Sri Lankan civilians trapped by Tamil Tigers 'last stand'

A recent internal UN report, however, estimates that nearly 6,500 civilians had died in the war zone prior to the Apr. 20 outflow. On Saturday, medical officials in the LTTE-held area told the BBC and other news agencies that scores had died during two days of government shelling that hit a makeshift hospital. The government denied the claim.

War crimes by both sides?

It has also pushed back against leaked UN satellite data that appeared to show recent aerial bombardment of civilian areas. The release of the satellite images, which Sri Lankan officials say are inconclusive, appear to be part of an internal UN row over how far to expose what some UN officials are calling war crimes by both sides.

Human rights groups and other observers warn that any final offensive would spell disaster for those caught in the crossfire. A repeat of the Apr. 20 exodus is complicated by the area's topography and the ruthlessness of the LTTE, which is killing anyone caught escaping by boat or land, says another aid worker in direct contact with civilians there.

Ramani Hariharan, a retired Army colonel who was an intelligence chief during India's 1987-1990 peacekeeping operation in Sri Lanka, says it would be almost impossible to distinguish civilians from fighters in the densely packed area. "It's not a neat operation. It's going to be messy. Messy operations lead to casualties," he says.

Dire conditions for trapped civilians

In the war zone, conditions are increasingly dire as thousands of families huddle in trenches in fear of incoming shells. Most only eat one in three days, says the second aid worker. Last week, the International Committee of the Red Cross (ICRC), the only foreign relief agency present, delivered by boat 30 tons of food aid, the first to arrive since early April.

"The fighting is going on. The food is arriving. Do you leave your trench to get food for your family? Do you take the risk? These are tough choices," says Sophie Romanens, a spokesperson for the ICRC.

On the road to the town of Putumattalan, the war's toll is writ large in the empty, burnt-out villages ringed by fallow fields. Only military patrols and distant explosions break the silence of a land seemingly scoured of humanity. Near the front line a line of red buses await the next exodus of war refugees. Since Thursday, none have come out.

Outside a makeshift clinic, Army Private P.O. Athula recalls fierce fire fights for control of this area. Many of the LTTE combatants are children, he says. Three out of four are young women, he estimates. If possible, he says it's better to capture and try to rehabilitate these fighters, who are forced to join the LTTE. "If they are children," he says, "I try not to kill them."

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