After the War

One psychiatrist’s mission to heal the trauma in Sri Lanka's north and east

This image, released by the Sri Lankan government, claims to show an army soldier carrying a child near Mullivaikal during the final offensive against the Tigers in 2009. Sri Lankan Ministry of Defence / AFP PHOTO
Elections 2024
01 May, 2014

DRIVING NORTH along Sri Lanka’s newly relaid A9 highway last August, our van came upon an immaculately green lawn that stood out in a landscape of desolate scrubland. We were just outside the town of Kilinochchi, the former stronghold of the Liberation Tigers of Tamil Eelam, and stopped to take a look. A broad tiled path cut through the middle of the grass, and crouched on either side of it were three politely smiling government soldiers, using scissors to snip, one by one, every stalk that had grown too tall or unkempt. The path led up five short steps to a platform, and surging up from it was a huge, perfectly rectangular slab of concrete. Embedded near its centre was a larger-than-life brass bullet, polished to a golden shimmer, from which several deep fractures radiated outwards. The deepest of these rose all the way to the upper edge of the slab, and from it burst an enormous brass lotus frozen in the act of unfolding, glimmering in the vast, cloudless sky. This monument was constructed shortly after the government’s decisive victory over the Tigers, who for twenty-six years waged a bitter civil war for a separate Tamil homeland. From the ruins of war, the monument seemed to declare to the island’s historically Tamil north and east, the flower of peace was at last blooming.

Early the next morning, having driven east from Kilinochchi for several hours over narrow, rutted dirt roads, we came to the quiet village of Mullivaikal, right on Sri Lanka’s north-eastern coast. The final battle of the war was fought here in May 2009, and the site has attained mythical stature among the country’s Tamils. More than three hundred thousand Tamil civilians were trapped in a small area around this village for five months as the Tigers made their last, desperate stand against the Sri Lankan army. Most had been displaced from their homes by a steady army advance that began in early 2008, and forced to retreat eastwards with the rebels. In Mullivaikal, exhausted, wounded, with little food or water and nowhere left to go, they dug hundreds of bunkers for shelter against the army’s indiscriminate shelling. According to a UN report, which the Sri Lankan government aggressively disputes, as many as forty thousand civilians died in the war’s last days.

That number would have been far higher had not a small number of dedicated Tamil doctors and nurses stayed behind instead of crossing over to the safety of government lines. In the last days they ran a makeshift clinic out of Mullivaikal’s abandoned primary school, saving hundreds of lives without proper instruments or anaesthetics. Four years on, there was hardly any sign left of those events at the school. The classrooms had been repaired, the school reopened. It was the middle of school holidays, but uniformed students were setting up chairs and sweeping out classrooms, and several teachers were preparing cauldrons of rice and curry for lunch. The hustle and bustle was in preparation for the opening of the school’s new library building. There were several visitors from outside the village too—educators, donors and well-wishers who had contributed to the project. Despite the flurry of movement all around, they spoke in whispers and walked with light steps, out of respect for all that happened here during the war.

Listening to the various speeches in front of the main school building, I noticed a large mango tree that had somehow survived the violence. Suspended by a hefty piece of rope from its thickest branch was a large, hollow, bullet-shaped object. Its chipped exterior had been painted green and yellow, but its inner surface was rusting. It was the exoskeleton of a shell, I discovered afterwards from one of the teachers, found in the school grounds by students. It was used now as the school’s bell, rung at the beginning and end of lessons, a monument to the recent past very different from the one built by the government outside Kilinochchi. For the children of Mullivaikal, every hour of primary education is punctuated by its gong, a reminder of what happened in the place they come to be educated for life in their new nation.

