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Looming shadow: How and why a distant war could threaten vitality of Sri Lankan healthcare

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An Independent Freelance Correspondent

As the sun sets over the Indian Ocean, the tranquil beauty of Sri Lanka feels many a world away from the smoke, thunder, misery and deaths in the Middle East, taking place in the midst of a senseless war. Yet for all that, in our interconnected world, a butterfly might flit its wings in the Gulf, and a storm might eventually break over our own little paradise island, as a strange reversal of the status quo. However, the escalating conflict in the Middle East is no longer just a distant headline for Sri Lankans; it is an ominous cloud gathering that threatens the very backbone of our much-bandied social contract, our healthcare system.

While we often view war through the lens of geopolitics or rising oil prices, the “Ground Zero” of its impact in Sri Lanka may well be the hospital ward, the local dispensary, and the dinner tables of our most vulnerable citizens, just as much as it would impact on the healthcare professionals who are responsible for maintaining a well-oiled machine; the pun being intentional.

The Fuel Paradox: When Mobility Becomes a Luxury

Our health service runs on wheels as much as it does on training and wisdom. The entire system has to be supported by energy. The Middle East remains the lifeblood of our energy supply, and any disruption to the Strait of Hormuz would send immediate shockwaves to our fuel pumps. Lack of fuel, as well as skyrocketing prices of oil, would have a cascading detrimental effect on our health service.

For the average citizen, a spike in fuel prices is not just a “transport issue” but a miserable calamity that could become a noteworthy barrier to life-saving healthcare. When bus fares double and three-wheeler charges skyrocket, a mother in a rural village may think twice and even hesitate to take her feverish child to the nearest Base Hospital. In the calculus of poverty, the cost of the journey often outweighs the urgency of the ailment, until and most unfortunately, it sadly and tragically becomes too late.

Furthermore, our healthcare workers, the doctors, nurses, public health midwives, clerks, orderlies, and other grades of minor staff, are certainly not immune to the impacts of the fuel crisis. Unlike many top-tier officials of the rest of the public service, most medical staff rely on their own vehicles or public transport to reach their posts. If fuel becomes a rationed luxury, we risk a kind of inevitable “silent strike” where the healers simply cannot afford to commute to the hallowed places of healing. The other grades of staff mentioned are certainly no less important to run the machine, and they will also be at the receiving end of the fuel crisis and transport problems.

A Bitter Pill: The Private Sector Squeeze

While the state provides free healthcare, the private sector has long acted as a vital pressure valve for the national system. However, the conflict is rapidly tightening the screws here as well.

 =The Price of Healing: Most of our medicines and vaccines are imported. With global shipping routes disrupted and “war risk” insurance premiums surging, the landed cost of a simple strip of a commonly used medicine or a vital course of antibiotics to clear a lung infection would climb disproportionately.

 =The “In-Patient” Inflation: Private hospitals are energy-intensive hubs. From the electricity that powers life-support machines to the diesel that runs emergency generators, rising costs will most unfortunately have to be passed directly to the patient.

 =Consultation Charges: As overheads, maintenance costs, staff salaries, and medical supplies spiral, even the renowned Private Hospitals, as well as even the most dedicated private practitioners, would find themselves forced to increase fees.

When the private sector becomes unaffordable, those patients migrate back to the already overstretched state hospitals, creating a “domino effect” of long queues and exhausted resources.

The Empty Plate: Nutrition as the First Line of Defence will be in danger

Perhaps, the most insidious impact of the Middle Eastern crisis is the one that happens at the grocery store leading to great difficulties in getting food into the table. Sri Lanka relies heavily on remittances from our workers in the Gulf and the robust export of our “black gold”- Ceylon Tea. The war has stalled tea exports to major markets like Iran and Iraq, costing the industry millions every week. Simultaneously, if our workers in the Middle East face displacement, the flow of foreign exchange into our country, which would benefit even the villagers, might just dry up.

When a family’s income drops, the first thing to be sacrificed is often the “quality” and even the quantity of the food that comes onto the table. We might see a return to starch-heavy, protein-poor diets. For a pregnant mother, this means anaemia and untold risks to the yet-to-be-born baby. For a growing young child, it means stunting and weakened immunity. For the elderly, it will mean increasing the frailty of old age. We are essentially “importing” a future health crisis of malnutrition that no amount of free medicine can easily fix.

