW),Article 10 of the Protocol of San Salvador,Article 16 

of the African Charter on Human and Peoples' Rights (African Charter),Article 14 of the 

Protocol to theAfrican Charter on Human and Peoples' Rights on the Rights of Women in 

Africa,Article 14 of theAfrican Charter on the Rights and Welfare of the Child,Article 11 

of the European Social Charter (ESC) 

14 

The Millennium Development Goals (MDGs) are eight goals to be achieved by 2015 

that respond to the world's main development challenges. The MDGs are drawn from the 

actions and targets contained in the Millennium Declaration that was adopted by 189 

nations-and signed by 147 heads of state and governments during the UN Millennium 

Summit in September 2000. 

19

Justifiability of Right 

to Health in Sri Lanka 


4. Justifiability i i i t of Right to Health in Sri Lanka 

a 

4.1. As a Constitutional Right 

Under Article 27(2) (c) of the Directive Principles of the Constitution, it 

should be one of the objectives of the state to realize adequate standard of 

living of all citizens for themselves and their families, including 

adequate food, clothing and housing, the continuous improvement of 

living conditions. However the Fundamental Rights Chapter of the Sri 

Lankan Constitution does not expressly recognize the right to health in 

Sri Lanka. But the development of Sri Lankan legal system by 

innovative judicial decisions has implied certain optional avenues in 

which one can entertain a right based approach as to the health under the 

Constitution. 

One of such avenue is the identification of right to life as an enforceable 

right. Though there is no expressed recognition in the Constitution, the 

15 

right to life has been identified by the Judiciary in several cases , as it is 

implied in theArticle 11 and 13(4) of the constitution. While the freedom 

from torture or cruel, inhuman or degrading treatment or punishment is 

conferred by Article 11, Article 13 (4) stipulates that no person shall be 

punished except by order of a competent court, made in accordance with 

procedure established by law. It is very much obvious that right to health 

is a concomitant of right to life because right to life would be pointless if 

it is unhealthy. Therefore it is submitted that the infringement of a right to 

health can be justiciable under the Sri Lankan Constitution because the 

right to life would be meaningless without primary health care. This is 

inferred from the land mark decision of the Supreme Court in the case of 

Sanjeewa, AAL (on behalf of G.M.Perera) V Suraweera, OIC, 

16 

Wattala and others . The bench ruled in this case that citizens have the 

right to choose between state and private medical care to save one torture 

victim's life. While identifying the interrelationship between of right to 

life and right to health has, Justice Fernando also made a citation of the 

Article 12 of the ICESCR to support his views. 

15 

Silva v Iddamalgoda 2003 2 SLR 63, Rani Fernando v OIC Seeduwa Police, 

SC/FR/700/2000, SC Minutes 26.07.2004 

16 

2003 1 SLR 317 

22

The next avenue is the equal protection of the law or the principle of non 

discrimination in relation to health facilities as it is enshrined in article 12 

of the constitution. The equality of access to health care and services 

should be established by the government and also any discrimination on 

the grounds of race, colour, sex, language, religion, political or other 

opinion, national or social origin, property, birth, physical or mental 

disability, health status and civil, political, social or other status can be 

considered as an infringement of Article 12. In addition, according to 

Article 12.4, it is legitimate to provide special health protection for the 

advancement of women, children and disables. 

The third avenue in this regard is the Freedom from torture, cruel, 

inhuman and degrading treatment or punishment. When required health 

care is not being provided or mal-treatments in giving health care or 

related facilities can be interpreted as inhuman and degrading 

treatments. European Court of Human Rights has held that an expulsion 

of anAIDS victim from the country who has been in serious condition as 

17 

amounting inhuman and degrading treatment . Therefore Sri Lankan 

judiciary, in the near future, will not be hesitated to consider such matters 

under the purview ofArticle 11, if the circumstances are required so. 

4.2. As a Statutory right 

Right to health is given a statutory recognition in so many statutes in Sri 

18 

Lanka. Before the 13th Amendment, the Health Services Act ,had been 

enacted to provide for the constitution and responsibilities of the 

department of health and for the establishment of regional hospitals 

boards and hospital committees, and to secure more efficient 

administration by the local Authorities in relation to public health. But, 

inconsistent with this Health Services Act, after the 13th Amendment, 

most of the Provincial Councils have enacted Provincial Health Services 

Statutes to provide for an efficient and productive health service in the 

provinces while implementing the subject of health as setout in List 

No:01 of the ninth schedule of the Constitution and other related matters. 

17 

18 

D v United Kingdom, 2 May 1997, European Court of Human Rights 

No 12 of 1952 

23

In addition, Penal Code contains a separate Chapter on the offences 

affecting the public health, safety, convenience, decency, and 

19 

morals. By Sections 262 and 263 it has made punishable to do a 

negligent or malicious act likely to spread infection of any disease 

dangerous to life. In addition, adulteration of foods, making atmosphere 

noxious to health, fouling the water of a public spring or reservoir, inter 

alia are made as offences under the Penal Code and also under the Food 

Act. Therefore, according to these provisions, no doubt exists as to the 

recognition of the statutory right regarding right to health. 

From these statutory rights, another constitutional right has been 

emerged. For an instance, if the relevant government body fails to 

perform their statutory functions necessary to facilitate public health, 

then the aggrieved parties can entertain a Writ application for the proper 

discharge of functions according to theArticle 140 of the Constitution. 

19 

Chapter xiv of the Penal Code 

24

Do the Health Rights 

of the IDPs Require a Special 

Protection? 

Taken by : Ramesha Balasooriya

5. Do the Health Rights of the IDPs Require e a Special 

Protection? 

t o The international and local laws and standards on right to health are 

equally relevant to IDPs. Therefore an involuntary question will raised 

that why a special attention is required for health concerns of IDPs. The 

economic, social and security status after the displacement 

automatically make them vulnerable to health hazards. This is to say that 

soon after the displacement, most often they have to live in community 

centers where the general living conditions such as essential foods, 

water, shelter and sanitation is very much poor and therefore, the risk of 

health outbreaks are higher in those places. Even in the stages of 

resettlement, homes, wells and latrines are being damaged and it takes 

time to come to the normal life. With the loss of livelihood opportunities 

and other economic barriers also prevent them from spending a 

considerable monetary allocation on health and other sanitary 

requirements. Especially, among this vulnerability, the extreme 

vulnerable groups such as pregnant mothers and women and child 

headed families require special protection. Ignorance of the health 

conditions after the displacement therefore, will lead to another disaster 

and at the same time, if the situation aggravates and if it leads to an 

epidemic situation, the rendering cost to overcome will be higher. 

Therefore, the Guiding Principles on Internal Displacement 

20 

(GPID) which deals with the rights of IDPs specifically need to be 

adhered in this regard. Principle 18 of GPID states that all IDPs have the 

right to an adequate standard of living and at the minimum, regardless of 

the circumstances, and without discrimination. Competent authorities 

shall provide IDPs with and ensure access to essential food and 

portable water, basic shelter and housing, appropriate clothing and 

essential medical service and sanitation. 

20 

GPID comprises a normative framework drawn from established international 

humanitarian law and human rights law on the rights of the displaced persons and the 

governments' and other authorities' obligations towards displaced persons introduced by 

the United Nations in 1998. 

26

Principle 19 (1) of GPID discusses about all wounded and sick 

internally displaced person's health rights and when necessary their right 

to have access to psychological and social services. Principle 19 (2) 

elaborates that special attention should be paid to the health needs of 

women, including access to female care providers and services, such as 

reproductive health care, as well as appropriate counseling for victims of 

sexual and other abuses. Principle19 (3) states that special attention 

should also be given to the prevention of contagious and infectious 

diseases, includingAIDS, among internally displaced persons. 

For the purpose of alleviating human suffering arising out of calamity 

and conflict, and to ascertain the right to live with dignity of those 

affected by disaster and their right to assistance, The Humanitarian 

Charter and Minimum Standards in Disaster Response of The 

21 

Sphere Project (Sphere Principles) has been formulated to develop a 

set of universal minimum standards in core areas of humanitarian 

assistance. The aim of the project is to improve the quality of assistance 

provided to people affected by disasters, and to enhance the 

accountability of the humanitarian system in disaster response. Since 

these Minimum Standards are very much crucial in assessing health 

rights of IDPs, it is worthy to brief on, in this research. They set out 

minimum standards on Hygiene Promotion, Water Supply, Excreta 

Disposal, Vector Control, Solid Waste Management and Drainage. 

22 

Since these sectors are significant determinants for survival in the 

initial stages of a disaster and they are more susceptible to diseases such 

as water-borne diseases due to inadequate sanitation, inadequate water 

supplies and poor hygiene. These standards are devised to ensure that 

people affected by disasters have access to at least the minimum 

requirements of water, sanitation, food, nutrition, shelter and health care 

to satisfy their basic right to life with dignity. 

21 

The Sphere Project is a programme of the Steering Committee for Humanitarian 

Response (SCHR) and Inter Action with VOICE and ICVA with the help of so many 

agencies, launched in 1997. Source- http://www.sphereproject.org 

22 

SeeAnnexure II for the Minimum standards on each sector 

27

It is submitted therefore that the right to health of IDPs should receive the 

same protection available to other citizens. According to the Article 12 

(1), all persons are equal before the law and are entitled to the equal 

protection of the law. Therefore, special mechanisms, if the situation 

requires should be provided to uplift their rights because different 

qualities of health standards for persons residing in different geographic 

locations may constitute discrimination under the international law and 

alsoArticle 12 of Sri Lankan Constitution. 

The adoption of special measures intended to bring about de facto 

equality for disadvantaged groups such as special measures for the 

development of living standards in welfare centers is not a violation of 

the right to equality of other normal public, so long as such measures do 

not lead to the maintenance of unequal or separate standards for different 

groups, and provided they are not continued after the objectives for 

which they were taken have been achieved.Article 12 (4) also stipulates 

that Nothing in the Article 12 shall prevent special provisions being 

made, by law, subordinate legislation or executive action, for the 

advancement of women, children or disabled persons. Therefore an 

affirmative action to protect the right to health of conflict affected 

displaced persons will not be discriminatory to other Sri Lankan citizens. 

28

Health Administrative System in Sri Lanka 

Public Sector 

(Preventive, Curative & 

Rehabilitative Care) 

Private Sector 

(Curative Care) 

Ministry of Health Care & 

Nutrition.(Protection & 

Promotion of Peoples' 

Health 

Provincial Health 

Administration 

(Management and effective 

Implementation of Health 

Services) 

Minister of Health Care & Nutrition 

Provincial Minister (Health) 

Department of Health Services 

Directors of health 

Teaching Hospitals 

National Hospitals 

General Hospitals 

National Health Council 

National Institute of Health Science 

State Pharmaceutical Corporation 

Provincial Secretary 

Provincial Director of Health Service (PDHS) 

Deputy Provincial Director of Health 

Service (DPDHS) 

Medical Officers 

Provincial Hospitals 

Health Education Officer Divisional Directors of Health Services/ 

Planning and Programming Officer 

Medical Officer of Health (DDHS/MOH) 

Regional Supervising PHI/PHNO 

Food & Drug Inspector Preventive Curative 

Other Divisional Officers 

Supervising Public Health Inspector DMO District Hospital 

Public Health Inspector 

MO Peripheral Unit 

Public Health Nursing Sister 

RMO/AMO Rural Hospital 

Supervising Public Health Midwife RMO/AMO Central Dispensary 

Public Health Midwife 

Maternity Homes 

Branch Dispensaries 

Visiting Stations 

Source- www.health.gov.lk 

29

General Curative health 

situation of the districts 

Taken by : NPDS for IDPs Project, Human Rights Commission of Sri Lanka

6. General e Curative health h situation t i of the districts 

i t s 

As per the List I (Provincial Council List of 9th Schedule) referred in 

Article 154 A of 13th Amendment to the Constitution, the establishment 

and maintenance of public hospitals, rural hospitals, maternity homes, 

dispensaries (other than teaching hospitals and hospitals established for 

special purposes) ; Public health services, health education, nutrition, 

family health, maternity and child care, food and food sanitation, 

environmental health and Formulation and implementation of Health 

Development Plan and of the Annual Health Plan for the Province come 

under the purview of relevant Provincial councils. According to the 

Concurrent List (List III referred 13th Amendment of the Constitution), 

schools for training of Auxiliary Medical Personnel; the supervision of 

private medical care, control of nursing homes and of diagnostic 

facilities within a Province; Population control and family planning and 

Constitution of Provincial Medical Boards are to be done by both parties. 