I had been taken to the opening ceremony by Dr S Sivathas, who had helped raise funds for the library. Of the sixty-seven consultant psychiatrists serving Sri Lanka’s population of twenty million, Sivathas is the only one currently working full-time in the former rebel territories. For most of the war he lived in the relative safety of the country’s capital, Colombo, but he had himself transferred to the government hospital in the large northern town of Vavuniya the day after the government declared victory. For the last five years Sivathas has confronted a daunting task: to address the massive amount of personal and communal trauma that accumulated in Sri Lanka’s north and east over 26 years of war, and especially in the two final, brutal years of fighting. His first major undertaking was to train a cadre of sixty community support officers and twenty facilitators, most of them young people who had themselves been trapped in Mullivaikal. Today, they run weekly workshops and counselling sessions in their respective villages, and form the backbone of Sivathas’ programme of long-term support for traumatised populations. Sivathas still spends weekends in Colombo with his family, but during the week he travels across the north and east with gruelling dedication, moving by bus, van, bike and foot to small towns and villages, where he oversees the work of this cadre and deals with cases they are unable to address.

On the evening of my first day with the doctor, I spoke at length with Sivakumar, a community support officer from the town of Mallavi, who appeared at least a decade older than his thirty-seven years. Sivakumar described the terror of the final stages of the war with an unsettling earnestness. In the months of continuous displacement during the retreat, the barrages of shelling never stopped for more than a few hours, he told me. “As we moved from one place to another we saw bodies and body parts scattered across roads and open spaces like grains of rice. You could hear the wailing of people grieving for their dead everywhere.” When the fighting was finally over, those who survived were interned for months in government camps, where, many of them allege, torture and rape by the military were widespread. It was well over a year before most of them were released, to return to what was left of their homes. “Even now I can’t get a good night’s sleep,” Sivakumar said. “The memories come into my head, and I’m afraid to close my eyes.”

Dr S Sivathas is the only Sri Lankan psychiatrist working fulltime in the territories formerly controlled by the Tigers. courtesy S Sivathas

We slept that night at the home of Saro, one of Sivathas’ facilitators in the village of Keridamadu, a few hours west of Mullivaikal. Drinking tea on the portico the next morning as we waited for a Ministry of Health van to take us to our next destination, we watched a young woman in her mid twenties walk into the garden through the gate in the thatched fence. She was well dressed, wearing a loose brown shalwar kameez with a red thread tied around her upper arm to signify she was fasting. Seeing us she smiled, hesitated, then acceded to Sivathas’ invitation to sit down.

It was impossible to tell from her appearance or comportment, but Rani lost her mother, father, brother and sister-in-law during the last months of the war. The night before, Saro, her cousin, had told Sivathas about Rani’s surprisingly complete recovery from these losses, and had asked her to come over that morning at his suggestion. Between sips of tea, Sivathas began, very conversationally, asking Rani about her morning routine, her part-time work, and the situation at home with her husband and children. Rani deflected these questions with quiet giggles, embarrassed to be asked about herself so explicitly. Sivathas persevered. “Saro told me about what happened to you during the war,” he said. “About how you returned to ordinary life and your duties with such ease, as if by magic. As a psychiatrist I’m curious about how you did it, whether you’re very religious, whether praying helped you, or whether you’re just a resilient person.” Rani’s large eyes smiled at the doctor’s frankness, as if to say she didn’t think there was anything to be surprised about at all. It wasn’t hard to believe that all was indeed well with her, that she had truly managed to come to terms with everything that had happened.

As the doctor gently probed into the recent past, though, asking carefully about those in her family who passed away, about how her life was different from before, Rani became agitated. She angled her face down, and her eyes welled up with tears. Drawing her chair back without a sound, she stood up and went inside to join Saro in the kitchen. Half an hour later, when she stopped by the portico again on her way out, she looked as she had when she arrived, bright-eyed and confident. In her expression there was an acknowledgment of the brief rupture in her calm that the three of us had witnessed, but also a firm indication that it wouldn’t be allowed to resurface.

The directness and informality of Sivathas’ style is sharply at odds with that of other medical professionals in Sri Lanka, where doctors are used to an almost headmasterly respect from their patients. He keeps his interactions with his patients continuous with everyday life, and often ignores social and professional norms that come in the way of his work. This is not, to be sure, simply a product of the doctor’s own temperament. Sivathas’ intimacy with his counsellors, his lack of stiffness, and his unabashed readiness to impose himself upon the lives of others, are marks of how far removed his work is from the context of ordinary medicine. When each and every individual in a place has been affected by trauma, it becomes part of the community itself, a normal, everyday phenomena. Sivathas’ response to these conditions has been to make the therapeutic stance a part of his ordinary comportment, so that the eliciting, soothing and suggesting that exist for so many psychiatrists only in rigidly demarcated contexts have become for him a part of almost every interaction.

