MSF historical perspective
of Sierra Leone
MSF currently has 40 ex-pat and another 150 national staff active in the field.
Permanent MSF presence in Sierra Leone began in 1995 in Freetown and Bo. The very first interventions were for cholera and health care for displaced. Quickly new areas of need were discovered and MSF began a very big TFC (+1,000 children) in Kenema, and to provide surgical and hospital care for war victims in Bo.
By 1996 MSF was working in the camps in Bo for the 250,000 displaced
civilians from the south of the country. MSF was able to carry out
assessments and measles vaccination campaigns in Kailahun District (the
headquarters of RUF) in 1996. There had been no assistance to the civilians
in this district since 1991.
Programs expanded following elections in 1996 when there was a temporary end to hostilities. MSF then expanded to work also in Pujehun to the south.
In May 1997 there was another coup d'etat and the military took over the country. They called the RUF to come to the capitol and together they formed the Armed Forces Ruling Council (AFRC) junta.
The president of Sierra Leone, plus the UN and all humanitarian
organizations except MSF, ACF, Merlin and ICRC stopped any permanent expat
presence in the country, refusing to be present under a Junta regime
(ironically it was the first time since the war began that NGOs had 100%
access throughout Sierra Leone). MSF then spread to Kambia (north-west on
the border with Guinea) and to Makeni. These programs were nutrition,
medical care and in Makeni also PTSD program.
In February 1998 ECOMOG pushed the Junta out of Freetown. As they fled,
two MSF expatriates were kidnapped and held for two weeks. They were
released without harm.
MSF stayed in the capital throughout the 10 days of fighting with a
surgical team in the main government hospital treating the war wounded.
The MSF teams that were present up-country were trapped, and eventually
had to run to the bush for their own safety with the other organizations
present (this team was almost executed).
Following this retreat of RUF and the Junta, there was massive
destruction. MSF was very busy in Freetown with the treatment of wounded,
in Bo and Pujehun in the re-building of clinics that were looted and
destroyed, and in Kambia with malnutrition problems.
By April 1998, amputees started arriving from the east of the country.
All kinds of people; the youngest five years old. The stories were
horrific, and it was clear that this violence was wide-spread throughout
the countryside. The worst atrocities that we recorded occurred in the area
of Koidu and the district of Koinadugu where entire villages were
massacred; one after the other.
ECOMOG was deployed but only to the major towns. At the end of 1998, RUF
and AFRC started a series of attacks, beginning in the east, and very
rapidly advanced to the outskirts of the peninsula where Freetown is
located.
At this time all International NGOs evacuated (except ICRC, who were
later dragged by ECOMOG from their home at gun point and threatened to be
executed for suspicion of supporting RUF). MSF went to Abidjan. It is from
this point that this filming of Cry Freetown begins.
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In January 2000, MSF issued a report entitled "Assessing Trauma in
Sierra Leone" and simultaneously called on the international community
to devote greater resources for the treatment of mental trauma in
war-torn Sierra Leone. MSF's mental health programme was launched last
spring. The team is rehabilitating the Kisi psychiatric hospital and
has set up a psychiatric referral service. Nine mental health
counsellors have been trained and they in turn will train more. MSF is
rehabilitating a community-based structure for mental health care,
supporting a local NGO called FAWE (Forum for African Women's
Education). There have been 2,000 referrals since May 1999.
Since the coup d'état in May 1997, MSF has run a surgical
programme at the Connaught Hospital in Freetown for war-related cases.
Health care support has been provided to eight clinics and one mobile clinic in the
capital, six of which will be handed over to the ministry of health
over the next few months. In preparation for this, MSF is looking at
the possibilities of introducing a cost recovery system to cover the
day to day running and expenses of these clinics. The emergency
preparedness programme continues and the team intervened in the cholera
epidemic in September and October 1999.
MSF also provides medical assistance in a displaced camp in
Freetown where 700 amputees with their families. They had all
received treatment by MSF teams in Connaught Hospital. A team
supplies water to two other camps for the displaced.
MSF continues its programme in Kambia although the team was unable to
enter the area for most of 1999. Since September 1999, MSF has run a
feeding centre (TFC) and an out-patients and in-patients service. MSF
is trying to ensure a permanent MSF presence in Kabala where teams
have been in and out providing medical assistance. A
doctor and logistician will set up a permanent base there over the
next few weeks. MSF has worked on and off in Makeni in Tonkalili
county since 1997. The clinic programme which targets up to 500,000
people continues.
In the southern province, MSF continues to provide support to 30 clinics
in the districts of Bo, Pujehun and Bonthe.
Many of these structures have been
rehabilitated by MSF. MSF will also be setting up a mission in Mattru
in Bonthe district and has also expanded to Zimmi.
In Kenema MSF teams support health care structures. Teams also
intervened in a shigellosis epidemic which broke out in December
1999. There have already been 1,500 cases. MSF closed
Kailahun in early December following the kidnapping of MSF workers
