The short and tragic Political history of Sierra Leone!

Sierra Leone

In 1961, Sierra Leone gained its independence from the United Kingdom. In the years following the death of Sierra Leone’s first prime minister Sir Milton Margai in 1964, politics in the country were increasingly characterized by corruption, mismanagement, and electoral violence that led to a weak civil society, the collapse of the education system, and, by 1991, an entire generation of dissatisfied youth were attracted to the rebellious message of the Revolutionary United Front (RUF) and joined the organization. Albert Margai, unlike his half-brother Milton, did not see the state as a steward of the public, but instead as a tool for personal gain and self-aggrandizement and even used the military to suppress multi-party elections that threatened to end his rule.

When Siaka Stevens entered politics in 1968, Sierra Leone was a constitutional democracy. When he stepped down, seventeen years later, Sierra Leone was a one-party state.Stevens’ rule, sometimes called “the 17 year plague of locusts,”saw the destruction and perversion of every state institution. Parliament was undermined, judges were bribed, and the treasury was bankrupted to finance pet projects that supported insiders.When Stevens failed to co-opt his opponents, he often resorted to state sanctioned executions or exile.

In 1985, Stevens stepped down, and handed the nation’s preeminent position to Major General Joseph Momoh, a notoriously inept leader who maintained the status quo. During his seven-year tenure, Momoh welcomed the spread of unchecked corruption and complete economic collapse. With the state unable to pay its civil servants, those desperate enough ransacked and looted government offices and property. Even in Freetown, important commodities like gasoline were scarce. But the government hit rock bottom when it could no longer pay schoolteachers and the education system collapsed. Since only wealthy families could afford to pay private tutors, the bulk of Sierra Leone’s youth during the late 1980s roamed the streets aimlessly. As infrastructure and public ethics deteriorated in tandem, much of Sierra Leone’s professional class fled the country. By 1991, Sierra Leone was ranked as one of the poorest countries in the world, even though it benefited from ample natural resources including diamonds, gold, bauxite, rutile, iron ore, fish, coffee, and cocoa.

Diamonds and the “resource curse”

The Eastern and Southern districts in Sierra Leone, most notably the Kono and Kenema districts, are rich in alluvial diamonds, and more importantly, are easily accessible by anyone with a shovel, sieve, and transport.[27] Since their discovery in the early 1930s, diamonds have been critical in financing the continuing pattern of corruption and personal aggrandizement at the expense of needed public services, institutions, and infrastructure. The phenomenon whereby countries with an abundance of natural resources tend to nonetheless be characterized by lower levels of economic development is known as the “resource curse“.

Alluvial diamond miner

The presence of diamonds in Sierra Leone invited and led to the civil war in several ways. First, the highly unequal benefits resulting from diamond mining made ordinary Sierra Leoneans frustrated. Under the Stevens government, revenues from the National Diamond Mining Corporation (known as DIMINCO) – a joint government/DeBeers venture – were used for the personal enrichment of Stevens and of members of the government and business elite who were close to him. When DeBeers pulled out of the venture in 1984, the government lost direct control of the diamond mining areas. By the late 1980s, almost all of Sierra Leone’s diamonds were being smuggled and traded illicitly, with revenues going directly into the hands of private investors. In this period the diamond trade was dominated by Lebanese traders and later (after a shift in favor on the part of the Momoh government) by Israelis with connections to the international diamond markets in Antwerp. Momoh made some efforts to reduce smuggling and corruption in the diamond mining sector, but he lacked the political clout to enforce the law. Even after the National Provisional Ruling Council (NPRC) took power in 1992, ostensibly with the goal of reducing corruption and returning revenues to the state, high-ranking members of the government sold diamonds for their personal gain and lived extravagantly off the proceeds.

Diamonds also helped to arm the Revolutionary United Front rebels. The RUF used funds harvested from the alluvial diamond mines to purchase weapons and ammunition from neighboring Guinea, Liberia, and even SLA soldiers. But the most significant connection between diamonds and war is that the presence of easily extractable diamonds provided an incentive for violence. To maintain control of important mining districts like Kono, thousands of civilians were expelled and kept away from these important economic centers.

Although diamonds were a significant motivating and sustaining factor, there were other means of profiting from the Sierra Leone Civil War. For instance, gold mining was prominent in some regions. Even more common was cash crop farming through the use of forced labor. Looting during the Sierra Leone Civil War did not just center on diamonds, but also included that of currency, household items, food, livestock, cars, and international aid shipments. For Sierra Leoneans who did not have access to arable land, joining the rebel cause was an opportunity to seize property through the use of deadly force. But the most important reason why the civil war should not be entirely attributed to conflict over the economic benefits incurred from the alluvial diamond mines is that the pre-war frustrations and grievances did not just concern that of the diamond sector. More than twenty years of poor governance, poverty, corruption and oppression created the circumstances for the rise of the RUF, as ordinary people yearned for change.

The demographics of rebel recruitment

Revolutionary United Front

As a result of the First Liberian Civil War, 80,000 refugees fled neighboring Liberia for the Sierra Leone – Liberian border. This displaced population, composed almost entirely of children, would prove to be an invaluable asset to the invading rebel armies because the refugee and detention centers, populated first by displaced Liberians and later by Sierra Leoneans, helped provide the manpower for the RUF’s insurgency.The RUF took advantage of the refugees, who were abandoned, starving, and in dire need of medical attention, by promising food, shelter, medical care, and looting and mining profits in return for their support.When this method of recruitment failed, as it often did for the RUF, youths were often coerced at the barrel of a gun to join the ranks of the RUF. After being forced to join, many child soldiers learned that the complete lack of law – as a result of the civil war – provided a unique opportunity for self-empowerment through violence and thus continued to support the rebel cause.

Libyan and arms dealing role

Muammar al-Gaddafi both trained and supported Charles Taylor. Gaddafi also helped Foday Sankoh, the founder of Revolutionary United Front.

Russian businessman Viktor Bout supplied Charles Taylor with arms for use in Sierra Leone and had meetings with him about the operations.

The Sierra Leone Civil War

SLA response; Sobels

SLA soldiers and advisers

The initial rebellion could have easily been quelled in the first half of 1991. But the RUF – despite being both numerically inferior and extremely brutal against civilians – controlled two-thirds of Sierra Leone by the year’s end. The SLA’s equally poor behavior made this outcome possible. Often afraid to directly confront or unable to locate the elusive RUF, government soldiers were brutal and indiscriminate in their search for rebels or sympathizers among the civilian population. After retaking captured towns, the SLA would perform a ‘mopping up’ operation in which the towns people were transported to concentration camp styled ‘strategic hamlets’ far from their homes in Eastern and Southern Sierra Leone under the pretense of separating the population from the insurgents. However, in many cases, this was followed by much looting and theft after the villagers were evacuated.

The SLA’s sordid behavior inevitably led to the alienation of many civilians and pushed some Sierra Leoneans to join the rebel cause. With morale low and rations even lower, many SLA soldiers discovered that they could do better by joining with the rebels in looting civilians in the countryside instead of fighting against them.The local civilians referred to these soldiers as ‘sobels’ or ‘soldiers by day, rebels by night’ because of their close ties to the RUF. By mid-1993, the two opposing sides became virtually indistinguishable. For these reasons, civilians increasingly relied on an irregular force called the Kamajors for their protection.

Rise of the Kamajors

Kamajors

A grassroots militia force, the Kamajors operated invisibly in familiar territory and was a significant impediment to marauding government and RUF troops.[49] For displaced and unprotected Sierra Leonans, joining the Kamajors was a means of taking up arms to defend family and home due to the SLA’s perceived incompetence and active collusion with the rebel enemy. The Kamajors clashed with both government and RUF forces and was instrumental in countering government soldiers and rebels who were looting villages.The success of the Kamajors raised calls for its expansion, and members of street gangs and deserters were also co-opted into the organization. However, the Kamajors became corrupt and deeply involved in extortion, murder, and kidnappings by the end of the conflict.

National Provisional Ruling Council

Within one year of fighting, the RUF offensive had stalled, but it still remained in control of large territories in Eastern and Southern Sierra Leone leaving many villages unprotected while also disrupting food and government diamond production. Soon the government was unable to pay both its civil servants and the SLA. As a result, the Momoh regime lost all remaining credibility and a group of disgruntled junior officers led by Captain Valentine Strasser overthrew Momoh on 29 April 1992. Strasser justified the coup and the establishment of the National Provisional Ruling Council (NPRC) by referencing the corrupt Momoh regime and its inability to resuscitate the economy, provide for the people of Sierra Leone, and repel the rebel invaders. The NPRC’s coup was largely popular because it promised to bring peace to Sierra Leone. But the NPRC’s promise would prove to be short lived.

Woman in a Sierra Leone village

In March 1993, with much help from ECOMOG troops provided by Nigeria, the SLA recaptured the Koidu and Kono diamond districts and pushed the RUF to the Sierra Leone – Liberia border. The RUF was facing supply problems as the United Liberation Movement of Liberia for Democracy (ULIMO) gains inside Liberia were restricting the ability of Charles Taylor’s NPFL to trade with the RUF. By the end of 1993, many observers thought that the war was over because for the first time in the conflict the Sierra Leone Army was able to establish itself in the Eastern and the Southern mining districts.

However, with senior government officials neglectful of the conditions faced by SLA soldiers, front line soldiers became resentful of their poor conditions and began helping themselves to Sierra Leone’s rich natural resources. This included alluvial diamonds as well as looting and ‘sell game’, a tactic in which government forces would withdraw from a town but not before leaving arms and ammunition for the roving rebels in return for cash. Renegade SLA soldiers even clashed with Kamajor units on a number of occasions when the Kamajors intervened to halt the looting and mining. The NPRC government also had a motivation for allowing the war to continue, since as long as the country was at war the military government would not be called upon to hand over rule to a democratically elected civilian government.The war dragged on as a low intensity conflict until January 1995 when RUF forces and dissident SLA elements seized the SIEROMCO (bauxite) and Sierra Rutile (titanium dioxide) mines in the Moyamba and Bonthe districts in the country’s south west, furthering the government’s economic struggles and enabling a renewed RUF advance on the capital at Freetown.

