Sierra Leone: Humanitarian concerns and the displaced population


Renewed fighting in Sierra Leone has forced hundreds of thousands of people to leave their homes to find safety, food and shelter elsewhere. The immediate cause was the attacks in early May by rebel Revolutionary United Front (RUF) forces against the newly deployed forces of the UN Mission in Sierra Leone (UNAMSIL). Hundreds of UN peacekeepers surrendered their arms and were taken prisoner.

While international attention focused on the UN hostage crisis, the plight of Sierra Leone's citizens was largely ignored. Tens of thousands of persons from the embattled Northern province left their homes and began concentrating in the vicinity of Mile 91, Port Loko and the capital Freetown. Thousands of others dispersed elsewhere in RUF controlled areas or crossed the border into neighbouring Guinea.

Interviews by MSF determined that while many persons fled because of food shortages and fear of human rights abuses by the RUF forces, the primary reason for leaving their homes was the bombings carried out by helicopter gunships under the direction of the Sierra Leone Army (SLA). Those who have left their homes for the bush face severe hardships and are easy targets for those with guns - as is evident from the sick, hungry and often traumatised people who appear at displaced persons camps in government-controlled areas.

Today, many of the newly displaced persons are in a precarious position, close to ongoing fighting and targets of various armed groups, which are wracked by infighting. Also at great risk are those civilians in RUF-controlled territory who remain subjected to rebel atrocities and are without access to humanitarian assistance. Currently the major towns of Kambia, Makeni and Magburaka have become deserted: civilian health-clinics and hospitals have been forced to close down or were abandoned, markets are closed and schools are no longer functioning. In some places the population has largely been reduced to RUF rebels. Largely because of security concerns, humanitarian agencies, including MSF, are having great difficulties providing assistance to these populations.

The security and health of the civilian population in Sierra Leone must be the primary concern of the international community. The parties to the conflict must respect human rights and humanitarian law and, in particular, avoid actions that cause internal displacements. The international community needs to take appropriate and effective steps to ensure the protection of internally displaced persons. Special attention needs to be given to providing those displaced or are now inaccessible with access to humanitarian assistance.

This report is based on the field experiences of MSF staff and on interviews conducted in June and early July in Mile 91, Lungi and Freetown and their environs.

Causes of Displacement

Fighting since May has resulted in the forced displacement of much of the population in Sierra Leone's Northern province -- currently more than 150,000 internally displaced persons have been registered by international agencies. These include 45,000 people now staying in Mile 91 and environs, 60,000 in the Port Loko district, and 14,000 in the Western Peninsula (including Freetown). Another 5000 persons have sought refugee in Forecariah in Guinea. Undoubtedly thousands more have been displaced in RUF areas that are currently inaccessible.

MSF has learned of various reasons for this displacement. In early May civilians in large numbers fled from Mange, Rokupr and Port Loko because of human rights abuses being committed by the RUF, including killings, rape, forced labour, abductions, armed robbery, arson and looting. Others, well aware of the RUF's dismal human rights record, left for fear of such violations.

Lack of food has been another reason for leaving their homes. The renewed fighting came at the beginning of Sierra Leone's "hungry season" when the rainy season crop is being planted and food supplies are at their lowest. Existing shortages were exacerbated by the cutting off of the roads -- and therefore food supplies -- between Freetown and towns in the Northern province.

In May in Makeni, a long-time RUF stronghold, lack of food caused some people to leave. However, many more left the town when it appeared that Government forces would attack, although a ground attack never materialised.

But despite the dangers of remaining home in areas controlled or contested by the RUF, residents typically tried to stay as long as possible. Some would leave during the day and return at night to keep their homes from being looted. In a country where human rights abuses have become a way of life, people tried their best to endure. Only when their homes had been looted or when their lives were in immediate danger did many finally decide to leave.

