On April 7, the World Health Organization celebrated World Health Day with the ambitious theme of a “healthier tomorrow”. On the same day, Muhammed Azmeer, 31, a medical officer at the National Hospital of Sri Lanka, saw nightmare turn to reality at his ward in Colombo as the stock of basic medical necessities ran out due to widespread shortages in the country, which is suffering from its worst economic crisis in decades.

“Needles, gloves, K wires [used to repair bones], nails, plates, screws, surgical spirits, everything is running out,” said Azmeer. With foreign reserves at an all-time low, the island nation of 22 million is grappling with an acute shortage of essentials such as fuel, cooking gas, milk powder and now medicines.

Several public hospitals have even suspended routine surgeries while some are left with no choice but to opt for inferior alternatives with the nearest sizes available for tubular needles and K wires to keep surgeries going. “This has more chances of having post-surgical failures and infections which will add nothing but more burden to the patient and the free health system of Sri Lanka,” Azmeer said.

The South Asian nation has been lauded for strong health outcomes and the low cost of healthcare services despite not spending a lot on public health, according to Dr Ravindra Rannan-Eliya, executive director at the Colombo-based think tank Institute for Health Policy.

“Health spending in Sri Lanka as a share of national income has been pretty flat in terms of what the government spends since the 1980s,” said Rannan-Eliya. But today, this impressive healthcare system is struggling to provide basic treatment for common illnesses due to a catastrophic shortage of life-saving medicines, 90% of which are imported.

After announcing a medical emergency last fortnight over rapidly depleting medical supplies, Sri Lanka’s most respected trade unions, the Government Medical Officers’ Association, has put out a desperate call for donations from abroad. Dr Samantha Ananda, spokesperson of the association, said power cuts lasting several hours a day have worsened the situation for hospitals which are forced to prioritise surgeries.

Doctors, nurses and healthcare professionals across Sri Lanka have also protested over the widespread shortage of medicines. “Doctors are just not prepared for this imminent collapse of the health system,” said Ananda.

The Sri Lanka Medical Association also sent a letter to President Gotabaya Rajapaksa on April 7 saying hospitals will no longer be able to provide emergency services due to a critical shortage of drugs and medical equipment. The letter said that unless supplies are urgently replenished, “within a matter of weeks, if not days, emergency treatment will also not be possible. This will result in a catastrophic number of deaths.”

The government, in response, appointed a national health coordinator to oversee the donations on behalf of the health ministry of Sri Lanka. “This is just a sticking plaster,” said Rannan-Eliya. “It’s not really addressing the fundamental problems which will still remain irrespective of the donations,” he said.

According to Rannan-Eliya, the response of the health ministry does not, in any way, address the shortage of supplies among private sector pharmacies, which are not supported by the government.

Schools in Sri Lanka have cancelled exams in March, newspapers have so far suspended their print editions, as the cash-strapped country ran out of printing paper. Doctors have not been spared either. “We are now writing our operational notes on the leftover cut-outs of A4 sheets,” Azmeer said of the situation at the National Hospital of Sri Lanka in Colombo.

Exacerbated by repeated tragedies – the long-drawn-out civil war, the 2004 tsunami, Easter bombings, the Covid-19 pandemic, and now the economic downturn – the panic-stricken communities in Sri Lanka are increasingly concerned amid fears of countrywide starvation. The crisis has led to mass protests across the country calling for the resignation of President Gotabaya Rajapaksa over the colossal economic mismanagement.

It also did not take long for the financial crisis to turn into a political one as the entire cabinet resigned days after President Rajapaksa revoked the state of emergency, which did little to quell the anger of thousands who have been chanting outside the office of the president in Colombo – “go home Gota”.

The political power in Sri Lanka is concentrated in the Rajapaksa family. Brothers Gotabaya Rajapaksa and Mahinda Rajapaksa are president and prime minister respectively. Two other brothers, Basil Rajapaksa and Chamal Rajapaksa, held the posts of ministers of finance and irrigation respectively. The president’s nephew, Namal Rajapaksa, held the post of sports minister.

All three brothers have stepped down from their posts. The president, with enormous powers, has resisted demands to step down even after some of his own party members joined protests calling for his removal.

According to Alan Keenan, a senior consultant on Sri Lanka at the London-based International Crisis Group, one of the major reasons why Gotabaya Rajapaksa does not want to resign is because he could then face criminal prosecution.

“…As soon as he’s out of power, he’s very vulnerable to criminal prosecution for a lot of different issues for alleged involvement in corrupt deals, his alleged role in certain attacks on journalists when he was defence secretary, his involvement in decision making about the war and the alleged war crimes,” said Keenan. “He’s worried about how susceptible he might be to prosecution, either in Sri Lanka or in foreign jurisdictions as well.”

The government’s newly appointed finance minister has sought $3 billion in external assistance and the support of a debt restructuring programme with the International Monetary Fund over the next six months to help restore supplies.

The Sri Lankan government has also turned to India and China for help. “Sri Lanka is so desperate for money right now that they’ll go anywhere and whether you go to the IMF, India or China, it will have its strings attached,” said Keenan.

The support of the International Monetary Fund will only come at the cost of radical changes in policies, while the Chinese involvement in Sri Lanka will always be there, according to Keenan. “The Chinese money brings with it authoritarian and worrisome political strings of media control and no space for dissent,” Keenan said.

India has extended a $400-million currency swap and a $500-million credit line for fuel purchases to crisis-hit Sri Lanka. India also sent 40,000 tonnes of rice staples as the first major food aid. “India has also brought strings. The generosity from India is basically in exchange for a number of oil tanks and power projects in Sri Lanka that the Indians have wanted,” Keenan said.

Meanwhile, much of the anger during the demonstrations has been directed at the Rajapaksa clan, which has been in power for most of the past two decades. Even some pregnant women and mothers have taken to the streets demanding a better future for their children.

The minority Muslim community has also come forward by breaking their Ramadan fast at protest sites to share food with vulnerable people. “We see there’s a massive protest movement,” Keenan said. “The democratic spirit in Sri Lanka hasn’t been crushed by any means.”

Darshan Dalal is a journalist based in London.