As many as 200,000 civilians are trapped in the war zone in northern Sri Lanka, sleeping in the open or hiding in trenches, as food, water and medical supplies run out and artillery shells explode among them, relief agencies said Thursday.
In what it says is a final assault to end a 25-year rebellion, the Sri Lankan military says it has driven ethnic Tamil separatist fighters out of their strongholds and is now battling them house to house in pockets of resistance.
Tens of thousands of civilians have taken refuge on a sandy spit of land between the ocean and a brackish lagoon, with a mined bridge preventing escape from one end and heavy fighting blocking the other, the relief workers said.
“They describe almost constant shelling, spending hours and hours in bunkers,” said Annemarie Loof, the head of Mission Sri Lanka of Doctors Without Borders Holland, who spoke to wounded survivors who had reached a medical center outside the conflict area.
Journalists and relief workers have been barred from the area, but witness reports and amateur video images portray a desperate and brutal battle from which there seems to be no refuge.
“They describe how they spend days on end in bunkers — indiscriminate shelling, people injured and dying around them, no time or space to bury the dead,” Ms. Loof said. “The wounds we see are mostly conflict-related — gunshot wounds and shrapnel wounds.”
The shelling killed a Sri Lankan relief worker with the International Committee for the Red Cross, a spokeswoman for the organization said Thursday.
The government rejects these reports and puts the number of trapped civilians at 70,000. The numbers are impossible to verify, but independent estimates range from 150,000 to 200,000.
According to the Defense Ministry Web site, the army commander, Lieutenant General Sarath Fonseka, told his officers that military operations “should be carried out taking all possible safety precautions with utmost precision” to avoid harming civilian refugees.
“Our progress from now onwards should be made meticulously, taking maximum precautions, keeping the civilian factor in mind at all times,” he said.
The rebels, known as the LTTE, for Liberation Tigers of Tamil Eelam, have been fighting for an independent homeland in northern Sri Lanka after decades of marginalization by Sri Lanka’s Sinhalese majority.
After many failed assaults over the years, the government now says it is close to eliminating the rebels as a regular force, although analysts say guerrilla war and terror attacks are likely to continue.
More than 70,000 people have been killed over the years and tens of thousands wounded or displaced in a conflict that has been characterized by a disregard for the welfare of civilians.
Human rights groups say the recent fighting has taken a high toll on the civilian population as the government pushes the rebels out of their strongholds.
Government shelling has killed and injured thousands, the groups say, particularly in enclaves of refuge like the sandy spit that the government had declared to be “no-fire zones.”
They accuse the rebels of using civilians as human shields, recruiting children as fighters and firing on civilians trying to flee to government-controlled areas.
“The Sri Lankan armed forces and the LTTE appear to be engaged in a perverse competition to demonstrate the greatest disregard for the civilian population,” Human Rights Watch said in a recent report.
The Red Cross has evacuated 2,400 people from the spit of land in eight ferry operations, said a spokeswoman, Sarasi Wijueatne.
The head of ICRC operations for South Asia, Jacques de Maio, said the humanitarian disaster was the worst he had ever witnessed. He said his staff was overwhelmed by the scale of need.
“When we reach the beach with the ferry there are exchanges of fire, there are thousands of people on this beach, they are stranded on basically sand and salty water,” he said.
“When we evacuate them, our people have to select the ones eligible,” he said, “meaning we have to exclude many others. And this is very difficult to handle for people on the ground.”
By boat or on foot, about 35,000 people — the lucky ones — have managed to flee south to Vanuniya, where Doctors Without Borders has a medical unit.
“They are tired, hungry, and frightened, and have no information about their family members who did not manage to escape the conflict zone,” the group said in a report. “Many are injured, some with infected wounds that are weeks old.”
Ms. Loof described one pregnant woman who had lost both arms in artillery fire.
“They did a C-section and the baby came out fine, but after four days in the hospital they had to send her to one of the camps to make way for other patients,” Loof said. “She was crying. She couldn’t even hold her baby, and there was no one to help her. All her relatives were dead.”
The emotional trauma can be harsh as well, relief workers said. “People arrive here in a state of extreme anxiety and fear,” wrote a Doctors Without Borders mental health officer, Karen Stewart, in a recent blog posting.