Hektoen International

A Journal of Medical Humanities

Sri Lanka, a pearl of the Indian Ocean

Photo by Genine Alyssa Pedreno-Andrada on Pexels

Sri Lanka is an island nation in the Indian Ocean just south of the Indian subcontinent. Once called Ceylon, its history spans over 2,500 years, beginning with the arrival of Prince Vijaya from India in the sixth century BCE. In the third century BCE, the Emperor Ashoka’s son introduced Buddhism. The island’s position along ancient maritime trade routes attracted merchants from Rome, Greece, China, and the Arab world, making it a melting pot of civilizations. It began with the ancient kingdoms of Anuradhapura and Polonnaruwa, which constructed sophisticated irrigation systems and massive reservoirs that still function today.

The Portuguese (1505–1658), Dutch (1658–1796), and British (1796–1948) successively controlled parts or all of the island. British rule ended in 1948, leaving a centralized administration, a plantation-based economy, widespread use of English, and the introduction of tea cultivation, which became synonymous with the island’s global identity. About seventy percent of the population today practices Buddhism, but Hinduism flourishes particularly in the north, and the overall culture is a blend of Sinhalese, Tamil, Muslim, and Christian traditions. This cultural pluralism manifests itself in such festivals as a ten-day Buddhist celebration featuring elaborately decorated elephants, traditional dancers, and fire performers, as well as classical, acrobatic, and colorful dances. Traditional crafts include wood carving, brass work, and handloom weaving. The local cuisine features rice and curry as the staple meal, prepared with cinnamon, cardamom, and cloves.

Sri Lanka became independent from Britain in 1948. Ethnic tensions between the Sinhalese majority (about 74%) and the Tamil minority (about 18%, concentrated in the north and east) escalated as successive governments discriminated against the Tamils, such as by making Sinhalese the sole official language and restricting university admissions to their disadvantage. These measures fueled Tamil grievances and demands for autonomy. Tamil political movements, especially the powerful militant Liberation Tigers of Tamil Eelam (LTTE), increasingly called for a separate state in the north and east. War broke out in July 1983 following the anti-Tamil pogrom known as Black July, in which Sinhalese mobs killed thousands of Tamils after an LTTE ambush killed thirteen soldiers. The LTTE became infamous for its ruthless tactics, suicide bombings, assassinations, and child soldier recruitment. They assassinated high-profile figures such as Indian Prime Minister Rajiv Gandhi (1991) and Sri Lankan President Ranasinghe Premadasa (1993).

As the LTTE consolidated control in the north and east, India intervened in 1987, sending the Indian Peace Keeping Force (IPKF), but clashes with the LTTE soon led to its withdrawal in 1990. The LTTE captured territory and established a de facto state with its own police, courts, and taxation. Between 2002 and 2006, a Norwegian-brokered ceasefire briefly halted fighting, then peace talks collapsed as both sides accused each other of violations. Between 2006–2009, the government under President Mahinda Rajapaksa launched a decisive military campaign. By May 2009, the LTTE was crushed, its leader killed, and the war ended. Its cost was devastating: an estimated 80,000–100,000 died, hundreds of thousands of Tamils were forced into refugee camps, and both sides committed massacres and human rights abuses. Reconciliation has been slow; Tamil grievances persist, and the challenge of building a truly inclusive nation persists.

Since the war’s end, the country has pursued economic development, balancing agriculture with trade and services. Tea remains its most important export. In recent decades, tourism, textiles, and overseas remittances have become central to the economy. The island’s golden beaches, lush rainforests, and diverse wildlife have made it a magnet for tourists and travelers. The country has historically invested in universal education, achieving relatively high literacy rates.

Sri Lanka’s healthcare system is also a success story among developing nations. Successive governments have prioritized free universal healthcare, establishing a network of free public hospitals and clinics. Life expectancy rates and infant mortality figures are comparable to those of many developed countries, maternal mortality rates have declined dramatically, and malaria was eradicated in 2016. An extensive network of public health midwives and nurses reaches even remote villages, provides prenatal care, and educates communities about nutrition and hygiene. Traditional medicine, particularly Ayurveda, coexists with Western medicine, and many Sri Lankans utilize both systems, consulting Ayurvedic practitioners for minor conditions but modern medicine for severe illnesses. As Sri Lanka faces pressures from an aging population, an increasing prevalence of diabetes and cardiovascular conditions, and the brain drain of medical professionals seeking opportunities abroad, it moves forward, balancing the preservation of ancient heritage with the demands of modernization.


GEORGE DUNEA, MD, Editor-in-Chief

Fall 2025

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