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SRI LANKA: Return to Ruin

Photo by Jacqueline M. Koch Photo by Jacqueline M. Koch Photo by Jacqueline M. Koch Photo by Jacqueline M. Koch Photo by Jacqueline M. Koch Photo by Jacqueline M. Koch Photo by Jacqueline M. Koch Photo by Jacqueline M. Koch Photo by Jacqueline M. Koch

In January 2008, the war in Sri Lanka had re-ignited, in earnest, forcing tens of thousands from their homes. Thousands of tsunami survivors were homeless again, this time due to the shelling from the renewed military offensive.

The war continued to take its toll. Rural clinics were looted and gutted; doctors were afraid to come to work, and patients struggled to get needed health care. Abduction, and a grim future as a child soldier, were the greatest threats to young girls and boys. For girls in their early teens, there was a choice, and many took it: To marry and start having children.

After the widespread destruction caused by the 2004 tsunami, Sri Lankans along the eastern coast had just a brief taste of peace. After rebuilding their communities, thousands were again displaced again, fleeing their homes as government troops stepped up efforts to root out Tamil Tiger rebels.
As the conflict pushed further north, it pushed the stakes higher for young boys who risked abduction and forced conscription as child soldiers.
Young girls faced the same threat. At 13, Niroshini barely escaped a brutal kidnapping attempt as she walked home from school with friends. Of seven of her friends who were walking home that same day, three were abducted and have never been seen again.
To escape the fate of a child soldier, teenagers like Niroshini and her husband are getting married young and having children. She married three months after escaping the attempted kidnapping. At age 15, she is pregnant. "I feel more secure," she says.
Atchala, 15, cradles her first child. Also a teen war bride to escape forced conscription, she and her family have just returned to their homes after being uprooted in the violence between government soldiers and Tamil Tiger rebels. But returning home, they find their communities and infrastructure destroyed, including clinics that once provided maternal health.
The heavy cost of war is impossible to ignore at a small hospital and materinity home in western Batticaloa. It was robbed and looted and operates without the most basic facilities such as running water or a toilet. Yet over 30,000 people remain dependent on this clinic for health care. Nurse K. Thiruchelvre, heating tea water on an oil drum, says security threats only add to the problem. "Even the midwife left, she was too scared to stay here."
Pregnant mothers who live in areas of recent conflict, where security risks remain high, face additional challenges. They must leave their rural homes for the main town of Batticaloa well before their due date to be closer to a health facility. They stay with family or friends until the day they deliver.
At the Batticaloa Teaching Hopsital, the maternity wards are full. The lack of functioning clinics and health staff in conflict areas forces an added a burden onto an already overwhelmed facility.
Babies are the most vulnerable patients when hospital staff stretched too thin. The risk of hospital-acquired infections rises, usually claiming infants at a disproportionate rate. In one hospital, a baseline study found over 30 percent of babies on a ward had contracted an infection, 90 percent of which were fatal.