Executive Outcomes

Executive Outcomes

In March 1995, with the RUF within twenty miles of Freetown, Executive Outcomes, a paramilitary group from South Africa, arrived in Sierra Leone. The government paid EO $1.8 million per month (financed primarily by the International Monetary Fund), to accomplish three goals: return the diamond and mineral mines to the government, locate and destroy the RUF’s headquarters, and operate a successful propaganda program that would encourage local Sierra Leoneans to support the government of Sierra Leone.[17] EO’s military force consisted of 500 military advisers and 3,000 highly trained and well-equipped combat-ready soldiers, backed by tactical air support and transport. Executive Outcomes employed black Angolans and Namibians from apartheid-era South Africa’s former 32 Battalion, with an officer corps of white South Africans.[60] Harper’s Magazine described this controversial unit as a collection of former spies, assassins, and crack bush guerrillas, most of whom had served for fifteen to twenty years in South Africa’s most notorious counter insurgency units.

As a military force, EO was extremely skilled and conducted a highly successful counter insurgency against the RUF. In just ten days of fighting, EO was able to drive the RUF forces back sixty miles into the interior of the country. EO outmatched the RUF forces in all operations. In just seven months, EO, with support from loyal SLA and the Kamajors battalions, recaptured the diamond mining districts and the Kangari Hills, a major RUF stronghold. A second offensive captured the provincial capital and the largest city in Sierra Leone and destroyed the RUF’s main base of operations near Bo, finally forcing the RUF to admit defeat and sign the Abidjan Peace Accord in Abidjan, Côte d’Ivoire on 30 November 1996. This period of relative peace also allowed the country to hold parliamentary and presidential elections in February and March 1996. Ahmad Tejan Kabbah (of the Sierra Leone People’s Party [SLPP]), a diplomat who had worked at the UN for more than 20 years, won the presidential election.

Abidjan Peace Accord

Abidjan Peace Accord

The Abidjan Peace Accord mandated that Executive Outcomes was to pull out within five weeks after the arrival of a neutral peacekeeping force. The main stumbling block that prevented Sankoh from signing the agreement sooner was the number and type of peacekeepers that were to monitor the ceasefire. Additionally, continued Kamajor attacks and the fear of punitive tribunals following demobilization kept many rebels in the bush despite their dire situation. However, in January 1997, the Kabbah government – beset by demands to reduce expenditures by the International Monetary Fund – ordered EO to leave the country, even though a neutral monitoring force had yet to arrive. The departure of EO opened up an opportunity for the RUF to regroup for renewed military attacks. The March 1997 arrest of RUF leader Foday Sankoh in Nigeria also angered RUF members, who reacted with escalated violence. By the end of March 1997, the peace accord had collapsed.

AFRC/RUF coup and interregnum

Armed Forces Revolutionary Council

Freetown, Sierra Leone

After the departure of Executive Outcomes, the credibility of the Kabbah government declined, especially among members of the SLA, who saw themselves being eclipsed by both the RUF on one side and the independent but pro-government Kamajors on the other. On 25 May 1997, a group of disgruntled SLA officers freed and armed 600 prisoners from the Pademba Road prison in Freetown. One of the prisoners, Major Johnny Paul Koroma, emerged as the leader of the coup and the Armed Forces Revolutionary Council (AFRC) proclaimed itself the new government of Sierra Leone. After receiving the blessing of Foday Sankoh, who was then living under house arrest in Nigeria, members of the RUF – supposedly on its last legs – were ordered out of the bush to participate in the coup. Without hesitation and encountering only light resistance from SLA loyalists, 5,000 rag-tag rebel fighters marched 100 miles and overran the capital. Without fear or reluctance, RUF and SLA dissidents then proceeded to parade peacefully together. Koroma then appealed to Nigeria for the release of Foday Sankoh, appointing the absent leader to the position of deputy chairman of the AFRC. The joint AFRC/RUF leadership then proclaimed that the war had been won, and a great wave of looting and reprisals against civilians in Freetown (dubbed “Operation Pay Yourself” by some of its participants) followed. President Kabbah, surrounded only by his bodyguards, left by helicopter for exile in nearby Guinea.

President Kabbah

The AFRC junta was opposed by members of Sierra Leone’s civil society such as student unions, journalists associations, women’s groups and others, not only because of the violence it unleashed but because of its political attacks on press freedoms and civil rights. The international response to the coup was also overwhelmingly negative. The UN and the Organization of African Unity (OAU) condemned the coup, foreign governments withdrew their diplomats and missions (and in some cases evacuated civilians) from Freetown, and Sierra Leone’s membership in the Commonwealth was suspended.The Economic Community of West African States (ECOWAS) also condemned the AFRC coup, and ECOMOG forces demanded that the new junta return power peacefully to the Kabbah government or risk sanctions and increased military presence.

ECOMOG’s intervention in Sierra Leone brought the AFRC/RUF rebels to the negotiating table where, in October 1997, they agreed to a tentative peace known as the Conakry Peace Plan. Despite having agreed to the plan, the AFRC/RUF continued to fight. In March 1998, overcoming entrenched AFRC positions, the ECOMOG forces retook the capital and reinstated the Kabbah government, but let the rebels flee without further harassment. The regions lying just beyond Freetown proved much more difficult to pacify. Thanks in part to bad road conditions, lack of support aircraft, and a revenge driven rebel force, ECOMOG’s offensive ground to a halt just outside Freetown. ECOMOG’s forces suffered from several weakness, the most important being, poor command and control, low morale, poor training in counterinsurgency, low manpower, limited air and sea capability, and poor funding.

Unable to consistently defend itself against the AFRC/RUF rebels, the Kabbah regime was forced to make serious concessions in the Lome Peace Agreement of July 1999.

Lome peace agreement

Lome Peace Accord

Given that Nigeria was due to recall its ECOMOG forces without achieving a tactical victory over the RUF, the international community intervened diplomatically to promote negotiations between the AFRC/RUF rebels and the Kabbah regime. The Lome Peace Accord, signed on 7 July 1999, is controversial in that Sankoh was pardoned for treason, granted the position of Vice President, and made chairman of the commission that oversaw Sierra Leone’s diamond mines. In return, the RUF was ordered to demobilize and disarm its armies under the supervision of an international peacekeeping force which would initially be under the authority of both ECOMOG and the United Nations. The Lome Peace Agreement was the subject of protests both in Sierra Leone and by international human rights groups abroad, mainly because it handed over to Sankoh, the commander of the brutal RUF, the second most powerful position in the country, and control over all of Sierra Leone’s lucrative diamond mines.

DDR process

Main article: Disarmament, Demobilization and Reintegration

Following the Lome Peace Agreement, the security situation in Sierra Leone was still unstable because many rebels refused to commit themselves to the peace process. The DDR camps were an attempt to convince the rebel forces to literally exchange their weapons for food, clothing, and shelter. During a six-week quarantine period, former combatants were taught basic skills that could be put to use in a peaceful profession after they return to society. After 2001, DDR camps became increasingly effective and by 2002 they had collected over 45,000 weapons and hosted over 70,000 former combatants.

UNAMSIL intervention

UNAMSIL

In October 1999 the UN established the United Nations Mission to Sierra Leone (UNAMSIL). The main objective of UNAMSIL was to assist with the disarmament process and enforce the terms established under the Lome Peace Agreement. Unlike other previous neutral peacekeeping forces, UNAMSIL brought serious military power. The original multi-national force was commanded by General Vijay Jetley of India. Jetley later resigned and was replaced by Lieutenant General Daniel Opande of Kenya in November 2000. Jetley had accused Nigerian political and military officials at the top of the UN mission of “sabotaging peace” in favor of national interests, and alleged that Nigerian army commanders illegally mined diamonds in league with RUF. The Nigerian army called for General Jetley’s resignation immediately after the report was released, saying they could no longer work with him.

UNAMSIL forces began arriving in Sierra Leone in December 1999. At that time the maximum number of troops to be deployed was set at 6,000. Only a few months later, though, in February 2000, a new UN resolution authorized the deployment of 11,000 combatants. In March 2001 that number was increased to 17,500 troops, making it at the time the largest UN force in existence, and UNAMSIL soldiers were deployed in the RUF-held diamond areas. Despite these numbers, UNAMSIL was frequently rebuffed and humiliated by RUF rebels, being subjected to attacks, obstruction and disarmament. In the most egregious example, in May 2000 over 500 UNAMSIL peacekeepers were captured by the RUF and held hostage. Using the weapons and armored personnel carriers of the captured UNAMSIL troops, the rebels advanced towards Freetown, taking over the town of Lunsar to its northeast. For over a year later, the UNAMSIL force meticulously avoided intervening in RUF controlled mining districts lest another major incident occur. After the UNAMSIL force had essentially rearmed the RUF, a call for a new military intervention was made to save the UNAMSIL hostages and the government of Sierra Leone. After Operation Palliser and Operation Khukri the situation stabilized and UNAMSIL gain control.

In late 1999, the UN Security Council asked Russia for participation in a peacekeeping mission in Sierra Leone. The Federation Council of Russia decided to send 4 Mil Mi-24 attack helicopters with 115 crew and technical personnel into Sierra Leone.[3] Many of them had combat experience in Afghanistan and Chechnya. The destroyed Lungi civil airfield in the suburbs of Freetown became their base of operations. A Ukrainian Detached Recovery and Restoring Battalion, and aviation team were stationed near Freetown. The two post-Soviet troop contingents got along well, and left together after the UN mandate for peacekeeping operations ended in June 2005.

