With large numbers returning, new crises are now possibilities

Sierra Leone - With the ongoing demobilisation and disarmament of troops involved in the long civil war in Sierra Leone, a fragile calm exists in Sierra Leone. However the return of the population to their homes is bringing the possibility of following crises for the country. Total land area: 71,740 km2 (almost twice the size of the Netherlands) Population: 4,568,000* Infant mortality (< 1 year): 170 deaths per 1,000 live births* (1995-2000) Life expectancy: 37.2 years* One doctor per: 14,300 people (estimate 1984)* Drinking water: 28 % of the population has access to safe drinking water (UNICEF) No. of refugees: estimated at 145,000 in neighbouring countries No. of displaced persons: 2.5 million
  *Source: L'état du monde 2001 The civil war in Sierra Leone has been one of the most violent in Africa, claiming over 50,000 lives and displacing 2.5 million people (half the total population). Many of the people leaving Sierra Leone have found refuge in neighbouring countries such as Guinea. Since September 2000, over 50,000 refugees have returned to Sierra Leone from Guinea, but an estimated 85,000 still remain there. Many returnees have now become Internally Displaced Persons (IDPs), as their homes are still unsafe. In both the current and former rebel-held territories the medical needs are enormous. Now the large influx of refugees returning from Guinea threatens to trigger a new emergency in and around the government-held capital of Freetown, as homes in the more distant countryside are still too unsafe for habitation. Refugees are also reportedly returning through RUF-controlled areas in the east of the country. Medical needs in the areas currently or formerly controlled by the RUF rebels are considered enormous. Some of those areas had been without support for up to three years. Nine years of ongoing civil war have almost totally destroyed the health care system in Sierra Leone. The vaccination rate is low and epidemics of malaria, yellow fever, lassa fever, cholera and measles have broken out in recent years. The secondary health care is virtually non-existent. MSF in Sierra Leone MSF first intervened in Sierra leone in 1986 during a cholera epidemic. Today, the organisation is active in wide areas of the country and, with the current political situation, MSF is gaining access to populations previously beyond reach. Activities extend from basic health care service to emergency surgery to psychological support and care for the war-wounded as well as nutritional and medical activities. MSF programs are in key cities and towns, including Freetown, the countryside and in the IDP camps. In addition to medical and nutritional aid programs, MSF is monitoring the resettlement of the IDPs and providing surgical care as well as psychological support to the affected populations. In Mile 91, a small town that was a focal point of IDPs who were trapped during the ongoing civil war, MSF activities have now expanded to cover the entire Tonkolili District, supporting health posts and hospitals, including providing emergency surgery. The current situation has meant an expansion of MSF activity into RUF-held territories and MSF has been able to provide support to three health posts and the local hospital under the Tonkolili programme. As of June this year, MSF has also restarted activities in the formerly rebel-held Kambia. MSF currently has active projects in the Tonkolili, Bombali, Kambia, Port Loko and Moyamba Districts as well as in Kenema and Freetown.