The Supply Chain Shadow

Modern medicine is a “just-in-time” industry. Many of our specialised vaccines and a variegated plethora of treatments require a “cold chain” – a continuous refrigerated journey. With major Gulf air hubs facing disruptions, these temperature-sensitive medicines must be rerouted. This adds days to the journey and increases the risk of “spoilage.” A vaccine that loses its potency due to a shipping delay is not just a financial loss; it is a lost shield for a child and even, older and elderly people.

Sadly, just like the fuel situation, there have not been any worthwhile efforts to “stockpile” at least some of the essential medicines. Of course, unlike just storing fuel to stockpile, medicines have their own problems with shelf-life and expiry dates. It is indeed a vexing problem that might cause a major, tricky situation at some time in the future. The government is planning to issue medicines for two months from the clinics etc. One only hopes that the currently available stock could be used effectively without that initiative leading to a desperate shortage of essential drugs.

Navigating the Storm: Some Ways to Mitigate the Crisis

This author has brought to light some of the issues that we may see in the future. However, it is not an exhaustive or complete list of all possible consequences. There could be quite a few more. While the situation is grave at present, it is perhaps not unmanageable. To protect the vitality of our healthcare, we must adopt a “War Footing” of preparedness:

1. Fuel Priority for Healthcare: The government must establish a “Green Lane” for healthcare personnel and emergency vehicles, ensuring that they have subsidised or prioritised access to fuel to prevent service interruptions. This has to include the private healthcare personnel as well.

2. Strategic Buffer Stocks: We must move away from “just-in-time” imports and build a minimum 6-month buffer stock of essential medicines and vaccines. We need to utilise regional cooperation with neighbours like India to diversify supply routes.

3. Strengthening Primary Care: By investing in local dispensaries and public health midwives, we can treat ailments before they require expensive hospital stays, as well as extended forms of treatment, reducing the transport burden on patients.

4. Nutritional Safety Nets: Expanding school meal programmes and providing fortified food supplements to pregnant mothers can act as a firewall against the malnutrition that is likely to be caused by economic shocks.

5. Digital Health Integration: Expanding “telemedicine” can allow specialists to consult with rural patients remotely, saving both the doctor and the patient the high cost of travel.

A Call for Preparedness, but not a Harbinger of Panic

It is ever so easy to read these points and see a looming, tremendously gloomy fog that could envelop our revered Motherland in the not-too-distant future. However, from a clearer perspective, the purpose of this analysis is not for the writer to act as a prophet of doom, but for this enterprise to serve as a wake-up call for proactive management and to take all necessary steps, well in time, to avoid a catastrophe.

Our health service is the crown jewel of our nation. It has been built on the Herculean effort of generations who believed that health is definitely a right, and certainly not a privilege. To protect it, we must look beyond our borders and understand that the proverb “a stitch in time saves nine” is what we need now. We must strengthen our social safety nets before the ripples of the Middle Eastern war become a tidal wave that hits our shores. We need to act purposefully now, to be able to steadfastly cushion whatever blows that might come our way in the future.

This is not a forecast of a disaster that is one-hundred per cent certain to occur. In stark contrast, it is meant to be a sober and sombre analysis of possible ramifications that we must prepare for today, to save the lives of our people and look after their health tomorrow.

Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paediatrics), MRCP(UK), FRCP(Edin),
FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.



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Features

Engelbert’s 90th birthday bash

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The legendary Engelbert Humperdinck, who is known for his hit songs such as ‘A Man Without Love’, ‘Release Me’, ‘Spanish Eyes’, ‘The Last Waltz’, ‘Am I That Easy To Forget’, ‘Ten Guitars’ and ‘I Can’t Stop Loving You’, turned 90 on 02 May, 2026, and there were some lovely Hollywood-related celebrations.

Before his birthday, Engelbert’s new single ‘I’ve Got You’ was released – on 23 April – and Engelbert had this to say: “‘I’ve Got You’ is especially close to my heart. It speaks to love, loyalty, and the quiet strength we find in one another”.

The main birthday event was held at The Starlight Cabaret, in Los Angeles, California, and Sri Lankan Raju Rasiah, now based in the States, and his wife Renuka, who are personal friends of Engelbert, were invited to participate in the celebrations, along with Ingrid Melicon – also a Sri Lankan, now domiciled in America.