Other Subjects and Functions not Specified in List I or List III are 

reserved by the Central Government. 

Out of 182 Government Medical Institutions located in the selected 

districts, only two institutions (GH-Batticaloa and TH-Anuradhapura) 

come under the management of central government. All the other 

hospitals/institutions come under the supervision of relevant Provincial 

Councils. Following are some of the general observations about the 

curative health facilities in the selected districts. 

Mannar 

Mannar district comprises 1,880 Sq Km land area (3% of country land) 

23 

and 99,000 populations (0.5% of total population) and around 30,000 

24 

IDPs (30 % 0f district population) . There are 6 government medical 

institutions and out of them only 10 institutions are functioning and their 

total bed strength is 345. DH Adampan and RH Vidataltivu 

23 

24 

Source-Survey General's Department & Registrar General's Department,2005 

30,112 of IDPs as at 31st June 2008-See Annexure I 

32

are Functioning only as OPDs and it was also reported that the Adampan 

25 

DH was relocated to Vellankaulm in Manthai West due to shelling . RH 

Chilavaturai is closed and CDs in Periyamadu, Periyapandivrichchan, 

Thirukeetheswaram, Marichukkaddy and Iranaiiluppaikulam are not 

26 

functioning from 2003 . 

Puttalam 

Puttalam district covers 2,882 sq km of land and 812,601 numbers of 

27 

people are living there and among them, 61,274 are IDPs (7.5% 0f 

28 

district population) . There are 40 health institutions operating in the 

district and all of them come under the supervision of North Western 

Provincial Council. There are more than 70,000 IDPs relocated in 

Puttalam and they are relocated mainly in the Puttalam, 

Wanathawilluwa, Kalpitiya and Mundal DS divisions. There are 5 

Central Dispensaries functioning in 5 RLVs in Puttalam district, under 

the supervision of Mannar DPDHS.Among the other GH and BHs in the 

district, IDPs have easy access to the Puttalam BH comparatively. 

Puttalam BH encompasses 40 doctors, 90 nurses and 14 midwives and its 

bed strength is 344. According to DMO this amount of staff is 

insufficient to treat such large amount of host communities and IDPs. 

Due these scarce resources, both IDP community and host communities 

have to face big competition in fulfilling their health needs. 

25 

26 

27 

28 

Source- relief web - http://www.reliefweb.int/ ,30 November 2007 

Www.health.gov.lk/beds%20recata2006.xls 

DPDHS-Puttalam 

SeeAnnexure I for IDPs population in each district. 

33

Vavuniya 

29 

Population of Vavuniya is 182,808 , including 82,176 numbers of IDPs 

30 

(45 % of district population) and it covers 1966.9 Sq km of land . Out of 

10 medical institutions, the RH in Ulukulam, CD & MH in Pavatkulam 

and Neriyakulam function only as CDs and CD in Pulliyamkulam is 

31 

temporally closed . 

The General Hospital Vavuniya is the focal referral point among all the 

hospitals in the region. Although this Base Hospital of Vavuniya was 

upgraded to the District General Hospital status after re-categorization 

32 

of hospitals , the service delivery of the hospital is still reported as far 

below even than the Base Hospital level. Regarding the hospital health 

service facilities, it was evident that the inadequate infrastructure 

facilities have led to several difficulties, for a instance the total bed 

strength of the hospital is 302 beds and it has caused an over crowding 

status. Inadequate treatment facilities in the Vavuniya DGH such as lack 

of medical specialists in the hospital compel patients to be transferred 

33 

either to Anuradhapura and/or to Colombo and it causes immense 

hardships to the people of the region. In addition to those, there are so 

many infrastructure scarcities faced by GH Vavuniya despite its status as 

a focal referral hospital. Problems as to quarters, official transports, 

official vehicles and lack of proper drainage system are affecting the 

value of the service given to the people by the hospital. Insufficient 

number of wards, specially, not having wards for mentally disordered 

persons are among other burning issues of the hospital. 

29 

Source-GAOffice-Vavuniya, as at 31.12.2006 

30 

Source- Survey Department, Vavuniya 

31 

www.health.gov.lk 

32 

Circular 02-61/2005 on Re-categorization of Hospitals by Ministry of Health care and 

Nutrition 

33 

Observed in the discussion with Dr. Mrs. B. Pasupathirajah,GH- Vavuniya. 

34

Anuradhapura 

Anuradhapura district comprises 782,000 (4% of the total population) 

and 6,664 Sq. km of land (10.6% of total country lands) and 15,120 IDPs 

(2 % of district population). There are 60 government medical 

institutions in the district and the total bed strength of the district is 2,858. 

GH-Anuradhapura has been upgraded as a Teaching Hospital (TH) and 

managed by the central government from 01.03.2006 and it has 1273 

beds in strength (apart from ICU) whereas the normal patient's in-take 

rate is about 1450 per day. RH- Kebethigollewa has been upgraded as BH 

(bed strength - 30) but still functioning as RH and RH Nachchiyaduwa 

and CD & MH in Koonwewa, Tittagonewa, Welioya are functioning 

only as Cds. 

Batticaloa 

Batticaloa district covers 2,610 Sq.Km in lands (4.16% of total land) and 

comprises 549,000 populations (2.8% of total population) 18,171 IDPs 

(3.3 % of district population). There are 28 health institutions in the 

district the total bed strength of the district is 1295. GH - Batticaloa has 

been re-categorized as PGH (696 bed strength) and out of all health 

institutions in the selected districts, this is one of the two health 

institutions managed by the central government. 

The DH in Kattankudy is completely damaged by Tsunami and Vakarai 

Peripheral Unit (PU) has been destroyed in 1990 from conflict and it was 

further damaged by tsunami and after the resettlement it was upgraded as 

a DH. But it was reported that the infrastructure and the facilities 

available, are not sufficient. There is only one medical officer working 

whereas the requirement is 3 and there are only 3 nurses when they need 

8. Also they need further dispensary facilities to conduct the OPD 

effectively. Among other requirements, more delivery kits, additional 

nebulizers, communication facilities between other hospitals and the 

department, separate wards for children, elders and pregnant women and 

separate units for Surgical and Pediatric section are needed for a smooth 

34 

health service for the public . 

34 

Source- Fact Finding Mission at Vakarai- Batticaloa district by NPDS for IDPs Project 

on 5th June 2007. 

35

Among other Medical institutions in the district, prison hospital in 

Baticaloa is not functioning, the CD & MH in Navatkadu is functioning 

only as a CD and the CD in Thuraimulavanie has been completely 

35 

damaged by Tsunami . 

Trincomalee 

Having 388,000 (2% of total population) population, possessing 2,529 

sq.km of land (4.03% of total land) and among them 17,965 are conflict 

affected IDPs (4.6 % of district population). Trincomalee district has 28 

governmental medical institutions. DGH-Trincomalee is having 344 

beds in its strength and 15 wards. District Base Hospital, Kinniya has 

been completely destroyed by the tsunami. In RH -Kuchchaveli and in 

Rural Hospital of Thoppur has been re-categorized as a CD. 

6.1. Analysis on General Curative Health Sector of the Districts 

It was observed during the study that the main set back of the health 

systems in the districts is the inadequacy of the health infrastructure and 

the shortage of the human resources to meet primary health needs of the 

displaced people and the host communities. Especially, the on-going war 

between the government and the LTTE has put so many civilians in 

danger of their lives and health but the health infrastructure is reported as 

minimum when comparing to the needs arising against the backdrop of 

war. Therefore, capacitating hospitals with required equipments for a 

smooth functioning is also urgent matter to be resolved. Especially 

during the time of civil war, wounded people and soldiers are very often 

referred to these hospitals. But due to lack of facilities available in 

particular hospitals, government has to bear additional cost for transport 

and the threat to the life during the traveling is high. If those hospitals are 

well facilitated to face emergencies and displacements these additional 

costs can be used for development and the threats to lives also would be 

minimal. 

35 

www.health.gov.lk 

36

It was found that many heath institutions were destroyed either by 

Tsunami or due to the conflict, and still not rehabilitated properly. 

According to the General Circular No: 02-61/2005 of Ministry of Health 

on Re-categorization of Hospitals, five categories of hospitals were 

introduced namely, Teaching Hospitals/Provincial Hospitals, District 

General /District Base Hospitals (all existing General and Base 

Hospitals), Divisional Hospitals ( all District Hospitals, Rural hospitals, 

Peripheral Units), Primary Medical Care Units( Central Dispensaries & 

Maternity Homes) and Special Hospitals to enable the development of 

these hospitals in a uniform manner in order to provide equitable service 

to all districts and provinces. This circular recommends certain 

minimum facilities to be available in particular institutions. But it was 

observed that those recommendations are not been carried out and many 

hospitals are far beyond even than the minimum requirements. 

Regarding insufficiency of human resources in health sector in those 

areas, it was revealed that retention of health staff is the most difficult 

task for health administrators. According to the Secretary to the 

provincial Ministry of Health, Eastern Province, the main problem in the 

Eastern province is the retaining doctors and other staff within the 

province out of 23 doctors appointed only 12 reported to work and 32 

doctors have taken transfers to other districts. 

Having familiarize with the rights perspective of health and the above 

curative health issues in the selected districts it is inevitable to suggest 

that there is something lack in the system to address those raised health 

issues. It is obvious that the government is fighting with scars of 

resources and cost for social welfare but there is a particular sum 

allocated to health in every year. Such funds needs to be distributed 

according to the needs of the people and that needs are to be calculated on 

various factors. Population, availability of health facilities and 

institutions and health indicators of each district are among the deciding 

factors when taking a decision by the authorities. But, the most 

depressing story here is the unavailability or reliability of such health 

36 

By the General Circular Letter No:02-59/2008, the Ministry has given directions to 

subdivide the category of Divisional Hospitals according to the bed capacity namely, if it 

is more than 100 patient beds-Type A DH, between 50 to 100 beds-Type B DH, less than 

50 beds-Type C DH 

37

indicators in some districts. According to the National Health Policy, 

allocation of resources between provinces/ districts is being done based 

on their health needs and national priorities. To identify health needs of 

districts, the accurate medical records from all districts should be 

available. However, it is submitted that in some instances, funds are 

allocated without looking at real health needs of the particular districts. 

For an instance, Maternal Mortality Rate is reported as 1.4 per 10,000 

37 

live births in 2002 but with the cero maternal deaths from seven districts 

38 

including, Mannar, Vavuniya and Mulathivu and according to the data 

from Family Health Bureau, it is 5.3 in 2002 . In 2005 also the number of 

39 

maternity deaths in Mannar and Vavuniya is uncounted . Therefore the 

reliability of health indicators is questionable due to poor reporting 

system. 

37 

Annual Health Bulletin 2003, Table 1.3-“Vital Statistics 1945-2003”, source - 

RGD,www.health.gov.lk 

38 

District Variation in Maternal and Infant Mortality Rates 2002- without figures from 

Mulathiw, Mannar ,Kaluthara, Vavuniya ,Kegalle, Matale and.Pollonnaruwa. -RGD 

39 

Annual Health Bulletin 2005,Medical Statistics Unit, Ministry of Health 

38

Health Issues of 

Internally Displaced Persons 


7. Health Issues s s of Internally n l Displaced Persons 

s 

7.1. Access to health clinics 

Above, the availability of the health facilities in particular districts was 

discussed and the next step is to assess the “accessibility” of such health 

facilities to the IDPs. It is accepted that to establish utmost utilize of the 

rights those health facilities should be within the safe physical reach and 

at the same time it should be economically affordable. According to the 

Handbook for Emergencies by UNHCR, 1 health center should be there 

for 20,000 people and 1 referral hospital for 200,000 persons. However 

during the study it was found out in some welfare centers do have regular 

mobile clinics but for some WCs were visited by mobile clinics very 

rarely. It was also observed that in resettlement or relocation planning, 

the health concerns of such people have not been fairly considered. In 

selecting a transit camp or a relocation center, the factors like proper 

access to roads, hospitals, the availability of water, proper drainage, 

adequate conditions for sanitation and strategically located to serve the 

purpose of the operation should be the primary criteria for site 

40 

selection . 

