Checking on the health of children affected by conflict
KILINOCHCHI, 31 October, 2006 - Three-year-old Kisharthan doesn’t quite know why he’s lying on his back on a wooden board. His father’s hand is on his head and a nurse is holding his feet. He looks alarmed and thinks about crying, but before he can start he is whisked up on to his feet again. A midwife notes down a figure on her form and the next child is brought along to the measuring board.
In the Vanni districts of Kilinochchi and Mullaitivu in the north of Sri Lanka, around 67000 thousand people have left their homes in recent months – many of them fleeing from shelling and bombing as fighting broke out between the Sri Lankan Army and the Liberation Tigers of Tamil Eelam. Now UNICEF is assisting the Ministry of Health in carrying out a nutrition survey among the displaced people after reports that parents were having trouble getting enough food.
Data from last year shows that about a third of children under five were already underweight before the current crisis. Agricultural production in the Vanni area does continue despite the recent increase in tensions, but some supplies in the area are running low, and a lack of fuel means that rice milling plants are having difficulty functioning.
The UN’s global Emergency Relief Coordinator Jan Egeland has raised concern about limited access to conflict areas in Sri Lanka, and described the UNICEF-supported nutrition survey and a food security analysis by the World Food Programme as the first needs assessments carried out in the Vanni since the resumption of hostilities in early August.
The survey is focusing on pregnant women, lactating mothers and children under five. Kisharthan is one of the first children in line at the health centre at Mamoolai, not far from the east coast in Mullaitivu district. His father, Logeswayan Vallipuram says he left Jaffna a month ago. “I wanted to look after my son in a place where I didn’t have to worry about shelling and fighting,” he says. “I used to be a driver, but now I’m working as a labourer. If the situation at home becomes normal, I’ll go back,” he says.
Twenty-five mothers sit with small children inside the health centre. Around the walls are posters with messages on child health. A picture book is open, perused by a toddler sitting on his mother’s lap. At the front of the room, mothers fill out a questionnaire, a Public Health Inspector and Midwife in attendance. Ten health workers have been trained by the government-run Medical Research Institute in Colombo in preparation for the survey which will cover around 5000 people across 112 health centres.
Logeswan says that milk powder prices have risen very high. It’s a problem that several mothers mention. Konsi Nadeskumar, who has arrived at the centre with her one-year-old son Nathiyaran, says she has been in the Vanni for three months. “Our home is close to the front lines. Now we’re staying with relatives,” she says. “It’s hard for us to get food because we don’t have any income. We lost our boat and fishing equipment and my husband doesn’t have a job. It’s really difficult to get milk powder and noodles,” she says.
“Under-nutrition is chronic in this area,” says the Mullaitivu Deputy Provincial Director of Health Services Dr TW Jeyakularajah. “People had to leave their own plot of land. If they have to stay away from their homes any length of time, there will be nutritional implications. The sooner they can go home, the better,” he says. He points out that many in the displaced population have experienced this kind of upheaval before. Ten years ago, hundreds of thousands had to flee fighting in the north of Sri Lanka, only returning home several years later.
From the main room, parents enter a side-room for an individual interview before taking their children out to be measured and weighed. One by one, small children are suspended from a sling, which dangles below a circular set of scales. Most of the children find the experience unnerving and begin to cry, but one or two really enjoy themselves, grinning out at the watching adults.
Checking over the process, clipboard in hand, is UNICEF’s Priya Ramanan, one of the team who helped organize the survey. “The aim is to get a clear picture of the needs of the displaced people,” she says. “They answer questions on access to food and to health facilities, as well as access to clean water and toilets, and questions about their feeding habits and so on. From this we can find out the underlying causes of any under-nutrition.”
In Kilinochchi district, the government health workers are also using the survey to hand out corn soya blend and pre-cooked flower supplied by the World Food Programme to supplement parents’ diets. At the Maternity Home in Mulliyawalai twenty-nine mothers are waiting to take part in the survey. Amutharajan Mariyalaisa, holding her one-year-old daughter Ashomitha, is doing better than many. She and her husband are staying with friends after fleeing Jaffna three months ago.
“I was worried that Ashomitha was under weight,” she says. “She’s twelve months old and weighs nine kilos, but I was told that was all right.” She says she’s heard about the problems with milk powder, but for her that hasn’t been an issue. After receiving advice from health workers, she is continuing to breastfeed. She says her daughter’s doing well.