Episode: "Borders and Babies"
Since gaining independence from the United Kingdom
in 1961, Sierra Leone has rarely seen political stability. For more
than four decades, the nation has been plagued by abrupt changes
and disruptions of leadership: ethnic groups have challenged the
national government for more political representation and military
factions have competed for control over the nation’s considerable
In the late 1990s, however, an ongoing civil war between
the national government and rebel leader Foday Sankoh’s Revolutionary
United Front (RUF) came to a horrific boiling point. Successive
rebel offensives in 1998 and early 1999 culminated in massacres
and atrocities on the streets of Freetown, the nation’s capital.
The following year, 500 United Nations peacekeepers were temporarily
taken hostage by the RUF.
During the next several years it took several attempts
at a peace agreement and 17,000 UN peacekeepers backed by United
Kingdom forces to quell the violence. In January, 2002, after a
collection of more than 47,000 firearms by the UN, the war was declared
Advocacy for Populations Affected by War in
Although Sierra Leone has made significant steps towards
a lasting peace, government and UN resettlement projects for the
many internally displaced people (IDPs) who remain in Sierra Leone’s
refugee camps have resembled a mass-eviction.
In May 2002, MSF published “Populations
Affected by War in the Mano River Region: Issues of Protection,”
a report in which MSF condemned the resettlement programs and raised
the question of whether the welfare of civilians in west Africa
was being subordinated to the political aims of the peace process
in Sierra Leone.
Peace at Last: Medical Aid in Formerly Rebel-Held
Territories of Sierra Leone
In this episode, Dr. David Friend, Nurse Katiana Rivette,
and Project Coordinator Rebecca Golden are working at a Sierra Leone
government hospital in the northern town of Magburaka, in the formerly
rebel-held northern half of the country.
The civil war had prevented MSF’s constant presence
in the RUF heartland, but months before hostilities ceased in 2001,
Rebecca Golden was able to negotiate with rebel leaders and win
access to Magburaka for MSF. With demobilization and disarmament,
MSF has been able to strengthen and expand health care to populations
that had been cut off from food and medical aid during the conflict.
In Magburaka and Makeni, another northern city, MSF
has gone far towards rehabilitating the district hospitals. At Magburaka,
MSF doctors and surgeons conduct the only emergency surgery in the
northern districts, as well as assisting the hospital laboratory
and the maternity and pediatric wards. Twelve rural clinics in the
region are also supported by MSF.
The organization’s work in the north is rounded
out by a therapeutic feeding center (TFC) and clinic in Port Loko
and support to six hospitals in the northeastern province of Kambia.
Project Update: Magburaka Hospital
Many months after the cessation of fighting in Sierra
Leone, the war continued to punish people who had fled into the
bush in the northern regions. Although free to return to the looted
and smashed remains of the towns that they used to call home before
the war, many were malnourished, and malaria and other diseases
had flourished in the forests where they hid from the violence.
To make matters worse, in an area with no communications
infrastructure, many remained unaware that medical aid was now available
at Magburaka and Makeni.
Soon after National Geographic Channel film crews
visited Magburaka hospital, MSF volunteers decided to make an attempt
to publicize the hospital’s revitalized medical services,
in order to attract people with urgent medical problems from the
surrounding communities. A public service announcement was drafted
and disseminated by radio.
In the months following, Magburaka has been flooded
with people traveling at times from far away to get treatment. Surgical
needs have been especially pressing, with a perpetual influx of
pregnancies complicated by syphilis, hepatitis and malaria. Perforated
ulcers and hernias have also been common.
After months of long hours and no weekends, the overworked
staff received some help in the form of an additional MSF surgeon
in the fall of 2002. As of July, 2003, however, the hospital continued
to operate at capacity, and will continue to, in all likelihood,
until the most pressing surgical and obstetric needs in the north
have been addressed and peace brings the public health improvements
in staffing and infrastructure that the people of Sierra Leone deserve.