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Elsewhere, relief workers have found themselves caught up in civil wars that have been raging for years. In Sri Lanka, there were hopes for some kind of peace, however temporary, between government forces and the Tamil Tiger rebels who have waged a 21-year war for independence in the northern part of the country. Scores of displaced Tamil families taking refuge in a school in Kudathanai had gratefully accepted food and water brought by government soldiers. But when soldiers arrived with a specially cooked New Year's meal, refugees refused it on orders from a rebel. That night part of the school was set on fire. "We are stuck between the army on one side and the [Tigers] on the other side," says K. Jayakumar, 29, a fisherman. "Please tell them both that we deserve some peace after all we have been through."
In all the worst-hit areas, the most immediate enemy is infection. Thousands of people were essentially attacked by their own flimsy homes, sliced up and gashed by falling planks of wood, shards of glass and jagged pieces of corrugated tin. So many wounds went untreated or were badly treated in local clinics that gangrene and tetanus have set in; amputation is the most common operation in field hospitals.
Among the first international aid workers to reach ground zero on the Indonesian island of Sumatra were the doctors and nurses of MSF. When they arrived at the one functioning hospital in Sigli, on the east coast, there was only a single, volunteer surgeon on hand. "Our hospital was crippled," says Dr. Taufik Mahdi, director of the 35-bed unit. "Most of our doctors and nurses were too traumatized to work or left to look for loved ones missing after the tsunami." That first day the MSF team performed six operations, and it hasn't stopped since. "The minute we sew one up," says Dr. Claire Rieux, a general practitioner from Paris, "another gets wheeled in."
Spending a day at the hospital with the MSF team reveals the scope of the crisis. "Oh, man, this one is really bad," an Australian doctor shouts as he approaches the operating theater. He's holding up the arm of a man whose limb looks like a shank of lamb. The elbow is essentially gone, and the lower and upper arm is barely held together by a few sinewy strings of muscle and flesh. Though paint is peeling off the walls and a layer of grime covers many of the hospital's windows, Sigli's only hospital is fairly clean compared with many others in Indonesia's remote provinces. There are small victories. A young girl is wheeled in for surgery, her left foot severed at the heel. The doctors fear they may have to remove her leg at the calf to stop the infection from spreading, but after a massive cleaning and huge doses of antibiotics, her foot is reattached.
Fran??ois Gillet, MSF's logistics coordinator in Sigli, is desperately trying to find extra beds, plugs and lightbulbs, which no one seems to have. "It's the little things that often get overlooked and are hardest to find," he says. The group has relied on satellite phones for most of its communications, but even they have been less than reliable. "This is why we have to be as organized as possible," says Belgian Alexis Moens, the field coordinator. "You have to put up a structure that is strong enough on both the medical and logistical sides. Otherwise, things just won't work."