The invitation said “An evening of music, memories and celebration. Let’s make it a night to remember!” And it certainly turned out to be a night never ever to be forgotten!

Invitees experienced a “magical entrance” with Engelbert’s name lighting up the screen and showing him performing his hit songs.

The invitees were also presented with a unique gift – a necklace with Engelbert’s face, engraved with the words “Remember, I Love You.”

Engelbert’s son, Bradley Dorsey, sang a tribute song ‘Only You’ for his dad, while Eddy Fisher’s daughters, Tricia and Joely, also got on stage to entertaining the distinguish gathering.

Engelbert didn’t perform but got on stage for the cutting of the birthday cake.

There was also a video compilation of birthday wishes from fellow celebrities, and the lineup included Gloria Gaynor, Micky Dolenz, Wayne Newton, Pat Boone, Lulu, Judy Collins, Deana Martin, Angélica María, Rupert Everett, Matt Goss, and more.

Birthday boy Engelbert Humperdinck

At 90, Engelbert is still performing. He’s on THE CELEBRATION TOUR for his 90th year, with over 50 international dates in 2026, including Australia, Germany, the US, and Canada. He’ll be at Massey Hall in, Toronto, on 06 October, 2026. He said: “The stage is my home… Canada has always been a highlight”.

He performed 60+ concerts, worldwide, in 2025, and says karaoke keeps his songs fresh: “Most of my songs are on karaoke because people love to sing them”.

 

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Features

Skin treatment …

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Hi! Got a few more easy-to-do beauty tips for my lovely readers.

* Oatmeal and Honey Scrub:

Grind 01 tablespoon oats into a soft powder. Add 01 teaspoon of honey to it and mix in a small amount of water, or milk, until it forms a paste.

Wash your face with lukewarm water and apply the scrub, gently using circular motions.

Massage for about 01 minute, leave it on for another 05 minutes and then rinse with cool water and pat dry.

Apply moisturiser afterward.

Benefits: Gently removes dead skin cells, helps soften rough skin, reduces dryness caused by sun exposure; honey helps keep skin moisturised, and oats soothe irritated skin.

How Often to Use: 01–02 times per week

Best For: Rough, dry, skin

* Tomato Pulp Treatment:

Wash a fresh ripe tomato well and then cut and mash it into pulp.

Clean your face and then spread the tomato pulp evenly on sun-damaged areas.

Leave it on for 10 minutes, rinse with cool water, and then apply a light moisturiser.

Benefits: Helps refresh dull skin, gives skin a fresh, bright look and helps cool overheated skin.

How Often to Use: 02–03 times a week.

Avoid If: Your skin is very sensitive, or have cuts, peeling, or irritation.

* Green Tea Compress:

Brew a green tea bag, or 01 teaspoon green tea in a cup of hot water for 05 minutes.

Allow it to cool completely and then soak a cotton pad, or soft cloth, in the tea, and place the pads gently on your face or affected areas.

Leave for about 10 minutes, then remove the cotton pad and let skin air dry naturally.

Benefits: Helps calm redness, refreshes tired skin, provides antioxidants for skin recovery, can reduce heat and irritation after sun exposure, and helps hydrate and soothe skin.

How Often to Use: Daily or whenever your skin feels irritated

Best Time to Use: Evening or after sun exposure.

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Features

Oil prices rise like rockets, fall like feathers (if you’re lucky)

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Crude oil is the lifeblood of the global industrial economy, yet the journey from a subterranean reservoir to a litre of petrol at the forecourt involves a cascade of physical transformations, commercial transactions, and fiscal interventions that profoundly shape who bears the cost, and how much. A sudden shift in the world market price of crude, whether triggered by OPEC+ supply discipline, geopolitical disruption, or a demand shock, does not translate uniformly into consumer prices across the globe. The consequences are systematically different, depending on a country’s tax policy, exchange rate, efficiencies in refining processes, distribution processes and dependence on energy imports.

The Refining Process: From Crude to Finished Products

Crude oil is a naturally occurring mixture of hydrocarbons and its chemical composition varies by field: Heavy sour crudes from Venezuela, or Saudi Arabia, require additional processing, raising refining costs by USD 2–5 per barrel. One standard barrel contains approximately 159 litres.

