With no end to Sri Lanka's 15-year long civil war in prospect, the plight of the nation's one million internal refugees is turning into a humanitarian catastrophe.
Fleeing from the ferocious battles along the road that leads to the northern city of Jaffna, hundreds of thousands of displaced Tamils are living in improvised shelters without electricity, running water or sanitation, dependent on rations dispatched from the South.
The Colombo government disputes the claimed size of the population of Vanni, the northern region, and only sends rations for half that number. The result, according to a Christian Aid worker who recently returned to Colombo, is malnutrition on a scale unprecedented in Sri Lanka's history.
A recent survey of 16,000 children, found that only a quarter were properly nourished. More than a third were suffering from third-degree malnutrition, the level beyond which children exhibit distended stomachs and skinny frames. Anecdotal evidence suggests that small numbers of people have already died of starvation.
Malnutrition exacerbates the region's health crisis. Much of Vanni is dense jungle, and where the refugees have cut down trees to make shelters, malaria is now raging out of control. In the Mullaitivu district on the north-east coast, nearly 340,000 people were treated for clinical malaria in 1997, amounting to half of all outpatients seen. The Christian Aid worker said: "Every other person one meets in Vanni has contracted malaria at least twice. It is normal to meet people who have had malaria seven to nine times since they were displaced to Vanni."
The epidemic results in a breakdown of resistance to other diseases long banished from Sri Lanka, such as tuberculosis and typhoid, which have again become common.
This crisis is made worse by the government's embargo on medicines. Along with the rationing of food and other goods, the government has, since 1995, imposed tight controls on the shipping of medicines to the North. Even such basic medicines as aspirin and antibiotics are in short supply.
If images of northern Sri Lanka's internal refugee crisis were to reach the outside world, there would be an international outcry. But since the resumption of hostilities in April 1995, the government has enforced a strict blackout of independent coverage of the war.
Talking to people recently returned from the region, it becomes clear why. It is because the Government's writ runs no further than the areas which it has under direct military control. The far northern town of Kilinochchi, for example, which has been fiercely contested this week with up to 300 deaths on both sides, was formerly home to some 50,000 Tamils. When the battle for the town began in 1996, the entire population fled into the countryside.
This is in a sense a black-and-white struggle: where the government digs in, the population - 100 per cent Tamil - flees. The only exception is Jaffna, where half the 450,000 population has returned since the government retook the city in November 1995.
The government's plan to rebuild the historic Tamil Library there has begun the work of creating trust, as have the local elections held last month. But elsewhere the task of persuading the North's Tamils that they belong not to Eelam but to Lanka, has yet to begin.