• This is Part 1 of a 13-part series. The following parts will be published in upcoming issues of The Daily Morning  

The 30 years of internal conflict in Sri Lanka has produced a new generation of veterans at risk for the chronic mental health problems that resulted following prolonged exposure to the war. Over 200,000 members of the Sri Lanka armed forces and the Police had been directly or indirectly exposed to combat situations during these years. 

There had been nearly 20 major military operations conducted by the armed forces from 1987 to 2009. A large number of combatants from the Sri Lanka armed forces were exposed to hostile battle conditions and many soldiers underwent traumatic battle events outside the range of usual human experience. These experiences include seeing fellow soldiers being killed or wounded and the sight of unburied decomposing bodies, of hearing screams for help from the wounded, and of helplessly watching the wounded die without the possibility of being rescued. Following combat trauma in Sri Lanka, a significant number of combatants were diagnosed with post-traumatic stress disorder (PTSD).

The combat operations in the North and the East had involved military personnel in major ground combat and hazardous security duty. A significant number of combatants had post-traumatic reactions soon after the traumatic combat events. The majority of these reactions were undetected and untreated.

The deaths include 27,639 Liberation Tigers of Tamil Eelam (LTTE) cadres, 23,327 Sri Lankan soldiers and Police officers, 1,155 Indian soldiers, and tens of thousands of civilians. The last phase of the war resulted in 280,000 internally displaced persons.

Combat trauma experienced by soldiers

War is particularly traumatic for soldiers because it often involves close violence, including witnessing death through direct combat, viewing the enemy before or after killing them, and watching friends and comrades die (H. Hendin and A.P. Haas’s ‘Combat adaptations of Vietnam veterans without PTSDs’). After exposure to combat trauma, soldiers are more likely to have psychological ailments, predominantly stress-related symptoms, problems with social relationships and various other problems.

The wounds that they received from war are not confined to the battlefield. It frequently transformed to their domestic environment as well. Although studies are needed to systematically assess the mental health of members of the armed services, very few studies were conducted during the last 30 years.

The most common mental health issue for soldiers is PTSD and related symptoms of depression, anxiety, inattention, sleeping related difficulties, nightmares, and survival guilt.

The dedication and the courage of the armed forces cannot be underestimated and the Sri Lankan combatants fought a three-decade-long internal conflict and they were able to gain a clear victory. Sri Lanka paid an immense price for the victory. As a result of the three decades war, many soldiers suffered physical and psychological casualties. Unfortunately, society is gradually forgetting the sacrifices made by these people.

Although many see war as a heroic effort, there are thousands of untold traumatic stories in the Eelam war. Some soldiers shared their traumatic stories with us and these stories reveal the magnitude of their suffering. These stories represent the true nature of combat trauma in Sri Lanka.

The psychological casualty of the Operation Liberation

The Operation Liberation or the Vadamarachchi Operation was conducted in 1987. It was the first major military Operation in Sri Lanka. Nearly 8,000 soldiers participated in this campaign. The most popular and famous officer of the Army, the late Lieutenant General Denzil Lakshman Kobbekaduwa commanded this military offensive against the LTTE.

Corporal Ax36 is one of the psychological casualties of Operation Liberation. During this battle, he faced many battle related stresses. He was physically and mentally exhausted. After serving a number of years in the Army, Cpl. Ax36 witnessed many traumatic events. He suffered nightmares, intrusions, hyper-arousal, and flashbacks. He was avoiding people and places related to his traumatic experiences and became emotionally numbed. In 2003, Cpl Ax36 was diagnosed with PTSD.

Corporal Ax36 describes his present emotional and physical ailments as follows.

“I was one of the soldiers who took part in the Vadamarachchi Operation in 1987. Our main aim was to liberate the Jaffna Peninsula and destroy the LTTE positions. When we came near the Thondamannar bridge, the LTTE destroyed the bridge using explosives. We had to advance slowly. One of our soldiers died in front of my eyes as a result of a booby trap. I can still recall his face filled with blood. It was a horrific incident.

Needless to say that I was terrified by this event, because I am a human although I wore a military uniform. I was shaken by the death and demolition. Even after many years, I still see these events in my dreams. To evade the nightmares, I used to take alcohol and go to sleep. I cannot stand any loud noises, as I become frightened and my heart starts pounding. Often, I try not to think about past events. When I see the television, if I see any combat related story or pictures, I disconnect myself with it. I hate to talk about past events, especially those related to the war.

I have no strength in my body now. My joints are aching. I cannot even walk a mile. Prematurely, I have grown old. My mind is full of melancholic feelings. I am unable to feel happiness. For many years, I never experienced cheerfulness.

I am unable to concentrate and I am very forgetful. I have forgotten the names of my fellow soldiers who served with me in the same unit. Sometimes, I feel that I have no reason to live. My family members avoid me because of my hot temper. Unlike in the early days, I cannot control my anger. I have been turned into an irritable, cold person. Several times, I thought of disappearing from this world. But, according to my religion, it is a sin. Therefore, I have resisted the idea of committing suicide.”

Private K & survival guilt

There is a higher incidence of depression in veterans who had been in combat and lost a friend. Survival guilt is an especially guilt invoking symptom.

‘Survivor guilt’ is the term used to describe the feelings of those who, fortunately, emerge from a disaster, which mortally engulfs others. On an irrational level, these individuals wince at their privileged escape from death’s clutches (M.R. Harvey's ‘Towards an ecological understanding of resilience in trauma survivors: Implications for theory, research and practice’).

Private K is a soldier who was severely troubled by survival guilt. He joined the Army in 1992 and served in the North. While serving in combat, his buddy was shot in front of his eyes near the Punanai station. He fell down and lost consciousness. Although Private K wanted to help his friend, he could not reach the friend due to heavy fire. Along with the other soldiers, he attacked the enemy and eventually went near his friend. But, he was dead. This incident made him so upset. He felt guilty that he could not help the buddy.

By 1997, he often experienced headaches, intrusions about his dead friend and showed marked depression. He became irritable and gave a startling reaction to any slight sound. Private K felt uneasy with the military duties and wanted to avoid military situations. In 2003, he was referred to the Military Hospital in Colombo and diagnosed as having PTSD. Private K’s condition improved following drug therapy (selective serotonin reuptake inhibitors) and psychotherapy (cognitive behavioural therapy and eye movement desensitisation and reprocessing). By 2005, he was free of most of the PTSD symptoms. After cognitive restructuring, he got the insight and now Private K knows that he was not responsible for the death of his friend.

Did I bury him alive?

Private Lx26 became pitiful when he witnessed the death of his fellow soldier who got killed by a sniper shot. The troops had no means to bring the body back. After the confirmation of death, Private Lx26 was ordered to bury the body. When he touched his friend’s body, he could feel the body’s warmth, maybe due to the hot Northern climate. Private Lx26 dug a pit and buried his friend’s body in the midst of sorrow. Then, they advanced towards Omanthai. After several days, Private Lx26 had an irrational and guilty feeling that he had buried his friend alive. He suppressed this painful feeling for a long time. Gradually, it became a distressing thought, which he could not bear anymore. In 2003, he experienced a severe depressive reaction following survival guilt. He had full-blown symptoms of clinical depression. 

He was treated with rational emotive therapy in which his irrational and illogical ideas were confronted via a friendly and therapeutic mediation. After the therapeutic intervention, Private Lx26 was free from the devastating psychological burden that he had carried for a lengthy number of years.

(The writer is a Doctor of Medicine)

……………………………………………………………………………………………………………………..

The views and opinions expressed in this article are those of the author, and do not necessarily reflect those of this publication.