Sri Lankan forces have renewed their offensive against the rebel Liberation Tigers of Tamil Eelam (LTTE) after a 48 hour pause in fighting to allow civilians to escape the war zone. The latest assualt launched on Tuesday is aimed at capturing a Tamil Tiger naval installation on the northeast coast, the army said. The military claims it has killed dozens of rebel fighters in the latest battles, and is in the final stage of operations to defeat the LTTE. Meanwhile, the International Committee of the Red Cross (ICRC) said that at least three civilians were killed and another 10 injured when a hospital in the war zone in the country's north was shelled for the fourth time in two days. The repeated attacks on the hospital in Puthikudiyiruppu has led to the deaths of 12 people in total, according to the ICRC. The military is said to have surrounded LTTE rebels in the Puthikudiyiruppu jungle region. Also on Tuesday, the Sri Lankan army said that its forces had captured the LTTE's seventh and final airstrip, effectively grounding the rebel's small air force. Trapped civilians On Sunday aid agencies said 250,000 civilians were trapped in areas where heavy fighting was raging. The government puts the number of trapped civilians at about 120,000.
It is unclear as to how many people have managed to flee the area. The Sri Lankan government has said it cannot guarantee the safety of civilians living among LTTE separatists in the north of the country. Lakshman Hulugalle, a government spokesman, urged civilians to seek shelter in a government "safe zone", but did not say how the civilians would be able to flee if they were being held against their will as human shields, as claimed by the government's military. The LTTE denies holding civilians against their will, saying that people were refusing to go since they feared that the army would abuse them. The shelling of the Puthikudiyiruppu hospital has raised fears for civilians. 'Acute stress' Sophie Ramanens, an ICRC spokesperson, told Al Jazeera: "Humanitarian law has to be respected ... we call on both parties to respect their obligations to spare medical facilities."
Morven Murchison-Lochrie, an ICRC medical co-ordinator at the hospital, told the AFP news agency that the staff was "under acute stress, surrounded as they are by the sound of the ongoing fighting and the influx of new patients". "Ambulances are constantly arriving, but people are also being brought in by wagon, pick-up truck, tractor and even motor scooter." Brigadier Udaya Nanayakkara, a military spokesman, said that the army was not responsible for the attacks. "Now the LTTE is firing very desperately everywhere artillery ... one of these shells may have fallen into that area," he said. The army has declared that rescuing civilians trapped by its offensive against the Tigers is one of its top priorities.
Mahinda Rajapaksa, the Sri Lankan president, had given the LTTE 48 hours to free trapped civilians inside the area, which the LTTE ignored. The government said it would guarantee safety to people moving during that period, but that it could not ensure that those people who remained among the rebels would be free from danger. Hundreds of civilians, including children, have been killed or wounded in fighting since last week, the Red Cross has said. Colombo disputes the figures. The rebel Tamil Tigers have been fighting government forces since 1983, alleging marginalisation by Sinhalese-dominated Colombo. |
Sri Lankan forces renew offensive
Sri Lanka Tigers urged to end war
 The Tigers have been fighting for a separate homeland since the 1970s |
The US, EU, Japan and Norway have urged Sri Lanka's Tamil Tiger rebels to lay down their arms and discuss ending hostilities with the government.
The nations said there remained only a short time before the Tigers lost the territory still under their control.
Both sides "should recognise that further loss of life - of civilians and combatants - will serve no cause", the nations said.
The Sri Lankan government says it is close to defeating the rebels.
Up to 250,000 civilians may be trapped by the fighting.
'Sovereignty'
Norway, Japan, the US and the EU are described as the Tokyo Co-Chairs, who sat at the Tokyo Conference on Reconstruction and Development of Sri Lanka in 2003.
In a joint statement, they expressed "great concern" for the plight of civilians.
 | INSURGENCY TIMELINE 1976: Liberation Tigers of Tamil Eelam form in the north-east 1987: India deploys peace-keepers to Tamil areas but they leave in 1990 1993: President Premadasa killed by Tiger bomb 2001: Attack on airport destroys half Sri Lankan Airlines fleet 2002: Government and rebels agree ceasefire 2005: Mahinda Rajapaksa becomes president 2006: Heavy fighting resumes 2009: Army takes main rebel bases of Kilinochchi and Mullaitivu  |
The nations also urged both sides to "declare a temporary no-fire period to allow for evacuation of sick and wounded, and provision of aid to civilians".
The Sri Lankan government has previously ruled out any ceasefire and has vowed to crush the rebels.
The Tigers have said they will not lay down their arms until they have a "guarantee of living with freedom and dignity and sovereignty".
The Tokyo Co-Chairs said both sides "must respect international humanitarian law".
They said they would help transfer internally displaced people to humanitarian camps.
The statement comes amid reports of repeated artillery attacks on a hospital in Tiger-held territory.
The Red Cross says the hospital in Puthukkudiyiruppu town in Mullaitivu district has been hit five times in the past few days, leaving at least 12 civilians dead.
One strike was on a paediatric ward, it said.
 The Sri Lankan military has vowed to crush the rebels |
The government says it is not responsible for the attacks and has told civilians to leave the war zone. Pro-rebel websites blaming the army.
The hospital is one of the last functioning health facilities in the area.
Sri Lanka's military says it has designated a safe zone for civilians in a 32 sq km buffer zone on the A-35 main road which links Paranthan and Mullaitivu.
The zone is inside a gradually shrinking rebel enclave north of Mullaitivu.
The Tigers are proscribed as a terrorist group by many nations, including the US and the EU.
