In February 2009, during the final months of Sri Lanka’s civil war, the town of Puthukkudiyiruppu witnessed one of the most harrowing war crimes of the conflict: the relentless bombardment of its hospital. Reports indicate that on the last day the hospital was open, it was subjected to shelling for 16 consecutive hours, forcing its eventual evacuation to a school in Puttumatalan across in the no-fire zone.[1]
The Geneva Conventions and the Protection of Hospitals
Under the Geneva Conventions, hospitals are entitled to special protection during armed conflicts. Article 18 of the Fourth Geneva Convention states that hospitals “may in no circumstances be the object of attack” unless they are used to commit acts harmful to the enemy.[2] Even then, attacks can only be carried out after due warning and a reasonable time limit, to give civilians a chance to escape. The presence of LTTE medical workers or injured combatants did not affect the civilian character of medical facilities during the civil war.[3]
Reports indicate that makeshift hospitals in Sri Lanka were clearly marked with red cross symbols yet were still targeted. Each time a hospital was established in a new location, the doctors transmitted GPS coordinates to the Sri Lankan government to ensure the hospitals would be protected from attacks. Yet, on several occasions, attacks occurred on the day coordinates had been transmitted.
The Indiscriminate Use of Cluster Bombs
The Sri Lankan government has repeatedly denied using cluster munitions during the civil war. However, numerous sources including UN experts have confirmed finding cluster bomblets, particularly in Puthukkudiyiruppu (hereafter, PTK).[4][5] Cluster munitions are a type of weapon that scatters multiple bomblets over a wide area – typically the size of one or two football fields. Their use in populated areas violates the prohibition of indiscriminate attacks, which is a fundamental principle of international humanitarian law.
According to Amnesty International, between 5% and 20% of these submunitions fail to explode, creating a long-term hazard for civilians.[6] The left-behind explosive debris hampered post-conflict rebuilding in those areas and continues to pose an ongoing threat to civilians 16 years later.
1 February 2009: PTK Hospital suffered three attacks. The first attack saw 1 person injured by shrapnel inside the hospital. The second attack saw a shell hit the hospital, killing 1 and injuring 4. The third attack hit the women and children’s ward.
2 February 2009: PTK Hospital was bombed with 7 killed and 15 injured.
3 February 2009: PTK Hospital staff headquarters and the women’s ward were bombed, at least 2 killed and several injured.
5 February 2009: Ponnampalam Memorial Hospital (also in PTK) was repeatedly shelled, with 60 casualties inside and outside the hospital.
9 February 2009: Putumattalan Hospital (makeshift hospital for PTK) walls damaged by shrapnel as a shell hit 10 metres east of the hospital compound.
10 February 2009: Putumattalan Hospital shelled with 16 people killed.
These attacks not only caused immediate devastation but also have had long-lasting consequences, leaving communities in the area without access to vital medical care during the war and its aftermath.
A Global Pattern of Impunity
Individuals who wilfully or recklessly order or carry out unlawful attacks on civilians and civilian medical facilities are responsible for war crimes. States are obligated under the laws of war to investigate alleged war crimes and prosecute those responsible. Despite clear evidence of war crimes in Sri Lanka, such as these attacks on hospitals, no meaningful legal action has been taken. The failure to prosecute those responsible not only denies justice to victims but also sets a dangerous precedent for future conflicts.
In recent years, similar tactics have been employed in Gaza and Syria, where hospitals have been deliberately targeted, in clear violation of international humanitarian law. The Syrian conflict saw more than 600 attacks on hospitals between 2011 and 2021 according to reports by Physicians for Human Rights.[7] A UN-report cited at least 136 attacks on hospitals and medical facilities in Gaza between October 2023 and June 2024.[8]
The lack of accountability in Sri Lanka has emboldened perpetrators elsewhere, demonstrating how impunity breeds repetition. Governments and international bodies must take urgent steps to address these violations and prevent history from repeating itself.
Call to Action: The War on Healthcare Must End
The deliberate and systematic destruction of medical facilities is not just a violation of international law; it is an assault on humanity itself. Such attacks deprive the most vulnerable of essential care, erode trust in humanitarian systems, and prolong the suffering of entire populations.
