As heavy fighting continues in northern Sri Lanka, over 200,000 civilians remain trapped in the conflict in the Vanni region. But, over the past few weeks, some 35,000 people have managed to flee to the city of Vavuniya, 80 km south of the conflict zone. They tell of a beleaguered population living under constant threat of shelling and surrounded by the bodies of the dead and wounded. Food and drinking water are scare, and there is almost no access to medical care. Here are some of their stories.

Patient 1: A risky escape

Five-year-old R. lies asleep on the hospital bed. His eight-year-old sister lays her head on the bed and stares blankly ahead of her. The little boy is suffering from a gunshot wound in his leg. A dressing has been tightly wrapped around it.

The family arrived at the hospital on Feb. 8 after fleeing the conflict zone. Both the father and son had been shot at by soldiers in the panic and chaos of crossing frontlines to reach government-controlled areas.

The family was trapped for weeks in the rebel-held pocket. Forced to flee because of constant shelling, they were displaced several times. From Mankulam, they fled to Udayarkaddu, where they spent ten days under daily shellfire, hiding in bunkers they dug for themselves in the ground.

"It was terrifying. People got killed every day. We had no water, no food, no drugs," recounts his mother. By that time, there was no money left. Her teacher's salary had not been paid for two weeks. "When my daughter got sick, we realised we had to get out of the bunker to get some medicines. It was very dangerous. Every day we asked my husband what would happen to us. Would we just stay and die here?"

Knowing the army wanted the population to reach a transit camp in Visuvamadhu, the family crossed the frontlines with a large group of people. To flee faster, they decided to leave on motorbikes.

"People ran with a white flag towards the government-held area. We were on separate motorbikes. I was behind with my daughter and my husband was ahead of us with my son. The soldiers were surprised and shot both my husband and son before they realised we were just civilians fleeing the conflict zone."

When the soldiers realised, they sent the family to an army hospital from where they were transferred to Vavuniya for emergency treatment. Her husband is being treated in the next ward.

Patient 2: Shelled and shelled again

C., aged 15, was injured in the conflict area when a shell fell close to the bunker where she and her family were hiding. All the family's four children were wounded, but she sustained the most serious injuries.

Thrown out onto the side of the road by the blast, the girl called for help. Around her, everybody was running in panic as the shelling continued. Only after the third attack were her cries for help heard. "There were three consecutive shelling attacks and it took three hours before my daughter could be rescued by some youngsters," explains her mother.

C. was transported to a local hospital but by that time she had lost a lot of blood. She needed to be referred to PTK hospital, the only health structure in the conflict area with the capacity to provide emergency care.

"The hospital was shelled too, the blasts were terrifying. Now that we have reached Vavuniya hospital and are safe, I still can't stop jumping every time something falls on the floor," the mother admits.

On the bed, her teenage daughter is crying. Her leg is immobilised in a thick dressing and she tries in vain to find a position on the bed that will ease the pain. Her mother strokes her hair, trying to comfort her while gently redoing her plaits.

After all, not so long ago C. was just an ordinary schoolgirl.

Wounded on Jan. 11, she did not manage to reach Vavuniya hospital until two weeks later, when the Red Cross was able to evacuate seriously injured patients after the hospital was repeatedly shelled.

Her left leg has sustained skin damage and her right leg has bad fractures. The bone structure of the pelvis and her thigh was also damaged. Part of her leg had to be repositioned. The surgery was extremely painful, and her left leg is now shorter, leaving her with a limp for the rest of her life.

"I'm not crying because of the pain, but because my brothers and sisters are still in the conflict zone," she explains in broken sentences. Her mother, like most people who have made it to government-held areas, is staying in a transit camp. She is desperately searching for her family and trying to get any information she can about her children left behind.

Patient 3: Nowhere safe to go

D., an extremely thin woman, is lying immobile with several dressings on her stomach. She is suffering from an abdominal injury after being wounded by shrapnel. She peers anxiously from under her arm folded over her face, as if to protect herself.

By her side, her 53-year-old mother tells how they were asked to go to Vavipunam in the safe zone on Jan. 19. A few days later, artillery shelling began.

"There was no food and no water. We had left our bunkers in the morning to go to the paddy field to try and get some food, when the shelling started. Out of the 15 family members that were there, three were killed on the spot. In total, 25 people were wounded."

"We took my daughter to a local hospital but that too was shelled. Then we moved to PTK hospital and there again we were attacked."

D. was evacuated by the Red Cross on Jan. 29. Her brother, also wounded, was sent to Vavuniya and then to Mannar hospital. To free up beds in Vavuniya hospital, patients with minor injuries are being referred to other health structures.

On top of being in a lot of pain, the distress of having no news about other family members is almost unbearable.

"The rest of the family is trapped in the Vanni. We were under daily attacks and the fighting still continues. D.'s three-year-old is still in the conflict zone. Her grandfather is now looking after her, or so we think. We don't know if they are alive, wounded or if they have managed to get out. Imagine how we feel."

Medical organisation Medecins sans Frontieres is providing nutritional support and distributing basic relief items to people staying in the government-run camps in Vavuniya. In the hospital, an MSF surgeon, alongside Ministry of Health medical staff, has operated on over 300 patients in the past two weeks. Around 90 percent of the injuries, including gunshot and shrapnel wounds, are a direct result of the fighting. MSF urgently calls on both parties of the conflict to ensure the safety of civilians and allow them access to humanitarian assistance.

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