Lying howling on a torn mattress, in a cot by a window overlooking the Sri Lankan capital, Colombo, the wounded toddler was a pitiful sight.
A female relative fretted, trying to calm the girl down as the medics worked around her. The 18-month-old had been shot in the stomach in the final stages of the fighting in the north-east of the country and there was an ugly line of stitches across her abdomen where doctors had operated to remove the bullet. Her right leg was missing a chunk of flesh and had been gashed.
The little girl is one of thousands of casualties hidden away from public view in hospitals across Sri Lanka, guarded by soldiers and police who roam the wards. As soon as they are fit enough to be moved, the injured are returned to the grim internment camps that are home to approximately 300,000 people.
Health workers and human rights activists say that the country’s medical services cannot handle the huge numbers of children and adults needing treatment for terrible injuries sustained during the final weeks of the fighting.
But the government appears determined to keep the true scale of the disaster out of the public eye, barring access to the hospitals and arresting three doctors who worked inside the war zone, accusing them of fabricating casualty figures.
According to unofficial UN figures obtained by the Guardian, more than 8,000 civilians were killed in the last four months of the war and more than 17,000 were wounded. The figures do not include those killed and injured in the final three days of the fighting. The Sri Lankan health ministry says it does not have up-to-date numbers.
UN sources say that initial analysis suggests an abnormally high number of child casualties, up to 45% of the overall total; a figure closer to 33% would have been expected. That would mean 3,600 children killed and 7,650 wounded, although some of those are believed to have later died from the injuries because of a lack of facilities to treat them.
After the Sri Lankan president, Mahinda Rajapaksa, claimed last week that victory was achieved without spilling a drop of civilian blood, the Guardian managed to gain access to the Lady Ridgeway hospital for children in Colombo on Saturday and spoke to staff to try to assess the true picture.
The ward on the sixth floor, where some of the most seriously injured children are being treated, was a depressing sight. Small children with amputated limbs, gunshot wounds and burns lay in cots around the ward.
The matron said they had received many such cases, brought down from the war zone for treatment in the specialist children’s hospital, but she could not say how many. "This girl was shot in the stomach," she said, gesturing to the child screaming in the cot by the window. "The stitches are from where the doctors removed the bullet."
Other children sat on chairs at the side of the ward, a girl with her arm in plaster, a boy with what appeared to be burns. Others lay in cots with gauze and bandages on their wounds. The wards were clean and tidy and the staff attentive, fussing over their patients, the nurses wearing immaculate uniforms. They appeared surprised to receive a visitor as the ministry of defence had repeatedly refused requests for permission to enter the hospital.
The matron said the children would be treated and then sent back with their parents to the camps around Vavuniya in northern Sri Lanka once they were well enough to be moved. It was not possible to establish how each child had received its injuries and from which side in the conflict.
Staff would not allow the patients or their relatives to be interviewed without the permission of the hospital director, who refused and ordered the Guardian to leave.
But according to others who have been into other hospitals around the country, the situation is the same everywhere.
Wards are packed with the casualties of the war, with doctors struggling to cope with the sheer volume of casualties.
"Children have suffered horrendously and disproportionately," said James Elder, Unicef’s spokesman in Colombo. "The medical system is stretched to breaking point dealing with children who have been injured."
He urged the government to allow injured children and their parents to leave the camps so that they could recuperate in a more appropriate environment.
Bhavani Fonseka, from the Colombo-based Centre for Policy Alternatives, said that the government appeared determined to prove that fewer people had been killed and injured than was reported while the fighting was going on.
"There is a policy of don’t talk, keep it under wraps," she said. "But the truth is that there are so many injured that they have had to ship them to hospitals around the country. It is huge numbers if you look at the kids spread around the hospitals."
Fonseka, who had visited two hospitals, said she had seen children with both legs or both arms amputated. "We are going to have a generation of amputees," she said.
She added that the situation was made worse for some of the traumatised children because they were being guarded by members of the same armed forces who were responsible, in some cases, for their injuries.
The UN is understood to be concerned about the lack of medical facilities inside the camps and at the government’s reluctance to make proper use of outside help.
During a visit to the internment camps on Saturday, the UN secretary general, Ban Ki-moon, met one young girl with wounds to both her legs. She told him that she had been hit by shrapnel but that there were no medical facilities in the camp where she could undergo surgery and no pain relief available.
Meanwhile Rajapaksa rejected an appeal by Ban to lift restrictions on aid delivery to the overcrowded camps.
The president said that security had to be assured "in view of the likely presence of LTTE [Tamil Tiger] infiltrators" among the refugees.
"As conditions improved, especially with regard to security, there would be no objections to such assistance, from organisations that were genuinely interested in the wellbeing" of the displaced Tamils, he said.
In a separate development a statement from the LTTE confirmed for the first time that their leader, Velupillai Prabhakaran, had been killed. The body of Prabhakaran was produced by the Sri Lankan army last week. Pictures showed him lying with eyes open and a cloth covering an apparent deadly head wound.
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