It is crucial that we continue to advocate for the protection of medical facilities in conflict zones and ensure that those responsible for war crimes are brought to justice. The international community must take decisive action by:
Pressuring governments to hold perpetrators accountable and imposing sanctions. For example, Marshal of the Sri Lanka Air Force WDRMJ Goonetileke who was the air force commander for the period during the hospital bombings.
Supporting initiatives that advocate for justice and provide assistance to survivors.
Raise awareness by sharing this information and amplifying the voices of survivors.
The 2012 report of the Secretary-General’s Internal Review Panel on UN Action in Sri Lanka by Charles Petrie criticised the UN for withdrawing its staff from the conflict zone, underreporting civilian casualties, failing to publicly condemn human rights violations, and mishandling internal communications. The report also highlighted how the UN did not adequately challenge the Sri Lankan government’s obstruction of humanitarian efforts. These failures left civilians vulnerable and unprotected, allowing attacks on hospitals and medical facilities to continue with impunity. Despite clear evidence that hospitals in government-declared no-fire zones were repeatedly shelled, the UN remained largely silent, failing to apply sufficient international pressure.
The targeting of healthcare facilities in conflicts worldwide—from Sri Lanka to Syria to Gaza—demonstrates that impunity fuels a cycle of violence. Without accountability, these heinous acts will persist, putting millions of lives at risk. We must collectively demand stronger protection for healthcare in war zones, stronger enforcement of international law, and meaningful justice for victims. Only through persistent advocacy, accountability, and global solidarity can we ensure that hospitals and medical workers are no longer seen as legitimate targets of war but are instead recognised and respected as vital lifelines for humanity.
War on Healthcare: Remembering the Hospital Bombings of 2009
In February 2009, during the final months of Sri Lanka’s civil war, the town of Puthukkudiyiruppu witnessed one of the most harrowing war crimes of the conflict: the relentless bombardment of its hospital. Reports indicate that on the last day the hospital was open, it was subjected to shelling for 16 consecutive hours, forcing its eventual evacuation to a school in Puttumatalan across in the no-fire zone.[1]
The Geneva Conventions and the Protection of Hospitals
Under the Geneva Conventions, hospitals are entitled to special protection during armed conflicts. Article 18 of the Fourth Geneva Convention states that hospitals “may in no circumstances be the object of attack” unless they are used to commit acts harmful to the enemy.[2] Even then, attacks can only be carried out after due warning and a reasonable time limit, to give civilians a chance to escape. The presence of LTTE medical workers or injured combatants did not affect the civilian character of medical facilities during the civil war.[3]
Reports indicate that makeshift hospitals in Sri Lanka were clearly marked with red cross symbols yet were still targeted. Each time a hospital was established in a new location, the doctors transmitted GPS coordinates to the Sri Lankan government to ensure the hospitals would be protected from attacks. Yet, on several occasions, attacks occurred on the day coordinates had been transmitted.
The Indiscriminate Use of Cluster Bombs
The Sri Lankan government has repeatedly denied using cluster munitions during the civil war. However, numerous sources including UN experts have confirmed finding cluster bomblets, particularly in Puthukkudiyiruppu (hereafter, PTK).[4] [5] Cluster munitions are a type of weapon that scatters multiple bomblets over a wide area – typically the size of one or two football fields. Their use in populated areas violates the prohibition of indiscriminate attacks, which is a fundamental principle of international humanitarian law.
According to Amnesty International, between 5% and 20% of these submunitions fail to explode, creating a long-term hazard for civilians.[6] The left-behind explosive debris hampered post-conflict rebuilding in those areas and continues to pose an ongoing threat to civilians 16 years later.
Throughout February, SLC is remembering the hospital bombings that occurred in February 2009. Here is data from just some of the attacks, collected by Human Rights Watch.
These attacks not only caused immediate devastation but also have had long-lasting consequences, leaving communities in the area without access to vital medical care during the war and its aftermath.
A Global Pattern of Impunity
Individuals who wilfully or recklessly order or carry out unlawful attacks on civilians and civilian medical facilities are responsible for war crimes. States are obligated under the laws of war to investigate alleged war crimes and prosecute those responsible. Despite clear evidence of war crimes in Sri Lanka, such as these attacks on hospitals, no meaningful legal action has been taken. The failure to prosecute those responsible not only denies justice to victims but also sets a dangerous precedent for future conflicts.
