IV. Humanitarian Access

The humanitarian needs of the more than 2o0,000 civilians trapped in the Vanni have only grown more acute since Human Rights Watch's December 2008 report documenting these needs in detail.[63] According to a February 6 statement by the World Food Program (WFP): "Livelihoods have been almost completely lost, exacerbating the general food insecurity, and traditional coping mechanisms have been exhausted. People depend almost entirely on humanitarian food assistance for survival."[64]

International aid agencies have had very limited access to the Vanni since the Sri Lankan government ordered the UN to leave the region in September 2008.[65] The government has permitted food relief to be delivered, but it has not allowed international aid workers to remain on the ground to ensure that the aid is reaching the population at risk. Since September, the WFP has delivered 8,300 metric tons of mixed food commodities to the area in 11 separate convoys. Since January 16, the WFP has been unable to deliver any food to the area, citing "heavily mined roads and lack of sufficient security guarantees." At this writing in mid-February, a government-organized convoy of 13 trucks carrying 153 metric tons of WFP food into the Vanni area on January 29 was the last food convoy to reach the area.[66]

On February 10, an international agency received information from its staff, which had relocated to a place along the coast, that the only supplies that they had left were rice, flour, and oil. They had run out of water and the nearest water was 1.5 kilometers away. Walking there was extremely risky as the area was frequently shelled-an artillery shell had recently landed just 100 meters from the agency's bunker.[67]

A source indicated to Human Rights Watch that one of the main reasons for the difficulty in organizing convoys in and out of the Vanni was that the SLA and the LTTE  were unable to agree on the route to be used. Seeking to use the humanitarian convoys to advance their military positions, both sides insisted on different routes, blocking the delivery of much-needed aid to thousands of civilians.[68]

One individual who joined convoys delivering food supplies on December 23 and 29 said that Sri Lankan government troops used the convoys moving northwards to advance closer to LTTE positions. He told Human Rights Watch that on December 29:

We got to the last SLA checkpoint near Oddusuddan from where the ICRC was supposed to accompany us through no-man's land to the LTTE checkpoint 13 kilometers south of PTK. As soon as we passed the SLA checkpoint, military vehicles joined the convoy and followed the convoy on both sides. LTTE saw it and started firing. The army returned fire and the convoy had to stop for one hour. At this time nobody was injured, but when the same thing happened to the GA [government] convoy the next day, their driver was injured in crossfire.[69]

A second source confirmed that the SLA had used the convoy on December 29 to advance its position, saying that "long lines of SLA troops were walking alongside the convoy."[70]

Beyond shortages of food and water, lack of medical supplies-also due to restrictions on humanitarian access-has been sharply felt at the remaining treatment centers. ICRC spokeswoman Sophie Romanens, while noting that many patients have been evacuated recently, described the situation at the Putumattalan makeshift hospital as critical: "What our people are saying is that people injured by the fighting are coming in [to the makeshift hospital] by the dozen every day. People are still being injured by the fighting and they just can't get the medical treatment that they need there. It is not a hospital…. For them, it is a matter of life and death."[71]

Similar problems have prevented international organizations from evacuating patients and medical staff from the war zone. This has included evacuating patients from the PTK hospital, which came under repeated shelling from Sri Lankan forces. "Premkumar" told Human Rights Watch:

On January 26, the patients [at PTK hospital] were loaded onto trucks to be evacuated. They were unloaded, however, shortly afterwards. Some said that the LTTE had refused to allow the convoy to pass. Some say that the SLA was to blame. Being loaded and unloaded like that was very painful to the patients.

Another source confirmed to Human Rights Watch that about 50 patients were loaded onto the trucks around 11 a.m. on January 26. They were unloaded about three hours later, however. One woman died from her injuries just 10 minutes after she had been loaded onto a truck.

The ICRC was finally able to escort 226 sick and wounded patients requiring urgent medical attention from PTK hospital on January 29. Despite repeated requests from the ICRC, government forces and the LTTE did not grant safe passage to evacuate additional patients and medical staff for nearly two weeks, forcing patients and medical staff to evacuate to the Putumattalan make-shift hospital on February 4.[72] Finally, on February 10 and 12, the ICRC evacuated more than 600 patients by boat from Putumattalan to the district capital of Trincomalee, far away from the fighting.[73]

Under international humanitarian law, the government is responsible for meeting the humanitarian needs of the war-affected population. Parties to an internal armed conflict-in this case the Sri Lankan government and the LTTE-must allow humanitarian relief to reach civilian populations that are in need of food, medicine, and other items essential to their survival.[74] If the government is unable to fully meet this obligation, it must allow the humanitarian community to do so on its behalf. Parties to a conflict must ensure the freedom of movement of impartial humanitarian relief personnel-only in cases of military necessity may their activities or movements be temporarily restricted.[75]

The UN Guiding Principles on Internal Displacement provide authoritative standards on the obligations of governments to internally displaced persons. Under the principles, the authorities are to provide displaced persons "at a minimum" with safe access to essential food and potable water, basic shelter and housing, appropriate clothing, and essential medical services and sanitation.[76] Many of these needs are not currently being met in the Vanni, as documented above and in Human Rights Watch's December 2008 report.