They started fighting in the 1970s for a separate state for Tamils in Sri Lanka's north and east.
Norway has been a broker in previous rounds of unsuccessful peace talks between the rebels and Sri Lanka's government.
Sri Lanka hospital shelled for fourth time by LTTE
Three people were killed and 10 wounded when a hospital treating victims of Sri Lanka's civil war was shelled for a fourth time in two days, the International Committee of the Red Cross told CNN Tuesday.
Artillery shells slammed into the hospital in the northern district of Mullaittivu on Monday evening. Strikes on the hospital on Sunday -- including one that hit the pediatric ward -- left 11 people dead, including some children, according to an aid worker who spoke to witnesses.
Government forces and Tamil rebels are locked in a battle for the remaining rebel strongholds in northern Sri Lanka, where the the country's ethnic Tamil minority has been fighting for an independent homeland since 1983.
Humanitarian groups say as many as 250,000 unprotected civilians are trapped in the area. The civil war has left more than 70,000 people dead.
International humanitarian aid agencies have asked for increased access to the region, calling conditions in northern Sri Lanka a "nightmarish situation."
Sarah Crowe of UNICEF told CNN Monday that aid from the United Nations was getting into the war zone only every few days. 
"We need open access," she said. "These children and families need to be protected and they need to get out fast." Hundreds of civilians, including children, have been wounding in fighting since the end of last week.
Government officials have accused aid organizations and foreign media of sensationalizing civilian casualties.
"It looks as if it's convenient for certain agencies to exaggerate the numbers so that this can be converted to a humanitarian crisis in the public eye, " Secretary of Foreign Affairs Dr. Palitha Kohona told CNN.
Over the weekend, Defense Secretary Gotabaya Rajapaksa promised to "continue with the military offensive until we liberate the remaining area under LTTE (the rebel group's) control," according to Sri Lanka's state-run news agency.
Sri Lankan President Mahinda Rajapaksa has promised to allow safe passage to trapped civilians and urged the Tamil Tigers, as the rebels are commonly known, to promise the same.
A handful of U.N. staff are working round the clock to save a growing number of children caught in the crossfire, a U.N. spokesman said Saturday.
Children as young as 4 months old were being treated in area hospitals for shrapnel injuries and other wounds of war, spokesman James Elder told CNN.
"There is just intense fighting in a small area where children and other civilians are," Elder said. "The space [where conflict is taking place] is shrinking and the fighting is augmenting."
Last Thursday, U.N. aid workers rescued 50 critically injured children and 105 adults, he said.
"We are trying to get as many people out of there as we can," Elder said.
Sri Lanka hospital 'attacked again'
 About 50,000 troops are involved in the operation in the north-east |
The Red Cross in Sri Lanka says a hospital in territory held by the Tamil Tigers has been shelled again.
A health worker told the BBC that six people were injured in the attack on the hospital in Puthukkudiyiruppu town in Mullaitivu district.
Aid workers say the hospital was hit three times over the weekend, with nine people killed. The government says it is not responsible.
It has told civilians to leave the area where it is fighting the Tamil Tigers.
'Decisive stage'
Puthukkudiyiruppu is situated in an enclave held by the rebels and is home to tens of thousands of civilians.
The hospital is one of the last functioning health facilities in the area.
The BBC's Anbarasan Ethirajan in Colombo says health workers reported six injuries when a ward was hit by shellfire on Monday. They say the casualty figure could have been higher if patients had not taken cover.
In an earlier attack, the UN said, the shells hit a crowded paediatric unit. At least nine people were killed in the firing, the Red Cross said.
It is not clear who fired them, with pro-rebel websites blaming the army for the attacks, and the military denying any role.
In a statement, the government said fighting in the north-east was at a "decisive stage" and that it could not guarantee civilians' safety in the area.
Separately, the army said it had found an underground bunker complex it believed was a home of the top leader of the Tamil Tigers.
| INSURGENCY TIMELINE 1976: Liberation Tigers of Tamil Eelam form in the north-east 1987: India deploys peace-keepers to Tamil areas but they leave in 1990 1993: President Premadasa killed by Tiger bomb 2001: Attack on airport destroys half Sri Lankan Airlines fleet 2002: Government and rebels agree ceasefire 2005: Mahinda Rajapaksa becomes president 2006: Heavy fighting resumes 2009: Army takes main rebel bases of Kilinochchi and Mullaitivu |
The two-storey-deep bunker was found hidden in a coconut plantation in Mullaitivu district during fighting on Monday, the army said.
The ministry said the bunker had electricity generators, air conditioning and medical supplies.
There was no sign of the rebel leader Velupillai Prabhakaran.
The Sri Lankan government has told civilians to leave the area of fighting in the north-east but it is unclear how tens of thousands of civilians can escape.
Sri Lanka's military says it has designated a safe zone for civilians in a 32 sq km buffer zone on the A-35 main road which links Paranthan and Mullaitivu.
The safe zone is inside a gradually shrinking rebel enclave north of Mullaitivu.
Aid workers say that, in recent days, shells have fallen into the zone and people have been killed there. Both sides deny being responsible for firing into the area.
The Sri Lankan military said there had been more heavy fighting on Monday, with two rebel leaders critically wounded.
There is no independent confirmation of the claim - journalists are not able to reach the front lines.
The army offensive has pushed the rebels into a 300 sq km (110 sq mile) corner of jungle.
Aid agencies say up to 250,000 civilians are in the area.
The government says the number is closer to 120,000. It accuses the Tamil Tigers of not allowing civilians to leave, saying they are being used as human shields.
The rebels say the civilians prefer to stay where they are under rebel "protection".