For most displaced persons interviewed by MSF, the main reason for their fleeing their homes was not the RUF nor the food shortages -- but, rather, bombings carried out by the two helicopter gunships controlled by the Sierra Leone armed forces. Most of the bombings took place during the first two weeks in June. Places bombed were Makeni and some surrounding villages, Magburaka, villages around Kabala in Koinadugu district, and Rokupr, Kambia and Mange in Kambia district.

CA said that as many as 25 houses were destroyed in the bombing of Patebanamatakan, a village just outside of Makeni. She said she saw the dead bodies of one woman, two men, and three boys lying in the street. A five-year-old girl and a seven-year-old boy she knew were wounded. There was one boy who was shell-shocked and had still not recovered from the blast. "He was crazy," she said.

On May 29th, a helicopter dropped leaflets into Makeni. Called the Lion News and dated that day, the leaflet "thanked" the leadership of the RUF for the absence, among other things, of medical facilities, law and order, food aid and education. A second leaflet, imprinted with Republic of Sierra Leone Government Forces, was dropped two days later criticising RUF corruption and atrocities and stating: "RUF: this time we've dropped leaflets. Next time it will be: a half inch Gatling machine gun or 57mm rockets or 23mm guns, or 30 mm grenades or ALL OF THEM!"

The first bombing of the town occurred that day. The helicopter gunship continued to bomb Makeni over the next ten days, causing approximately 50 civilian deaths and destruction of civilian property. Some 1000-1500 persons a day left the town for elsewhere. Magburaka, just south of Makeni, was bombed on June 7th. The last reported bombing in the area took place on June 25th, resulting in damage to Makeni's central mosque and cemetery.

It was morning and MK saw the helicopter gunship approaching. It began dropping leaflets, so MK ran to the nearest house to hide. About 15 people were inside. Then the bombs started exploding. The second bomb fell very close and the pressure of the blast lifted him from the ground. Six more bombs followed. He was bleeding from his eyes and shell fragments had pierced his buttocks and shoulder. Four of those he had been hiding with were killed by the blast, including a cousin and a neighbour.

Other towns in the Northern Province became targets of the helicopter gunship. In early June outside Kabala, district, residents fled bombings of their villages. In Kambia district bombings were reported in the towns of Rokupr, Kambia, and Mange causing large population movements to the Lungi peninsula and Port Loko. Leaflets dropped here instructed RUF fighters on how to surrender to the UN and the government and informing them they would be given food and drink. The very presence of the helicopter in this area caused many people to flee the area before any bombing had occurred.

In many cases actions by both sides contributed to the forced displacement of the population. In Kambia district, Kabala and along the route from Magburaka to Mile 91, people left their homes simply to avoid getting caught in the crossfire when fighting broke out between RUF and pro-Government forces. Displaced from Kambia district told MSF that they had fled bombings from the government gunship as well as anticipated and actual atrocities committed by the RUF.

MSF also interviewed displaced persons from the Bombali and Upper Tonkolili districts who were displaced two or three times before arriving at Mile 91. They had left their homes because of gunship bombings but suffered harassment and looting by RUF rebels seeking food and by members of the pro-government Civil Defence Forces.

After the bombing of Makeni on June 7th, JT and his wife, who was seven-month's pregnant, decided to seek refuge in a nearby village. The RUF came to the house where they were staying and robbed them of everything -- including the clothes they had prepared for the coming child. The next day they moved to a village further from Makeni and again the RUF harassed them. For ten days they travelled, often harassed by the RUF, until they reached Mile 91, arriving without money or belongings.

The departure of people from major towns has had a ripple effect. After Makeni and Magburaka had emptied and were then looted, RUF soldiers went looking for food in the outer villages. The harassment that followed and resulting food shortages caused these villagers to flee.

Violations of Human Rights and International Humanitarian Law

The nine-year long civil war in Sierra Leone has been marked by serious human rights and humanitarian law violations by all parties to the conflict. Although MSF has not attempted systematically to document violations that have occurred since the renewal of fighting, it did learn of many such abuses from recently displaced persons.