Crude oil is preheated to approximately 370–400°C and the operating principle exploits differences in boiling points. The resulting fractions, collected from top to bottom, include: light petroleum gases (LPG) boiling below 40°C; naphtha and gasoline fractions in the 40–205°C range; kerosene and jet fuel between 175°C and 275°C; diesel and gas oil from 250°C to 350°C; and atmospheric residue above 350°C which is then processed in a vacuum distillation unit to recover further distillates, including lubricating oil base stocks.

Primary distillation alone is insufficient to meet market demand. Gasoline demand far exceeds the natural yield of the distillation cut. A modern complex refinery achieves the following approximate product yields from a light sweet crude: petrol/gasoline ~45%; diesel/gasoil ~25%; kerosene/jet fuel ~10%; LPG ~5%; heavy fuel oil ~10%; and other by-products ~5%. These ratios shift with crude quality and refinery configuration, and response differently to crude price changes.

The Crude Truth: How Oil Prices Punish the Poor Twice

An accounting perspective reveals a waterfall of costs, each layer added by a distinct economic actor and subject to a distinct set of market forces and regulatory interventions. A companion of the approximate cost structure for a litre of petrol at the retail level, assuming a crude oil price of USD 70 per barrel (approximately USD 0.44 per litre of crude equivalent), between advanced and emerging economies, can be explained in four layers:

Layer 1 — Crude Oil Cost (~51% of Retail Price)

The foundation of every fuel product is the crude oil acquisition cost. At USD 70/barrel, the raw material cost embedded in one litre of refined petrol is approximately USD 0.44. This figure includes wellhead lifting costs, field operating expenses, royalties, and sovereign resource taxes paid to the producing country, as well as freight and insurance for ocean tanker shipment.

For emerging economies, without domestic refining capacity, or with currencies that are not freely convertible, this layer is doubly exposed: a crude price increase is compounded by any simultaneous depreciation of the local currency.

Layer 2 — Refining Margin (~20% of Retail Price)

The gross refining margin, measured by the industry’s standard 3-2-1 crack spread;

Crack Spread (gross refining margin) = (2×Gasoline Price) + (1×Diesel Price) − (3×Crude Price)

Critically, this gross figure must not be confused with profit. A refinery typically uses 6–8% of its own crude input as process fuel, and significant variable operating costs. This gross refining margin, the difference between the value of products produced and the cost of crude, varies considerably with market conditions.

In advanced economies with large, integrated refinery systems, these margins are moderated by competition and long-term supply contracts. In emerging economies, dependent on a single import refinery or on product imports rather than crude, refining costs are effectively set by the international product market, leaving little domestic control over this cost layer.

Layer 3 — Distribution and Marketing (~11% of Retail Price)

Refined products must travel from the refinery gate to the consumer through a distribution network involving primary pipelines or product tankers, regional storage terminals, secondary truck distribution, and retail fuel stations. In advanced economies, this infrastructure is mature, privately operated, and highly efficient, contributing a relatively stable USD 0.05–0.10 per litre to the retail price. In many emerging economies, the distribution infrastructure is fragmented, underdeveloped, or state-controlled, introducing additional costs, quality inconsistencies, and opportunities for rent-seeking. In Sri Lanka, for instance, the state-owned Ceylon Petroleum Corporation has historically cross-subsidised distribution costs, masking the true economic cost until subsidy withdrawal forced rapid price adjustments in 2022.

Rent-Seeking is extracting value without creating value; essentially corruption and inefficiency

Licensing corruption:Limited fuel station licenses create artificial scarcity; Licenses sold/traded at premiums; Political connections needed to obtain licenses

Quality adulteration: Consumers pay for “petrol” but get lower-quality mix

Quota manipulation:Subsidised kerosene (meant for poor households) diverted to diesel mixing; Creates black markets during shortages

Phantom costs:

Layer 4 — Taxation (18–60% of Retail Price)

Taxation is the most variable, politically sensitive, and analytically important layer in the cost structure. In advanced economies a high tax bases serve a dual purpose: generating substantial fiscal revenue and acting as an automatic price stabiliser. When crude rises, the absolute tax component remains constant, so the percentage of the price attributable to crude increases less than proportionately at the retail level.

In contrast, emerging economies historically imposed low fuel taxes or active subsidies, particularly for diesel, LPG, and kerosene used by low-income households. Sri Lanka’s fuel tax component, prior to the 2022 crisis, was, they claim, effectively negative in real terms due to administered pricing below cost.

