Episode: "Borders and Babies"

Country Background: Sierra Leone

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 mineral wealth.

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 over.

Advocacy for Populations Affected by War in Sierra Leone

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.