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BackgroundThree decades of internal conflict, displacing 300,000 civilians, in the Northern and Eastern Provinces of Sri Lanka ended in May 2009. Civilians affected by the fierce fighting in the proceeding months were ushered by the military into internally displaced persons (IDP) camps in an area called ???Manik Farm??? in Vavuniya District until they could be resettled. The Ministry of Health led the provision of health services to the displaced in coordination with the humanitarian health cluster at the national and field level immediately after of the war.MethodsThe Ministry of Health plans and reports were reviewed, along with reports from health sector partners and national and international guidelines on coordination in humanitarian relief operations. The way the Ministry of Health coordinated with health sector partners via the health cluster was different from other coordination models where military and civil administration were involved in providing humanitarian relief also was compared.ConclusionsThe review shows that the health sector coordination mechanism adapted in Sri Lanka had a clear leadership and guidance for health sector partners according to national plans and frameworks. It was indicated by better health outcomes like mortality and morbidity among displaced population in IDP camps in Manik Farm.

Asian tsunami in 2004 had a tremendous impact on the health system of Sri Lanka leaving many healthcare institutions damaged in the costal provinces and destabilizing the healthcare delivery network. Immediately after the tsunami, health authorities in Sri Lanka realized, health workers should be prepared well if they are to face any future disasters successfully. In this background, the Ministry of Health set its agenda to train all levels of health cadres on disaster preparedness and mitigation whenever there are opportunities. Ministry of Health established the Tsunami Rehabilitation Unit (TRU), later renamed as Disaster Preparedness and Response Unit (DPRU) and mandated it to prepare the health sector for future disasters. During a disaster, well trained health cadre is an asset to any health manager facing the burden of the emergency at the ground level. Trained health personnel on disaster management become a human resource multiplier to fill the gaps of scarce skilled health staff in the field operations. We reviewed the Ministry of Health reports, plans, meeting minutes, reports of training institutions, routine reporting from Ministry of Health departments and reports from health sector partners to compile and then analyze to construct this case study. We provide an overview of how DPRU coordinated and used the opportunities following Tsunami 2004 and then during the humanitarian crisis at the end of 30 years of armed conflict in 2009 to train the health staff. This case study also describes how DPRU networked with government and non governmental organizations to train the different categories of government health staff.

AimsThis paper examines the coordination framework and interventions undertaken by the Sri Lankan health sector in providing essential health services to the displaced communities in the aftermath of the violent conflict in 2009. The narrative describes, in a chronological format, the strategies and actions undertaken by the health sector in response to a rapidly changing humanitarian crisis. The paper examines some of the key challenges faced by the health sector in the post-conflict recovery phases, the most pertinent being the human resources for health needs.MethodsA review of Ministry of Health departmental meeting minutes/circulars, inter-agency health coordination meeting reports, weekly surveillance reports, inter-agency/agency assessments, media files, and donor and health cluster member reports were compiled and then analyzed in order to construct a narrative on how the Health Sector responded to the humanitarian crisis (from acute emergency phase to the post-conflict recovery and resettlement phase). The authors also were integrally involved in the planning, development, implementation, and monitoring of a spectrum of health sector interventions during the humanitarian crisis from within Government and the United Nations system.RecommendationsA health systems strengthening approach, which places emphasis on human resources for health, can be effective in delivering high impact, sustained, high quality health care even in difficult and complex humanitarian emergencies such as civil war. The Sri Lankan experience has shown that harnessing effective human resource management stratergies in crisis also is vital for the post-conflict health system recovery phase that follows.The excuse that ???the system may be too overwhelmed???; or health departments ???too overstretched??? to lead a coordinated effort can be mitigated with positive leadership and planning. The dividends of working in such an approach also ushers reconcilliation via a unified health workforce and promoting the idea of health as a bridge for peace.