Opinion
Centenary of Sri Lanka Medical Council: To evolve or to revolve?
The Sri Lanka Medical Council, as the sole regulator of medical professionals in Sri Lanka, has played a vital role in shaping the nature, quality, and character of medical professionals and the medical profession for a century.
The speech made by Justice Yasantha Kodagoda on 5 July 2025 at the Centenary Celebrations of the SLMC, deserves praise and our sincere thanks for its forthrightness. The speech presents to the medical community at large, an invitation and opportunity to look more inwards than outward in its regulatory role for the future. His Lordship’s speech was aptly titled “Strategies for Addressing Malpractices in Healthcare Systems”. This is also the very point that was reiterated by the current registrar of the SLMC who stated, “With a vision for continuous improvements and adaptation, the SLMC is poised to navigate the future of healthcare with the same dedication that has defined its first century.”
We have been told for at least the past decade that there is a new Medical Bill which is with the Ministry of Health which will address the issues raised by the medical professions and health professionals which will enable the dedicated men and women of future SLMCs to perform the duty of the SLMC. In summary, it is to protect the citizens of Sri Lanka from the medical professionals (‘The SLMC is a statutory body established for the purpose of protecting health care seekers by ensuring the maintenance of academic and professional standards, discipline and ethical practice by health professionals who are registered with it’)
As pointed out by Justice Kodagoda, issues pertaining to medical ethics by practicing medical professionals, and the manner in which the SLMC has handled such issues in the recent past in particular, has led to increasing public concern about the SLMC. His Lordship went further and even proposed a mechanism/s to overcome such public concern with a particular reference to ethical issues resulting from the practice of medicine. He quite correctly used words such as ‘neutrality’ and ‘representation’ to a ‘Complaints Secretariat’, which he proposed to be instituted to handle issues on complaints against medical professionals. He even suggested that non-medical professionals should be allowed to serve on such disciplinary panels.
As of now the composition of SLMC Council is exclusively limited to doctors as far as the medical profession is concerned. Thus, whatever process is suggested within this fundamental framework, it will, as of now, ultimately result in Self-regulation of Doctors by Doctors. This is the real question which needs addressing and one hopes that the new Medical Bill, decades in the making, will address the fundamental question of ‘Can the medical profession self-regulate itself or does the composition of the SLMC need fundamental reform to include non-medical personnel on its council to unbiasedly perform its statutory duty of protecting the Sri Lankan citizen from the Sri Lankan medical profession?
The institution on which the SLMC was modeled on, over a century ago is the General Medical Council (GMC) of the United Kingdom which was established in the year1858. Initially its members were elected by the members of the profession and enjoyed widespread confidence from the profession. The 167-year-old GMC has undergone many reforms to serve the public and profession in a more transparent, accountable and responsible manner over the years. With regards to public concern that the GMC was self-regulating itself to the detriment of public trust in it, was addressed in 2013. The General Medical Council (GMC) in the UK was reduced to 12 members from 24 members on January 1, 2013. The Council has 12 members, include 6 medical professionals (registrant members) and 6 non-medical individuals (lay members). The GMC also has an Executive Board that handles daily operations and over 1,000 associates who support its work.
An interesting article appeared in the comments section of the British Medical Journal of 12th November 2022. That opinion piece was titled The GMC (General Medical Council) has been failing for 30 years. The opinion of the authors, Martin Mckee and Scott L. Greer, dealt with matters of transparency pertaining to the regulatory role of the GMC within the profession in the United Kingdom. This opinion piece was brought to the notice of the SLMC by way of an e-mail and regular post on 17th November 2022. The point of discussion which was requested from the SLMC was ‘is the current composition of the Council of the SLMC unbiasedly capable of ‘self-regulation’ of the profession at large?’ and ‘Has/Is the Sri Lanka Medical Council acted/acting in the best interest of the citizens of Sri Lanka or Is it acting in the self-interest of the profession, or more specifically the self-interest of an elected/selected segment of the medical profession?’
With regards to the composition of the SLMC Council, and the Medical Bill of a wider outlook which has been proposed, the SLMC called for submission of proposals by way of a newspaper advertisement on 5th October 2018. The Sri Lanka Medical Association (SLMA) Council at the time submitted a set of proposal to be included in the new Medical Bill to the SLMC on 22nd October 2018 (the deadline for submission was 28th October 2018).