Operation Khukri

Operation Khukri

Operation Khukri was a unique multinational operation launched in the United Nations Assistance Mission in Sierra Leone (UNAMSIL), involving India, Nepal, Ghana, Britain and Nigeria. The aim of the operation was to break the two-month-long siege laid by armed cadres of the Revolutionary United Front (RUF) around two companies of 5/8 Gorkha Rifles (GR) Infantry Battalion Group at Kailahun by affecting a fighting break out and redeploying them with the main battalion at Daru. About 120 special forces operators commanded by Major (now Lt. Col.) Harinder Sood were airlifted from New Delhi to spearhead the mission to rescue 223 men of the 5/8 Gorkha Rifles who were surrounded and besieged by the Revolutionary United Front (RUF) rebels for over 75 days. The mission was a total success which resulted in safe rescue of all the besieged men and inflicted several hundreds of casualties on the RUF, where Indian troops were part of a multinational UN peacekeeping force.

British intervention

British military intervention in the Sierra Leone Civil War

A British Harrier jet, such as those used to support government forces

In May 2000, the situation on the ground had deteriorated to such an extent that British Paratroopers were deployed in Operation Palliser to evacuate foreign nationals and establish order.They stabilized the situation, and were the catalyst for a ceasefire that helped end the war. The British forces, under the command of Brigadier David Richards, expanded their original mandate, which was limited to evacuating commonwealth citizens, and now aimed to save UNAMSIL from the brink of collapse. At the time of the British intervention in May 2000, half of the country remained under the RUF’s control. The 1,200 man British ground force – supported by air and sea power – shifted the balance of power in favor of the government and the rebel forces were easily repelled from the areas beyond Freetown.

End of the war

Several factors led to the end of the civil war. First, Guinean cross-border bombing raids against villages believed to be bases used by the RUF working in conjunction with Guinean dissidents were very effective in routing the rebels. Another factor encouraging a less combative RUF was a new UN resolution that demanded that the government of Liberia expel all RUF members, end their financial support of the RUF, and halt the illicit diamond trade. Finally, the Kamajors, feeling less threatened now that the RUF was disintegrating in the face of a robust opponent, failed to incite violence like they had done in the past. With their backs against the wall and without any international support, the RUF forces signed a new peace treaty within a matter of weeks.

On 18 January 2002, President Kabbah declared the eleven-year-long Sierra Leone Civil War officially over. By most estimates, over 50,000 people had lost their lives during the war. Countless more fell victim to the reprehensible and perverse behavior of the combatants. In May 2002 President Kabbah and his party, the Sierra Leone People’s Party (SLPP), won landslide victories in the presidential and legislative elections. Kabbah was re-elected for a five-year term. The RUF’s political wing, the Revolutionary United Front Party (RUFP), failed to win a single seat in parliament. The elections were marked by irregularities and allegations of fraud, but not to a degree that significantly affected the outcome.

War atrocities and crimes against humanity

During the Sierra Leone Civil War numerous atrocities were committed including war rape, mutilation, and mass murder, causing many of the perpetrators to be tried in international criminal courts, and the establishment of a truth and reconciliation commission. A 2001 overview noted that there had been “serious and grotesque human rights violations” in Sierra Leone since its civil war began in 1991.The rebels, the Revolutionary United Front (RUF), had “committed horrendous abuses.” The report noted that “25 times as many people” had already been killed in Sierra Leone than had been killed in Kosovo at the point when the international community decided to take action. “In fact, it has been pointed out by many that the atrocities in Sierra Leone have been worse than was seen in Kosovo.”

A school in Koindu destroyed by RUF rebel forces. In total, 1,270 primary schools were destroyed in the War.

These crimes included but are not limited to:

List of crimes

  • Mass killings of civilians – The most notorious mass killing was the 1999 Freetown massacre. This took place in January 1999 when the AFRC/RUF set upon Freetown in a bloody assault known as “Operation No Living Thing” in which rebels entered neighbourhoods to loot, rape and kill indiscriminately. A Human Rights Watch report documented the atrocities committed during this attack. The report estimated that over 7,000 people were killed and that at least half of them were civilians. Reports from survivors describe perverse brutality including incinerating people alive while locked in their houses, hacking civilians’ hands and other limbs off with machetes and even eating them.
  • Drafting of Underage Soldiers – About one quarter of the soldiers serving in the government armed forces during the civil war were under age 18. “Recruitment methods were brutal – sometimes children were abducted, sometimes they were forced to kill members of their own families so as to make them outcasts, sometimes they were drugged, sometimes they were forced into conscription by threatening family members.” Child soldiers were deliberately overwhelmed with violence “in order to completely desensitize them and make them mindless killing machines.”
  • Mass War Rape – During the war gender specific violence was widespread. Rape sexual slavery and forced marriages were commonplace during the conflict. The majority of assaults were carried out by the Revolutionary United Front (RUF). The Armed Forces Revolutionary Council (AFRC), The Civil Defence Forces (CDF), and the Sierra Leone Army (SLA) have also been implicated in sexual violence. The RUF, even though they had access to women, who had been abducted for use as either sex slaves or combatants, frequently raped non-combatants. The militia also carved the RUF initials into women’s bodies, which placed them at risk of being mistaken for enemy combatants if they were captured by government forces. Women who were in the RUF were expected to provide sexual services to the male members of the militia. And of all women interviewed, only two had not been repeatedly subjected to sexual violence; gang rape and individual rapes were commonplace. A report from PHR stated that the RUF was guilty of 93 per cent of sexual assaults during the conflict. The RUF was notorious for human rights violations, and regularly amputated arms and legs from their victims. Trafficking by military and militias of women and girls, for use as sex slaves is well documented. With reports from recent conflicts such as those in, Angola, the former Yugoslavia, Sierra Leone, Liberia, the DRC, Indonesia, Colombia, Burma and Sudan. During the decade long civil conflict in Sierra Leone, women were used as sex slaves having been trafficked into refugee camps. According to PHR, one third of women who reported sexual violence had been kidnapped, with fifteen per cent forced into sexual slavery. The PHR report also showed that ninety four per cent of internally displaced households had been victims of some form of violence. PHR estimated that there were between 215,000 and 257,000 victims of rape during the conflict.

After the war

Withdrawal

On 28 July 2002 the British withdrew a 200-strong military contingent that had been in country since the summer of 2000, leaving behind a 140-strong military training team with orders to professionalize the SLA and Navy. In November 2002, UNAMSIL began a gradual reduction from a peak level of 17,800 personnel. Under pressure from the British, the withdrawal slowed, so that by October 2003 the UNAMSIL contingent still stood at 12,000 men. As peaceful conditions continued through 2004, however, UNAMSIL drew down its forces to slightly over 4,100 by December 2004. The UN Security Council extended UNAMSIL’s mandate until June 2005 and again until December 2005. UNAMSIL completed the withdrawal of all troops in December 2005 and was succeeded by the United Nations Integrated Office in Sierra Leone (UNIOSIL).

Truth and Reconciliation Commission

The Lome Peace Accord called for the establishment of a Truth and Reconciliation Commission to provide a forum for both victims and perpetrators of human rights violations during the conflict to tell their stories and facilitate healing. Subsequently, the Sierra Leonean government asked the UN to help set up a Special Court for Sierra Leone, which would try those who “bear the greatest responsibility for the commission of crimes against humanity, war crimes and serious violations of international humanitarian law, as well as crimes under relevant Sierra Leonean law within the territory of Sierra Leone since 30 November 1996.” Both the Truth and Reconciliation Commission and the Special Court began operating in the summer of 2002.

Rehabilitation

Population

After the war many of the children who were abducted and used in the conflict need some form of rehabilitation, debriefing and care after the conflict came to an end. Only a handful of the children could be immediately sent home after six weeks of debriefing at a center for ex-combatants. This is due to many of the children suffering from drug withdraw symptoms, brainwashing, physical and mental wounds, as well as a lack of memory of who they were or where they came from before the conflict.

There was an estimated one to two million displaced persons and refugees who wanted to or needed to be returned to their villages.

Rebuilding

Reportedly thousands of small villages had been severely damaged due to looting, and targeted destruction of property that was held by perceived enemies. There was also heavy destruction of clinics and hospitals, leading to a concern about infrastructure stability.

Government

The European Union [EU] sent budgetary support with the support of the IMF, the World Bank and the UK in an effort to stabilize the economy and the government. The amount; € 4,75 million was made available by the EU from 2000 to 2001, for the government finance interalia, and social services.

Diamond revenues

Diamond revenues in Sierra Leone have increased more than tenfold since the end of the conflict, from $10 million in 2000 to about $130 million in 2004, although according to the UNAMSIL surveys of mining sites, “more than 50 per cent of diamond mining still remains unlicensed and reportedly considerable illegal smuggling of diamonds continues.”

Prosecution

Stephen J. Rapp, chief prosecutor

On 13 January 2003, a small group of armed men tried unsuccessfully to break into an armory in Freetown. Former AFRC-junta leader Koroma, after being linked to the raid, went into hiding. In March, the Special Court for Sierra Leone issued its first indictments for war crimes during the civil war. Foday Sankoh, already in custody, was indicted; along with notorious RUF field commander Sam “Mosquito” Bockarie, Koroma, the Minister of Interior and former head of the Civil Defense Force, Samuel Hinga Norman, and several others. Norman was arrested when the indictments were announced, while Bockarie and Koroma remained at large (presumably in Liberia). On 5 May 2003, Bockarie was killed in Liberia. President Charles G. Taylor expected to be indicted by the Special Court and had feared Bockarie’s testimony. He is suspected of ordering Bockarie’s murder, although no indictments are pending.

Several weeks later, word filtered out of Liberia that Koroma had been killed as well, although his death remains unconfirmed. In June the Special Court announced Taylor’s indictment for war crimes. Sankoh died in prison in Freetown on 29 July 2003 from a pulmonary embolism. He had been ailing since a stroke the year prior.