RUF forces have been widely implicated in extra-judicial killings, rape, amputations, forced labour, flogging and looting. Through interviews of recently displaced persons, MSF received many reports of rape, killing, and amputations in Mange and Kambia in Kambia district and in Masiaka and Lunsar in Port Loko district. In Makeni and Magburaka violations such as looting, forced labour, flogging, and abductions were most common. For instance, during an attack by the RUF in Mange in early May, civilians described rapes, the looting of vehicles and houses, and the abduction of boys for forced labour. MSF received accounts from throughout Kambia district of forced recruitment of men and boys into the RUF - unconfirmed reports said that each local leader had to provide 100 civilians for RUF fighting forces.

MD and her family had fled their village after RUF harassment and taken refuge in Mabong village, about 11 miles from Magburaka. The next day the RUF attacked and the family again decided to flee. They were threatened by the RUF as they crossed a river by the village. The RUF opened fire, shooting MD's mother, father, and younger brother in the back, killing them.

During the RUF attack on Mange in early May, civilians attempted to flee for safety. In one village the RUF captured a group of nine young girls. One nine-year old tried to resist being raped -- and they cut off her hand. She told MSF that similar things happened to the other girls in the group, but she did not know what eventually happened to them.

There have also been many reports of human rights violations by former rebel forces now fighting on behalf of the government. These forces, variously designated as ex-SLA (Sierra Leone Army), the West Side Boys and Occra Hills, have been implicated in rapes, assaults and looting and in extra-judicial killings of suspected RUF rebels. Members of the Civil Defence Forces (CDF) have threatened and robbed civilians at checkpoints. Those suspected of being RUF rebels have been beaten and detained.

After leaving Magburaka and trucking through 37 miles of RUF areas, CC and his family reached the CDF checkpoint at Mabong. There he saw a man he knew being roughed up by the CDF on accusations that he was rebel. Although he knew the man was not RUF, he left the area without helping him because he feared for his family's safety. Later, at another CDF checkpoint, CC saw a young boy tied down who was accused of being a rebel.

MSF is concerned that violations of humanitarian law may have been committed by both the Government forces and the RUF with respect to the bombings of towns in the Northern province. The RUF are responsible for placing civilians at unnecessary risk by deploying their forces in areas with a high concentration of civilians, such as markets. The RUF would fire at the helicopter, causing the helicopter to fire back or drop bombs, resulting in civilian casualties. Additionally, residents from Mange reported that the RUF threatened to kill them if they tried to leave the town, effectively using them as human shields (they fled at night to elude the RUF soldiers).

A teacher from Rokupr described how in early June the helicopter gunship had attacked RUF positions near the wharf, killing a woman and her daughter. Later in the day, the RUF fired an anti-aircraft gun at the helicopter from a Landrover near the crowded Bamoi Lumu market. The gunship returned fire and injured five people, including a boy who subsequently died. Fearing for their safety, the teacher and her family sneaked out of town a few nights later, eluding the RUF, who had threatened to kill anyone trying to leave.

Protocol II of the Geneva Conventions prohibits the civilian population being the object of attack, and harm to civilians must not be disproportionate to the military value of the target. The Geneva Conventions also prohibits acts or threats of violence where the primary purpose is to spread terror among the civilian population. Depending upon the circumstances of the bombings, the attacks may or may not have been legally justifiable.

Providing warnings to the civilian population that a bombing is imminent does not absolve the government for attacks that are directed at the population or are disproportionate in result. At times the leaflets served as genuine warnings. At others they may have been used to instil terror in the population - they certainly had that effect. Most disturbingly, MSF received reports that in Makeni and Magburaka the helicopter gunship began bombing while civilians were running to collect the leaflets.

Particularly troubling have been bombings on or near places where civilians congregate. Markets, mosques, cemeteries and residential neighbourhoods were damaged in Makeni and elsewhere. According to witnesses, the June 7th bombing of Magburaka occurred in the afternoon when the market was full, resulting in 15 to 20 dead and wounded.