As the SLMC is celebrating its Centenary and has stated its desire ‘for continuous improvements and adaptation, to navigate the future of healthcare with the same dedication that has defined its first century’ we reproduce below a few submissions made for the consideration of the SLMC back in 2018 with a particular reference to the Council of the SLMC and the process of appointment to the Council of the SLMC
(A). The composition and the term of office of the SLMC
1. The SLMC shall consist of a total of fifteen (15) members appointed by the Constitutional Council of Sri Lanka.
i. Ten (10) members shall be reputed medical/dental practitioners, who have been registered with the SLMC for a minimum period of 20 years.
ii. Two (02) members shall be Deans from the Faculties of Medicine, who have been registered with the SLMC for a minimum period of 20 years.
iii. Three (03) shall be leading professionals of high repute from education, law, finance or management professions, from the private or public sector, with a minimum period of service of 20 years after obtaining the first professional qualification or degree.
2. The President of the SLMC should be elected by the members of the SLMC at its first meeting.
3. The term of office of the Council shall be three (03) years.
4. Any person can serve in the Council only for a maximum of six years in toto.
(B). The process of appointment to the Council of the SLMC
1. The Registrar of the SLMC shall call for applications from eligible members of the Medical/Dental profession and members of the education, legal, finance or management professions, at least three (03) months before the expiry of the term of office of the SLMC.
2. All applications received shall be forwarded to the Constitutional Council through the Executive President of Democratic Socialist Republic of Sri Lanka.
3. The Constitutional Council shall appoint the members within a period of six (06) weeks from the date of submission of the names to the Constitutional Council by His Excellency the President of Sri Lanka.
4. The Constitutional Council shall ensure that the appointees can discharge their duties free from the influence of politicians and trade unions and can perform their functions without fear or favour.
These are a set of submissions among many the SLMC would have received during the period it sought public opinion for the new Medical Bill. We hope that the SLMC in its centenary year will revisit these proposals carefully and seriously address the issue of self-regulation of the doctors by doctors, and introduce more transparency in guiding the medical profession in Sri Lanka in to the future, keeping in mind its statuary role of ‘protecting health care seekers by ensuring the maintenance of academic and professional standards, discipline and ethical practice by health professionals who are registered with it’
As the SLMC enters its 2nd century, the powers that be at the SLMC and medical profession itself, must reflect objectively on the core statutory function of the SLMC. The outcome of this reflection ought to be finding the most suitable answer to the question (perhaps not the ideal answer) How can the SLMC as a statutory body protect the health seekers by ensuring the maintenance of academic and professional
standards, discipline and ethical practice by health professionals who are registered with it?
In doing so the SLMC must not revolve around what it thinks it is doing well but revolve around selected core issues and evolve in manner to serve the interest of the Sri Lankan public which is it’s statutory bound to do.
By Dr Ruvaiz Haniffa
Past President, Sri Lanka Medical Association (2018)
Opinion
When elephants fight, it is the grass that suffers
“As a small and open country, Singapore will always be vulnerable to what happens around us. As Lee Kuan Yew used to say: “when elephants fight, the grass suffers, but when elephants make love, the grass also suffers“. Therefore, we must be aware of what is happening around us, and prepare ourselves for changes and surprises.” – Prime Minister Lee Hsien Loong, during the debate on the President’s Address in Singapore Parliament on 16 May, 2018, commenting on the uncertain external environment during the first Trump Administration.
“When elephants fight, it is the grass that suffers”
is a well-known African proverb commonly used in geopolitics to describe smaller nations caught in the crossfire of conflicts between major powers. At the 1981 Commonwealth conference, when Tanzanian President Julius Nyerere quoted this Swahili proverb, the Prime Minister Lee Kuan Yew famously retorted, “When elephants make love, the grass suffers, too”. In other words, not only when big powers (such as the US, Russia, EU, China or India) clash, the surrounding “grass” (smaller nations) get “trampled” or suffer collateral damage but even when big powers collaborate or enter into friendly agreements, small nations can still be disadvantaged through unintended consequences of those deals. Since then, Singaporean leaders have often quoted this proverb to highlight the broader reality for smaller states, during great power rivalry and from their alliances. They did this to underline the need to prepare Singapore for challenges stemming from the uncertain external environment and to maintain high resilience against global crises.
Like Singapore, as a small and open country, Sri Lanka too is always vulnerable to what happens around us. Hence, we must be alert to what is happening around us, and be ready not only to face challenges but to explore opportunities.
When Elephants Fight
To begin with, President Trump’s “Operation Epic Fury”.
Did we prepare adequately for changes and surprises that could arise from the deteriorating situation in the Gulf region? For example, the impact the conflict has on the safety and welfare of Sri Lankans living in West Asia or on our petroleum and LNG imports. The situation in the Gulf remains fluid with potential for further escalation, with the possibility of a long-term conflict.