In August 2003 President Kabbah testified before the Truth and Reconciliation Commission on his role during the civil war. On 1 December 2003, Major General Tom Carew, who had been the Chief of Defence Staff for the Government of Sierra Leone and an important figure in the Sierra Leonean Army, was reassigned to civilian duties. In June 2007, the Special Court found three of the eleven people indicted – Alex Tamba Brima, Brima Bazzy Kamara and Santigie Borbor Kanu – guilty of war crimes, including acts of terrorism, collective punishments, extermination, murder, rape, outrages upon personal dignity, conscripting or enlisting children under the age of 15 years into armed forces, enslavement and pillage.[137]

Depictions

Leonardo DiCaprio, star of Blood Diamond

The civil war served as the background for the 2006 movie Blood Diamond, starring Leonardo DiCaprio, Djimon Hounsou and Jennifer Connelly.[138] During the end of the movie Lord of War, Yuri Orlov (played by Nicolas Cage) sells arms to militias during the civil war. The militias are allied with André Baptiste (Eamonn Walker), who is based on Charles Taylor.

The use of children in both the rebel (RUF) military and the government militia is depicted in Ishmael Beah‘s 2007 memoir, A Long Way Gone.

In the 2012 Documentary La vita non perde valore, by Wilma Massucco, former child soldiers and some of their victims talk about the way how they feel and live, ten years after the Sierra Leone civil war ending, thanks to the personal, familiar and social rehabilitation provided to them by Father Giuseppe Berton, an Italian missionary of the Xaverian order. The documentary has been analyzed in different Universities, becoming subject of various degrees,.

Mariatu Kamara wrote about being attacked by the rebels and having her hands chopped off in her book The Bite of the Mango. Ishmael Beah wrote a foreword to Kamara’s book.

Jonathon Torgovnik wrote about eight women that he interviewed after the war had ended in his book; Girl Soldier: Life After War in Sierra Leone. In the book he describes the experiences of the eight women who were abducted during the war and forced to fight in it.

The documentary movie Sierra Leone’s Refugee All Stars tells the story of a group of refugees who fled to Guinea and created a band to ease the pain of the constant difficulty of living away from home and community after the atrocities of war and mutilation.

The Sierra Leone Civil War (1991–2002) was a civil war in Sierra Leone that began on 23 March 1991 when the Revolutionary United Front (RUF), with support from the special forces of Charles Taylor’s National Patriotic Front of Liberia (NPFL), intervened in Sierra Leone in an attempt to overthrow the Joseph Momoh government. The resulting civil war lasted 11 years, enveloped the country, and left over 50,000 dead.

During the first year of the war, the RUF took control of large swathes of territory in eastern and southern Sierra Leone, which were rich in alluvial diamonds. The government’s ineffective response to the RUF, and the disruption in government diamond production, precipitated a military coup d’état in April 1992 by the National Provisional Ruling Council (NPRC). By the end of 1993, the Sierra Leone Army (SLA) had succeeded in pushing the RUF rebels back to the Liberian border, but the RUF recovered and fighting continued. In March 1995, Executive Outcomes (EO), a South Africa-based private military company, was hired to repel the RUF. Sierra Leone installed an elected civilian government in March 1996, and the retreating RUF signed the Abidjan Peace Accord. Under UN pressure, the government terminated its contract with EO before the accord could be implemented, and hostilities recommenced.

In May 1997 a group of disgruntled SLA officers staged a coup and established the Armed Forces Revolutionary Council (AFRC) as the new government of Sierra Leone.The RUF joined with the AFRC to capture Freetown with little resistance. The new government, led by Johnny Paul Koroma, declared the war over. A wave of looting, rape, and murder followed the announcement.[14] Reflecting international dismay at the overturning of the civilian government, ECOMOG forces intervened and retook Freetown on behalf of the government, but they found the outlying regions more difficult to pacify.

In January 1999, world leaders intervened diplomatically to promote negotiations between the RUF and the government. The Lome Peace Accord, signed on 27 March 1999, was the result. Lome gave Foday Sankoh, the commander of the RUF, the vice presidency and control of Sierra Leone’s diamond mines in return for a cessation of the fighting and the deployment of a UN peacekeeping force to monitor the disarmament process. RUF compliance with the disarmament process was inconsistent and sluggish, and by May 2000, the rebels were advancing again upon Freetown.

In 2000 the Sierra Leonean journalist, cameraman and editor, Sorious Samura released his documentary Cry Freetown. The self-funded film depicted the most brutal period of the civil war in Sierra Leone with RUF rebels capturing the capital city in the late 1990s. The film won, among other awards, an Emmy Award and a Peabody.

As the UN mission began to fail, the United Kingdom declared its intention to intervene in the former colony and Commonwealth member in an attempt to support the weak government of President Ahmad Tejan Kabbah. With help from a renewed UN mandate and Guinean air support, the British Operation Palliser finally defeated the RUF, taking control of Freetown. On 18 January 2002, President Kabbah declared the Sierra Leone Civil War over.

Rape during the Civil War!

During the Sierra Leone Civil War gender specific violence was widespread. Rape, sexual slavery and forced marriages were commonplace during the conflict. It has been estimated by Physicians for Human Rights (PHR) that up to 257,000 women were victims of gender related violence during the war. The majority of assaults were carried out by the Revolutionary United Front (RUF). The Armed Forces Revolutionary Council (AFRC), The Civil Defence Forces (CDF), and the Sierra Leone Army (SLA) have also been implicated in sexual violence.

Multiple perpetrator rape (MPR) was widespread during the conflict, with one report showing that seventy-six percent of survivors had been subjected to MPR. There were high levels of survivors having caught a sexually transmitted disease, and six percent reported that they had been forcibly impregnated. Human Rights Watch (HRW) said of the gender related violence that it had been “widespread and systematic”.

War crimes trials began in 2006, with thirteen people indicted for gender related violence, and for the first time, forced marriage was found by the trial chamber to be a crime against humanity.

Rape as genocide

According to Amnesty International, the use of rape during times of war is not a by-product of conflicts but a planned and deliberate military strategy. Since the end of the 20th century, the majority of conflicts have shifted from wars between nation states to communal and intrastate civil wars. During these conflicts the use of rape as a weapon against the civilian population by state and non-state actors has become more frequent. Journalists and human rights organisations have documented campaigns of genocidal rape during the conflicts in, the Balkans, Sierra Leone, Rwanda, Liberia, Sudan, Uganda, and in the Democratic Republic of Congo (DRC).

The strategic aim of these mass rapes are twofold, the first is to instil terror in the civilian population, with the intent to forcibly dislocate them from their property. The second, to degrade the chance of possible return and reconstitution by having inflicted humiliation and shame on the targeted population. These effects are strategically important for non-state actors, as it is necessary for them to remove the targeted population from the land. Rape as genocide is well suited for campaigns which involve ethnic cleansing and genocide, as the objective is to destroy, or forcefully remove the target population, and ensure they do not return.[4] Cultural anthropologists, historians and social theorists have indicated that the use of mass rape in wartime has become an integral part of modern-day conflicts, such as in Pakistan, the DRC, Darfur, Liberia, and Colombia.

The devastating effects of mass rape do not only affect the person assaulted, but also have a profound impact on familial and community bonds. The destruction wrought by sexual violence weakens the targeted population’s survival strategies. The stigma which is associated with rape often results in victims being abandoned, which can lead to the victims being unable to take part in community life, and makes it more difficult to bear and raise children. The use of mass rape allows an enemy to force suffering on an entire community, and in doing this it can lead to the annihilation of the targeted culture.

Perpetrators

The RUF, even though they had access to women, who had been abducted for use as either sex slaves or combatants, frequently raped non-combatants. The militia also carved the RUF initials into women’s body’s, which placed them at risk of being mistaken for enemy combatants if they were captured by government forces. Women who were in the RUF were expected to provide sexual services to the male members of the militia. And of all women interviewed, only two had not been repeatedly subjected to sexual violence; gang rape and individual rapes were commonplace. A report from PHR stated that the RUF was guilty of 93 per cent of sexual assaults during the conflict. The RUF was notorious for human rights violations, and regularly amputated arms and legs from their victims.

Estimates of victims

Trafficking by military and militias of women and girls, for use as sex slaves is well documented. With reports from recent conflicts such as those in, Angola, the former Yugoslavia, Sierra Leone, Liberia, the DRC, Indonesia, Colombia, Burma and Sudan. During the decade long civil conflict in Sierra Leone, women were used as sex slaves having been trafficked into refugee camps. According to PHR, one third of women who reported sexual violence had been kidnapped, with fifteen per cent forced into sexual slavery. The PHR report also showed that ninety four per cent of internally displaced households had been victims of some form of violence. PHR estimated that there were between 215,000 and 257,000 victims of rape during the conflict.

Of the types of assaults reported seventy-six per cent were multiple perpetrator rape (MPR), with seventy-five per cent of these being perpetrated by male only groups. The remaining twenty-five percent of sexual assaults were carried out by mixed sex groups, which indicates that one in four incidents of MPR women had actively participated.

HRW reported that “Throughout the nine-year Sierra Leonean conflict there has been widespread and systematic sexual violence against women and girls including individual and gang rape, sexual assault with objects such as firewood, umbrellas and sticks, and sexual slavery,” and that “the rebel factions use sexual violence as a weapon to terrorise, humiliate, punish and ultimately control the civilian population into submission.”

Aftermath

The violence directed towards women during the conflict was extraordinarily brutal. Militias were indiscriminate about the ages of those assaulted, and there was a marked tendency towards younger women and girls believed to be virgins. Some women were raped with such violence they bled to death following the assault. A report by MSF showed that fifty five per cent of survivors had suffered gang rape, with the attacks usually involving insertion of objects such as knives and burning firewood into the vagina.

There were reports of pregnant women being eviscerated with rebels placing wagers on the gender of the unborn child. Thirty four per cent of survivors have reported that they have caught a sexually transmitted disease, and a further fifteen per cent have reported being ostracised by their families due to having been raped. Six percent reported that they had been forcibly impregnated. Women who had been kidnapped and who had spent years living in the bush have reported severe health problems, such as tuberculosis, malnutrition, malaria, skin and intestinal infections, and respiratory diseases.

