International Activity Report 2004
Liberia

International staff: 70
National Staff: 450

War ends, but the crisis continues

Fierce fighting between rebel and government forces on the streets of the capital, Monrovia, between June and August 2003, killed more than 2,000 people and wounded many civilians. Although the fighting has ended, the war's long-term consequences continue to cause suffering among the civilian population.

In August 2003, Liberia's president, Charles Taylor, stepped down and accepted Nigeria's offer of political asylum. Soon after, the three warring parties signed a peace agreement ushering in a transitional government and a process of military disarmament and demobilization. Yet the long years of war, the latest round since 1999, have severely damaged the social fabric of Liberian society. Families have been separated as people were forced to flee to other parts of the country or neighboring nations. Many civilians died from war wounds, malnutrition or the epidemics that plagued the weakened population. The country's infrastructure, including the health care system, is destroyed. More than 40 percent of the population lacks health care and less than 20 percent have safe drinking water and sanitation facilities. Today there are only about 30 Liberian physicians working in this country of more than three million people.

Monrovia: during and after the battle

When Monrovia was under siege in July 2003 and other health facilities were forced to close as fighting neared, MSF staff converted their living compound into an emergency surgical hospital. By September, the fighting had ceased but Monrovia remained a city of squatters living without electricity, running water, shelter, sanitation or adequate food. Every new clinic opened by MSF was immediately flooded with people seeking treatment and clean water. Days after the fighting ended, MSF staff re-opened Redemption Hospital and converted a school into Mamba Point Hospital, both free, full-service facilities. They also restarted the 50-bed Island pediatric facility and Benson Hospital. MSF staff continued to run three cholera treatment units until they were no longer needed shortly after fighting ended. Teams also managed therapeutic feeding centers in the city, including one, still in operation, that treats severely malnourished children who also have tuberculosis. Among all of these facilities, the MSF teams were treating 1,500 to 2,000 people a day by September 2003. Later, in October, two medical clinics called Red Light and Logan were opened in the city to provide additional care to the local population. Once needs began to subside, MSF closed the Red Light clinic in April 2004 and Logan clinic in July.

The most common health problems seen were cholera, malaria, watery diarrhea, measles, sexually transmitted infections and pregnancy-related conditions. MSF introduced artemisinin-based combination therapy (ACT), the most effective malaria treatment today, to several of its clinics in Monrovia during the fighting. It also supplied more than 300,000 liters of drinking and washing water to centers for displaced people.

Devastation in rural areas

In the weeks following the battle in Monrovia, MSF assessment teams traveled beyond the capital to Grand Bassa, Grand Gedeh, Lofa, Montserrado and Nimba counties to assess health needs in parts of the country that had been cut off from humanitarian aid for months or, in some cases, even years. In the city of Buchanan in Grand Bassa county, MSF fed malnourished children from September 2003 until the early part of 2004 when needs declined. In Bong county, international staff rejoined Liberian staff who had continued providing medical consultations and clean water to more than 70,000 displaced people despite nearby fighting.

In some areas, MSF staff found people surviving amid horrendous living conditions in displacement camps and villages. Many had inadequate food, water and medical care. Malaria, respiratory infections, cholera, sexually transmitted infections and malnutrition rates were high. MSF began providing care in local hospitals and started health clinics which together carried out thousands of medical consultations each month. MSF also organized blanket feedings for more than 10,000 children.

In early October 2003, MSF began a program to treat survivors of rape and sexual violence in three displacement camps located north of Monrovia which shelter about 35,000 people. The project encourages rape survivors and their families to seek care quickly after sexual assaults in order to receive medical treatment necessary to prevent unwanted pregnancies and sexually transmitted infections, including HIV/AIDS. The team's Liberian staff works in the camps to spread the message that treatment is available and to encourage camp residents to take advantage of it. By July 2004, more than 800 people had come to MSF for treatment. All individuals who report being raped are examined and treated in the camps. Those needing extra care are referred to Redemption or Benson Hospital in Monrovia.

MSF has worked in Liberia since 1990.