The region, which is the GCC, Iraq, Iran, Israel, Jordan, Syria and Azerbaijan (I believe exports to Azerbaijan are through Iran), accounts for slightly over $1 billion of our exports. The region is one of the most important markets for tea (US$546 million out of US$1,408 million in 2024. According to some estimates, this could even be higher). As we export mostly low-grown teas to these countries, the impact of the conflict on low-grown tea producers, who are mainly smallholders, would be extremely strong. Then there are other sectors like fruits and vegetables where the impact would be immediate, unless of course exporters manage to divert these perishable products to other markets. If the conflict continues for a few more weeks or months, managing these challenges will be a difficult task for the nation, not simply for the government. It is also necessary to remember the Russia – Ukraine war, now on to its fifth year, and its impact on Sri Lanka’s economy.
Mother of all bad timing
What is more unfortunate is that the Gulf conflict is occurring on top of an already intensifying global trade war. One observer called it the “mother of all bad timing”. The combination is deadly.
Early last year, when President Trump announced his intention to weaponise tariffs and use them as bargaining tools for his geopolitical goals, most observers anticipated that he would mainly use tariffs to limit imports from the countries with which the United States had large trade deficits: China, Mexico, Vietnam, the European Union, Japan and Canada. The main elephants, who export to the United States. But when reciprocal tariffs were declared on 2nd April, some of the highest reciprocal tariffs were on Saint Pierre and Miquelon (50%), a French territory off Canada with a population of 6000 people, and Lesotho (50%), one of the poorest countries in Southern Africa. Sri Lanka was hit with a 44% reciprocal tariff. In dollar terms, Sri Lanka’s goods trade deficit with the United States was very small (US$ 2.9 billion in 2025) when compared to those of China (US$ 295 billion in 2024) or Vietnam (US$ 123 billion in 2024).
Though the adverse impact of US additional ad valorem duty has substantially reduced due to the recent US Supreme Court decision on reciprocal tariffs, the turbulence in the US market would continue for the foreseeable future. The United States of America is the largest market for Sri Lanka and accounts for nearly 25% of our exports. Yet, Sri Lanka’s exports to the United States had remained almost stagnant (around the US $ 3 billion range) during the last ten years, due to the dilution of the competitive advantage of some of our main export products in that market. The continued instability in our largest market, where Sri Lanka is not very competitive, doesn’t bode well for Sri Lanka’s economy.
When Elephants Make Love
In rapidly shifting geopolitical environments, countries use proactive anticipatory diplomacy to minimise the adverse implications from possible disruptions and conflicts. Recently concluded Free Trade Agreement (FTA) negotiations between India and the EU (January 2026) and India and the UK (May 2025) are very good examples for such proactive diplomacy. These negotiations were formally launched in June 2007 and were on the back burner for many years. These were expedited as strategic responses to growing U.S. protectionism. Implementation of these agreements would commence during this year.
When negotiations for a free trade agreement between India and the European Union (which included the United Kingdom) were formally launched, anticipating far-reaching consequences of such an agreement on other developing countries, the Commonwealth Secretariat requested the University of Sussex to undertake a study on a possible implication of such an agreement on other low-income developing countries. The authors of that study had considered the impact of an EU–India Free Trade Agreement on the trade of excluded countries and had underlined, “The SAARC countries are, by a long way, the most vulnerable to negative impacts from the FTA. Their exports are more similar to India’s…. Bangladesh is most exposed in the EU market, followed by Pakistan and Sri Lanka.”
So, now these agreements are finalised; what will be the implications of these FTAs between India and the UK and the EU on Sri Lanka? According to available information, the FTA will be a game-changer for the Indian apparel exporters, as it would provide a nearly ten per cent tariff advantage to them. That would level the playing field for India, vis-à-vis their regional competitors. As a result, apparel exports from India to the UK and the EU are projected to increase significantly by 2030. As the sizes of the EU’s and the UK’s apparel markets are not going to expand proportionately, these growths need to come from the market shares of other main exporters like Sri Lanka.
So, “also, when elephants make love, the grass suffers.”
Impact on Sri Lanka
As a small, export dependent country with limited product and market diversification, Sri Lanka will always be vulnerable to what happens in our main markets. Therefore, we must be aware of what is happening in those markets, and prepare ourselves to face the challenges proactively. Today, amid intense geopolitical conflicts, tensions and tariff shifts, countries adopt high agility and strategic planning. If we look at what our neighbours have been doing in London, Brussels and Tokyo, we can learn some lessons on how to navigate through these turbulences.