International and domestic reaction

The International Rescue Committee, in conjunction with the Sierra Leone government founded three Sexual Assault Referral Centers (SARC). Locally the SARC project are called “rainbow centers” and they give free psychosocial and medical care as well as offering legal advice. The United Nations High Commissioner for Refugees has singled out the SARC project as a “best-practice gender-based violence program”.

Post-war trials

The Special Court for Sierra Leone (SCSL), was founded on 16 January 2002, and at first adopted the definition of rape as laid down by the International Criminal Tribunal for the former Yugoslavia in the Dragoljub Kunarac case.[a] The prosecutor of the SCSL focused on investigating gender-related crimes, which resulted in the indictment of thirteen people for gender-related violence. In 2007 a trial chamber of the SCSL found that forced marriage was a crime against humanity, and the appeal chamber upheld this judgement in 2008 stating, “forced marriage is a distinct, inhumane act of sufficient gravity to be considered a crime against humanity” The prosecutor of the SCSL charged, Brima Bazzy Kamara, Alex Tamba Brima and Santigie Borbor Kanu, who were leaders of the AFRC, with counts of sexual slavery, forced marriages, and other forms of sexual violence committed by the men under their command.

On 20 June 2007, the three members of the AFRC were found guilty of rape as a crime against humanity, and sexual slavery as a war crime. They were also found guilty of recruiting child soldiers, who had also carried out acts of sexual violence on non-combatants. The rapes in the indictment were described as “brutal”, and were often in the form of gang rape.

The trials of Samuel Hinga Norman, Moinina Fofana and Allieu Kondewa, known as the “Civil Defence Forces case”, made little mention of gender-related crimes, this was due to the majority of the trial chamber’s judges systematically excluding evidence. This decision was criticised by the appeals chamber, however it declined a request for a new trial. The trial of three RUF members was the first time in either a national or international court convicted individuals for forced marriage and sexual slavery as a crime against humanity.

June 24, 1999 8:00PM EDT

Shocking War Crimes in Sierra Leone

New Testimonies on Mutilation, Rape of Civilians

(New York) – Rebel forces in Sierra Leone systematically murdered, mutilated, and raped civilians during their January offensive, Human Rights Watch charged today. In a report released on the eve of an important United Nations visit to Freetown, Human Rights Watch documented how entire families were gunned down in the street, children and adults had their limbs hacked off with machetes, and girls and young women were taken to rebel bases and sexually abused. Government forces and the Nigerian-led peacekeeping force supporting them also carried out serious abuses, although to a lesser extent, including over 180 summary executions of Revolutionary United Front (RUF) rebels and suspected collaborators.

“The January 1999 offensive against Freetown marked the most intensive and concentrated period of human rights violations in Sierra Leone’s eight-year civil war,” said Peter Takirambudde, executive director of the Africa division of Human Rights Watch.

“This is not a war in which civilians are accidental victims,” said Takirambudde. “This is a war in which civilians are the targets. The crimes against humanity described in this report are unspeakably brutal, and the world must not simply avert its attention from the crisis. The U.N. and its members states must show that the rights of all human beings are of equal value.”

Takirambudde urged Mary Robinson, the U.N. High Commissioner for Human Rights who visits Freetown, Sierra Leone on June 24, to mobilize international support for the investigation and punishment of Sierra Leone’s war criminals.

While the current peace negotiations taking place in Lomé, Togo, offer some hope that the civil war may come to a close, Human Rights Watch cautioned against granting amnesty to human rights violators as a condition for peace. “Conflict in Sierra Leone has been so tenacious precisely because of this cycle of impunity,” said Takirambudde. “Those responsible for torture and mutilations should not walk away scot-free.”

The sixty-page report, “Getting Away with Murder, Mutilation, and Rape: New Testimony from Sierra Leone,” documents how, as rebels took control of the city in January 1999, they made little distinction between civilian and military targets. Testimonies from victims and survivors describe numerous massacres of civilians gathered in houses, churches and mosques. One massacre in a mosque on January 22 resulted in the deaths of sixty-six people. A woman describes how she escaped from a burning house after rebels set her mother and daughter on fire. A child recounts how, from her hiding place, she watched rebels execute seventeen of her family and friends.

The report also includes testimonies from girls and women who describe how they were systematically rounded up by the rebels, brought to rebel command centers and then subjected to individual and gang-rape. Young girls under seventeen, and particularly those deemed to be virgins, were specifically targeted, and hundreds of them were later abducted by the rebels.

The rebels carried out large numbers of mutilations, in particular amputation of hands, arms, legs, and other parts of the body. In Freetown, several hundred people, mostly men but also women and children, were killed and maimed in this way. Twenty six civilians were the victims of double arm amputations. One eleven-year-old girl describes how she and two of her friends were taken away by a group of rebels, who then hacked off both of their hands.

It is difficult to ascertain what level of the RUF command ordered these human rights abuses, but the report describes how many of the attacks seemed to be well organized, and some were clearly planned and premeditated. Victims and witnesses describe widespread participation in the abuses, with very few accounts of individual combatants or commanders trying to halt them. The report documents special operations to round up civilians for mutilation, rape, and execution, as well as the existence of units specializing in particular forms of atrocities.

The report also documents how the RUF made extensive use of human shields both to enter Freetown and as defense against the air power of the Nigerian-led Economic Community of West African States Monitoring Group (ECOMOG) peacekeeping force. As the rebels withdrew, they set neighborhoods on fire, leaving up to 80 percent of some areas in ashes and an estimated 51,000 civilians homeless.

While the RUF committed the vast majority of atrocities and other violations of international humanitarian law during the battle for Freetown, those defending the capital also committed serious abuses, both during and after the rebel incursion. The report documents how members of ECOMOG, and to a lesser extent members of the Civil Defense Forces(CDF) and Sierra Leonean Police, routinely executed RUF prisoners and their suspected collaborators or sympathizers. While the victims were mostly young men, witnesses confirm the execution of some women, and children as young as eight. Officers to the level of captain were present and sometimes participated in these executions.

Human Rights Watch calls on all parties to the war, but especially the RUF rebels, who have been guilty of the worst abuses, to respect international humanitarian law as laid down in the Geneva Conventions and its protocols. In particular, parties to the conflict must distinguish at all times between civilians and combatants and desist from targeting civilians for attack.

“Influencing the actions of the rebel forces in Sierra Leone is difficult,” said Takirambudde. “But international pressure must be maintained to cease indiscriminate killings, rape, mutilation, and the abduction of civilians, especially children.”

While the international response to the Kosovo crisis has demonstrated how quickly and forcefully it can react to a human rights catastrophe, Human Rights Watch noted with concern the stark contrast with the lack of international response that these appalling atrocities committed in Sierra Leone have received. Eight years of war there have left over 50,000 dead and one million civilians displaced.

This day in Sierra Leone! The Ebola Virus Epidemic in Sierra Leone!

An Ebola virus epidemic in Sierra Leone occurred in 2014, along with the neighbouring countries of Guinea and Liberia. On March 18, 2014 Guinean health officials announce the outbreak of a mysterious hemorrhagic fever “which strikes like lightning.” It was identified as Ebola virus disease and spread to Sierra Leone by May 2014. The disease is thought to have originated when a child in a bat-hunting family contracted the disease in Guinea in December 2013. Consumption of African bushmeat, including rats, bats, and monkeys, is commonplace in Sierra Leone and West Africa in general.

At the time it was discovered, it was thought that Ebola virus is not endemic to Sierra Leone or to the West Africa region and this epidemic represents the first time the virus has been discovered there. However, some samples taken for Lassa fever testing turned out to be Ebola virus disease when re-tested for Ebola in 2014, showing that Ebola had been in Sierra Leone as early as 2006.

History of Ebola in Sierra Leone

Articles related to the
West African
Ebola virus epidemic
 
Overview
Nations with widespread cases
Other affected nations
Other outbreaks

In 2014 it was discovered that samples of suspected Lassa fever showed evidence of the Zaire strain of Ebola virus in Sierra Leone as early as 2006. Prior to the current Zaire strain outbreak in 2014, Ebola had not really been seen in Sierra Leone, or even in West Africa among humans. It is suspected that fruit bats are natural carriers of disease, native to this region of Africa including Sierra Leone and also a popular food source for both humans and wildlife. The Gola forests in south-east Sierra Leone are a noted source of bush meat.

Fruit bats gather on a tree in West Africa.

Bats are known to be carriers of at least 90 different viruses that can make transition to a human host. However, the virus has different symptoms in humans. It takes one to ten viruses to infect a human but there can be millions in a drop of blood from someone very sick from the disease. Transmission is believed to be by contact with the blood and body fluids of those infected with the virus, as well as by handling raw bush meat such as bats and monkeys, which are important sources of protein in West Africa. Infectious body fluids include blood, sweat, semen, breast milk, saliva, tears, faeces, urine, vaginal secretions, vomit, and diarrhoea.

Even after a successful recovery from an Ebola infection, semen may contain the virus for at least two months. Breast milk may contain the virus for two weeks after recovery, and transmission of the disease to a consumer of the breast milk may be possible. By October 2014 it was suspected that handling a piece of contaminated paper may be enough to contract the disease. Contamination on paper makes it harder to keep records in Ebola clinics, as data about patients written on paper that gets written down in a “hot” zone is hard to pass to a “safe” zone, because if there is any contamination it may bring Ebola into that area.

One aspect of Sierra Leone that is alleged to have aided the disease is the strong desire of many to have very involved funeral practices. For example, for the Kissi people who inhabit part of Sierra Leone, it is important to bury the bodies of the dead near them. Funeral practices include rubbing the corpses down with oil, dressing them in fine clothes, then having those at the funeral hug and kiss the dead body. This may aid the transmission of Ebola, because those that die from Ebola disease are thought to have high concentrations of the virus in their body, even after they have died.

For the 2001 outbreak of Sudan virus in Uganda, attending a funeral of an Ebola victim was rated by the CDC as one of the top three risk factors for contracting Ebola, along with contact with a family member with Ebola or providing medical care to someone with a case of Ebola virus disease. The main start of the outbreak in Sierra Leone was linked to a single funeral in which the WHO estimates as many as 365 died from Ebola disease after getting the disease at the funeral.