The Impact of a Crude Price Increase: Advanced vs. Emerging Economies

For example, if crude oil rises from USD 70 to USD 85 per barrel, an increase of approximately 21.4%. The mechanisms by which this shock is transmitted to consumers, and the capacity of economies to absorb or redistribute it, diverge dramatically along the advanced/emerging economy divide (Table 1).

Absorb shocks through tax relief

Advanced economies possess well-established fiscal frameworks that enable them to absorb temporary commodity shocks through tax relief, targeted transfers, or direct subsidies without compromising fiscal sustainability. Research by the Center for Global Development (2026) estimates the median fiscal cost of shielding consumers from the crude price increase of USD 15 scenario at approximately manageable cost of 0.4% of GDP for advanced economies.

Emerging economies face median fiscal costs of approximately 0.9% of GDP — effectively double. For Sri Lanka, entering the 2022 energy crisis with near-zero foreign reserves, even a temporary subsidy was fiscally impossible, forcing an immediate and politically destabilising pass-through of the full price increase to consumers. The lesson is stark: the ability to smooth out a commodity price shock across time is itself a function of prior fiscal strength, making the poor more vulnerable precisely because their governments are already under strain.

Inflation Pass-Through and Monetary Policy Credibility

The second transmission mechanism operates through the consumer price index and central bank behaviour. In advanced economies, fuel typically represents 3–5% of the CPI basket, and central banks enjoy high credibility in anchoring inflation expectations.

In emerging economies, fuel and food together often constitute 40–60% of CPI baskets, and central banks have historically struggled to maintain credible inflation targets. A 21% crude price increase translates into a far larger initial CPI shock. Worse, the loss of inflation credibility means that workers and businesses adjust wages and prices preemptively, generating persistent second-round inflation (> Double). To defend its inflation target, the emerging economy central bank must raise interest rates aggressively, simultaneously raising the cost of borrowing for businesses and governments, a painful policy dilemma in an economy already under stress.

Structural Current Account Vulnerability

The third and perhaps most structurally significant difference lies in the current account and foreign exchange dynamics. The advanced economies hold large reserve currencies and deep financial markets that allow them to finance import cost increases without immediate exchange rate pressure.

Sri Lanka, by contrast, allocated approximately 23% of its total import bill to petroleum products. A USD 15/barrel price increase instantly widens the current account deficit of these economies, depleting foreign exchange reserves. As reserves fall, currency markets anticipate further depreciation, precipitating speculative selling of the domestic currency. The resulting exchange rate depreciation, potentially 5–15% in a shock scenario, multiplies the cost of crude imports in local currency terms. A 21% USD price increase thus becomes a 28–39% local currency price increase at the refinery gate, before any refining, distribution, or tax component is added. This vicious cycle; crude price rise → reserve depletion → currency depreciation → amplified import cost → further reserve depletion, is a hallmark of emerging economy energy crises, and Sri Lanka’s 2022 experience illustrated it in extreme form.

Double bind when crude rises and subsidised

Countries that have historically subsidised fuel face a double bind when crude rises: the subsidy bill expands sharply (as the gap between subsidised price and market cost widens), while fiscal space contracts. The International Monetary Fund has consistently recommended subsidy reform, allowing fuel prices to reflect market cost while protecting the poor through direct cash transfers, as the fiscally sustainable path. Sri Lanka’s forced price liberalisation in 2022 (under IMF programme conditions) illustrate both the political difficulty and the macroeconomic necessity of this adjustment.

The Asymmetry of Oil Price Responses: Advanced vs. Emerging Economies

Advanced economies enjoy bidirectional flexibility in responding to oil price volatility; prices rise and fall with crude markets, leaving fiscal positions largely neutral. Emerging economies, by contrast, face a structural trap: when crude rises, subsidy bills explode, draining public finances; when crude falls, governments retain windfall savings to offset accumulated deficits rather than passing relief to consumers. Sri Lanka’s cycle from collapse to liberalisation to renewed subsidies illustrates this vividly. Underlying this is a political economy ratchet, price hikes are unavoidable, but reductions are politically captured, making permanent reform structurally elusive.

(The writer, a senior Chartered
Accountant and professional banker,
is a professor at SLIIT, Malabe. Views expressed in this article are personal.)

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