The Ceylon News

Aid groups have estimated more than 200,000 civilians were trapped in a tiny strip of land still controlled by the rebels along the northeastern coast. The military and the rebels deny attacking civilians, but reports from aid workers, health officials and evacuees implicate both sides.

Dr. Thurairajah Varatharajah, the government health officer for the Mullaittivu district, said Friday that artillery shelling was routinely hitting civilian areas in the region and the makeshift hospital he was running out of a school in the coastal town of Putumattalan was overwhelmed by casualties.

The facility was badly understaffed since most of the doctors and nurses either fled the war zone or had stopped coming to work, and the makeshift hospital was running out of some essential antibiotics and anesthesia, he said.

"We are facing in the hospital big problems on all sides. Not enough toilets, bad water supply, food is also a problem," he told The Associated Press by telephone.

The area around the hospital was shelled Monday, killing 22 people, he said.

Varatharajah estimated that more than 100 wounded civilians were coming to the hospital every day, most of them with injuries from artillery shells. However, it was impossible to give exact statistics because his administrative staff stopped coming to work amid the violence, he said.

Two weeks ago, Varatharajah estimated 300 civilians had been killed in the war zone since mid January, but he declined Friday to give another such total.

He did not say who he believed was firing the shells.

The Sri Lankan government denied the reports of civilian deaths, saying that the dead were rebel fighters in civilian clothing.

"How do you identify a civilian and a terrorist?" said Mahinda Samarasinghe, minister of human rights and disaster management.

Relatives have stopped bringing the dead to the hospital — instead burying them where they were killed — but many have told Varatharajah about those killed in the attacks that injured them.

"They will tell us 'There were five dead bodies in that area, two in that area,'" he said, explaining how he reached his estimate of 40 killed a day.

A second doctor in the area, who declined to be named for fear of angering the government, estimated that up to 40 people were killed daily.

Varatharajah said the civilians in the area had been suffering heavy casualties for three to four weeks as the military forced the Tamil Tigers into a broad retreat across the north and pushed the rebels to the brink of defeat.

The patients and medical staff had to evacuate the hospital in the town of Puthukkudiyiruppu last week after that facility came under heavy shelling for days. The staff, with the help of the Red Cross, set up a makeshift hospital in Putumattalan. However, that area came under shelling this week as well, he said.

Only eight of the 30 doctors normally assigned to the district remained, Varatharajah said. None were surgeons or anesthesiologists, but they were all performing emergency surgeries in an operating room set up in a classroom, he said.

He estimated he would need at least 80 doctors to properly treat all the wounded. Only three of his 20 nurses remained.

"We are always working," he said.

The artillery fire appeared to have stopped Friday after the government declared a 7.5-mile (12-kilometer) coastal strip that included the hospital a "safe zone" and pledged not to attack it, he said.

The Red Cross used a ferry to evacuate more than 600 patients and family members from the hospital this week, but with the fighting raging on, the hospital had 300 more wounded and another 200 suffering chronic disease in need of urgent evacuation, he said.

The Tamil Tigers have been fighting since 1983 for an independent state for minority Tamils after decades of marginalization by governments dominated by the Sinhalese majority. More than 70,000 people have been killed in the violence.

Also Friday, Sri Lanka rejected Britain's decision to appoint a special envoy to address the deteriorating humanitarian situation and help resolve the country's ethnic conflict.

British Prime Minister Gordon Brown on Thursday named a former defense secretary, Des Browne, as his special envoy for Sri Lanka.

But President Mahinda Rajapaksa and his Cabinet called the unilateral decision by Sri Lanka's former colonial ruler "unhelpful," noting that London failed to consult with Colombo before announcing Browne's appointment.

There was no comment from Downing Street early Friday.