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As Tamils flee Sri Lanka's conflict zone, details of their situation emerge.
This week an estimated 100,000 ethnic Tamils fled from the no-fire zone turned battlefield between Sri Lanka's government and the Liberation Tigers of Tamil Eelam (LTTE) in the country's northern Vanni region.
This dramatic mass exodus comes after civilians survived for four months on a 17 kilometer (10.5 mile) strip of land abutting the Indian Ocean. There the civilians were reportedly kept hostage at gunpoint and used as a human shield by the LTTE, while being shelled repeatedly by military forces.
According to the International Committee of the Red Cross (ICRC), 4,500 civilians were killed in the last three months.
The war is not over for the civilians who still remain trapped in the combat zone. Estimates of the exact number vary wildly: A government source said Thursday that there were no more than 15,000 people, while aid agencies estimate that at least 50,000 remained. A Sri Lankan medical doctor still in the combat zone said he believes 200,000 were stuck there.
Aid agencies fear that as the battle enters its final stage, casualties could reach their highest levels yet.
"One only needs to imagine: thousands of children, women and men stranded in the very midst of the combat zone," said Pierre Krahenbul, director of operations for the ICRC on Tuesday. "Every rocket or mortar fired is wounding or killing civilians."
Since November 2008, the Vanni has been completely off limits to independent media and most aid agencies. What small pieces of information have leaked out describe civilians trapped in an ongoing nightmare.
Extreme food and water shortages have led to malnutrition, and these hardships are further exacerbated by the local equatorial climate. A lack of necessary medicines has resulted in the deaths of children from diarrhea and other treatable diseases. Civilians have been living under patched-together tarpaulin tents, leaving them exposed to aerial bombardments. Even minor injuries from shrapnel are life-threatening because of a lack of clean bandages or antibiotics.
A March 2009 situation report issued by local medical staff from the combat zone describes how the only hospital facility in the area — a single concrete building, crowded with people lying on floors — was treating 120 to 150 casualties, 30 to 50 pregnant mothers, and more than 400 in-ward patients every day.
In addition, the "number of newly diagnosed, agitated mentally ill clients has been showing significant rise," the report said.
Though they have survived these horrific conditions, the tens of thousands of traumatized civilians who fled this past week face another major hurdle, as the government attempts to provide them with shelter, food, water and medical attention.