1.5 Human-induced and natural disasters

Linear growth retardation in the first 2 years of life and subsequent obesity are known risk factors for NCDs, especially CVD (Black et al., 2013). Table 1.12 shows that the rates of childhood undernutrition remain unacceptably high. There are interdistrict and intersectoral disparities. There has been little change between 2006 and 2016, except in the prevalence of stunting in the estate sector,4 probably a result of many nutrition-specific and nutritionrelated programmes carried out especially in this sector.

Table 1.12 Prevalence of stunting and wasting, 2006 and 2016

Source

Prevalence of stunting % Prevalence of wasting % Sri Lanka Urban Rural Estate Sri Lanka Urban Rural Estate

DHS (2006) 17.3 13.8 (2.8) 16.2 (3.3) 40.2 (14.2) 14.7 14.7 (3.2) 14.8 (2.7) 13.5 (3.8)

DHS (2016) 17.3 14.7 (3.6) 17.0 (4.0) 31.7 (8.8) 15.1 12.9 (1.6) 15.6 (3.2) 13.4 (3.7)

DHS: Demographic and Health Survey Sources: Department of Census and Statistics, 2009; Department of Census and Statistics, 2017

1.5 Human-induced and natural disasters

Sri Lanka experiences many natural hazards such as drought, floods, landslides, cyclones and coastal erosion. Some of these events have impacted life and infrastructure to an extent that can be called a disaster. The vulnerability of the country to natural disasters is noted to have increased in recent times and is attributed to increasing population pressure, land degradation and climate change.

The tsunami of 26 December 2004 was the most devastating natural disaster in the recorded history of the country, resulting in nearly 31 000 deaths and causing extensive damage to property (Galappathi and Karunanayake, 2007). The tsunami reached the east coast of the island within 2 hours of the earthquake, wrapped round the island affecting the south-east, southern, south-western and parts of the western coastline (Galappathi and Karunanayake, 2007).

Since Independence, Sri Lanka has experienced three armed conflicts, which impacted the whole country. Two insurgencies originated in the south of the

4 Urban sector: all areas administered by municipal and urban councils constitute the urban sector.

Estate sector: estate sector consists of all plantations that are 20 acres or more in extent and with 10 or more resident labourers. Rural sector: all areas other than urban and estate sectors comprise the rural sector. Source: Department of Census and Statistics, 2011a

country led by the JVP, a leftist party currently in mainstream politics. Many lost their lives and a considerable number were injured and displaced from their homes. However, these did not result in a major population migration (Siriwardhana and Wickramage, 2014).

The third was the more severe and protracted conflict with the LTTE. It is estimated that this resulted in the death of 61 878 people of all ethnicities during the period 1989–2009, and many more injured (Uppsala Conflict Data Program, 2020). This also resulted in the largest internal and external displacement experienced in Sri Lankan history. Studies have provided evidence of increased mortality, morbidity and disease burden, and increased prevalence of maternal and neonatal mortality, LBW, stillbirths and a decline in the use of antenatal care during the period of conflict and its immediate aftermath. Malnutrition, infectious diseases such as hepatitis A and leishmaniasis were prevalent among displaced persons. The conflict also had an enormous impact on the mental health of the population, particularly among those in the northern and eastern provinces. It is also important to recognize that health services in the conflict-affected areas continued to be funded, supplied and staffed at government expense throughout the conflict years, honouring the right to free care for all its citizens, including the rebels (Rannan-Eliya and Sikurajapathy, 2009). The resilience of the country’s health system enabled this continued service coverage and function within the conflict-affected areas in the face of many resource limitations and threats to individual safety. In the years since the cessation of the conflict, there has been a comprehensive restructuring of the health services in the affected areas with special attention to the needs of the population (Siriwardhana and Wickramage, 2014).