Sri Lanka, Evacuation of the Wounded and Sick

Evacuating the wounded and sick in Sri Lanka: 2009

IHL says

Basic international humanitarian law (IHL) rules applicable to this situation:

Whenever possible, and particularly after an engagement, each party to the conflict must, without delay, take all possible measures to search for, collect and evacuate the wounded, sick and shipwrecked without adverse distinction. 

The wounded, sick and shipwrecked must receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. No distinction may be made among them founded on any grounds other than medical ones. 

The parties to the conflict must allow and facilitate rapid and unimpeded passage of humanitarian relief for all civilians in need, without distinction, subject to their right of control. 

The parties to the conflict must ensure that authorized humanitarian relief personnel have the freedom of movement they need to carry out their work. 

The case in brief

In 2009 there was an escalation of violence in a longstanding armed conflict between Sri Lankan government forces and the Liberation Tigers of Tamil Eelam (LTTE), a non-state armed group. Fierce fighting in the north of the island caused thousands of casualties and left medical facilities without the staff and supplies required to properly treat the wounded and sick. Civilians became trapped in conflict-affected coastal areas without safe routes of escape.

With the agreement of both parties to the conflict, the Sri Lankan Navy and the ICRC conducted a series of sea evacuations, transporting the wounded and sick to fully functioning hospitals in safer parts of the country.

IHL compliance highlights

  1. Recognizing its humanitarian obligations towards conflict-affected civilians and wounded and sick combatants, the Sri Lankan Navy established comprehensive evacuation measures in cooperation with the ICRC, deploying naval personnel and vessels with standby rescue and medical teams in conflicted-affected seas.
  2. Between 10 February and 14 April 2009, Sri Lankan naval ferries chartered by the ICRC safely evacuated more than 7,000 people from Putumattalan, a conflict-affected area lacking functioning medical facilities, to Trincomalee. There wounded and sick evacuees were able to receive appropriate treatment at adequately equipped hospitals staffed by Health Ministry and specialist ICRC medical personnel. 

Case prepared by Angèle Jeangeorge, LL.M. student at Leiden University under the supervision of Professor Robert Heinsch as well as Sofia Poulopoulou and Christine Tremblay, PhD researchers, Kalshoven-Gieskes Forum, Leiden University; with the contribution of Jemma Arman and Isabelle Gallino, LL.M. students at the Geneva Academy.



[Source: ‘Sri Lanka: ever more sick and wounded evacuated from conflict area to hospital’, ICRC Interview (31 March 2009),]
As fighting between Sri Lankan government forces and the Liberation Tigers of Tamil Eelam (LTTE) continue, sick and wounded people continue to arrive at a makeshift health facility in Putamattalan, on the northern Sri Lanka coast. Because of the lack of properly functioning medical facilities in the conflict area, the ICRC has evacuated over 6,600 people – the sick and wounded and their attendants- to Trincomalee district by sea since 10 February. Upon arrival, patients are transferred to hospital for treatment. In Trincomalee Hospital, Ministry of Health staff and the ICRC medical team, consisting of a surgeon […], an anesthetist and a nurse, have threated over 1,900 patients since the first sea evacuation took place.


[Source: ‘Sri Lanka: Navy evacuates 514 civilians, patients from LTTE hostage’, Report from the Government of Sri Lanka (18 April 2009),]
The twenty first batch of 514 patients and civilians was evacuated on board "MV Green Ocean" on the 14th April 2009.
The evacuation of patients and civilians trapped in LTTE Clutches in the un-cleared areas in Mullaithivu is being carried out under the ICRC flag. Sri Lanka Navy is providing safe passage for evacuees on humanitarian grounds.
The patients among the evacuees, upon disembarkation at Pulmuadai, were provided with emergency medical treatment by Naval doctors and were rushed to the General Hospital in Padaviya by the Naval personnel for further treatment. Elaborate arrangements have been made to treat the sick and the wounded evacuees once they reach cleared areas. Hospitals have been equipped with adequate stocks of essential drugs and specialist medical personnel are assigned to treat the sick and the wounded as they are transferred to hospitals.
The twenty-first batch consisted of 106 adult males, 174 adult females and 234 children in total. Among them were 63 male and 63 female patients needing medical treatment. […]
In the meantime, Sri Lanka Navy rescued 59 civilians who had been fleeing from the LTTE clutches in Mulaithivu on the same day on two occasions. The first group consisted of 08 males, 15 females and 08 children while the second group consisted of 08 males, 14 females and 06 children. All had been found on board white flag hoisted fiber glass dinghies, while attempting to flee from the LTTE clutches in the No Fire Zone in Mulaithivu. Upon rescuing, the rescued civilians were safely brought ashore and provided with much needed food, refreshments and medical assistance.
The Navy, as part of its humanitarian operations, has put in place a number of comprehensive evacuation measures to facilitate the evacuation process. Naval personnel and vessels along with stand-by rescue and medical teams are on special deployment in the Northeastern seas for assisting Tamil civilians fleeing from LTTE clutches.


I. Classification of the Situation and Applicable Law
1. How would you classify the situation between Sri Lanka and the Liberation Tigers of Tamil Eelam (LTTE)? (GC I-IV, Art. 3). What additional information would you require in order to make such a determination? Under which conditions would Additional Protocol II be applicable to the situation? (P II, Art. 1)
II. Evacuation of the Wounded and Sick
2. What obligations are owed to the wounded and sick? Are they similar in times of international and non-international armed conflicts? Does this include an obligation to evacuate? (GC I-IV, Art. 3; P II, Art. 7; CIHL, Rules 109, 110 and 111). Do Sri Lanka’s obligations extend to areas controlled by rebel groups? How can it fulfil them there?
3. What is the ICRC’s legal basis for engaging in evacuation operations during non-international armed conflicts?
4. What obligations do States and non-state armed groups have with regard to allowing humanitarian organisations access to those in need? Does this include an obligation to ensure safe passage? (GC I-IV, Art. 3; CIHL, Rule 55 and Rule 56).
5. Is it lawful and advisable that the Sri Lankan Navy provides for safe passage for the evacuation?
III. Elements contributing to respect for IHL
6. What do you think may have motivated Sri Lanka to work with the ICRC to undertake evacuations in rebel controlled areas?  Do you think that an organisation’s neutrality and impartiality are important characteristics in the delivery of humanitarian relief? Why?
7. Why do you think the Sri Lankan government issued a public report about the successful evacuations? How do you think the evacuations might be viewed domestically? Internationally? By international organisations and relief agencies?