Mannar, it is also reported that resettled people in Thampanikkulam and 

Kattaiyadampan resettled villages are facing serious health problems 

since they do not have any dispensary nearby, for every health needs, 

including minor illnesses they have to travel Murunkan DH which is 

situated about 10 kilometers away from their villages. 

Anuradhapura, in Padaviya MOH area (including Padaviya and Welioya 

DS Divisions), most of the IDPs relocated in Gravel kanda, Gajabapura 

and Monarawewa and they are still living under the threat of LTTE 

attacks. There are only two medical institutions available in these areas, 

namely; Padaviya District Hospital & Sampath Nuwara RH. In Sampath 

Nuwara RH, two doctors, 4 nurses, and 9 attendants are serving in RH 

and in the case of emergency, Medical staff of Army helps to provide 

services. However the difficulties of transport and security in areas such 

40 

Handbook for Emergencies by UNHCR, p 223, Para 98 

40

as Janakapura , Kiri Ibbanwewa, Athawetunuwewa have reduce the 

number of patients coming to hospitals including, pregnant and feeding 

mothers. This indirectly causes the patients to disregard their illnesses at 

first stage and only after it become worse; it is being referred to the 

doctor. Soon after the resettlement of people in Yakawewa, 

Kanugahawewa of Kebithigollewa, the mobile medical services was 

functioned once a week but at present it is functioning only twice a 

month. People of the area appreciated the previous visits carried out once 

a week and the security problems and transport difficulties urge frequent 

mobile services to the villages. 

Lack of transport facility is one of other issues that affect the people in 

Batticaloa and pregnant mothers in most of the villages in Batticaloa 

west, have to walk 2km or 3km distance to arrive to the available 

hospital. In villages like Iruddusolaimadu, Pawatkodichchenai, 

Ganthinagar and Unnichchai of Vavunathivu it was reported that there 

have been numbers of snake bites but due to lack of transport facilities 

they could not take the patients to the hospitals on time. In some villages 

people face difficulties to go to the hospitals during the night because 

41 

during the emergency, traveling by motorbike and tractor is prohibited . 

In Trincomalee, it was also observed that since the road from Seruwila to 

Uppural is closed since April 2006, the resettled people in Uppural have 

to walk Illankaithuraimugathuwaram medical clinic which is situated 5 

Kilometers away from their village and this fact has caused irregular 

42 

attendance to clinics . 

Treatment and management of minor ailments 

Co-ordinate with the local medical institutions/authorities to establish mobile 

medical teams to visit temporary shelters for the displaced daily and provide 

treatment. 

Refer and transport those that require institutional care. 

“Provisional guidelines for emergency management of public health problems of the IDPs” issued by the 

Epidemiological Unit of Ministry of Healthcare & Nutrition for Batticaloa Health Staff-Section 5-See 

Annexure VI 

41 

Source- Fact finding mission at Batticaloa West by NPDS for IDPs Project on 27th, 

28th , 29th ofAugust 2007 

42 

Source-Remedial Institution's Co-ordination Mechanism Meeting Tricomalee 

District MINUTES, 26th February 2008 

41

7.2. Public Health Services 

The promotion of health and prevention of diseases is the main function 

of the Public Health Services and it is carried out by the Medical Officers 

of the Health (MOH) or by a Divisional Director of Health Service 

(DDHS) of the relevant provinces with the help of PHIs, PHNS, PHMs 

and other health workers. They are responsible for family health care, 

environmental sanitation, health education and control of communicable 

diseases of the particular area. 

Administration issues relating to preventive health care of IDPs 

Regarding the public health services to the displaced population in the 

selected districts, it was evidenced that there is a scarcity of the required 

health carders in many districts. According to “the proposed norms for 

public health technical staff” approved at the workshop held on 

11.06.1999 chaired by Deputy Director General (PHS) the DDHS/MOH 

area should be an area of 60,000 population and DDHS/MOH should be 

43 

assisted by 2 A/MOH to fulfill their duties . The required ratio for a PHI 

is that one (1) PHI for 9000 population and for PHM it is 3000. However 

the preventive health sector including environmental sanitation and 

reproductive health of displaced has been ignored due to the lack of staffs 

of particular areas. According to the health authorities the number of 

approved carder is calculated using these norms, but during the study 

that it was revealed it is not being practically carried out. 

Puttalam MOH area covers two IDP living areas, namely, Puttalam and 

Wanathawilluwa and there is 109,760 host community population and 

44 

24,344 IDPs are living in there . According to above “the proposed 

norms for public health technical staff”, 14 PHIs and 44 PHMs are 

43 

The duties of MOH comprise planning and managing community health activities, 

supervision of health institutions below district hospital levels, co-ordination with other 

sectors and agencies, financial management and logistics, training and research, health 

education and promotion of healthy lifestyle, Emphasis on problems of special groups 

like displaced, disabled, estate sector, etc environmental and occupational health, 

nutrition, control of communicable and non communicable diseases, home visiting 

when necessary, and being on call to the community, food safety and hygiene 

44 

Source-Puttalam MOH Office 

42

equired for the division, but currently only 4 PHIs and 19 PHMs and 

have been deployed to provide the health services to both Local 

communities and IDPs. But based on DPDHS-Puttalam data, “the 

approved PHI carder” is 5 positions as at fourth quarter of 2007, where 

only host community population exceeds 100,000 people. 

A Case Study 

Al Qassimi Relocation/Resetlement Village – Puttalam 

- 500 displaced families (From Mannar & Mulathivu) 

- 500 permanent houses 

- A Central Dispensary and a School are operating in RL V and administered by 

Mannar district administration. 

Nearest Maternity Clinic- Rathmalyaya Maternity Clinic (1 km away from RLV) 

The issue- 

Puttalam Regional Office of NPDS for IDPs Project of HRCSL received a complaint from six 

Vavuniya there are 4 MOH areas namely, Vavuniya, Vavuniya South, 

Vavuniya North and Cheddikulam and it was reported that though there 

45 

were 19 PHM vacant positions in the district as at July 2007 and it has 

been cured now. Only 4 PHM vacancies are prevailing as at 31st 

December 2007 in Vavuniya. However numbers of MOH and PHI 

vacancies have been increased at the end of 2007. Analyzing the data, it 

was found out that though the number of vacancies has been reduced, 

irregularities are existing in allocating man power to different MOH 

areas. Because all PHM vacancies of the district are reported from 

Vavuniya North MOH area (4 vacancies) and no MOH and no PHI was 

46 

assigned in that MOH area at the end of 2007 . 

45 

46 

See theAnnexure III. 

See theAnnexure IV 

43

In Trincomalee, it was observed that there is no SPHI is working in the 

MOH areas of Padavisiripura, Kuchcheveli, Morawewa and 

Ichchalampattu. For Gomarankadawala and Morawewa, no PHI has 

been assigned and no PHM is serving in Eachchalampattu where 

47 

resettlement is on going recently . There are only 83 PHMs in 

Trincomalee district whereas there should be 115 (32 vacant positions) 

48 

and no PHM was serving in Eachchalampattu MOH area . In 

Anuradhapura too, 30 PHM positions are vacant at while 22 Public 

Health Nursing Sisters are needed for MOH offices of the district, there 

are only 05 sisters attached to the Office(17 vacant positions) as at 

December 2006. 

Following is the current details on prevailing vacancies in the preventive 

health sector of the districts. 

Vacancies in Preventive Health Sector 

District 

Approved Cadre 

Vacancies 

MOH SPHI PHI PHNS SPHM PHM MOH SPHI PHI PHNS SPHM PHM 

Thrincomalee 10 6 37 10 10 115 1 -1 4 8 10 32 

As at September 

2007 

A’pura 22 13 80 22 19 422 -1 5 5 18 0 30 

As at March 

2008 

Vavuniya 5 15 41 2 5 4 

As at December 

2007 

Batticaloa 9 9 51 9 10 138 -2 4 -8 -6 1 -16 

As at January 

2008 

Puttalam 

As at 4 th Quarter 

2007 

9 9 44 10 9 172 0 4 8 3 5 -9 

Source- Relevant DPDHS offices in the Particular districts 

However it is evidenced that “the approved carder” in above diagram is 

not calculated according to” the proposed norms for public health 

technical staff”. If it is calculated according to “the proposed norms for 

public health technical staff”, the numbers of vacancies would be much 

higher than these figures. 

47 

48 

See theAnnexure V 

See theAnnexure V 

44

However though there is a scarcity of human resources and the legal 

duties of the preventive health sector are being unable to fulfill, the 

dedicated health staff have managed to prevent further health disasters 

following the disasters. But in some areas, it was reported that though 

they have sufficient staff, day to day visits are not being done and due to 

lack of monitoring system regarding their conduct. 

The changes to ethnic composition of some districts after displacement, 

have also posed some administrative issues in public health sector. In 

Puttalam, in 1981 there were 83 % of Sinhalese, 17 % of Tamil speaking 

persons. However in 2001; the Tamil speaking people in the district has 

been increased upto 26 %t because of the large number of displaced 

Muslim community from the Northern Province after 1989. Therefore it 

is obvious administrative decisions such as the language ability of the 

government staffs should be revised according to the new statistics at 

least in the relevant areas. For instance, in Puttalam MOH area there 

about 25,000 Tamil speaking IDPs and among 4 PHIs only one can speak 

Tamil and among 19 PHMs only 3 can manage with Tamil language. 

Language of these staffs is imperative because in relocations, the 

knowledge on environmental sanitation and family health issues have to 

be communicated to the displaced community by these officers. 

7.3. Shelter, water, sanitation and hygiene and disease prevalence 

Right to adequate housing, water, sanitation and hygiene is clearly 

enshrined in the human rights sphere. These rights are combined with 

other human rights such as right to live in security and with dignity. 

However, concerning displaced people this is quite different. After 

loosing their natural habitats and wealth, they are compelled to live 

either in community centers or with their friends and relatives. It was 

very much obvious during the study that the basic living standards to live 

in dignity are not being observed at the temporary shelters, welfare 

centers and in relocations. It is estimated that this catastrophe is being 

49 

“Population by ethnic group and district, Census 1981 & 2001” ,Department of 

Census and Statistics of Sri Lanka, 

http://www.statistics.gov.lk/Abstract_2006/abstract2006/table%202007/CHAP%202/ 

AB2-11.pdf 

50 

Observed in discussion with MOH Puttalam. 

45

enlarged due to the unexpected influx of IDPs after the recent 

displacements in war-tone areas. Therefore the poor living conditions in 

welfare centers are very much prevalent and following, is a bit of the 

above tragedy. 

Shelter 

According to the UNHCR and Sphere Principles, minimum shelter space 

for a person is 3.5 m2. Minimum site for a family is 500 Sq/ft. Minimum 

surface for a person 45 m2. But it was observed that these standards are 

not complied in many instances, in some welfare centers the floor area 

for a family is as low as 15 x 12 (180 Sq/ft) and this does not allow to 

maintain privacy and sometimes it helps to increase sexual exploitations 

of women and children by family members. For an example, in the 

Welfare Centre at Zahira College, Batticaloa, there are 549 people (165 

families) living in the camp since 2006 and among them 30 are lactating 

mothers and 6 are pregnant mothers. They are living in partitioned rooms 

of which floor area is about 15 x 15 (225) sq/ft and light and ventilation 

inside the dwellings is not sufficient for a healthy life. It is also observed 

that these dwellings are not roomy enough to maintain privacy. This is 

common in many welfare centers in those regions. 

In selecting sites for welfare centers and settlements, the lowest point of 

the site should be not less 

than 3 meters above the 

estimated level of the water 

table in the rainy season. 

However, in Santhinagar, 

Mannar, the relocated people 

had to move again from the 

relocations due to the flood 

situation of the area. In 

addition, over-crowding 

status in welfare center in 

Batticaloa is a critical problem. This is evident in Arthiviravar and 

Thiraimadu Welfare centers and in latter WC, one tent house is occupied 

by two-three families. This situation become worse when there is heavy 

rain and the transitional shelters were reported as inadequate and 

unsustainable. 

46

In Batticaloa West, the drinking water is distributed by bowsers in 

collaboration with Pradeshiya Sabha and UNICEF. But some villages 

get water only for three days in a week and because of the salty nature of 

the available bathing water some are opted to use drinking water for 

bathing. It was reported that the drinking water is not supplied to people 

in Pudhumandapathadi, Gandhinagar and the people in Unnichchei get 

55 

water from Unnichchai tank which is nearby . People in 

Sinnakudiruppuwa IDP relocation (150 persons, 42 families) in 

Kalpitiya DS Division, Puttalam due to the unsuitability of drinking 

water used to buy water from visiting water sellers to the village. 