(The writer is a retired public servant and can be reached at senadhiragomi@gmail.com)
by Gomi Senadhira
Opinion
QR-based fuel quota
The introduction of the QR code–based fuel quota system can be seen as a timely and necessary measure, implemented as part of broader austerity efforts to manage limited fuel resources. In the face of ongoing global fuel instability and economic challenges, such a system is aimed at ensuring equitable distribution and preventing excessive consumption. While it is undeniable that this policy may disrupt the daily routines of certain segments of the population, it is important for citizens to recognize the larger national interest at stake and cooperate with these temporary measures until stability returns to the global fuel market.
At the same time, this initiative presents an important opportunity for the Government to address long-standing gaps in regulatory enforcement. In particular, the implementation of the QR code system could have been strategically linked to the issuance of valid revenue licenses for vehicles. Restricting QR code access only to vehicles that are properly registered and have paid their revenue dues would have helped strengthen compliance and improve state revenue collection.
Available data from the relevant authorities indicate that a significant number of vehicles—especially three-wheelers and motorcycles—continue to operate without valid revenue licences. This represents a substantial loss of income to the State and highlights a weakness in enforcement mechanisms. By integrating the fuel quota system with revenue license verification, the government could have effectively encouraged vehicle owners to regularise their documentation while simultaneously improving fiscal discipline.
In summary, while the QR code fuel system is a commendable step toward managing scarce resources, aligning it with existing regulatory requirements would have amplified its benefits. Such an approach would not only support fuel conservation but also enhance government revenue and promote greater accountability among vehicle owners.
Sariputhra
Colombo 05
Opinion
BRICS should step in and resolve Middle East crisis
First, let us see why the war started by Israel and the US against Iran may be seen as a stupid undertaking. Israel was aiming for regional hegemony and US world dominance, which could be called an utterly foolish dream in today’s multipolar world order, which the theatre of war now reveals. They may have underestimated Iran’s capacity and also the economic fallout due to its ability to control the Strait of Hormuz.
In February 2026, reports emerged that General Dan Caine, the U.S. Chairman of the Joint Chiefs of Staff, privately warned President Trump about the significant risks of a major war with Iran, including potential U.S. casualties, depleted ammunition stockpiles and entanglement in a prolonged conflict. However, President Trump publicly dismissed these reports as incorrect. General Caine’s appointment by President Trump was considered controversial, as Caine was chosen over many active-duty four-star generals and lacks experience as a combatant commander or service chief. Under these circumstances Caine would have been expected to be subservient to Trump, yet he opted to disagree as he saw the danger. Trump countered his arguments saying it would be a quick job, take out the leadership, destroy the military structure and the people will take over the country. This did not happen and now most of the scenarios that Caine said was possible are gradually coming true.
Israel suffers damage
For Israel, too, damage is much more than expected and could prove to be decisive in its expansionist ambitions in the region if not its very existence. It had previously tried to drag former US presidents, Bush, Obama and Biden into a war with Iran, but they were aware of the underlying danger. The Gulf countries too were hit hard and the US could not protect them, and they may be regretting that they ever let the US set up military bases on their soil. Former US secretary of state Henry Kissinger once famously said, “To be America’s enemy is dangerous, to be its friend is fatal”.
The US may have succeeded in making states, such as Iraq, Syria and Libya, fail, but Iran is a different kettle of fish. Trump was jubilant after capturing the Venezuelan president and may have been planning to lay his hands on Cuba and Turkey and then try to annex Canada and Greenland. A man who promised a “no war” policy in his presidential campaign has converted his department of defence into a department of war in the real sense of the term. Trump must realise that he cannot act like a global policeman and undermine the sovereignty of other nations with impunity. Trump says “we have won” but has nothing to show as gains in the Iran war.
Trump’s concern about BRICS
Another factor in the equation is that Trump may have been concerned about the growing influence and membership of BRICS, which in effect appears to be anti-American if one were to go by its attempt to de-dollarise world trade. Of particular concern may have been the recent admission into BRICS, of several countries supposed to be staunch US allies, such as Saudi Arabia, UAE, and Egypt. Iran is an active member and was mending its fences with Saudi Arabia under the mediation of China. Further, two of the arch rivals of the US, China and Russia, are leading members of BRICS, which has become the meeting ground for the friends as well as foes of the US, under the stewardship of China. The US saw all this as a huge challenge to its dominant position in the world and Trump, who was trying to “make America great again”, saw that his dream may go up in smoke. He threatened countries which tried to adopt an alternative to the dollar with sanctions. He may have thought if Iran could be destabilised and structurally broken up, he would be able to kill two birds with one stone. He may have se an enemy of both the US and also its ally Israel and disrupt the BRICS organisation.
