International Activity Report 2004
Sierra Leone

International staff: 56
National Staff: 642

Giving medical care to survivors of war

Much of MSF's work today in this West African country is focused on providing and improving basic health care for both Sierra Leoneans and refugees from other countries. Approximately 60,000 of the refugees are Liberians who continue to reside in Sierra Leone because of continuing insecurity and food scarcity in their homeland. Poverty and unemployment remain high in Sierra Leone and the introduction of a costrecovery system involving user fees for medical services has led to a situation where fewer than half of all the people in Sierra Leone can obtain needed care. In the southern districts of Bo and Pujehun, MSF teams treat patients in public health clinics. Since April 2003, the 50-bed referral hospital in Gondama that was built by MSF has been operating at full capacity. In August 2004, 300 people were admitted to its wards. Its facilities include a pharmacy, isolation ward and therapeutic feeding center. Near the Liberian border, MSF staff assisted people until August 2004 at health clinics in Zimmi, Fairo and Sulimo. In northern Sierra Leone's Koinadugu district, MSF worked to improve health care among the local population and Sierra Leoneans returning from Guinea now that peace has returned. MSF treated patients at Kabala and Kailahun Hospitals and nine area clinics. Thousands of medical consultations were carried out in 2003, many due to malaria. MSF's work at Kabala Hospital was handed over to local authorities in May 2004. Now that Kailahun Hospital has been rehabilitated, MSF plans to hand over its activities there to the ministry of health by the end of 2004.

In the northern Kambia, Bombali and Tonkolili districts, MSF staff members provide maternal and child health care, emergency obstetrical and general emergency surgery, training and supervision of local medical staff, epidemiological surveillance and health education delivered in 3 district hospitals and 15 clinics. MSF is beginning to integrate HIV/AIDS activities into the current program by supporting voluntary testing and counseling. It is in the process of setting up a program to prevent mother-to- child transmission of HIV and to treat patients with opportunistic infections at Kambia Hospital.

As Liberian refugees begin to return to their own country and the populations in Sierra Leone's refugee camps decline, MSF continues to assist those remaining in camps. MSF works in five refugee camps in the districts of Bo and Pujehun, offering basic health care to camp residents and those in nearby communities. In 2003, MSF began a sexual violence program in Bo. Team members train medical staff to treat victims and provide direct medical and psychological care for survivors of rape or other forms of sexual violence. In the Taiama and Tobanda refugee camps, MSF provides medical care as well as mental health care for refugees who have been traumatized by violence, including former child soldiers.

Malaria is the main cause of death for children under five and the leading cause of illness and death for adults in Sierra Leone. Because traditionally used malaria drugs are often ineffective due to growing parasite resistance, the government of Sierra Leone in March 2004 changed the country's malaria-treatment protocol to artemisinin- based combination therapy (ACT). MSF has advocated strongly for the transition to these more effective drugs and is now working closely with health authorities in all of the medical facilities in which the organization works to implement ACT.

MSF has worked in Sierra Leone since 1986.