Availability of safe water is always concomitant with other health 

aspects .In Anuradhapura it was observed in Gravel Kanda, Gajabapura, 

Monarawewa relocations that most of natural deaths are happening due 

to unidentified reason and they also facing problems as to the suitable 

drinking water since still there is no any drinking water project for these 

areas. In Fact Finding Mission at Weli Oya by the Project, it was pointed 

out that there is high concentration of chloride in water and it is not 

suitable for drinking purposes without proper treatment and it was 

mentioned by the people that already 2 or 3 people have died from kidney 

failure as a result of this untreated water. 

55 

Source- Fact finding mission at Batticaloa West by NPDS for IDPs Project on 27th, 

28th , 29th ofAugust 2007 

47

Water 

Right to water accomplishes the availability of sufficient, safe, 

acceptable, physically accessible and affordable water for personal and 

domestic uses. According to the ministry of health 93.90% of 

51 

populations have the sustainable access to an improved water source . 

But according to the WFP only 21 percent in Mannar have access to safe 

52 

water . This shows the discrepancies of data between districts and 

situation of displaced population is quite problematic regarding access to 

water. 

Minimum water needs for a person for drinking purpose is 7 liters per 

day (UNHCR) and according to the Sphere Principles it is 15 liters of 

water is required for drinking, cooking, and personal hygiene. Maximum 

number of persons per tap is 250 persons and for a hand pump or dug well 

it is 400 persons. The maximum distance from any household to the 

nearest water point is 500 meters. Queuing time at a water source is no 

more than 15 minutes. Water sources and systems should be maintained 

such that appropriate quantities of water are available consistently or on 

a regular basis. However these standards are not observed in relation to 

many IDPs and following observations were notified during the study. 

In Mannar it was reported that in Nanattan, Kalimottai and 

Jeevothayam people are facing difficulties in getting suitable drinking 

water, especially, in dry and rainy seasons. It was also complained that 

the water, supplied by the local government authorities is not in good 

condition and PHI is hardly ever checking the Chlorine level of the water. 

In Padipalai DS division, Batticaloa there is a serious need for drinking 

water and it is reported that the particular Pradeshiya Sabhas are also 

unable to meet the needs of communities.It is observed that some 

of the common wells at Kirmichchodai, Vakarei are not chlorinated and 

54 

therefore not suitable for drinking or even for cleaning purposes . 

51 

Annul Health Statictics-2005,Organisation of health services, Table 17.b, “Health 

Indicators as in the MGD in Sri Lanka-Ministry of Health 

52 

Sri Lanka Food Security Assessment, based on the Integrated Food Security & 

Humanitarian Phase Classification Approach, 15-30,April,2007,WFP,Page 48. 

53 

Source- relief web - http://www.reliefweb.int/ ,30 November 2007 

54 

Source- Fact Finding Mission at Vakarai- Batticaloa district by NPDS for IDPs 

Project on 5th June 2007 

48

Ensuring safety of water 

Ensure adequate supply of safe drinking water. If pipeborne 

water is not available, water to be collected in 

tanks or barrels and chlorinated. 

Co-ordinate with the Divisional Secretary to ensure that 

water supplied by local authorities and other sources is 

properly chlorinated before distribution. 

“Provisional guidelines for emergency management of public health problems 

of the IDPs” issued by the Epidemiological Unit of Ministry of Healthcare & 

Nutrition for Batticaloa Health Staff- Section 1-See Annexure VI 

Sanitation 

Regarding displaced persons, sanitation and hygiene should be utmost 

importance due to the nature of common usage of relevant facilities and 

they are normally much more susceptible to illness and death from 

disease, which are related to a large extent to inadequate sanitation, 

inadequate water supplies and poor hygiene excreta disposal, vector 

control, solid waste disposal and drainage. However according to the 

available statistics published by Ministry of health, only 75.40% of 

56 

population have the access to improved sanitation . According to the 

Sphere Principles, minimum latrine facility for persons is one (1) latrine 

for 20 persons or ideally one (1) per family and Minimum distance 

between shelter and latrine should be 50m or more. Pit latrines and soak 

ways should be at least 30 meters away from any ground water source. 

One of the general observations made by the study is the open defecation 

by the people due to unavailability or lack of toilet facilities. The 

displaced people in Thanthamalai, Mavadi Munmari, Paddipalai, 

Sinnapullumalai in Batticaloa do not have enough toilet facilities and 

they used to use jungle for this purpose, but due to securitry reasons, 

sometimes that usage is also become problamatic especially at night. 

56 

Annul Health Statictics-2005,Organisation of health services, Table 17.b, “Health 

Indicators as in the MGD in Sri Lanka-Ministry of Health 

49

Another pathetic situation when they are using jungle at night and early 

in the morning is the security of women and children and this has to be 

serioursly conserned for thire protection and security. Manalchenai 

Transit camp is located in Muthur DS division, Trincomalee possessing 

IDPs from Batticaloa and Trincomalee now providing shelter to 199 

members of 69 families staying in the Transit camp. However there are 

only 6 toilets erected and therefore 1 toilet has to be shared by 34 people 

57 

whereas it should be 1 for 20 persons . Unfortunately it was also 

revealed though they have enough latrine facilities, sometimes some 

IDPs used to continue with open air defecation which is more 

aggregative for health concerns. 

In Puttalam, Alankuda B relocation center, out of 35 persons only 7 

persons have toilets and those are temporary in nature. Those temporary 

toilets only have a pit, a base, squatting slab and covered with cadjan 

58 

walls and with no roof . There are about 20 toilets made by an NGO but 

some of them cannot be used due to overflowing. Others are still 

continuing with open air defecation. The reasons for not having toilets 

are the financial difficulties of the families and the ambiguity regarding 

the ownership of the lands. This undermines the privacy and increases 

59 

number of flies and bad smell and caused a serious threat to healthy life . 

57 

Visit Report of Manalchenai Transit camp by NPDS for IDPs Project of HRCSL, 

Trincomalee, 18April 2008 

58 

Observed in Fact Finding Mission to Alankuda B welfare center, Puttalam through a 

Focal Group Discussion on 22nd September 2008 by NPDS for IDPs Project of HRCSL 

59 

Fact Finding Mission to Alankuda B welfare center,Puttalam, 22nd September 2008 

by NPDS for IDPs Project of HRCSL. 

50

The lack of coordination between the MOH and local authorities when 

erecting toilets, the failure of local authorities in garbage disposal and in 

supplying equipments and tools to control communicable diseases have 

also collectively caused the living standards of IDPs to be fallen down. In 

Puttalam, there is no proper drainage system in welfare centers and 

relocation centers and they also lack proper water supply. Another 

burning issue affecting health conditions of IDPs is the lack of proper 

mechanism for garbage collection. Urban Council of Puttalam possesses 

only 6 tractors for garbage collection and the less number of staff for this 

purpose has caused the situation worse. 

Safe disposal of excreta 

• Ensure adequate sanitary facilities at all temporary camps for the displaced. 

Where necessary, make arrangements to construct adequate number of 

temporary latrines according to the guidelines. 

Disposal of refuse 

• Co-ordinate disposal of garbage by sanitary burial or burning in suitable 

adjacent areas of temporary shelters. 

• Control flies, insects and rodents by proper use of physical and chemical 

methods (insecticides and TCL powder). 

• If garbage is removed daily by the local authorities using tractors, ensure 

enough barrels (garbage bins) are available in the temporary shelters for 

collection of garbage. 


Epidemiological Unit of Ministry of Healthcare & Nutrition for Batticaloa Health Staff - Section 3 & 4 - 

SeeAnnexureVI 

Disease Prevalence 

It is palpable that the disease prevalence is comparatively high in the 

aftermath of a disaster. Especially soon after a disaster the IDPs live in 

community wise and therefore the incidence of viral infections, 

diarrhoeal diseases are easy to outbreak among the community. In 

Arthiviravar camp where there were over 1,400 people, there were only 8 

toilets available and a high incidence of diarrhea was reported in this 

60 

camp . However it was revealed things have been changed after the 

resettlement and in present they only have about 300 members and 

authorities were able to manage the situation. Trincomalee also it is 

60 

Centre for Policy Alternatives, INFORM Human Rights Documentation Centre, Law 

and Society Trust, Women and Media Collective, Report of the Fact-Finding Visit to 

Batticaloa and Vakarai,April 2007, p.3 

51

eported that IDPs in the welfare centers are infected with some 

communicable diseases such as diarrhea, skin diseases, infected 

because of unhygienic condition of the welfare centers due to the 

improper maintenance of toilets; contaminated drinking water and 

irregular garbage disposal system. Recently it was reported that two 

persons in Orr's Hill and Moor Street of Trincomalee were dead due to 

61 

Dengue fever .According to findings of PHI the main reason for fever is 

the availability of water stores for mosquito breading, in many areas of 

Trincomalee district, the system of water supply is not proper and water 

is coming with low pressure. Therefore it is not enough to uplift the water 

to water tank. Due to this the people are storing the available water in big 

drums and barrels (without lids) and it is very much feasible to mosquito 

breeding and the disease spreading thereby. It was also reported that 

though there is reported TB patients among IDP community, the TB 

Center of Puttalum has been unable to hold any program for IDPs areas 

62 

due to insufficient funds . 

Following the influx of displaced population in Trincomalee and 

Batticaloa districts, the Epidemiological Unit of Ministry of Healthcare 

& Nutrition, has issued “Provisional guidelines for emergency 

63 

management of public health problems of the IDPs” which is very 

much worthy to be discussed. These guidelines (GLs) are recommended 

to minimize the adverse public health impact and to prevent the spread of 

communicable diseases of IDPs living in temporary shelters. Ensuring 

safety of water and water, safe disposal of excreta, disposal of refuse, 

treatment and management of minor ailments, prevention of control of 

potential outbreaks and disease surveillance are the important aspects 

health addressed by these GLs. The enforceability of these GLs are being 

fallen on the PHI and other field health staff under the supervision of 

DDHS/MOH and under the overall monitoring and supervision of the 

relevant Regional Epidemiologist (RE). 

61 

Remedial Institution's Co-ordination Mechanism Meeting Tricomalee District 

MINUTES, 26th February 2008 

62 

Field Study on Right to Health, NPDS for IDPs Project, Puttalam, July 2008 

63 

SeeAnnexure VI 

52

Regarding the impact of these GLs, an appreciation of them is inevitable 

because it address the many health hazards after a displacement and the 

guidelines were elaborative on the subjects. However the guidelines 

have been issued only for Batticaloa and Trincomalee districts while 

several other districts also providing shelter to similar or more number of 

64 

IDPs . Meanwhile it has not addressed the health aspects on personal 

hygiene, Provision of maternal and child health care services, 

immunization as it is laid down in detail, in the “Guidelines for 

management of public health effects in the community following 

Tsunami disaster”. In addition, regarding the enforceability, the above 

GLs were issued by Deputy Epidemiologist whereas the “Tsunami 

guidelines were issued by Director General of Health Services, which 

seems to have comparatively more powerful enforceability among the 

health staff. 

Sometimes it was detectable that the lack of knowledge and enthusiasm 

in healthy practices among IDPs, have contribute to down grade health 

of the people. It is evident when anti mosquito bed nets were distributed 

among the IDPs they do not use them properly. In Mujhahidanpuram 

relocation center, Wanthawillu Division, Puttalam the skin diseases have 

been infected among the children but their parents did not keen to direct 

them to basic medical treatments. 

Prevention and control of potential outbreaks 

In a case of in particular, prompt action must be taken to ensure early treatment and 

prevention of further spread. 

In case of contagious diseases such as acute respiratory tract infections and 

chickenpox, these cases should be isolated and referred to hospitals if necessary. 

Steps should be taken to control mosquito breeding to prevent and control mosquito 

borne diseases such as dengue, malaria and JE. 

Disease surveillance 

MOH/PHI should visit the camps daily to inquire into unusual occurrence of 

disease events/outbreaks. 

Collect and report data related to health events in camps according to the format 

provided by the Epidemiology unit (annexure). 

MOH should consolidate the above data weekly and send a consolidated report to 

RE with a copy to Epidemiology Unit (annexure). 


