Sierra Leone: Coping with a permanent medical emergency

Click on image for full size
Periodic clashes among pro-government civil militias (the Civil Defense Forces, or CDF), opposition forces (Revolutionary United Front, or RUF), and the Guinean army have meant very little increased security for the people, half of whom still live away from their own areas as refugees across borders or crammed into camps in unfamiliar parts of their homeland. Beginning in September 2000, many Sierra Leoneans taking refuge in Guinean border regions were forced to move by fighting and instability near the border (see page 28). Many headed to safer areas in Guinea, or to Conakry (the Guinean capital) and then by boat to Freetown, the capital of Sierra Leone. MSF has supplied medical screening, health clinics, and water and sanitation for their new camps within Sierra Leone. The broader population does not fare better: MSF is struggling with a permanent medical emergency where one in three children dies before the age of five, where epidemics of cholera, shigella (bloody diarrhea), and malaria are a familiar challenge (MSF first went to Sierra Leone in 1986 to deal with a cholera epidemic), and where health service staff are often unpaid and demoralized. In many areas, insecurity makes humanitarian aid only intermittently possible. MSF was forced to shut down most of its programs in the RUF-held northern parts of the country last year because of insecurity. Those projects are now being reopened. The hospital and clinics in Makeni are working again and, beginning in April 2001, access to health care was being restored for around half a million people in the RUF districts of Port Loko, Kambia, Bomboli, Koinadugu, and Tonkolili. Helicopters supply additional projects in the government enclaves of Kabala and Bumbuna. In government areas to the south, MSF continues work in Moyamba with a pediatric ward and nutritional support for children, in Kenema, where MSF provides inpatient care and supports five clinics, and in Mile 91, where around 30,000 displaced people get primary health care and water supplies from the MSF team. In the government-controlled part of Port Loko, MSF opened a therapeutic feeding center for children in May 2001. In the southern provinces, MSF continues to be the medical spine of three hospitals and 21 clinics in Bo, Pujehun, and Bonthe. In Freetown, MSF provides surgical care in the main hospital and supports two other hospitals and a range of clinics in camps for the displaced. Psychosocial counselors work with war trauma victims. MSF has also started a pain control project, which attempts to deal with the terrible legacy of war wounds and forced amputations. International staff: 50 National staff: 451