This blog is by Paul McMaster, a surgeon working with Medecins Sans Frontieres at Vavuniya hospital in northern Sri Lanka which is treating civilians from the conflict zone.

Our Medecins Sans Frontieres team in Vavuniya is very small at the moment.

I've been in the hospital the whole time - I do not have the big picture.

Over the last 24 hours we have seen for the first time fewer casualties coming into the hospital. We only saw 44 severely wounded patients coming into the hospital yesterday, although more have come in this morning. It might be that some of the other casualties are going elsewhere, to other hospitals. We've sent a team on a exploratory mission to try and find out exactly what's happening.

We have done 71 major operations over the past 24 hours. A lot of the 71 operations have been catching up on the last few days - people who we just haven't had time to treat. It has been bedlam in the hospital. But it hasn't got worse in the last 24 hours. We are working with Sri Lankan colleagues who are fully committed to helping the injured. We should recognise the effort they have made.

One of the patients I have seen is a little girl of about seven or eight who has a severe leg injury. Her elder sister is in the same bed with wounds on her arms and legs. Their sister has burns to her face. Their mother has been killed and their father is in intensive care. With the level of aftercare that we can provide at the moment he has a 50/50 chance of making it, at best.

We are only seeing the acute casualties - there are many people who are ill - several of the injured people also have chicken pox. We are hearing reports that there have been outbreaks of chicken pox in the camps because peoples' immune systems are so weak.

Things are continuing but the level of activity has dropped over the last 24 hours. We're trying to recover from the past few days. At the moment the Sri Lankan team are in theatre and we are trying to sort out the wards. We have 320 patients in a ward with 45 beds. It's so crowded that the nurses cannot physically walk around the ward.

We manage to get most patients into surgery - the problem is we desperately need more nurses to provide the level of aftercare they need if they're going to survive.

We are losing people who have major injuries because we do not have enough nurses to give them the level of aftercare they need. The nurses we've got are doing an excellent job - they are working 18-20 hours a day and I hear that some extra nurses are being sent to the hospital - the Sri Lankan medial authorities have made a real effort to send extra staff to help out.

There are simply too many people to treat them all - we are not able to save some people because we need to provide more aftercare - there are simply not enough nurses.

I do not have the big picture - we are hearing rumours that more people are going to come but can't verify this of course. The patients are telling us they've seen many more injured people - we're still preparing for many more people to come - Hugue (the MSF Head of Mission) and others have gone up to the Vanni crossing point to assess the situation.

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