Epidemiological Unit of Ministry of Healthcare & Nutrition for Batticaloa Health Staff- Section 6 & 7-See 

Annexure VI 

64 

SeeAnnexure I. 

53

7.4. Adequate Food Supply and Nutrition 

According to the Article 11 of ICESCR everyone has the right to food 

and right to be free from hunger. Especially during a period of internal 

displacement the food security of people is undoubtedly become worse 

due to loss of occupations, deterioration or the destruction of harvest and 

also due to loss of breadwinner of many families. This lack of food 

security is the main determinate of health and one of the causes of 

undernutrition status of Sri Lanka and according to the WFP, Northern 

and Eastern districts have much more child undernutrition than other 

65 

districts . Therefore the availability and adequacy of the food packages 

given to displaced people is being assessed here. 

Cooked meals 

According to The circular (No: NDRSC 2007/10), cooked meals of 

Rs.70.00 for an adult and of Rs.50.00 for child under 12 yrs per diem are 

provided to all those who vacate their permanent places of residence and 

seek shelter at welfare centers temporally irrespective of their level of 

income for maximum of 3 days and this period can be extended. 

Dry rations 

The persons who have lost their places of residence and all properties as a 

result of a disaster and living in a temporary camp are provided with dry 

rations for the period they stay in camps irrespective of their level of 

income. The circular (No: NDRSC 2007/10) authorizes that dry ration 

can be issued for one week and if the period is to be extended the 

approval of the Director of the National Disaster Relief Service Center 

(NDRSC) is needed. However it is reported that in relation to conflict 

affected IDPs, the dry ration will be given to them as long as they stay in 

the WCs and in relation to resettled and returned IDPs, dry ration will be 

given to them as long as the need for dry ration is prevailing. This period 

is different from district to district and it was evidenced that in 

Trincomalee for resettled and returned people dry ration will be given for 

six months after resettlement. 

65 


Humanitarian Phase ClassificationApproach,15-30,April,2007,WFP,Page 43 

54

As per the circular No: CGES/ER/95/01 issued by Ministry of Shipping, 

Ports, Rehabilitation and Reconstruction on 16th November 1995, 

scheme of dry ration is issued to the displaced families whose income is 

less than Rs.1500.00. However thereafter two circulars have been issued 

in this regard, namely, Circular No: D.S.S 2003/1, issued by the 

Department of Social Service and Circular No: NDRSC 2007/10 but the 

amount of dry ration is still remain as the previous circular. Under the 

later circulars the monthly income limit of the family should be less than 

3000. 

Following is the comparison of quantity of dry ration by those circulars. 

No:ofpersonsin 

the family 

Quantity of dry ration for a month (Rupees) 

Circular No: Circular No : 

CGES/ER/95/01 D.S.S 2003/1 

5 persons or more 1260 (315 x 4) 1960 (490 x 4) 2100 (525 x 4) 

4 persons 1008 (252 x 4) 1540 (385 x 4) 1820 (455 x 4) 

3persons 840(210x4) 1260(315x4) 1540(385x4) 

Circular No: 

NDRSC 2007/10 

2persons 616(154x4) 980(245x4) 1260(315x4) 

1 person 336 (84 x 4) 560 (140 x 4) 980 (245 x 4) 

According to WFP, usually a food intake of a person should comprise of a 

range of foods from at least four main food groups including; 

carbohydrates (Rice or Wheat form the bulk of the diet), proteins (Pulse, 

Grams, fish (tinned), Meat), Fats (Oil, Butter), micronutrient-rich foods 

(Vegetables and fruits are good sources of micronutrients).As per health 

consultants, one person needs energy of 2100 Kcal per day couple with 

66 

other nutrition requirements . Since the later circulars (2003/1 & 

2007/10) are still not carried out, one family with or more 5 persons is 

given only 42 rupees per day. This scenario is regrettable 

66 

Protein 10-12% total energy (52g-63g), but

when we compare with the rising cost of living, especially high prices for 

foods. According to the prevailing retail price index in Sri Lanka, June 

2008; one has to bear cost of 55-70 rupees only for a one (1) Kg of rice. 

This clearly shows the inadequacy of the quantity of dry ration and the 

adverse effect of these provisions greatly falls on families like single 

headed, women headed, child headed families and the families with a 

disabled breadwinner. Comparatively, consequent to Tsunami disaster, 

each member of a family unit were received dry ration worth Rs.375 /= 

67 

per week (1500/= per person for a month) and whereas according to the 

present provision of dry ration to conflict affected IDPs it is only 1260/= 

for a family with 5 or more members for a month. 

In addition, the poor quality of dry rations and discrepancies in issuing 

dry rations by Multi Purpose Cooperating Societies (MPCS) also 

reported by IDPs. IDPs in Wahalkada and Mawathawewa relocations in 

Anuradhapura complained about the availability of low quality food 

68 

items in cooperative societies issued for dry ration . Although the 

Project managed to solve the particular problem by arranging PHI to visit 

particular cooperative societies once a month still there is no proper 

mechanism to address the mater in long term basis. Meanwhile, due to 

“rice crisis” prevailed in around April, 2008 MPCS did not provide rice 

and flour was provided instead. However it was evident that even before 

and after “rice crisis” this pattern is being carried out due to the lack of 

required food stocks in MPCS. It was reported that there are 108 recently 

resettled families in Kalmadu (Ieeswaripuram) Resettlement village, 

69 70 

Vavuniya , have not received ration since October of 2007 . Recently it 

was also observed followed by Project visits to Hidayath Nagar RLV, 

Hijrath Nagar RLV, Poonaipitty RLV in Puttalam that 17 Families, 

displaced from Trincomalee & settled in Poonaippitty in 2006 and 7 

families displaced from Muttur 2006, living in Pulichchakulam 

67 

According to the Circular dated 05.01.2005 issued by the Director of Social 

Services of Department of Social Services 

68 

Complaint No :( HRC/IDP/AP/06/17) of NPDS for IDPs Project of HRCSL 

69 

These people were resettled on September and October 2007 from Poonthoddam 

WC 

70 

This particular incident is cured at this moment but it is mentioned to as an example 

of prevailing irregularity. 

56

are not receiving dry ration since government has taken a decision to not 

71 

provide dry ration for new IDPs . However no evidence of proof was 

found to establish such government decision. Differential treatments 

between IDPs were also evidenced in this regard since there is no well 

planed machinery or scheme to provide dry ration to those who stay with 

their friends and relatives. 

Ensuring safety of food 

Co-ordinate with the Divisional Secretary to ensure that food supplied by local 

authorities and other sources are hygienically prepared before distribution. 

Ensure all the food supplies to the displaced are hygienically stored, prepared and 

distributed. 

Strictly monitor the preparation of food in food handling establishments. 


Epidemiological Unit of Ministry of Healthcare & Nutrition for Batticaloa Health Staff- Section 2-See Annexure 

VI 

7.5. Nutrition status of extremely vulnerable groups 

The impacts of displacement are heavily felt to the women and children 

since they are more vulnerable to the troubles and diseases. The 

difficulties like loss of income earning opportunities, unstable house 

hold, food security, frequent displacement, low food protection, poor 

living conditions pave the way to deterioration of nutritional status of 

women and children. Following are some of the health problems posed 

to them. 

Undernutrition 

The prevalence of undernutrition is assessed by identifying 3 criteria 

namely, underweight (weight for age), stunting (height for age) and 

wasting (weight for height). It was observed that the status of reported 

undernutrition is comparatively higher in the district like Mannar, 

Batticaloa,Anuradhapura and Trincomalee. 

71 

Observed from the Visit report done by NPDS for IDPs Project, Puttalam on 

18.03.2008 

57

72 

While National underweight average is 33.4 percent , Mannar, 

Batticalia and Anuradhapura are among 12 districts, where underweight 

73 

prevalence is more than 35 percent . Regarding stunting also the rates in 

Batticaloa and Mannar are higher than national average of 16.6 percent. 

Addressing the wasting status higher rate of wasting is reported from the 

districts ofAnuradhapura, Mannar, Trincomlee, Vavuniya wasting rate is 

74 

higher than national average (16 percent) . In addition, according to the 

information from Family Health Bureau, the percentage of children (1-3 

years & 3-5 years) who are below 3rd centile level in Trincomalee and 

Batticaloa districts is comparatively higher than the national 

75 

percentage . In Vavuniya Protein energy malnutrition is the most 

prevalent nutritional problem and out of 6617, only 2952 children are 

tallied to normal weight and the rest, 55.4% children are suffering 

76 

malnutrition . 

Since the general status of district is such, more aggregative inference 

can be drawn on the conditions of IDPs in this regard. According to 

UNICEF Assessment data, 2007 in Batticaloa more than 5 percent of 

severe wasting was reported amongst IDPs. However the collecting data 

from IDPs was very much difficult in this regard since they do not 

possess those “birth cards” after the displacement. 

72 

UNICEF surveys (2003, 2004, 2005/6, 2006, WFP survey for Mulathivu, DHS 2000 

for some districts 

73 


Humanitarian Phase ClassificationApproach,15-30,April,2007,WFP,Page 44 

74 

ibid 

75 

Percentage of children 1-3 years below 3rd centile- Sri Lanka-24.9,Trincomalee 

34.9,Batticaloa- 36.2, Percentage of children 3-5 years below 3rd centile- Sri Lanka- 

27.4,Trincomalee- 36.8,Batticaloa- 40.3 ,Source-FHB 

76 

SeeAnnexure VIII, Source- DPDHS Office - Vuvuniya 

58

Nutritional status of pregnant women and lactating mothers 

The nourishment of pregnant mothers is vital since it affects not only on 

health condition of the mother but also on the child. The recommended 

weight gain during the pregnancy is 10 Kg, but it is reported according to 

National Nutrition Policy, 2007 the average weight gain reported in Sri 

Lanka is less than 7.5 Kg. Despite the provision of iron, folic acid and 

other vitamins by the health authorities through PHM, average anemia 

77 

prevalence is being reported as 37 percent amongst pregnant women . 

According to the data from DPDHS- Trincomalee, 2007, 5 percent of 

pregnant mothers are suffering from moderate anemia and 1.33 percent 

is suffering from severe anemia. It was also observed that while 87.3 

Percentage of pregnant mothers were protected against the rubella in the 

districts of Vavuniya, Trincomalee and Mannar, only 50 percent of them 

78 

were protected . 

Repercussions of above factors were greatly felt on the women of the 

above conflict affected area it is evidenced by higher Maternal Mortality 

Rates, low birth weigh rates reported in those districts. In 2005, 

Batticaloa and Vavuniya reported 81.2 and 68.7 of maternal mortality 

79 

rate per 1000 live births while national average is 38 . Low Birth Weight 

rate was also reported in the district of Batticaloa, Puttalam and 

80 

Anuradhapura as higher than national average and District like 

81 

Batticaloa and Anuradhapura possess higher Infant Mortality Rate . In 

Trincomalee, reported percentage of babies born with low birth weight 

approximately was about 12.8 %( 971 out of 7587 births) in 2006 and in 

82 

2007, it was 14.95% (964 out of 5457 births in June) . According to the 

77 

Medical Research Institute, Ministry of Health Care Nutrition and Uva Wellassa 

Development, UNICEF: Rapid assessment of coverage of micronutrient 

supplementation in Sri Lanka,2004 

78 

79 

80 

81 

Vavuniya 50.9,Trincomalee 54.2, Mannar 45.6-FHB- 2005 

FHB-2005, See theAnnexure VII 

National- 16.9,Batticaloa 20.2, Puttalam 21.1,Anuradhapura 19.2- FHB-2004 

National average- 11.2-per 1000 LB, Batticaloa 19.6, Anuradhapura 19.4-- Table 

4.Vital statistics by District,Annual Health Bulletin, 2005 

82 

See theAnnexure IX 

59

83 

details of conducted Maternity and Child Health Clinics , it was 

observed that the number of conducted Well Women Clinics in 

Trincomalee district were inadequate during the 2004 and 2005. 

Considering Nutrition status of pregnant mothers and lactating mothers, 

special nutritional intervention by the government, worth of Rupees 

500.00 is given to the target group in selected DS divisions.According to 

the circular No: 21, dated 2006.07.31 (amended 2007.02.19) the 

Commissioner General of Samurdhi, applicant should be a Samurdhi 

beneficiary to be entitled under this scheme. In addition to this category, 

if the mother is not from a Samurdhi beneficiary family, she should 

established that her family income is below the poverty line and her 

nutrition status is low and it has to be recommended by relevant MOH 

and further certified by Samurdhi development officer. However during 

the study it was revealed that the displaced expectant and lactating 

mothers do not receive this nutritional package even though they were 

qualified before their displacement. The fact that they are receiving the 

dry ration instead of Samurdhi has disqualified them from being 

qualified under this package. 