The war is affecting the economy of the BRICS countries quite badly. The fuel shortage due to closure of Strait of Hormuz has hit India hard and also China. The economies of the Gulf countries, whose oil is transported via the Persian Gulf and the Gulf of Oman, have also suffered immensely. South Africa, a founding member of BRICS imports oil mainly from the Middle East. Brazil, another founder member, though an exporter of oil, imports refined fuels from the Middle East. A large portion of food requirements also of the Gulf countries come through these sea routes. Thus, the BRICS organisation must be concerned about the consequences of the war if it drags on. It obviously augers ill for the BRICS, and it must act quickly to bring about a ceasefire and an amicable settlement as soon as possible.
Jeffrey Sachs’ opinion
Prof. Jeffrey Sachs, the eminent American economist, has argued that BRICS nations have a critical responsibility to play a leading role in stopping the war in the Middle East, particularly regarding the escalating conflict between the US/Israel and Iran. He contends that because the US is pursuing “global hegemony” and attempting to control the region, BRICS serves as the only effective “standing bulwark” against American domination.
Sachs has stated that if BRICS countries, particularly India, China, and Russia, stand together and demand an end to the war, “it will actually end”. He has described this collective action as the only way to make the world safe. Arguing that the Middle East conflict is a planned campaign by the US and Israel for regional dominance rather than a defensive action, he has called on BRICS to stop the US from running the world. He warned that a continued conflict, especially one that disrupts energy supplies, will cause enormous economic costs for Asia, Europe, and the US.
Sachs has argued that India should not have joined Quad, as he views Washington as using a “divide and conquer” strategy. He has characterised the BRICS countries as a fast-growing, multipolar bulwark that rejects the notion of a single “emperor” (referring to US influence). Sachs has warned that if the conflict is not stopped, it could lead to World War III and catastrophic regional consequences (India Today).
China and Russia, though rivals of the US, have the economic and military clout to exert pressure on the US. India is a friend of both the US and Israel and could act as a mediator to bring about an end to this meaningless war. Gulf countries, some of whom are BRICS members, could make a strong appeal to their friend and benefactor, the US, to see what its senseless aggression is doing to their countries.
Unity of BRICS essential
As of 2026, the expanded BRICS group (including Brazil, Russia, India, China, South Africa, Egypt, Ethiopia, Iran, Saudi Arabia, UAE, and Indonesia) represents approximately 49% of the world’s population. Moreover, its collective GDP is 35 – 40% of the global GDP when measured in PPP terms, which may be considered as higher compared to G7 countries which record 30%. Thus, BRICS is a force to be reckoned with provided its members stand together. However, they have not been able to do so though it is obvious that it would be beneficial to all of them. Bilateral conflicts within the BRICS, apparently intractable, are preventing any concerted action by these countries. In this regard, as Prof. Sachs says the onus is on China, Russia and India to come together to stop the war, which if allowed to drag on, will irreparably damage the economy and unity of BRICS and worse it would never be possible to attain any of its objectives. It is time the founder members Brazil, Russia, India, China and South Africa got together and review its goals, the need for such an organisation as BRICS, and the present danger it faces and take remedial steps as soon as possible if it is to remain a viable force with the potential to counter the hegemonic imperialist forces.
Further, the BRICS, as it consists of stakeholders of a new world order and also countries directly involved in the Middle East turmoil, may have an important role to play in working out an arrangement that could bring permanent and stable peace to the region. Once the dust settles on the military front, and the futility of war becomes apparent it may be time for the BRICS countries to raise a voice to demand a settlement based on the two-state solution that was adopted by the UN. Though Trump brushed this UN resolution aside and started taking over Gaza, once the war is over and he contemplates the economic cost of it to the US public – it costs US 1 – 2 billion dollars a day – he may realize the need for a solution acceptable to all. There have been several US presidents who were strong proponents of the two-state solution—an independent Palestinian state alongside Israel—as a core policy goal. Key proponents included George W. Bush (who first formally backed it in 2002), Bill Clinton, Barack Obama, and Joe Biden; they have viewed it as the most viable path to peace. Israel too after sustaining enormous damage may be forced to agree to a solution, if the US pressures it. Both Trump and Netanyahu, perhaps for personal reasons, wanted a war but they did not expect it to take the turn it has taken. Netanyahu’s days in power may be numbered and Trump may be forced by Republicans to change course as the majority of the US public does not approve of the war.
Therefore, time may be opportune for BRICS to stand together and call for a permanent solution to the Palestinian problem which is at the core of the Middle East conflict. Peace in the Middle East is vital for the further development of BRICS.
by N. A. de S. Amaratunga
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