Bushmeat has also been implicated in spreading Ebola disease, either by handling the raw meat or through droppings from the animals. It is the raw blood and meat that is thought to be more dangerous, so it is those that hunt and butcher the raw meat that are more at risk as opposed to cooked meat sold at market. Health care workers in Sierra Leone have been warned not to go to markets.

2014 Outbreak started

West African Ebola virus epidemic

In late March 2014 there were suspected but not confirmed cases in Sierra Leone. The government announced on 31 March 2014 that there were no cases in Sierra Leone.

Spring 2014: Early cases

The reported weekly cases of Ebola in Sierra Leone as listed on Wikipedia’s 2014 Ebola Virus in West Africa timeline of reported cases and deaths; some values are interpolated.

The epidemic is thought to have started in late May when 14 people returned from a funeral of a traditional healer, who had been trying to cure others with Ebola in Guinea. The first person reported infected was a tribal healer. She had treated an infected person(s) and died on 26 May. According to tribal tradition, her body was washed for burial and this appears to have led to infections in women from neighboring towns.

The corpses were highly contagious immediately after death, so precautions such as hazmat suits were needed. In this region the practice of kissing and touching the dead was implicated in helping to spread Ebola. However, two U.S. doctors who “followed all CDC and WHO protocols to the letter” still managed to contract the disease and it is not clear how they got the disease.

By 27 May 2014 it was reported 5 people died from the Ebola virus and there were 16 new cases of the disease. Between 27 May 2014 and 30 May the number of confirmed, probable, or suspected cases of Ebola went from 16 to 50. By 9 June, the number of cases had risen to 42 known and 113 being tested, with a total of 16 known to have died from the disease by that time.

The disease spread rapidly in the area, and the local government hospital was overwhelmed. At that hospital 12 nurses died despite having the world’s only Lassa fever isolation ward, according to the U.N. The hospital proved instrumental early on, detecting the first case in the country and supporting the release of a research paper on Ebola. However, the growing number of cases there led to infection and loss of Sierra Leone’s hemorrhagic fever expert, Doctor Khan, and the normal functioning of the hospital was disrupted because of the danger of getting infected by the disease.

Summer 2014: Continued growth, Khan dies

At this hospital in Kenema, samples were tested for Ebola. (Shown in June 2014)

On 12 June the country declared a state of emergency in the Kailahun District, where it announced the closure of schools, cinemas, and nightlife places; the district borders both Guinea and Liberia, and all vehicles would be subject to screening at checkpoints. The government declared on 11 June that its country’s borders would be closed to Guinea and Liberia; but many local people cross the borders on unofficial routes which were difficult for authorities to control. Seasonal rains that fall between June and August interfered with the fight against Ebola, and in some cases caused flooding in Sierra Leone.

By July 11, 2014 the first case was reported in the capital of Sierra Leone, Freetown, however the person had traveled to the capital from another area of the country. By this time there were over 300 confirmed cases and 99 were confirmed to have died from Ebola. There was another case before the end of the month.

On 29 July, well-known physician Sheik Umar Khan, Sierra Leone’s only expert on hemorrhagic fever, died after contracting Ebola at his clinic in Kenema. Khan had long worked with Lassa fever, a disease that kills over 5,000 a year in Africa. He had expanded his clinic to accept Ebola patients. Sierra Leone’s President, Ernest Bai Koroma, celebrated Khan as a “national hero”. On 30 July, Sierra Leone declared a state of emergency and deployed troops to quarantine hot spots.

In August, awareness campaigns in Freetown, Sierra Leone’s capital, were delivered over the radio and through loudspeakers. Also in August, Sierra Leone passed a law that subjected anyone hiding someone believed to be infected to two years in jail. At the time the law was enacted, a top parliamentarian was critical of failures by neighboring countries to stop the outbreak. Also in early August Sierra Leone cancelled league football (soccer) matches.

September 2014: Exponential growth, quarantines

A view of a part of an isolation ward in Freetown

Woman in household quarantine

Within 2 days of 12 September 2014, there were 20 lab-confirmed cases discovered in Freetown, Sierra Leone. One issue was that residents were leaving dead bodies in the street. By 6 September 2014 there were 60 cases of Ebola in Freetown, out of about 1100 nationwide at this time. However, not everyone was bringing cases to doctors, and they were not always being treated. One doctor said the Freetown health system was not functioning, and during this time, respected Freetown Doctor Olivette Buck fell ill and died from Ebola by 14 September 2014. The population of Freetown in 2011 was 941,000.

By 18 September 2014 teams of people that buried the dead were struggling to keep up, as 20–30 bodies needed to be buried each day. The teams drove on motor-bikes to collect samples from corpses to see if they died from Ebola. Freetown, Sierra Leone had one laboratory that could do Ebola testing.

WHO estimated on 21 September that Sierra Leone’s capacity to treat Ebola cases fell short by the equivalent of 532 beds. Experts pushed for a greater response at this time noting that it could destroy Sierra Leone and Liberia. At that time it was estimated that if it spread through both Liberia and Sierra Leone up to 5 million could be killed; the population of Liberia is about 4.3 million and Sierra Leone is about 6.1 million.

In an attempt to control the disease, Sierra Leone imposed a three-day lockdown on its population from 19 to 21 September. During this period 28,500 trained community workers and volunteers went door-to-door providing information on how to prevent infection, as well as setting up community Ebola surveillance teams. The campaign was called the Ouse to Ouse Tock in Krio language. There was concern the 72-hour lock-down could backfire.

Quarantine travel pass, Sierra Leone

On 22 September, Stephen Gaojia said that the three-day lock down had obtained its objective and would not be extended. Eighty percent of targeted households were reached in the operation. A total of around 150 new cases were uncovered, but the exact figures would only be known on the following Thursday as the health ministry was still awaiting reports from remote locations. One incident during the lock-down was when a burial team was attacked.

On 24 September, President Ernest Bai Koroma added three more districts under “isolation,” in an effort to contain the spread. The districts included Port Loko, Bombali, and Moyamba. In the capital, Freetown, all homes with identified cases would be quarantined. This brought the total areas under isolation to 5, including the outbreak “hot spots” Kenema and Kailahun which were already in isolation. Only deliveries and essential services would be allowed in and out. A sharp rise in cases in these areas was also noted by WHO.

As of late September about 2 million people were in areas of restricted travel, which included Kailahun, Kenema, Bombali, Tonkolili, and Port Loko Districts. The number of cases seemed to be doubling every 20 days, which led to the estimate that by January 2015 the number of cases in Liberia and Sierra Leone could grow to 1.4 million.

On 25 September there were 1940 cases and 587 deaths officially, however, many acknowledged under-reporting and there was an increasing number of cases in Freetown (the capital of Sierra Leone).

WHO estimated on 21 September that Sierra Leone’s capacity to treat Ebola cases fell short by the equivalent of 532 beds. There were reports that political interference and administrative incompetence had hindered the flow of medical supplies into the country.

October 2014: Responders overwhelmed

A road from Kenema to Kailahun District

By 2 October 2014, it was estimated 5 people an hour were being infected with the Ebola virus in Sierra Leone. By this time it was estimated the number of infected had been doubling every 20 days. On 4 October, Sierra Leone recorded 121 fatalities, the largest number in a single day. On 8 October, Sierra Leone burial crews went on strike. On 12 October, it was reported that the UK would begin providing military support to Sierra Leone in addition to a major UK civilian operation in support of the Government of Sierra Leone.

In October it was noted hospitals were running out of supplies in Sierra Leone. There were reports that political interference and administrative incompetence hindered the flow of medical supplies into the country. In the week prior to 2 October there were 765 new cases, and Ebola was spreading rapidly. At the start of October there were nearly 2200 laboratory confirmed cases of Ebola and over 600 had died from it. The epidemic also had claimed the life of 4 doctors and at least 60 nurses by the end of September 2014. Sierra Leone limited its reported deaths to laboratory confirmed cases in facilities, so the actual number of losses was known to be higher.

Sierra Leone was considering making reduced care clinics, to stop those sick with Ebola from getting their families sick with the disease and to provide something in between home-care and the full-care clinics. These “isolation centres” would provide an alternative to the overwhelmed clinics. The problem the country was facing was 726 new Ebola cases but less than 330 beds available.

More than 160 additional medical personnel from Cuba arrived in early October, building on about 60 that had been there since September. At that time there were about 327 beds for patients in Sierra Leone. Canada announced it was sending a 2nd mobile lab and more staff to Sierra Leone on 4 October 2014.

There were reports of drunken grave-diggers making graves for Ebola patients too shallow, and as a result wildlife came and dug up and ate at the corpses. In addition, in some cases bodies were not buried for days, because no one came to collect them. One problem was that it was hard to care for local health care workers, and there was not enough money to evacuate them. Meanwhile, other diseases like malaria, pneumonia, and diarrhoea were not being treated properly because the health system was trying to deal with Ebola patients. On 7 October 2014 Canada sent a C-130 loaded with 128,000 face shields to Freetown.

In early October 2014, a burial team leader said there were piles of corpses south of Freetown. On October 9 the International Charter on Space and Major Disasters was activated on Sierra Leone’s behalf, the first time that its charitably repurposed satellite imaging assets had been deployed in an epidemiological role. On 14 October 2014, 800 Sierra Leone peacekeepers due to relieve a contingent deployed in Somalia, were placed under quarantine when one of the soldiers tested positive for Ebola.

The last district in Sierra Leone untouched by the Ebola virus declared Ebola cases. According to Abdul Sesay, a local health official, 15 suspected deaths with 2 confirmed cases of the deadly disease were reported on 16 October in the village of Fakonya. The village is 60 miles from the town of Kabala in the center of the mountainous region of the Koinadugu district. This was the last district free from the virus in Sierra Leone. All of the districts in this country had then confirmed cases of Ebola.