Regarding health of women, the incidents of “minor parents” are 

reported as a much common factor in Kuchchevelli DS division of 

84 

Trincomalee district. In 2005 10.55 percentage of teenage pregnancy 

was reported from Trincomalee while national average is 6.2(FHB). This 

has led to many health issues of young girls and as well as infants due to 

the risk faced them at the period of pregnancy and due to malnutrition 

issues. 

83 

84 

See the Annexure X & XI 

See the Annexure XII 

60

7.6. Risk of HIV infections 

Sri Lanka is considered as having low prevalence of HIV notably less 

85 

than 0.1 percent (3800 persons) . The Government of Sri Lanka initiated 

HIV prevention and control efforts through the National STD and AIDS 

Control Program (NSACP) of the Ministry of Health in 1992.IDP 

community can be considered as most-at-risk population (MARP) to 

HIV and among the displaced community, especially women and 

children are vulnerable to sexual abuses and such incidents are not 

revealed to the world easily and most often remain as hidden crimes. 

86 

At present there are about 81,000 Sri Lankan refugees living in India , 

and the only humanitarian package, available to them is the dry ration. 

Due to their poverty, they are being forced to engage in prostitution. 

During the study it was observed that those Indian refugees are coming 

back into Sri Lanka through illegal ways. The problem posed here is that 

the unavailability of a mechanism to test them whether they are infected 

with HIV or not. However such kind of unavailability is understandable 

since the migration is done by illegal ways. But re-integration of them 

into the community will pose serious health risks because they 

themselves may not be aware of the infection and this fact urges a 

mechanism to check the infectious status at the grass root level. 

7.7. Mental health of IDPs 

Inheriting a civil conflict for more than 25 years the factors like loss of 

loved ones, families, wealth and livelihood have caused majority of the 

people in war affected area to be mentally disordered. The security 

concerns and frequent threats to the life have also amplified the number 

of mentally affected patients. In Puttalam, it was reported that out of 300 

87 

patients coming for the psychiatric clinics, majority are IDPs . 

85 

http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/ 

EXTSAREGTOPHEANUT/EXTSAREGTOPHIVAIDS/0,,contentMDK:20287586~ 

menuPK:568884~pagePK:34004173~piPK:34003707~theSitePK:496967,00.html 

86 

87 

http://www.refugeesinternational.org/content/article/detail/933/, as at 20.01.2004 

Observed from the discussion with Dr. Fareed District Medical Officer 

61

In Mannar, a unit called Psycho Social Forum has been formed and under 

88 

the coordination of this Forum , 11 governmental and nongovernmental 

administrators including 20 NGOs are working to develop 

mental health conditions of the people. Its objective is to provide and 

promote the mental health of the needy people. According to their 

statistics from 2006 to 2007, 208 numbers of mental patients had come 

for counseling and treatment. It is reported by this unit that the suicide 

rate is also high in Mannar and most of them are between the ages of 14 - 

24 years. 

Trincomalee Mental Health Unit is also dearth of enough staff to take 

care of patients. There are only 3 female nurses, 3 female minor staff 

persons and one male staff. Therefore it is difficult to control some 

patients during the critical situations. The most pathetic situation relating 

to mental health of IDPs is that the shortage of psychiatrists in those 

areas. It is evidenced that though there are 49 psychiatrists are present in 

the country they are not evenly distributed among the districts as in 13 

89 

districts out of 25, no psychiatrist is available . In Mannar, Vavuniya, 

Trincomalee andAnuradhapura, no psychiatric is serving. 

7.8. Addressing similar issues differently-unequal responses to 

different types of displacements 

The health problems after Tsunami devastation was addressed by issuing 

certain guidelines as circulars, to health workers, especially to 

community health workers by the Ministry of Health care & Nutrition. 

Following are some of those circulars. 

29.12.2004-General Circular Letter No: 01-28/2004, Actions 

to prevent possible health problems after the Tsunami disaster, 

by Director General of Health Services. 

29.12.2004- General Circular Letter No: 02-170/2004, 

Psychosocial support for Internally Displaced Persons due to 

Tsunami disaster, by Deputy Director General of Health 

Services. 

88 

Officially started on 01.06.2006 

89 

Source-Table 22, Distribution of specialists in curative care services by districts, 

September 2005 

62

07.01.2005-General Circular: 01-01/2005, Guidelines 

for provision of Health Promotion and Education 

Services following the disaster caused by Tsunami, by 

Director General of Health Services. 

10.01.2005- General Circular Letter No: Guidelines 

for management of public health effects in the 

community following Tsunami disaster, by Director 

General of Health Services. 

In addition following guidelines/instructions were also issued 

01.01.2005-Guidelines for Provisions of Maternal and Child 

Health Services following the disaster caused by Tsunami, by 

Additional Secretary Medical Services 

07.01.2005-Distributuion of the health card for IDPs in campstsunami 

2004, by Deputy Director General (PHS) 

13.01.2005-Guideline for feeding infants and young children 

(1-5 years) including orphans and those not living with mothers 

(Tsunami affected areas), by Director, Maternal and Child 

Health, FHB. 

It is true that the tsunami devastation in 2004 destroyed and displaced a 

lager number of human lives. These types of approaches by health 

authorities should be admired and praised for preventing further health 

problems following the Tsunami. At the same time, the conflict for more 

than two decades has caused more than millions of people displaced 

from their natural habitats and such displacement is still happening. The 

difference of two types of disasters is one is man made and the other is 

natural. Especially displacement from conflict is always being treated as 

secondary vis-à-vis displacement by Tsunami, by both state authorities 

and also by private organizations. But it is obvious that the conflict 

affected IDPs are also being displaced without their wrongs and the state 

and other humanitarian actors should have similar concern and 

responsibility for the problems aroused from such displacement. 

The above circulars and guidelines specifically demonstrate that they are 

to handle the health problems after Tsunami. But the health authorities of 

the view that those circulars and guidelines equally address the health 

63

problems of conflict affected IDPs. But such kind of view is not legally 

valid since, no official notice/letter/circular is saying that those circular 

is equally applicable to the health concerns of conflict affected IDPs. If 

they are equally applicable, there is no point of issuing “Provisional 

guidelines for emergency management of public health problems of the 

IDPs” by the Epidemiologist for the Batticaloa and Trincomalee in 2005. 

Therefore it shows inequitable responses by health authorities for the 

consequences of two disasters. 

According to the National Health Policy, services and programmes will 

be introduced by the Ministry to meet the emerging health needs, inter 

alia the health problems of displaced populations. Though they have 

established “Disaster Preparedness and Responses Unit” in the Ministry 

in line with that policy, any other services and programmes, specially 

addressing the health problems of conflict affected displaced population 

are not discernible yet. 

7.9. Security problems 

Inability to access to some areas due to security problems is another 

burning issue for the government health staff, NGOs and also to the 

patients. It was reported from RDHS-Mannar that closure of the 

Uyilankulam checkpoint is increasing travel costs for the majority of 

health workers as 90% of staff working in Manthai West, now must travel 

from Mannar Island through the A9 road. However this is only one of 

such reported incidents where security problems is a factor in deciding 

health conditions and people are also hesitated to travel from villages to 

the town though more facilities and services are available, because the 

value of life is bigger than suffering from an illness. 

It is sometime evident that even though the funds and donations are there 

to facilitate the health requirements of the displaced people, the burdens 

such as security problems and lack of cooperation between the parties, 

undermine this process. In Wahalkada Central Dispensary, earlier it was 

reported that the doctor is providing services only 2 days for a week, but 

after NPDS for IDPs Project's intervention residential doctor was 

arranged to work for all the weekdays. Though MOH office is 

conducting mobile medical clinics in threaten areas with the help of 

NGOs like World Vision & Sarvodaya it was reported as not sufficient. 

64

They also face with serious security problems and transport problems in 

their efforts to take medicines from outside. 

7.10. Role of health professionals 

Role of health professionals and hospital staff is also open to discussion 

because the right of every people to receive basic health care from the 

government for free and the governments' obligation thereto, is not 

always observed by some health professionals and health staff and this is 

a black mark for the rest of dedicated health professionals serving in the 

country. Therefore the attitudes and the role of health staff have to be 

developed in focusing rights of people. Meanwhile incidents of medical 

90 

negligence are also reported due care and diligence by health staff and 

professionals are required to facilitate these marginalized people. 

90 

Source- Complaint No: HRC/AP/01/436/06 mentioning that a boy was dead due to 

wrong injection by a doctor of Kekirawa hospital.- Complaint No:(HRC/AP/01/671/06) 

,two children have been disabled due to wrong injection by a doctor of Anuradhapura 

hospital, NPDS for IDPs Project,Anuradhapura. 

65

Conclusion 


8.C onclusion 

The need for physically and mentally healthy population for a country is 

therefore very much obvious as for a country like Sri Lanka, where 

human resource is its greatest asset, no matter these people from North or 

South. The observance of this study proves that the government has 

taken steps to protect and promote the health of people throughout the 

country, although there are some lacunas in the health services not only 

in the North and East in the other parts of the country as well. However, in 

the North and East the scenario is different since the people living in 

those areas are suffering from the consequences of the war and in case of 

sudden displacements and in case of people living in Welfare Centres, 

where many a time there is a possibility of spread of diseases and it is 

necessary to make available health services to the people in North and 

East with special consideration. It can be seen from the study, that even 

though the health services are available in those areas it is inadequate to 

cater the needs of the people. 

Therefore the government, as the care taker of the people, should take 

actions to strengthen the services of heath sector in the North and East 

with special consideration, as it is necessary to ensure the right to health 

of the people. In the case of government is unable to fulfill the need it is 

needed to obtain the services of humanitarian organizations to provide 

humanitarian assistance and protection to these people. Thus, it can be 

seen that, some discussed issues may be difficult to overcome in the 

short-term, long term strategies are required to handle these socially 

spread health problems of the people living in the North and East of the 

country. 

68

Recommendations 


9. Recommendations 

1) Improvements of health related facilities and human 

resources in the districts. 

Health related facilities 

a) The minimum standards as it is required in “Re-categorization 

of Hospitals Circular” should be implemented so as to ensure 

qualitative service at the district level. Especially, in those areas 

the conflict it self requires a developed curative health service 

since the possibilities of accidents/injuries are frequent. 

b) Where there is a considerable addition of IDP population to the 

general population of a particular district, the amount of 

allocations of medicine and other resources should be increased 

in proportionate to the addition. 

2) Human resources 

a) An appropriate system of deploying man power in health sector 

must be introduced and reasonable facilities and incentives 

should be made available to the health professionals and staffs in 

rural and unsecured areas. It is only by encouraging them and 

giving more concessions, hardships happening while traveling 

from one hospital to another can be reduced. 

b) “The Proposed Norms for Public Health Technical Staff” is 

recommended to pursue with recent updates, if needed since it 

has been drafted in 1999. Therefore new recruitments should be 

carried out if there is less number of cadres to meet the needs of 

the public. The monetary allocations from the treasury for such 

recruitments should be obtained on the basis of national 

importance. 

c) Regarding anomalies existing in allocating cadres, a proper 

monitoring system should be worked out within the provincial 

level and national level to monitor the deployment of human 

resources. 

70

d) In the case of security problems and inability to visit displaced 

persons, an appropriate system should be formed and 

monitored, if needed with coordination of security forces. It is 

suggested to establish focal points within the Ministry of Health 

in national level or to establish focal points at provincial or 

district levels. These focal points of the security forces will 

provide effective and efficient coordination in discharging the 

services. Because during and the post disaster period, 

maintaining a proper community health is imperative to prevent 

further calamities. 

e) Since there has been instances of the existing health staff of the 

host district unable to cope up with the new crowd, in case of 

displacements of a larger number of persons to another district, 

the required number of health personnel should be allocated 

either from the previous district or from the central government 

as soon as possible. If it is taking time, incentives should be paid 

to them for the additional covering persons. 

4) Strengthening of medical record system. 

