International staff: 50
National staff: 318
In mid-1999, peace accords seemingly put an end to Sierra Leone's eight-year civil war, and it appeared that peace in Sierra Leone was, if not at hand, at least a step closer.
However, by July 2000, what MSF had feared had come to pass: government forces (the Sierra Leone Army) and rebel forces (the Revolutionary United Front) had begun fighting again, and the peace agreement crumbled like dust. Traumatized civilians were subject anew to bombings, attacks, forced amputations, rapes and abductions.
Many, especially those in the rebel-held northern province, fled their homes in fear of the rebels and bombing by government forces. For MSF, the current situation in Sierra Leone is a grim example of all that can be aggressive to a civilian population.
Even without the factional violence shaking the country, the health of the population was far from assured. The health system has progressively deteriorated: staff are ill-paid and poorly trained, the logistical network is weak and the vaccination rate is low. The country is subject to periodic outbreaks of epidemics, notably cholera, measles and shigellosis (bloody diarrhea).
Before the fighting started up again in May 2000, MSF had been working in the capital, Freetown, the southern and eastern provinces, and several towns in the northern province. Even in the absence of outright war, insecurity had remained high. In December, an MSF vaccination project in the northern town of Kailahun was suspended after the MSF team was taken hostage for ten days.
Many programs are suspended in the north
This spring's renewed fighting forced the evacuation of most programs in the northern province. In the district of Kambia, MSF provided basic health care at 11 clinics. The organization also ran a feeding program for children under five and an inpatient dispensary in Kambia town. The fighting in May forced the closure of these programs. In Makeni, MSF provided basic care at six clinics and several dispensaries. This program, too, was forced to close when the security situation deteriorated.
In Bombali and Tonkolili districts of the northern province, MSF had to suspend a measles vaccination campaign. Despite the vaccination of 100,000 children, many more were left unvaccinated.
MSF continues to work in the northern area of Kabala, providing basic health care at a hospital and six clinics.
The situation in other parts of the country has remained relatively stable. In the southern province, MSF continues to support three hospitals and 28 clinics in Pujehun, Bo and Bonthe. In Moyamba, MSF works in five clinics and supports a pediatric ward and nutrition program for children under five. In Mile 91, a town 50km southwest of Makeni, MSF works in two clinics for newly displaced people from the Makeni area. In the eastern province, MSF has a primary health care project in Kenema, a fairly inaccessible area.
The psychological scars of conflict
The latest fighting in Sierra Leone has severely disrupted the lives and physical health of many civilians. It has also weighed heavily on their mental well-being. For the last several years, MSF has been working to understand and address the populations's mental trauma, a devastating consequence of years of violence.
In 1999, MSF undertook a survey of Freetown's residents and displaced people. Of the 245 people interviewed, the survey revealed that almost everyone had been exposed to conflict, including attacks on villages, explosion of mines, aerial bombing, the burning of property and the destruction of houses. Over 40% of the respondents reported having been abducted.
MSF has trained local aid workers in psycho-social health care and has a mental health program in Freetown. MSF also assists a local NGO that works with female victims of sexual abuse in Freetown and Kenema.
MSF continues to provide surgical care for war victims at Connaught Hospital, general surgery and medical care at two other Freetown hospitals, and basic care at an area clinic. The capital is home to several camps for displaced people and victims of the war; MSF is actively supporting one such camp, Murray Town, home to many civilian victims of forced amputations, and has worked in others.
MSF first intervened in Sierra Leone in the wake of a 1986 cholera epidemic.