Médecins Sans Frontières (MSF) has started to scale down its work in Sierra Leone, nearly five years after the end of the country's violent civil war. The Sierra Leonean Ministry of Health is taking over two of MSF's projects.

Permanent MSF presence started in Sierra Leone in 1995, focusing on providing emergency health care to victims of the conflict. Our teams experienced a horrific episode in 1998, when civilians in the countryside were systematically mutilated. In two months, MSF treated 225 war victims in the Connaught hospital in the capital, Freetown.

The conflict was brutal: it left some 50,000 dead, countless people badly mutilated and the
country's infrastructures destroyed. By the time it ended in 2001, the health system had been devastated and large sectors of the population did not have access to any health care.

Over the past few years, MSF has provided medical care in several locations across the country, particularly focusing on pregnant women and children under five. Today, malaria is the number one killer in Sierra Leone: last year MSF staff treated 47,598 people for the disease. Children below the age of five and pregnant women are the most vulnerable.

In 2004, MSF and other organisations successfully advocated for a change in the national protocol for the treatment of malaria. Although the implementation of the new protocol has been slow and medical care for malaria still needs to be monitored, today Artemisinin-based Combination Therapy (ACT) is available in the country.

At the end of July, MSF handed over to the Ministry of Health its basic health care and hospital support programmes in Kambia and Tonkolili districts.

Many people in the country still live in dire poverty but the situation is no longer the humanitarian crisis that caused us to work there in the first place. However, because mortality rates are still very high in the country, other MSF teams are continuing to work in Sierra Leone.

While scaling down in some areas, MSF is continuing providing medical care for those who otherwise would be left without.