Sri Lankan public health system in crisis as doctors warn of rising dengue fever infections

Sri Lankan man covers his face as a municipal worker fumigates insecticide to curb mosquito breeding to try to control dengue fever in Colombo, Sri Lanka, Thursday, June 28, 2012. [AP Photo/Gemunu Amarasinghe]

Sri Lanka’s workers and oppressed masses, struggling to cope with the ongoing COVID-19 pandemic and brutal austerity measures being imposed by the Wickremesinghe government, are now being hit by a rapidly spreading dengue outbreak.

Health Services deputy director general Dr. G. Wijesuriya told the media last week that dengue fever infections have tripled over the last two years. He warned that the island faced a major increase of the deadly disease in the coming weeks with heavy rains. According to the Sri Lanka Medical Association (SLMA), 15 persons have died from dengue in the first four months of the year.

Wijesuriya pointed out that intensive care units in several hospitals are already overcrowded with dengue patients. 45 dengue-infected children are currently being treated at the Lady Ridgeway Children’s Hospital (LRH), Sri Lankan’s main children’s hospital. Wijesuriya, who is also the LRH director, said: “The majority of these children are in the 5 to 14 year age group and some are suffering from hemorrhagic [cases], a severe form of dengue.”

Speaking with the Daily Mirror, Dr Ananda Wijewickrama, senior consultant physician at Sri Lanka’s Infectious Diseases Hospital (IDH), warned: “At the moment, we are experiencing a [dengue] epidemic. The worry is that it is likely to get worse.… Normally, the number of patients tends to increase in June and July but Sri Lanka has already recorded over 34,000 cases. In that context, the worst is yet to come.”

Dengue, which is particularly deadly for kids, is spread through mosquitoes. It was first reported in 1965. Since 1989, it has become a semi-permanent epidemic.

Dengue fever symptoms. [Photo: Mikael Häggström ]

National Dengue Control Unit director Dr Nalin Ariyaratne revealed that 33,722 dengue infections have been reported in Sri Lanka from January 1 to May 14. “The Association for the Prevention of Dengue has identified 59 Medical Officer of Health (MOH) divisions as highly contagious areas with 50 percent of the patients identified in the Western Province,” he said.

Twenty-one percent of the Western Province dengue patients are from Gampaha district, with 18 percent and 7 percent respectively from the Colombo and Kalutara districts. The Health Ministry said that although second and third variants of dengue are mainly dominant, the original strain is still spreading, even after 14 years.

It is the highest number of dengue infections since 2017. In that year, 440 died out of 186,101 of those infected. Every hospital in the Colombo area, including the National Hospital and the IDH, were overwhelmed with dengue patients. Limited hospital beds meant that some patients died without having received any treatment. This sort of situation is developing once again.

COVID-19 continues to spread, with many new infections and deaths reported. According to the Epidemiology Unit of the Health Ministry, 150 infections have been recorded and 16 deaths in the last 20 days.

Like their counterparts internationally, the Sri Lankan government has placed profits ahead of lives and abandoned rudimentary safety procedures. According to the country’s highly undercounted official statistics, 672,304 people have been infected and 16,856 have died from COVID-19 in Sri Lanka.

At the same time, malaria, previously eliminated in Sri Lanka, has re-emerged. Institute of National Health science director Thamara Kalubowila recently told the media that the country recorded its first malaria death in April this year, the first in 14 years. There had been 14 malaria infection cases in the first four months of 2023.

On May 9, President Wickremesinghe sent a letter to all the country’s district secretaries instructing them to take “all measures” necessary to prevent the spread of dengue. Wickremesinghe’s real concern is that increasing dengue infections will intensify the already rising popular opposition to his government and its social austerity attacks on the working masses.

Notwithstanding Wickremesinghe’s call for the population to take “all measures” to prevent dengue, no concrete program has been announced and no money allocated for any such measures.

But under the president’s so-called instructions, thousands of police officers and soldiers, along with health officials, are going house to house in “MOH divisions at risk of dengue,” identifying mosquito breeding places. Residents are being ordered to prevent these breeding places from developing while being threatened with legal action under dengue prevention laws if they fail to do so.

During the 2017 dengue outbreak, then President Maithripala Sirisena and his prime minister, Ranil Wickremesinghe, took legal action against thousands of people accused of violating the dengue prevention laws.

The purpose of these operations is to help the government to wash its hands of any responsibility for stopping the disease and placing responsibility onto the population. Likewise, the deployment of police and military personnel, under the pretext of dengue prevention, is part of the increasing militarisation of political rule.

The real attitude of the Wickremesinghe government is revealed in its allocation for public health in the 2023 budget. While spending 539 billion rupees for its military-police repressive apparatus, it has allocated a meagre 322 billion rupees for health.

Successive Sri Lankan governments, including the current Wickremesinghe regime, have allocated less than 2 percent of gross domestic product (GDP) to public health. Health, education and other basic social programs were gutted in order to pay for Colombo’s 26-year communalist war against the separatist Liberation Tigers of Tamil Eelam (LTTE). These social attacks have intensified under IMF dictates since the 2008 global economic crash.

Sri Lanka’s public health system is on the brink of collapse with the government hospital network severely understaffed and lacking essential equipment and pharmaceuticals.

According to 2017 figures, the most recent available, there were only 1,720 public health inspectors (PHIs) in Sri Lanka—i.e., only one PHI for every 13,000 people. A PHI told the World Socialist Web Site that in some parts of the island, the proportion was 1 for every 30,000 people. The minimum World Health Organisation (WHO) standard is 1 to 10,000.

The training of professionals in the public health sector and awareness programs for people has been cut. Other measures, like spraying anti-mosquito larvae and smoking which was conducted by MOH offices and local government bodies, have been almost entirely ended.

The PHI who spoke to the WSWS explained: “If you want to control diseases like dengue, you have to implement advanced programs for solid waste management. Parallel programs are needed to provide the people with scientific knowledge on these diseases and their control. And for workers like us to do our duties with satisfaction, we should have decent wages and be freed from oppressively large workloads.”