Some 10,000 frontline health workers in Sri Lanka are working tirelessly to arrest the spread of COVID-19 that has affected 235 people and claimed seven lives until Wednesday. Partnering them in their response to the public health crisis is the Sri Lankan military, playing many roles from contact-tracing to running quarantine centres to distributing relief.
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As soon as the Epidemiology Unit of the Ministry of Health hears from a designated laboratory of a positive case, its staff activate “case search” among the infected person’s close contacts, doctors attached to the unit said. The “activation” essentially involves informing the military and State Intelligence Service immediately, who then proceed to trace those who had been in contact with the patient, and direct them to quarantine, Dr. Deepa Gamage, Consultant Epidemiologist, told The Hindu .
Doctors underscore the military’s efforts in stepping up the national response to the pandemic. But they also point to the public health system’s track record — Sri Lanka was declared Malaria-free in 2016 — and its strengths particularly in preventive community medicine that are proving valuable at this time.
Sri Lanka’s Health Ministry has geographically earmarked ‘Medical Officer of Health’ (MOH) areas across the island of 21 million, to provide preventive health services at a community level, through a team of medical officers, public health nurses, health inspectors and midwives. “It [MOH area] was started in 1926 and then expanded. So, we have these networks and a system in place, going back nearly a century, especially in the area of maternal and child health care,” said Dr. Manuj C. Weerasinghe, head of Department of Community Medicine, University of Colombo. The MOH networks are efficient in their grassroots medical intervention, strengthening Sri Lanka’s capacity for preventive health care in general and during a crisis like this.
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If that is the case, does the public health sector really need military assistance to combat COVID-19 now is a question that critics of militarisation ask. Dr. Weerasinghe thinks it does. “A pandemic requires rapid action. Military has the capacity and the resources — they are able to run quarantine centres [the military runs 54 centres, according to official sources], and maintain supply chains. The public health sector working hand-in-hand with the military has shown results now, hasn’t it,” he said, pointing to Sri Lanka’s relatively low number of positive cases, that sceptics attribute to “low testing”.
National Operation Center
The military was officially roped into Sri Lanka’s COVID-19 response mid-March, a week after the first local tested positive. President Gotabaya Rajapaksa set up a ‘National Operation Center for Prevention of COVID- 19 Outbreak’ led by Army Commander Shavendra Silva.
“Placing an army General at the helm of the campaign against the epidemic is as inane as asking a medical doctor with zero-military training to lead a war,” columnist Tisaranee Gunasekara wrote in Groundviews.org, a Colombo-based civic media portal. But, some Sri Lankan leaders and their supporters have repeatedly likened the pandemic to a “war”, sparking discomfort among sections — especially the Tamil minority that bore the brunt of the actual civil war.
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Further, local media reports have highlighted the police and Army’s efforts to track down those reportedly in hiding, and evading quarantine. The Sunday Times newspaper reported that the State Intelligence Service — headed by a former military intelligence chief — is leading the contact-tracing effort that involves perusal of immigration records and data analysis. Meanwhile, the Acting Inspector General of Police directed the Criminal Investigation Department to take stern action against those who spread false information or launch “malicious attacks on public servants” involved in essential services, raising concern over the space for free expression.
It is not as if medical professionals don’t have a say. They play a key role in decision making and charting out the action plan, senior doctors in the public health sector and outside the system said.
Future course
But when the future course isn’t clear, many questions emerge, according to Dr. R. Surenthirakumaran, attached to the Department of Community Medicine, University of Jaffna.
One, is the economic question. “COVID-19 is not going away any time soon, we have to deal with it for some time to come. How is the government planning to address the jobs and livelihoods lost meanwhile? How long can this curfew go on when people are in hunger?” he asked.
How then can it be relaxed? “Whether it is public transport, or a school or university the risk is going to be very high. Can we provide hand-washing facilities in public places? Can we practise physical distancing later too? These are also questions we must think about,” Dr. Surenthirakumaran told The Hindu .
“It is true that there are limits to the capacity of public health officials to trace contacts or monitor quarantine centres 24 X 7. The military has the resources. But just because they seem efficient, do we allow the military to take charge?” he asked, adding: “this is not a war”. “We have no specific laws to guide us through a pandemic — what is the role of the public health sector? Of essential services or the military? We need to be clear on these.”
