July 18, 2003
Following the two June attacks by rebel forces on the Liberian capital of Monrovia, MSF has stepped up its activities to provide urgent medical, nutritional, and water and sanitation services to the hundreds of thousands of displaced Liberians in the city and camps for displaced persons in the surrounding county. Poor sanitation in the city and a lack of food distribution in the camps for are contributing to an increase in cases of cholera, malaria, malnutrition, diarrhea, and respiratory infections.
Due to ongoing insecurity in large areas of Liberia, access by humanitarian organizations to populations in need is limited to only one quarter of the country. Already reduced medical services were further diminished following the last round of fighting in Monrovia in late June, when MSF was forced to evacuate Redemption Hospital, leaving the country without a single fully functioning public hospital.
Health Care in Monrovia
During the most recent attacks of June 24-26, MSF evacuated staff and 30 critical patients, including 12 child cholera patients, from Redemption Hospital to the relative safety of an MSF compound in Mamba Point, Monrovia. Within days, MSF staff had transformed two former residences into hospitals that now provide some of the only free in-patient and out-patient medical services currently available in the city.
The MSF New Hospital in Mamba Point is a 100-bed in-patient care facility with an emergency room and surgical theater, as well as wards for obstetrics and gynecology, pediatrics, dressing, observation, and general medicine. The hospital also runs a pharmacy and a laboratory for blood transfusion and malaria tests. With only one surgeon on staff, the hospital admitted 113 patients during the week of July 7-14, treating war wounded, complicated births, including 8 cesarean sections, as well as malaria and respiratory illnesses. Children admitted to the pediatric ward are primarily being treated for severe malaria and respiratory infections, as well as malnutrition.
The Second MSF Hospital in Mamba Point provides urgently needed out-patient services to residents and displaced persons in the city. Housed in tents on a vacant lot overlooking the ocean, the MSF "OPD" (out-patient department) is taking care of 300-400 patients per day. Malaria, respiratory infections, and diarrhea are some of the most common ailments being treated. Patients with more severe illnesses are referred to the in-patient facilities available at this hospital, where nearly 60 patients are currently being treated in adult and pediatric wards, an obstetrical/gynecological department, and a therapeutic feeding center where severely malnourished children receive medically monitored feedings. An observation center located next to the OPD provides facilities and specialized staff to observe and care for patients suspected of suffering from cholera.
Combating Cholera, Poor Sanitation, and a Lack of Medical Services in Monrovia
In the Samuel K. Doe (SKD) Stadium in Monrovia, where an estimated 20,000 internally displaced persons are currently living, MSF is running an out-patient clinic, with facilities for short-term in-patient observation, and a 50-bed cholera treatment center. MSF also provides 60,000 liters of water a day to residents of the stadium. Elsewhere in Monrovia, MSF runs 6 clinics [in Soniwein (pop. 30,000), New Georgia (40,000), New Kru Town (110,000), Duport Road (67,000), Clara Town (52,000), and Logan Town (40,000)], offering basic medical services for displaced persons and referrals to other facilities for serious cases. MSF also provides medicines to support the Westpoint Clinic. This week, MSF opened a new mobile clinic serving displaced persons living near Chicken Soup Factory in Gardnersville where a number of cholera cases have been detected.
Overcrowding and poor sanitation in the city has resulted in an increase in cholera in the past month. In addition to the cholera treatment center in Doe Stadium, MSF set up a 110-bed cholera treatment unit in JFK Hospital, and two new cholera treatment units with a 60-bed capacity in Randal Street and a 270-bed capacity in UN Drive in central Monrovia. MSF disinfection teams have been deployed to sanitize 220 homes and 9 displaced persons centers in the city where cholera cases have been identified. A system of 6 "lazarets" - emergency cholera treatment kits - equipped with oral-rehydration solution, chlorine, and other cholera treatment materials have been pre-positioned throughout the city to prepare for further outbreaks. MSF has also set up 8 rehydration points around Monrovia where displaced persons suffering from dehydration can be treated and screened for cholera. To help alleviate the poor water facilities in the city, MSF is trucking 70,000 liters of water per day to distribution centers in key locations in the city.
Caring for Displaced Persons Outside of Monrovia
Liberians have been fleeing fighting in their country for nearly 14 years, and the upsurge in hostilities during June forced even more people from their homes, driving many closer to Monrovia and camps for displaced persons in nearby Montserrado County. MSF is currently running mobile clinics for internally displaced persons living in Seighbe (housing 11,000 persons), Plumcor (6,000 persons), and Rick's (3,500) camps. The rainy season, increased insecurity, and a lack of general food distribution in the camps since March has lead to a rise in the cases of malaria and malnutrition in the past weeks, particularly in children under five years of age. In response, and in preparation for an additional increase in malnutrition, MSF is building a therapeutic feeding center in Seighbe camp with a capacity for treating 500 persons. Due to the high incidence of rape among displaced women living in the camps, MSF has also launched a Sexual Gender Based Violence Training program to sensitize medical staff working in the camps.
In Bong County, east of Monrovia, MSF has been running out-patient clinics since 2001 that currently serve approximately 50-60,000 displaced persons in the Salala, Maimu, and Totota camps. MSF also runs an in-patient medical facility in the centrally located Maimu camp providing out- and in-patient care, general consultations, and mother-child health care. MSF also provides water and sanitation support in the camps.
MSF currently has 19 international and 290 national staff working in Liberia, and is supporting 584 public health workers.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)