Seventeen Sri Lankans working for an international aid agency were slain execution-style, and ambulances ferrying wounded civilians have been blown off the road.
The attacks in northern and eastern Sri Lanka took place during fierce fighting between ethnic Tamil rebels and government troops dominated by the Sinhalese majority.
"Even in a war, there are certain (groups) that are not touched, such as the Red Cross symbol and NGOs," said Jeevan Thiagarajah, executive director of the Consortium of Humanitarian Agencies.
But in the recently resurgent Sri Lankan conflict, "both have been blown off the road, literally," he said.
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