The absence of developed medical records system in the districts has 

caused off beam or incorrect decision making in allocating financial and 

other resources and therefore, a well planned health recording system is 

needed to be implemented. The delay in forwarding Indoor Morbidity 

and Mortality Reports (IMMR) by the hospitals available throughout the 

country should be reduced and the statistical staff and required facilities 

thereto needed to be provided effectively. 

5) Special measures/mechanisms to deal with displacement. 

a) The content and implementation of “Provisional guidelines for 

emergency management of public health problems of the IDPs” 

should be developed. 

Regarding the content, health aspects on personal hygiene, 

Provision of maternal and child health care services, 

immunization is not addressed in this guideline as it is 

71

elaborated in the “Guidelines for management of public health 

effects in the community following Tsunami disaster”. These 

aspects are of very much importance during and post disaster 

periods and this type of guideline or circular should address 

those factors too. In implementing, firstly, these types of 

guidelines should guide all the districts where there are 

considerable numbers of IDPs. Secondly, the issuing authority 

of these guidelines is the Chief Epidemiologist and it is 

suggested that if it is issued in a manner of a “circular” by the 

Director General of Health Service, it would be more 

enforceable. 

In addition, if a hand book could be prepared with all necessary 

factors to be considered in assuring the health of the people in 

disasters it would benefit the displaced people and the 

humanitarian aid workers in discharging their activities. Such 

hand book should consider the standards mentioned in 

“minimum standards of Sphere Principles”, and etc. It will 

definitely make the monitoring process much easy. The 

participation of other departments within the Ministry of Health 

in drafting the hand book is necessary since each department is 

responsible for different activities. 

a) The health information system following a disaster should be 

more strengthened and alternatives ways should be used to 

contact the people in the cases of daily visits are not possible. 

b) Auniform guideline is recommended to cover all types of health 

hazards in all types of displacements since the different type of 

displacements have been addressed differently by the health 

authorities. However, if the Tsunami circulars equally 

applicable to conflict affected IDPs, it should be clearly 

demonstrated by another official document and it should be 

distributed among all affected MOH areas and to the all level of 

community health workers in their languages. 

c) The activities and services of the “Disaster Preparedness and 

Responses Unit” of the Ministry should publish among the 

displaced community and other stakeholders so as to make easy 

access to those services. 

73

e) In the cases of security problems and problems regarding long 

distance, mobile clinics both curative and preventive should be 

held in WCs or resettled areas, considering the need of the 

people with support of DPDHS, MOH and NGOs. i.e. it is 

suggested to conduct the clinics twice a month immediately after 

the displacement and subsequently it can be increased or 

reduced based on the requirement of the clinic. 

f) The curative heath of children, pregnant mothers, disabled and 

elders should be assured and their access to health clinics should 

be given a paramount concern. 

g) Public transport facilities should be made available with enough 

security to the people at least in the days of conducting clinics at 

hospitals. 

h) The maintenance of living standards is WCs and in resettled/ 

relocated areas has to be carried out with a proper coordination 

between public health workers and relevant local government 

authorities, according to the accepted norms and minimum 

standards. Especially, a well planned garbage disposal system 

should be followed with the coordination of both parties. 

i) The availability of curative health care facilities and the lowest 

distance to the nearest center and availability of drinking water, 

sanitation facilities, drainages and the suitability of the slope of 

the land in selecting temporary sites and in planning relocation 

and resettlement for of IDPs should be key factors in deciding 

locations for IDPs. 

6) The quantity and nutrition status of dry ration to be 

increased. 

a) Though the quantity of dry ration has been increased, by the 

Circular (2007) of Ministry of Resettlement and Disaster Relief 

Services, it is not activated yet. The quantity of dry ration is still 

remained as issued under the 1995 circular, even after economic 

situation is completely different from the situation in 1995. 

Therefore the 2007 circular (No: NDRSC 2007/10) should be 

implemented as soon as possible. 

73

) Regarding the quality of dry rations, a constant inspection and 

monitoring system should be carried out in order to check the 

quality of the dry ration of MPCS. The irregularities in issuing 

dry ration should be cured with enough monetary allocations to 

meet sudden displacements. 

6) Special concerns for the nutritional status of vulnerable 

groups. 

Especially, special concerns should be made to improve the 

nutritional status of vulnerable groups such as, women and 

children. The nutritional packages such as “Poshana Malla” 

should be made available to the displaced pregnant women 

without considering the fact that they are having “dry ration” 

instead of “Samurdhi”. 

8) Promote health education among IDPs. 

Unhealthy practices such as open air defecation still happens 

and proper involvement of community health workers is 

essential in this regard. Health education, therefore should be 

promoted as soon as the displacements and also during the 

process of relocation, resettlement and return. Regarding risk of 

sexually transmitted diseases as AIDS, the target group should 

be given advices by community health workers regularly. In 

addition to the promotion of education, adequate facilities 

should be provided to ensure the health of the people. Facilities, 

such as making available adequate toilets, water, washing 

facilities and etc should be provided. 

9) Inclusion of Right to health in the Constitution 

Inclusion of right to health in the Constitution as a basic right is 

recommended having understood the importance of health to the 

life and to live in dignity. This is once tried in Draft Constitution 

of 2000 byArticle 25 and under that every citizen has the right to 

access to health care services including emergency medical 

treatment and sufficient food and water. Therefore incorporation 

of right to health in the Constitution and progressive realization 

74

of that right by the government is recommended because then the 

uncertainty to make that right justicaible will be over.

Annexure 

Annexure 1 

IDPs Population Figures in the Districts 

The District 

IDPs Population(as at IDPs Population (31.06.2008) 

01.01.2008) 

Mannar 46,735 30,112 

Vavuniya 47,142 82,176 

Trincomalee 25,623 17,965 

Batticaloa 54,189 18,171 

Anuradhapura 9,912 15,120 

Puttlam 63,016 61,274 

Total 246,617 224,818 

Source- District Secretariats of the relevant districts. 

Annexure II 

Minimum Standards of the Basic Needs 

S.N 

O 

Subject Standard of UNHCR Standard of Sphere 

principal 

01 Minimum surface for the person 45m 2 – 30m 2 45m 2 

02 Minimum shelter space for the person 3.5m 2 3.5m 2 

03 Minimum site for a family 500Sq/ft 

04 Minimum site security area away from 50Km 

conflict area 

05 Minimum food energy requirement for 2,100Kcal 

2,100Kcal 

aperson 

06 Minimum food assuming per person for 

aday 

350 – 

400g/person/day of 

staple cereal 

20 – 40 g/person/ day 

of an energy rich food 

(oil, fat) 

50g/person/day of a 

protein rich food 

(legumes) 

Protein–12%(52g–63g) 

Fat – 17%(40g) 

Vitamin A - 0.5mg 

ThiamineB1–0.9mg 

Riboflavin B2 – 0.6mg 

Folic acid – 160g 

NiacinB3–6.6mg 

VitaminB12–0.9ug 

Vitamin C – 28mg 

VitaminD–3.2–3.2ug 

calciferol 

Iron–22mg 

76

07 Nutrition standard Emergency level > 

15% of the population 

under five years old 

below 80% weight for 

height 

Or 

10% of the population 

under five years old 

below 80% weight for 

height together with 

aggravating factors. 

08 Crude Mortality rate (CMR) 

Normal rate among a settled population 

Emergency programme under control 

Emergency programme in serious 

trouble 

Emergency out of control 

Major catastrophe 

09 Mortality rate among children under 5 

years old 

Normal rate among a settled population 

Emergency programme under control 

Emergency programme in serious 

trouble 

Emergency out of control 

0.3 to 0.5 / 10,000/ 

day 

1/10,000/day 

>2/10,000/day 

>5/10,000/day 

1/10,000/day 

2/10,000/day 

>4/10,000/day 

10 Minimum water needs for a person 7 Litres/person/per 

day 

11 Minimum water needs for health centre 40- 

60Litres/patient/per 

day 

12 Minimum water needs for feeding 

centre 

CMR is maintained at or 

reduced to less than twice 

the baseline rate 

documented for the 

population prior to the 

disaster 

15 Litres/per/person/day 

(Include drinking, cooking 

&personalhygiene 

40-60Litres/patient/per day 

20- 

30Litres/patient/per day 

30Litres/patient/per 

day 

1 per 200 persons 1 per 250 persons 

13 Maximum number of persons per Tab 

stand 

14 Maximum number of persons per Hand 1 per 200 persons 1 per 400 persons 

pump or dug well 

15 Minimum distance between shelter and 100m 

water tab 

16 Concentration of faecal coli form are 

usually expressed per 100ml of water Faecal Coli form Microbiological water 

Water Quality 

/100ml 

quality faecal coli form 

a. Reasonable quality 

1–10 

bacteria (>99% of which 

b. Polluted 

10–100 

are E.Coil) 

c. Very polluted 

100–1000 

Chlorine residual at the 

d. Grossly polluted 

> 1000 

tab: 0.5mg per litre 

17 Minimum Latrine facilities for persons 1 Latrine for 20 1 Latrine for 20 persons 

77

Annexure III 

Statistics relating to Public Health Midwifes in Vavuniya 

PHM Area 

Current 

Population 

Actual 

number of 

officers 

required 

according to 

the 

population 

The 


officers 

attached 

to each at 

present 

area 

The 


vacant 

positions 

01 Kovil Kulam 4309 01 01 - 

02 Vavuniya Town 4468 01 - Vacant 

03 Vairavapuliyankulam 7046 02 01 - 

04 Vavuniya North 6349 02 01 - 

05 Thanddikulam 4569 01 - Vacant 

06 Rambaikulam 5279 01 - Vacant 

07 Thonnikkal 12299 04 01 - 

08 Moonrumuripu 2543 01 01 - 

09 Pandarikulam 15374 05 01 - 

10 Sithamparapuram 3934 01 - Vacant 

11 Samalankulam 5279 02 01 - 

12 Koomankulam 11008 04 01 - 

13 Nellukkulam 9444 03 01 - 

14 Rajendrankulam 4146 01 01 - 

15 Pambaimadu 4646 01 - Vacant 

16 Poovarasankulam 4105 01 - Vacant 

17 Nochchimoddai 3711 01 01 - 

18 Sasthirikoolankulam 9659 03 01 - 

19 Maha Rambaikulam 12042 04 01 - 

20 Palamoddai 4057 01 - Vacant 

21 Semamadu 4773 01 - Vacant 

22 Omanthai 3092 01 - Vacant 

23 Echchankulam 10580 03 01 - 

Source- DPDHS Office Vavuniya as at July 2007 

78

MOH Office Carder Positions in Vavuniya as at 31.07.2007 

S/No 

DS Division 

MOH PHI PHM 

Cadre Present Cadre Present Cadre Present 

Strength 

Strength 

Strength 

01. Vavniya 2 2 9 6 23 14 

02. Vavuniya South 1 1 2 2 6 3 

03. Vengalacheddik 1 1 2 2 6 2 

ulam 

04. Vavuniya North 1 1 2 2 6 3 

Total 5 5 15 12 41 22 

Source- DPDHS Office Vavuniya 

Annexure IV 

MOH Office Carder Positions in Vavuniya as at 31.12.2007 

S/No 

DS Division 

MOH PHI PHM 

Cadre Present Cadre Present Cadre Present 

Strength 

Strength 

Strength 

01. Vavniya 2* 1 9 6 23 23 

02. Vavuniya South 1 1 2 2 6 6 

03. Vengalacheddik 1 1 2 2 6 6 

ulam 

04. Vavuniya North 1 0 2 0 6 2 

Total 5 3 15 10 41 37 

Source- DPDHS Office Vavuniya 

79

Annexure V 

Carder position as at September 2007-Trincomalee 

MOOOH 

AMOH 

Management Assistant 

SPHI 

PHI 

PPA 

OL 

SL 

Driver 

Watcher 

KKS/OES 

SDT 

SD Labourer 

PHNS 

SPHM 

Programme Assistant 

PHM 

PPHM 

Total 

MOH Office 

C 1 1 2 10 1 1 1 2 1 1 1 1 2 2 2 30 59 

1 Trincomalee I 1 1 1 1 7 1 4 2 1 2 1 1 20 8 51 

C 1 1 1 5 1 1 1 1 1 1 1 1 2 2 1 15 36 

2 Kantlai I 1 1 1 1 3 1 4 1 1 1 21 36 

C 1 1 1 5 1 1 1 1 1 1 1 1 2 2 1 17 38 

3 Muthur I 1 1 1 6 4 1 1 1 10 4 30 

C 1 1 1 6 1 1 1 1 1 1 1 1 2 2 1 12 34 

4 Kinniya I 1 1 1 7 2 3 1 1 1 9 22 49 

C 1 3 1 1 9 15 

5 Thampalagamam I 1 1 3 3 1 1 9 3 22 

C 1 1 1 1 1 1 1 1 1 1 1 1 2 2 1 5 22 

6 Padavisripura I 1 1 1 1 1 2 1 8 

C 1 2 1 6 10 

7 Seruwila I 1 1 2 2 1 4 11 

C 1 2 1 1 11 16 

8 Kuchchaveli I 3 1 2 1 5 7 19 

C 1 1 1 1 3 7 

9 Gomarangadawela I 1 1 1 1 4 

C 1 1 1 4 7 

10 Morawewa I 2 2 

C 1 1 1 3 6 

11 Ichchilampathai I 1 1 4 6 

25 

Sub Total C 10 0 5 6 37 10 5 5 6 5 5 5 5 10 10 11 115 0 0 

I 9 2 5 7 33 0 5 23 6 6 4 2 0 2 0 2 83 49 

23 

8 

Source- DPDHS Office-Trincomalee 

80

Annexure VI 

Ministry of Healthcare & Nutrition 

Epidemiological Unit 

231, de Saram Place, Colombo 01000, Sri Lanka 

Telephone: Epidemiologist :(+94-11-)2681548, Epid unit: (+94-11-) 

2695112 Fax: (+94-11-)2696583, E-mail: chepid@sltnet.lk 

and epidunit@sltnet.lk 

_____________________________________________________ 

My No. EPID/22/2007 

19 April 2007. 

Deputy Provincial Director of Health Services, 

Batticoloa. 