The Royal Navy’s Argus

In late October 2014, the United Kingdom sent one of their hospital ships, the Royal Navy’s Argus, to help Sierra Leone. By late October Sierra Leone was experiencing more than twenty deaths a day from Ebola. In October 2014, officials reported that very few pregnant women were surviving Ebola disease. In previous outbreaks pregnant women were noted to have a higher rate of death with Ebola.

Officials struggled to maintain order in one town after a medical team trying to take a blood sample from a corpse were blocked by an angry machete-wielding mob. They allegedly believed the person had died from high-blood pressure and did not want the body being tested for Ebola. When security forces tried to defend the medical team, a riot ensued leaving two dead. The town was placed on a 24-hour curfew and authorities tried to calm the situation down. Despite this several buildings were attacked.

On 30 October the ship Argus arrived in Sierra Leone. It carried 32 off-road vehicles to support Ebola treatment units. The ship also carried three transport helicopters to support operations against the epidemic. By the end of October 2014 there were over 5200 laboratory confirmed cases of Ebola virus disease in Sierra Leone.

Ebola outbreak in West Africa – outbreak distribution map as of 29 October 2014

On 31 October 2014 an ambulance driver in Bo District died of Ebola. His ambulance picked up Ebola patients (or suspected Ebola cases) and took them to treatment centers.

November 2014: Continuing struggle

On 1 November, the United Kingdom announced plans to build three more Ebola laboratories in Sierra Leone. The labs helped to determine if a patient had been infected by the Ebola virus. At that time, it took as much as five days to test a sample because of the volume of samples that needed to be tested.

On 2 November, a person with Ebola employed by the United Nations was evacuated from Sierra Leone to France for treatment. On 4 November, it was reported that thousands violated quarantine in search for food, in the town of Kenema. On 6 November, it was reported that the situation was “getting worse” due to “intense transmission” in Freetown as a contributing factor; the capital city reported 115 cases in the previous week alone. Food shortages and aggressive quarantines were reported to be making the situation worse, according to the Disaster Emergency Committee. Sierra Leone established call centers in Port Loko and Kambia, according to MSSL Communications as reported on November 21; this was in addition to the June hotline originally established.

On 12 November, more than 400 health workers went on strike over salary issues at one of the few Ebola treatment centers in the country. On 18 November, the supply ship Karel Doorman of the Royal Netherlands Navy (Koninklijke Marine) arrived in Freetown, with supplies. Its Captain-Commander, Peter van den Berg, took steps to reduce the chance of the crew contracting Ebola virus disease.

The Neini Chiefdom in Koinadugu District was subject to isolation after Ebola cases. On 19 November, it was reported that the Ebola virus was spreading intensely; “much of this was driven by intense transmission in the country’s west and north,” the WHO said.

Ebola treatment centre built by the UK in Kerry Town in 2014

A British-built Ebola Treatment Centre which started in Kerry Town during November generated some controversy because of its initially limited capacity. However, this was because they were following guidelines of how to safely open an Ebola treatment unit. This was the first of six planned treatment centres which, when completed, would be staffed by a number of NGOs.

In mid-November the WHO reported that while all cases and deaths continued to be under-reported, “there is some evidence that case incidence is no longer increasing nationally in Guinea and Liberia, but steep increases persist in Sierra Leone”. On 19 November, it was reported that the Ebola virus was spreading intensely; “much of this was driven by intense transmission in the country’s west and north”, the WHO said. The first Cuban doctor to be infected with the virus was flown to Geneva. On 26 November, it was reported that due to Sierra Leone’s increased Ebola transmission, the country would surpass Liberia in the total cases count. On 27 November, Canada announced it would deploy military health staff to the infected region. On 29 November, the President of Sierra Leone cancelled a planned three-day shutdown in Freetown to curb the virus.

December 2014

A situation map of Sierra Leone and surrounding nations showing the districts with reported cases of Ebola, as of 17 December 2014

On 2 December, it was reported that the Tonkolili district had begun a two-week lockdown, “which was agreed in a key stakeholders meeting of cabinet ministers, parliamentarians and paramount chiefs of the district as part of efforts to stem the spread of the disease,” according to a ministry spokesman. The move meant that a total of six districts, containing more than half of the population, were locked down.

Sierra Leone indicated, in a report on 5 December, that about 100 cases of the virus were now being reported daily. On the same day, it was further reported that families caught taking part in burial washing rituals, which can spread the virus, would be taken to jail. On 6 December, a report indicated that the Canadian Armed Forces would send a medical team to the country of Sierra Leone to help combat the Ebola virus epidemic.

On 8 December, the doctors in Sierra Leone went on strike, demanding better treatment for health care workers, according to Health Ministry spokesman Jonathan Abass Kamara.

On 9 December, Sierra Leone authorities placed the Eastern Kono District in a two-week lock-down following the alarming rate of infection and deaths there. The lock down lasted until 23 December. This followed the grim discovery of bodies piling up in the district. The WHO reported fear of a major breakout in the area. The district with 350,000 inhabitants buried 87 bodies in 11 days, with 25 patients dying in 5 days before the WHO arrived.

On 12 December, Sierra Leone banned all public festivities for Christmas or New Year, because of the outbreak. On 13 December, it was reported that the first Australian facility had been opened; “operations will be gradually scaled up to full capacity at 100 beds under strict guidelines to ensure infection control procedures are working effectively and trained staff … are in place”, one source indicated.

Médecins Sans Frontières/Doctors Without Borders, in partnership with the Ministry of Health, carried out during December the largest-ever distribution of antimalarials in Sierra Leone. Teams distributed 1.5 million antimalarial treatments in Freetown and surrounding districts with the aim of protecting people from malaria during the disease’s peak season. A spokesman said “In the context of Ebola, malaria is a major concern, because people who are sick with malaria have the same symptoms as people sick with Ebola. As a result, most people turn up at Ebola treatment centres thinking that they have Ebola, when actually they have malaria. It’s a huge load on the system, as well as being a huge stress on patients and their families.”

Between 14 December and 17 December Sierra Leone reported 403 new cases with a total of 8,759 cases on the latter date. On 25 December, Sierra Leone put the north area of the country on lockdown. By the end of December Sierra Leone again reported a surge in numbers, with 9,446 cases reported.

On 29 December 2014, Pauline Cafferkey, a British aid worker who had just returned to Glasgow from working at the treatment centre in Kerry Town, was diagnosed with Ebola at Glasgow’s Gartnavel General Hospital.

2015 Outbreak continues

January 2015

On January 4, the lockdown was extended for two weeks. On this day the country reported 9780 cases with 2943 deaths. Among healthcare workers there were 296 cases with 221 fatalities reported.

On 8 January MSF admitted its first patients to a Treatment Centre (ETC) in Kissy, an Ebola hotspot on the outskirts of Freetown. Once the ETC is fully operational it will include specialist facilities for pregnant women. By 9 January the case load in the country exceeded 10,000, with 10,074 cases and 3,029 deaths reported. On 9 January, it was reported that South Korea would send a medical team to Goderich.

On 10 January Sierra Leone declared its first Ebola-free district. The Pujehun district in the south east of the country reported no new cases for 42 days.

February 2015

A worker at Kerry Town clinic was evacuated to the United Kingdom on February 2, 2015, after a needlestick injury. On 5 February, it was reported that there was a rise in weekly cases for the first time this year. The U.N. indicated that the sharp drop in cases had “flattened out” raising concern about the virus.

March 2015

Port Loko District Ebola Response Centre staff removes contaminated items in April 2015.

On 5 March, a report indicated cases in Sierra Leone continued to rise. The government of Sierra Leone declared a three-day country-wide lock-down including 2.5 million people on 18 March. The U.N. indicates the outbreak will be over by August of this year.

The 3-day lock-down of over 6 million inhabitants revealed a 191% increase in possible Ebola cases. In Freetown alone 173 patients meeting the criteria for Ebola were discovered according to Obi Sesay from the National Ebola Response Centre.

Spring 2015

As of 12 May, Sierra Leone had gone 8 days without an Ebola case, and was down to two confirmed cases of Ebola. The WHO weekly update for 29 July reported a total of only three new cases, the lowest total in more than a year. On 17 August, the country had its first week with no new cases, and one week later the last patients were released.

August/September 2015

A new death was reported on 1 September after a patient from Sella Kafta village in Kambia District was tested positive for the disease after her death. On 5 September another case of Ebola was identified in the village among the approximately 1000 people currently under quarantine. A woman tested positive for the virus. The “Guinea ring vaccine” has been administered by a WHO team in the village since Friday 5 September. On 8 September the head of the National Ebola Response Center confirmed new cases of Ebola. This brought the total from the village to four cases, with all of them being under the “high risk” contact cases with the death of the new index case in the village. In total four cases were then confirmed including the dead woman.

On 14 September, the National Ebola Response Centre confirmed the death of a 16-year-old in a village in the Bombali district. Swabs taken from the body tested positive for the disease. The village was placed under quarantine. She had no history of travelling outside the village, and it is suspected that she contracted the disease from the semen of an Ebola survivor who was discharged in March 2015. Seven of her immediate contacts were taken to an Ebola treatment centre, with a further three patients she had contact with at a health clinic. A new study to be published in the New England Journal of Medicine indicates the possibility that the virus may lurk in the semen of survivors for up to six months. Nearly half of 200 patients tested had traces of the virus in their semen six months after surviving the disease. On 7 November, the World Health Organization declared Sierra Leone Ebola-free.

January 2016

Sierra Leone entered a 90-day period of enhanced surveillance which was scheduled to conclude on 5 February 2016, but due to a new case in mid-January it did not. On 14 January, it was reported there had been a fatality linked to the Ebola virus. The case occurred in the Tonkolili district. Prior to this case WHO had advised, “we anticipate more flare-ups and must be prepared for them … massive effort is underway to ensure robust prevention, surveillance and response capacity across all three countries by the end of March.” On 16 January, it was reported that the woman who died of the virus may have exposed several individuals; the government announced that 100 people had been quarantined. On the same day, WHO released a statement, indicating that originally the 90-day enhanced surveillance period was to end on 5 February. Investigations indicate the female case was a student at Lunsar in Port Loko district, who had gone to Kambia district on December the 28th until returning symptomatic. Bombali district was visited by the individual, for consultation with an herbalist, later going to a government hospital in Magburaka. WHO indicates there are 109 contacts, 28 of which are high risk, furthermore, there are three missing contacts.The source or route of transmission which caused the fatality is still unknown. A second new case was confirmed on 20 January; the patient had contact with the previous fatality. On 17 March, the WHO declared the country Ebola-free.

