Puthukkudiyiruppu Hospital in the northern Vanni region was shelled Sunday afternoon, killing at least two people and injuring at least five others. The compound sustained two direct hits, International Committee of the Red Cross (ICRC) said.

"We’re shocked that the hospital was hit, and this for the second time in recent weeks," said Paul Castella, head of the Colombo delegation of ICRC. "Wounded and sick people, medical personnel and medical facilities are all protected by international humanitarian law. Under no circumstance may they be directly attacked."

The hospital currently has over 500 in-patients, some of them still waiting to be transferred to the government-controlled area for more adequate treatment. Despite Sunday’s attack, people injured by the fighting continue to arrive at the facility.

The ICRC has been supporting the hospital’s staff by setting up a makeshift structure for triage, receiving ambulances, and helping to clean the facility. It has also provided mattresses for patients who find themselves in the corridors because there is no longer any room in the wards.

"The staff is under acute stress, surrounded as they are by the sound of the ongoing fighting and the influx of new patients," said Morven Murchison-Lochrie, an ICRC medical coordinator, who is present in the hospital. "Ambulances are constantly arriving, but people are also being brought in by wagon, pick-up truck, tractor and even motor scooter."

Despite this, she said, the staff remained inventive and committed to caring for the injured and sick who had made the dangerous trip to the hospital.

Appealing to those involved in the fighting, Mr Castella said: ‘’The ICRC calls on both parties to respect their obligation to spare medical facilities and activities, as required by international humanitarian law in all circumstances."

ICRC staff is present in the hospital and, together with the Sri Lanka Red Cross Society, continue to support the Ministry of Health staff caring for the injured and sick there.