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Around this same time, both the medical school and the field hospital were electric with worry. The Sri Lankan government wanted to shut down the Jaffna General Hospital. Technically it was a government hospital under their control, and a civilian site that they could not attack–but the Tigers regularly fired at the military from its vicinity. Although I could not abide that the Tigers used a civilian hospital for their own protection, if it were to close, the ill and injured would have fewer places to go. Many civilians would leave Jaffna. And that would give the military a clear route to seize control – p. 223
We had thought the Indians would save us, but in fact their brutality was greater than that of the Sri Lankan government. As the atrocities mounted, the Indian Peace Keeping Force gained a different nickname: the Innocent People Killing Force. . .houses like ours, which had been occupied by the Tigers, were abandoned and wired with explosives. . .My house was not the only place I loved and could not protect. The campus, which had been a site of fighting, was closed. My beloved Jaffna General Hospital, despite its status as a declared safe zone, had been damaged. It was barely running – p. 274.
In July 1987 India brokered a peace accord with Sri Lanka and sent its Indian Peace Keeping Force (IPKF) to enforce a truce. Initially welcomed by many Tamils as protectors, Indian troops soon clashed with the LTTE, which rejected the accord. In October 1987 the IPKF launched Operation Pawan to capture Jaffna. This offensive surprised and outraged Tamils who had seen India as an ally. The course of this fighting involved serious violence on both sides: Indian troops committed civilian killings, and the LTTE carried out lethal attacks against Indian forces. On the night of 21–22 October 1987 IPKF soldiers entered the Jaffna Teaching Hospital and opened fire on patients and staff. Reports describe a massacre of Tamil civilians: a Tamil Guardian source notes “at least 68 civilians, including 21 medical personnel, were killed” as grenades and rifle fire ripped through the hospital.
The IPKF justified its actions by claiming that militants were firing from the hospital. While the Tamil Tigers’ use of a civilian hospital as cover for military operations constitutes a violation of humanitarian norms (specifically the principle of distinction, which obligates combatants to separate themselves from civilians), the ethical breach does not absolve the Indian forces of responsibility. The subsequent massacre by Indian soldiers is a clear violation of international law. Under the Geneva Conventions, hospitals are protected spaces, and the deliberate targeting of patients and medical personnel is a war crime. Ethically, the event underscores a fundamental dilemma in modern warfare: when one party disregards the rules of war, it often tempts or provokes the opposing force to respond in kind, leading to cycles of violence that erode moral boundaries. The novel compels readers to confront both of these truths–that the Tigers strategically exploited civilian infrastructure, and that the IPKF responded with indiscriminate brutality, failing to distinguish between combatants and civilians. In doing so, it raises urgent questions about the limits of ethical conduct in war, the weight of institutional responsibility, and the cost borne by non-combatants when those limits are ignored.
Survivors recalled scenes of carnage. In 2017, BBC News interviewed a former hospital worker who had hidden in a room for hours, hearing “gunfire and staff shouting as they were being shot dead,” and identifying the shooters as Indian soldiers. When doctors arrived days later, they reported that the hospital “smelled of stale blood” and heard accounts of some colleagues being forced to lie beneath corpses to avoid being shot.
First, I must tell you the story as you might have heard it overseas, from those who support the Tigers and those who criticize the Indians. The Indian peacekeepers burst into the hospital, which had been declared a safe zone, and shot at doctors, nurses, patients in their beds. They massacred people who were caring for others, people who held up their hands in surrender, people who identified themselves as part of the medical profession. Eighty-seven people died. . .Widen your lens, stand further away, and see who the Tigers left out of the picture, see who profits from the death of ordinary people. . .The Tigers remove their own people from the hospital, cadres we are treating, and leave everyone else to the mercy of the vengeful Indian soldiers, who slaughter with no care for who is civilian and who is combatant (p. 280).
Efforts at accountability proved fruitless. The Indian government never charged any soldiers over the hospital killings. No formal international inquiry took place. In Sri Lanka, families of the victims have repeatedly sought justice and closure through the courts. As recently as 2025 a Sri Lankan court authorized the exhumation and proper Hindu funeral of a Tamil mother and child shot in 1987.
The tragedy at the hospital is both a symbol of the brutality of the Indian military and an indictment of the Tiger’s own ruthlessness. The hospital, meant to serve and save lives, was transformed into a stage for death. Across many conflicts, armed groups have used schools, churches, and hospitals for cover or legitimacy, knowing full well that their presence in such spaces complicates the rules of engagement.
A memorial at Jaffna Teaching Hospital now honors the doctors, nurses and patients killed on October 22, 1987. Each year survivors and families hold commemorations.
Possible discussion questions for use with students:
- Why was the Jaffna General Hospital supposed to be a “safe zone”? What are the ethical implications of targeting or using such sites for armed resistance?
- If a struggle for liberation demands sacrifice, whose bodies should be/are being offered and by whom? Who is protected? Who is left behind?
- How does the novel portray the shifting allegiances and betrayals experienced by Tamil civilians during this time? How does Sashi’s perspective evolve during this time?
- Throughout the novel, multiple versions of the same event circulate through different stories told about it. In the “Hospital Notes” chapter, Sashi contrasts the international news account with the version known by those present. What does this suggest about the challenges of retelling histories of violence? How should we think about the reliability of different sources, how many sources are needed, from whom, and which are the most reliable?