Two days later, I sat in on a weekly workshop for elderly, mostly widowed women at a community centre in the village of Malayalapuram, just south of Kilinochchi. Sivathas playfully bantered with the women as they trickled in, before gently asking them to join the circle and talk about how they were doing. There was no definite starting point to the session, no sudden switch from ordinary conversation to formal therapy, but the discussion turned gradually to questions of livelihood, routine and depression.

When the meeting was over, I followed the doctor and a young community support officer out into the bright, oppressive heat. We were going to the home of one of the participants, a strikingly gaunt woman in her early sixties, with eyes like basins filled to the verge of spilling. She had been unable to stop crying for the duration of the meeting, and talking to Sivathas as she walked her words were still dissolved in tears. She kept repeating the same few lines about her situation, following a logic of her own rather than responding to anything the doctor said. The support officer looked at me with an almost apologetic smile. “She lost eight members of her family in the last week of the war,” she explained. “Both her sons, their wives, and three grandchildren.”

We walked along a dirt path with thatched palm-leaf fences on both sides, and entered the woman’s partly withered, partly overgrown garden. The doctor did his best to persuade the woman to begin taking antidepressants—it was the only time in the week I spent with Sivathas that I heard him talk about medication. The woman responded with indignation. “I don’t want to change how I feel,” she said again and again. “It’s only right that this is my state after all this has happened to my family.” I wondered whether the woman might not be right, then turned to find the support officer chuckling silently beside me, not maliciously but with a mixture of sympathy and impatience. Leaning over, she whispered that the woman hadn’t stopped talking about her troubles for four years, though everyone else in the village had suffered too. “Imagine what it must be like for her son’s child to live in a home like this,” she said, motioning to a shirtless girl of about nine or ten on the portico.

The support officer, I found out later from Sivathas, is twenty years old. The Tigers conscripted her elder brother when fighting with the army resumed late in 2007. After the war, she searched everywhere for him, unsuccessfully. Unable to give him up for dead, she suffered from a debilitating depression until she started working for the doctor, after which her condition slowly improved. Talking to people regularly about their situations, according to Sivathas, has helped many of his support officers and facilitators cope with their own grief.

Freud suggested in his essay ‘Mourning and Melancholia’ that the basic function of mourning is to allow the bereaved to dwell on their attachment to the lost object, thereby gradually and painfully detaching themselves from something they have built their lives around, and clearing space inside themselves for a future without it. Traditional mourning rituals for the forty thousand who died during the last stages of the war, however, were usually out of the question. Death could come anywhere, at any time. Those who were killed usually had to be left behind, and searching for the remains of loved ones during lulls in the fighting and shelling often yielded only body parts or disfigured corpses, not the whole bodies required for proper rites. Many simply could not tell what happened to their friends and relatives, and even today cannot acknowledge that those missing are probably dead.

The impossibility of mourning individuals has been compounded by an inability to mourn the collective past. In the months following the end of the war, the Sri Lankan government systematically erased all vestiges of the Tigers in the north and east, including several large cemeteries for dead fighters. Attempts at grieving publicly by Tamil civil society in the last few years have also been disrupted, with organisers and participants taken in for questioning and often detained. These policies are not surprising, in a way. The act of mourning in this context is, in the government’s reckoning, necessarily political: to mourn a civilian killed in the war’s final days is to criticise the army’s use of indiscriminate shelling, just as to mourn the past is to endorse the separatist goals of the Tigers. The government’s efforts at stifling mourning are an extension of its wartime policy of total destruction. The psychological effects this has had, however, are immense. When an entire population is prevented from mourning, according to the doctor, a sharp disjunction inevitably forms in people’s minds between the past and present. It was his duty, Sivathas told me on our last day together, to reunify the minds of all these people, so that they may return to ordinary life as much as is possible.