The Brink of Collapse

Dengue has been on the island for as long as anyone has kept records, a seasonal misery that arrives with the monsoon and usually recedes with it. What is happening now is of a different order by Sri Lankas own measures. More than 76,000 people have been infected this year and 53 have died, the worst outbreak in nearly a decade, with the caseload running at more than double last years by the middle of the summer. Hospitals in Colombo and the surrounding districts have been admitting over a thousand dengue patients a day. Doctors describe wards where beds ran out weeks ago. The health ministrys own officials concede the system is close to collapse.

Sri Lankas answer has been, predictably, to call in the military. Since June, officers from all three services have been assigned to a special unit under the presidents office, drones have been sent over rooftops, and soldiers have been going door to door, inspecting gardens and issuing warnings. In the middle of July the government doubled the personnel involved. Anyone who lived through 2020 will recognise the shape of this overtly militarised response. The coronavirus pandemic was run through army task forces under a serving general, quarantine was enforced by troops, and public health became another theatre of command. It seems whatever crisis occurs on this island, the state reaches first for its soldiers.

But much has changed since the last great dengue outbreak in 2017. The economic collapse of 2022 hollowed out the public health service, as medicines ran short and stocks were never fully replenished. Doctors and nurses continue to leave for jobs abroad in their thousands, and the ones who stayed carry caseloads that would have been unthinkable ten years ago. Then came Cyclone Ditwah at the end of last year, which drowned whole districts and left standing water across the low country just as the rains resumed, ripe conditions for the Aedes mosquitoes that carry the disease.

Meanwhile the International Monetary Funds austerity programme is being implemented faithfully by the self-styled Marxist government in Colombo, and its weight has fallen on precisely the services now buckling. Health spending has been squeezed alongside everything else the public depends on. The outbreak found a population already weakened, and a health service with nothing left in reserve.

One budget line has escaped. Seventeen years after the end of the armed conflict, the military still commands one of the largest allocations in the states accounts. This is why a government too stretched to staff its wards with doctors and nurses can nonetheless find manpower for soldiers to knock on every doorstep in Gampaha. The deployment is being presented as evidence of seriousness. It reads better as evidence of what this state has chosen to keep funding through every crisis it has faced.

There is another line the government has found money for - an eight-month long two billion rupee advertising campaign targeting tourists from around the world, in an attempt to drive up visits to the island. Much of that spending targets the off-peak months, which happen to be the monsoon months when the Aedes mosquito breeds and the wards fill up.

The National Peoples Power (NPP) came to office promising to be unlike every other regime that preceded it. Less than two years in, its soldiers are in the streets on civilian duties as the healthcare system teeters on the brink of collapse. The change it promised has not arrived. And the people queuing outside the fever wards this month have paid part of the price for it.