Effects on the Population

Sierra Leone's civil war has already taken a tremendous toll on society. Over the years, families have had to flee the warring factions time and again. The health care system in much of the country does not function. MSF has documented pervasive mental trauma induced by wartime atrocities. Rebel factions have abducted thousands of children, abusing them and forcing them to join their armies.

The renewal of heavy fighting has made a tenuous situation worse for the newly displaced and the population in RUF-controlled areas. There is considerable concern for the health and security of the displaced populations at Mile 91 and Port Loko especially.

In June at Mile 91, MSF conducted approximately 8,000 consultations during a two-week period (200-400 consultations per day in each of four clinics) and found high numbers of malaria, respiratory infections and exhaustion. There were several cases of watery diarrhoea and bloody diarrhoea. MSF's greatest medical concern is malnutrition. Although the clinics have received 35 cases so far they suspect that there are many undetected cases. The non-governmental organisation ACF found on the first day they opened their clinic in Yonibana that there were already 52 cases of severe malnutrition. This will continue to be a growing concern as those coming to Mile 91 often arrive weak and hungry, and food is in short supply and expensive. Thus far only a small number of the displaced persons have benefited from food distributions.

The displaced populations at Mile 91 and Port Loko are vulnerable not only because they are near areas of continued fighting, but humanitarian goods meant for them are a magnet to the ill-supplied armies in the vicinity. Attacks followed both food distributions to the Port Loko displaced persons camp. At Mile 91, international food agencies have had difficulty bringing in food and supplies in part because of apprehension that it would create similar risks for the displaced population. Because existing clinics are over-stretched and there is the threat of epidemic, MSF is establishing an emergency health program for the displaced persons at Mile 91.

The proliferation of various ostensibly pro-government forces, often consisting of former rebel soldiers, has added to the security concerns of the displaced persons. These groups are largely untrained, badly equipped and short of food, and they have made travel in government-controlled areas extremely hazardous.

In-fighting among these pro-government forces poses a further threat to the safety of civilians. Fighting between factions of the Sierra Leone Army in mid-June resulted in the deaths of 11 soldiers near Lunsar in Port Loko district; instability within the SLA also exists in the vicinity of Mile 91. There is also a danger at Mile 91 of full-fledged fighting within the Gbete and the Kamajor groups of the Civil Defence Forces.

The population living in RUF-controlled areas - roughly half the country - is also now at greater risk. Insecurity reigns in largely empty towns and in rural areas under uncertain control. Dangerous roads means food shipments from Freetown cannot get to much of the north, fostering looting and robbery. In May insecurity forced MSF to cancel a measles vaccination program in the province, leaving many children unprotected despite the high risk of epidemic. Current security concerns have made it impossible for humanitarian agencies to function in RUF areas such as Makeni and Kambia.

The RUF have responded to dwindling food supplies by continuing to rob civilians of their own limited rations. They have further threatened the health of the population in areas that they control by dismantling existing health services. This has included: taking over of a medical facility near Magburaka causing non-military medical personnel to leave; stealing medical supplies from a clinic in Kambia town to be sold for profit or for use by a clinic only treating RUF; and, at three clinics in Kambia district, only treating wounded RUF members.

There are reports that some displaced persons at Mile 91 have returned to Makeni and Magburaka because of the lack of assistance and security they feel at Mile 91. These people may be able to find more available food and shelter, but will have no access to healthcare. In Kambia district, which is under RUF control has been inaccessible to aid agencies since early May, there are reports of adult malnutrition (indicating that child malnutrition could be quite serious) and suspected cases of bloody diarrhoea.


Sierra Leone's latest upheaval has produced unforeseen complications and contradictions. The displacement of hundreds of thousands of people has occurred as a result of government military action, and only secondarily because of RUF atrocities. Insecurity in displacement camps is as much the result of infighting and lawlessness from pro-government armies as it is from rebel forces. It should be clear therefore that simple solutions, focusing blame only on one side of the conflict, will not address all of the problems facing the civilian population. MSF urges the international community to exert greater political will to adopt a more comprehensive approach to Sierra Leone's problems, one that will encompass, rather than ignore, these troubling complications and contradictions.