In recent years, similar tactics have been employed in Gaza and Syria, where hospitals have been deliberately targeted, in clear violation of international humanitarian law. The Syrian conflict saw more than 600 attacks on hospitals between 2011 and 2021 according to reports by Physicians for Human Rights.[7] A UN-report cited at least 136 attacks on hospitals and medical facilities in Gaza between October 2023 and June 2024.[8]
The lack of accountability in Sri Lanka has emboldened perpetrators elsewhere, demonstrating how impunity breeds repetition. Governments and international bodies must take urgent steps to address these violations and prevent history from repeating itself.
Call to Action: The War on Healthcare Must End
The deliberate and systematic destruction of medical facilities is not just a violation of international law; it is an assault on humanity itself. Such attacks deprive the most vulnerable of essential care, erode trust in humanitarian systems, and prolong the suffering of entire populations.
It is crucial that we continue to advocate for the protection of medical facilities in conflict zones and ensure that those responsible for war crimes are brought to justice. The international community must take decisive action by:
The 2012 report of the Secretary-General’s Internal Review Panel on UN Action in Sri Lanka by Charles Petrie criticised the UN for withdrawing its staff from the conflict zone, underreporting civilian casualties, failing to publicly condemn human rights violations, and mishandling internal communications. The report also highlighted how the UN did not adequately challenge the Sri Lankan government’s obstruction of humanitarian efforts. These failures left civilians vulnerable and unprotected, allowing attacks on hospitals and medical facilities to continue with impunity. Despite clear evidence that hospitals in government-declared no-fire zones were repeatedly shelled, the UN remained largely silent, failing to apply sufficient international pressure.
The targeting of healthcare facilities in conflicts worldwide—from Sri Lanka to Syria to Gaza—demonstrates that impunity fuels a cycle of violence. Without accountability, these heinous acts will persist, putting millions of lives at risk. We must collectively demand stronger protection for healthcare in war zones, stronger enforcement of international law, and meaningful justice for victims. Only through persistent advocacy, accountability, and global solidarity can we ensure that hospitals and medical workers are no longer seen as legitimate targets of war but are instead recognised and respected as vital lifelines for humanity.
[1] Human Rights Watch (2009), Sri Lanka: Repeated Shelling of Hospitals Evidence of War Crimes https://www.hrw.org/news/2009/05/08/sri-lanka-repeated-shelling-hospitals-evidence-war-crimes
[2] OHCHR (2025), Geneva Convention relative to the Protection of Civilian Persons in Time of War Adopted 12 August 1949 https://www.ohchr.org/en/instruments-mechanisms/instruments/geneva-convention-relative-protection-civilian-persons-time-war#:~:text=to%20such%20areas.-,Article%2018,the%20Parties%20to%20the%20conflict.
[3]IHL Treaties (2025) Geneva Convention, Article 12. https://ihl-databases.icrc.org/en/ihl-treaties/gci-1949/article-12/commentary/2016
[4] The Guardian (2016) Cluster bombs used in Sri Lanka’s civil war, leaked photos suggest https://www.theguardian.com/world/2016/jun/20/cluster-bombs-used-sri-lanka-civil-war-leaked-photos-suggest
[5] BBC News (2012), Cluster bombs found in Sri Lanka, UN expert says https://www.bbc.co.uk/news/world-asia-17861187
[6] Amnesty International (2009), Sri Lanka: Cluster bomb strike on hospital is despicable https://www.amnesty.org/en/latest/press-release/2009/02/sri-lanka-cluster-bomb-strike-hospital-despicable-20090204/
[7] Physicians for Human Rights (2021) “No Place is Safe for Health Care”: The Attack on Syria’s al-Atareb Hospital https://phr.org/issues/health-under-attack/attacks-in-syria/al-atareb-surgical-hospital-no-place-in-syria-is-safe-for-health-care/
[8] OHCHR UN (2024) Thematic Report: Attacks on hospitals during the escalation of hostilities in Gaza https://www.ohchr.org/sites/default/files/documents/countries/opt/20241231-attacks-hospitals-gaza-en.pdf
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