Provisional Guidelines for Emergency Management of Public 

Health Problems of the Internally Displaced People 

The following provisional guidelines are recommended to minimize the 

adverse public health impact and to prevent the spread of communicable 

diseases of the displaced population living in temporary shelters. 

1. Ensuring safety of water 

Ensure adequate supply of safe drinking water. If pipe-borne 

water is not available, water to be collected in tanks or barrels 

and chlorinated. 

Co-ordinate with the Divisional Secretary to ensure that water 

supplied by local authorities and other sources is properly 

chlorinated before distribution. 

2. Ensuring safety of food 

Co-ordinate with the Divisional Secretary to ensure that food 

supplied by local authorities and other sources are hygienically 

prepared before distribution. 

Ensure all the food supplies to the displaced are hygienically 

stored, prepared and distributed. 

Strictly monitor the preparation of food in food handling 

establishments. 

81

3. Safe disposal of excreta 

Ensure adequate sanitary facilities at all temporary camps for 

the displaced. Where necessary, make arrangements to 

construct adequate number of temporary latrines according to 

the guidelines. 

4. Disposal of refuse 

Co-ordinate disposal of garbage by sanitary burial or burning in 

suitable adjacent areas of temporary shelters. 

Control flies, insects and rodents by proper use of physical and 

chemical methods (insecticides and TCLpowder). 

If garbage is removed daily by the local authorities using 

tractors, ensure enough barrels (garbage bins) are available in 

the temporary shelters for collection of garbage. 

5. Treatment and management of minor ailments 

Co-ordinate with the local medical institutions/authorities to 

establish mobile medical teams to visit temporary shelters for 

the displaced daily and provide treatment. 

Refer and transport those that require institutional care. 

6. Prevention and control of potential outbreaks 

In a case of diarrhoea in particular, prompt action must be taken 

to ensure early treatment and prevention of further spread. 

In case of contagious diseases such as acute respiratory tract 

infections and chickenpox, these cases should be isolated and 

referred to hospitals if necessary. 

Steps should be taken to control mosquito breeding to prevent 

and control mosquito borne diseases such as dengue, malaria 

and JE. 

7. Disease surveillance 

MOH/PHI should visit the camps daily to inquire into unusual 

occurrence of disease events/outbreaks. 

Collect and report data related to health events in camps 

according to the format provided by the Epidemiology unit 

(annexure). 

MOH should consolidate the above data weekly and send a 

consolidated report to RE with a copy to Epidemiology Unit 

(annexure). 

82

The above guidelines should be carried out by Public Health Inspectors 

and other field health staff under the supervision of DDHS/MOH. It is of 

uttermost importance that the DDHS/MOH takes a personal interest in 

these activities.Asatisfactory outcome will depend on the enthusiasm of 

the DDHS/MOH as well as his/her team. 

In order to carry out the above, it is strongly recommended that a 

committee should be formed in each and every camp, comprising of 

selected responsible persons, village leaders and field level 

governmental and non-governmental officials. 

In addition, RE would be responsible for overall monitoring and 

supervision of above activities carried out in the DPDHS division, with 

the guidance of PDHS, DPDHS and the Epidemiologist. 

Dr. P. Palihawadana 

Deputy Epidemiologist 

CC: 

Addl. Secretary, Ministry of Healthcare & Nutrition 

Director General of Health Services 

Deputy Director General (Public Health Services) 

Provincial Director of Health Services, Eastern Province 

Regional Epidemiologist, Batticoloa 

MOH Batticoloa, Chenkalady, Kaluvanchikudy, 

Valaichchenai, Kathankudy, Eravoor, Pattipalai, Vavunativu, 

Vakarai, Vellaveli, Ottamavadi 

83

Annexure VII 

Health Indicators 

Island wide data 

Data of Districts 

Vavu 

Tri’ 

male Manna Puttala 

Indicators Data(000) Year Source niya A’pura e r Batti mm 

Total Mid year population (000) 19,668 2005 RGD 145 782 838 99 549 737 

Total Number of Births 370,424 2005 

1275 

RGD 3465 15092 8415 2062 113330 

Crude Birth Rate (per 1000) 18.8 2005 RGD 18.3 19.5 21.2 18.3 21.2 18.1 

Total Number of Deaths 129,822 2005 RGD 665 3962 1817 331 4509 3324 

Crude Death Rates (1000 population) 6.6 2005 RGD 4.6 5.1 4.7 3.3 8.2 4.5 

Neonatal Mortality Rate (per 1000 Live Birth) 9.2 2003 RGD 5.2 17.6 1 5.8 15.3 5.6 

Infant Mortality Rate (per 1000 Live Birth) 11.2 2003 RGD 6.8 19.4 2.5 2.6 19.6 5.9 

Maternal Mortality Rate (per 1000 Live Birth) 38 2004 FHB 68.7 22.7 23.6 DNA 81.2 43.7 

New acceptors Rate for family planning 75 2005 FHB 91.7 44.2 42.7 51.5 68.4 

Percentage of teenage pregnancy 6.2 2005 FHB 4.9 8 10.5 7.7 9.5 10.3 

Percentage of mothers Registered before 12 weeks 

of POA 

75.4 2005 

FHB 42.3 84.1 50.1 58.5 63.9 74.8 

Percentage of pregnant women protected with 

rubella 

87.3 2005 

FHB 50.9 93.5 54.2 45.6 70.7 82.7 

Percentage of low birth weight 16.9 2005 DHS 13.6 16.9 12.2 6.6 20.2 13.6 

Percentage of Mother Received post partum Care 

during 1st 10 Days of Delivery (out of Estimated 

Births) 

67 2005 

FHB 11.2 68 44.5 41.6 70.2 78 

Percentage of infant Weighted below 3rd centile 8.9 2005 FHB 13 7.3 10.1 7.2 11.9 6.1 

Percentage of Children 1-3 years below 3rd centile 24.9 2005 FHB 28.8 24.4 34.9 25.8 36.2 15.3 

Percentage of Children 3-5 years below 3rd centile 27.4 2005 FHB 32.3 25.9 36.8 28.7 40.3 15.9 

Coverage School Medical Infection 98.5 2005 

FHB 87* 80 77 94 100 

Number of Functioning Well women Clinic 426 2005 FHB 0 14 12 17 5 10 

Source- http://www.familyhealth.gov.lk * Including data from Mannar 

84

Annexure VIII 

Statistics relating to malnutrition of the children in Vavuniya 

Age 

No. of those 

who came 

to weigh 

the 

children. 

No. of those 

in normal 

weight 

(N). 

No. of 

under 

growth 

children 

(O). 


children 

under 

weight 

(X). 


children 

under 

growth and 

under 

weight 

(OX). 


children 

below 

under 

weight 

(XX). 

Months 0-04 368 306 09 29 18 15 

Months 05-09 596 388 37 68 65 39 

Months 10-12 358 179 18 74 45 42 

Months 13-17 558 193 34 99 122 110 

Months 18-24 786 327 54 139 98 173 

Months 25-35 1179 487 86 193 153 261 

Months 36-42 861 342 41 140 137 203 

Months 43-60 1911 730 102 258 296 516 

Total 6617 2952 381 1000 934 1359 

Source- DPDHS Office - Vuvuniya 

Annexure IX 

Details of New born children who are in underweight (less than 

2.5Kg) in Trincomalee district 

Year 2003 2004 2005 2006 2007 

N0.of babies 

born with 853 1134 1139 971 964 

low weight 

%of babies 

born with 12.2 16.3 15.7 12.8 14.95 

low weight 

Source: DPDHS Trincomalee 

85

Annexure X 

MCH Clinics at Trincomalee District 

MOH Area 

Total 

no. of 

clinics 

Clinic 

No 

Ante Natal 

Clinics 

Clinic 

session 

per 

month 

Child Welfare 

Clinic 

Clinic 

No 

Clinic 

session 

per 

month 

Family Planning 

Clinic 

Clinic 

No 

Clinic 

session 

per 

month 

WWC 

Clinic 

Clinic 

No 

Registered 

FP Clinics 

Clinic 

session per 

month 

Trincomalee 24 21 31 24 59 5 20 0 3 

Kantalai 11 11 23 10 22 9 20 1 5 

Muthur 

21 10 23 20 29 4 12 0 4 

Ichchilampathai 

Thampalagamam 8 6 18 7 18 7 18 0 3 

Kinniya 15 12 21 14 26 3 12 1 3 

Seruwila 3 3 5 3 5 3 5 0 1 

Kuchchaveli 6 5 12 6 15 4 9 0 4 

Gomarangadawela 1 1 4 1 2 1 1 0 1 

Morawewa 3 2 6 3 5 0 0 0 1 

Padavisripura 1 1 4 1 2 1 1 0 1 

Total 93 72 147 89 183 37 98 2 26 


Annexure XI 

Performance of Well Women ClinicActivities - Trincomalee 

2004 2005 

No. of functioning WWC 01 00 

First Visit 78 26 

Cervical Visualization 23 00 

Diabetes Mellitus 07 00 

Hypertension 09 08 

Breast abnormalities 00 01 

No Pap Smears taken 23 00 

No. Cervical smear reports 

08 00 

received 

Total CIN positives 00 00 


86

Annexure XII 

Registration of Pregnant mothers by Trincomalee RDHS 

Trincomalee 

/ RDHS 

Pregnant 

mothers 

registered 

Pregnant 

mothers 

registered 

under 12 

weeks (%) 

Pregnant 

mothers 

registered 

12-20 weeks 

(%) 

Pregnant 

mothers 

registered 

after 20 

weeks (%) 

2004 6327 53.6 19.2 5.7 10.3 

2005 8136 50.1 18.5 7.6 10.5 

Source: Annual Report Family Health of Sri Lanka (2004 & 2005) 

Teenage 

Pregnancy 

(%) 

87

Article 25 Right to adequate standard of living for health and well-being. 

(1) Everyone has the right to a standard of living adequate for the health 

and well-being of himself and of his family, including food, clothing, housing 

and medical care and necessary social services, and the right to security in 

the event of unemployment, sickness, disability, widowhood, old age or other 

lack of livelihood in circumstances beyond his control. 

(2) Motherhood and childhood are entitled to special care and assistance. All 

children, whether born in or out of wedlock, shall enjoy the same social 

protection 

- Article No.25 - UDHR 

National Protection and Durable Solutions for 



No 65/1, Muththaiyahpillai Avenue, Ward Place, Colombo 07 

Tel : +94112662587, +94112681734 Fax : +94112688145 

Email : hrccidp@sltnet.lk Web : www.idpsrilanka.lk

Right to Health of Internally Displaced Persons - IDP SriLanka

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