Healthcare capacity

Long-term political factors contributed to the Ebola crisis including the acute dependency on external health assistance, patron-client politics, corruption and a weak state capacity. Prior to the Ebola epidemic Sierra Leone had about 136 doctors and 1,017 nurses/midwives for a population of about 6 million people. On 26 August, the WHO (World Health Organisation) shut down one of two laboratories after a health worker became infected. The laboratory was situated in the Kailahun district, one of the worst-affected areas. It was thought by some that this move would disrupt efforts to increase the global response to the outbreak of the disease in the district.

“It’s a temporary measure to take care of the welfare of our remaining workers,” WHO spokesperson Christy Feig announced. He did not specify how long the closure would last, but said they would return after an assessment of the situation by the WHO. The medical worker, one of the first WHO staff infected by the Ebola Virus, was treated at a hospital in Kenema and then evacuated to Germany. By 4 October 2014, it was announced he has recovered and left Germany.

As the Ebola epidemic grew it damaged the health care infrastructure, leading to increased deaths from other health issues including malaria, diarrhoea, and pneumonia because they were not being treated.The WHO estimated on 21 September that Sierra Leone’s capacity to treat Ebola cases fell short by the equivalent of 532 beds.

Death of health workers

St John of God Hospital Sierra Leone, also known as Mabesseneh Hospital, near Lunsar. This is one of the hospitals operated in part by the Spanish aid organization Brothers Hospitallers of St. John of God, which lost multiple health workers to Ebola including two evacuated to Spain.

On 27 August 2014 Dr. Sahr Rogers died from Ebola after contracting it working in Kenema. Sierra Leone lost three of its top doctors by the end of August to Ebola.

A fourth doctor, Dr. Olivette Buck, became ill with Ebola in September and died later that month. Dr. Olivette Buck was a Sierra Leone doctor who worked in Freetown, who tested positive for Ebola on 9 September 2014 and died on 14 September 2014. Her staff believes she was exposed in August. She eventually went to Lumley Hospital on 1 September 2014 with a fever, thinking it was malaria. After a few more days of illness she was admitted to Connaught Hospital.

By 23 September 2014, out of 91 health workers known to have been infected with Ebola in Sierra Leone, approximately 61 had died.

On 19 October the WHO reported 129 cases with 95 deaths of healthcare workers (125 / 91 confirmed). On 2 November 2014, a fifth doctor, Dr. Godfrey George, a medical superintendent of Kambia Government Hospital died as a result of Ebola infection. On 17 November 2014, a sixth doctor, Dr Martin Salia, died as a result of Ebola infection, after being transported by medevac to Nebraska Medical Center in the United States.

On 18 November 2014 a seventh doctor, Dr Michael Kargbo, died in Sierra Leone. He worked at the Magburaka Government Hospital.

Dr. Aiah Solomon Konoyeima was reported to have Ebola in late November 2014, which would make him the eighth physician to contract Ebola. He was reported to have died from the disease on December 7, 2014, becoming what was reported as the tenth doctor to die from Ebola.

On 26 November 2014 a ninth doctor, Dr. Songo Mbriwa, was reported to be sick with Ebola disease. He was working at an Ebola treatment centre in Freetown. He was one of the doctors that cared for the late Dr Martin Salia, who experienced a false-negative Ebola test, but did indeed have it and may have exposed others.

On Friday 5 December a senior health official announced the death of two of the country’s doctors in one day. This brings the total number of doctors who have succumbed to the disease in Sierra Leone to ten. Dr Dauda Koroma and Dr Thomas Rogers are the latest deaths among healthcare workers. The two doctors were not in the front line of the Ebola battle and did not work in an Ebola treatment hospital.

On 18 December Dr. Victor Willoughby died from the disease after being tested positive for the disease on Saturday 6 December. The doctor died hours before he was to receive ZMAb, an experimental treatment from Canada, according to Dr. Brima Kargbo the country’s chief medical officer. Dr. Victor Willoughby is the 11th doctor, and a top physician, to succumb to the disease.

Evacuations

Since the beginning of the outbreak in Sierra Leone in late May 2014, several people have been evacuated. An increasing lack of hospital beds, medical equipment, and health care personnel made treatment difficult. On 24 August William Pooley, a British nurse, was evacuated from Sierra Leone. He was released on September 3, 2014. In October 2014 he announced he would return to Sierra Leone.

On 21 September 2014 Spain evacuated a Catholic priest who had contracted Ebola while working in Sierra Leone with Hospital Order of San Juan de Dios. He died on the 25th September in Madrid. On 6 October 2014 a nurse who treated the priest tested positive for Ebola. By 20 October 2014 the nurse seemed to have recovered after many days battling the disease in the hospital, with tests coming back negative.

A doctor from Senegal contracted Ebola while working in Sierra Leone for the WHO, and was evacuated to Germany at the end of August 2014. By 4 October 2014, it was announced he has recovered and returned to Senegal.

In late September, a doctor working for an International Aid organization in Sierra Leone, was evacuated to Switzerland after potentially being exposed. He later tested negative for the disease.

In late September 2014, an American doctor working in Sierra Leone was evacuated to Maryland, USA, after being exposed to Ebola.” Just because someone is exposed to the deadly virus, it doesn’t necessarily mean they are infected”, said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH. He was evacuated after a needle sticking accident and even developed a fever, but he was determined not to have Ebola and was released the first week in October 2014. After being discharged he remained at home under medical observation, checking his temperature twice a day for 21 days.

In early October, a Ugandan doctor who contracted Ebola while working in Sierra Leone was evacuated for treatment to Frankfurt, Germany. The doctor was working at Lakaa Hospital and flown out from Lungi Airport.

On 6 October 2014, a female Norwegian MSF worker tested positive for Ebola virus and was subsequently evacuated to Norway. Norwegian authorities reported that they had been granted a dose of the experimental biopharmaceutical drug ZMAb, a variant of ZMapp. ZMapp has previously been used on 3 Liberian health workers, of which 2 survived. It was also used on 4 evacuated westerners, of which 3 survived. A U.N. employee was evacuated to France in early November 2014 after contracting Ebola.

On 12 November 2014 Dr Martin Salia, a permanent resident of the United States, tested positive for Ebola while working as a specialist surgeon at the Connaught Hospital in Freetown. He is the sixth Sierra Leone doctor to have contracted Ebola virus disease. Initially he preferred to be treated at the Hastings Holding Centre by Sierra Leonean medical personnel; however on 15 November 2014 he was evacuated to the Nebraska Medical Center where his condition was reported as “still extremely critical” on Sunday 16 November. On Monday, 16 November the hospital released a statement that he “passed away as a result of the advanced symptoms of the disease.”

On 18 November a Cuban doctor, Felix Baez, tested positive for Ebola and was due to be sent to Geneva for treatment. He later recovered. Baez was one of 165 Cuban doctors and nurses in Sierra Leone helping treat Ebola patients. There were a further 53 Cubans in Liberia and 38 in Guinea, making this the largest single country medical team mobilized during the outbreak.

Confounding factors

Freetown, Sierra Leone

Sierra Leonean government intransigence

On October 5, the New York Times reported that a shipping container full of protective gowns, gloves, stretchers, mattresses and other medical supplies had been allowed to sit unopened on the docks in Freetown, Sierra Leone, since August 9. The $140,000 worth of equipment included 100 bags and boxes of hospital linens, 100 cases of protective suits, 80 cases of face masks and other items, and were donated by individuals and institutions in the United States.

The shipment was organised by Mr Chernoh Alpha Bah, a Sierra Leonean opposition politician, who comes from Sierra Leonean President Ernest Bai Koroma‘s hometown, Makeni. The New York Times reported that political tensions may have contributed to the government delay in clearing the shipping container, to prevent the political opposition from trumpeting the donations.

Government officials stated that the shipping container could not be cleared through customs, as proper procedures had not been followed. The Sierra Leonean government refused to pay the shipping fee of $6,500. New York Times noted that the government had already received well over $40 million in cash from international donors to fight Ebola. The New York Times noted that in the 2 months that the shipping container remained on the docks in Freetown, health workers in Sierra Leone endured severe shortages of protective supplies, with some nurses having to wear street clothes.[212]

David Tam-Baryoh, a radio journalist, was held for 11 days when he and a talk show guest, an opposition party spokesperson, criticised how President Ernest Bai Koroma handled the Ebola outbreak in a live broadcast on 1 November 2014. The weekly show Monologue was taken off-air mid-show from the independently run Citizen FM. He was arrested on 3 November and sent to the Pademba Road jail, after an executive order was signed by the president. On 14 November Sierra Leone’s Deputy Information Minister Theo Nicol gave a statement that Baryoh had “been put on a ten thousand dollar bail by the Criminal Investigation Department after a statement has been taken from him”.

Amid concerns for his health, Tam-Baryoh apparently signed a confession to ensure his release from the prison, engineered by a committee made up of his lawyer, 2 journalists and a peace studies lecturer of the University of Sierra Leone. Rightsway International, an independent human rights group, has condemned President Koroma for allegedly dictating to the committee about obtaining the confession. A statement later released by the group read:

Rightsway is disappointed that Tam Baryoh’s forced confession has been published widely by pro-government media outlets and social networks. The publication of forced confessions is often used to discredit dissident news and information providers. This is a media propaganda tool used by dictatorial regimes, to avoid being exposed, investigated and punished for the grave violations of human rights.

Local conspiracy theories

  • “The Ebola outbreak was sparked by a bewitched aircraft that crashed in a remote part of Sierra Leone, casting a spell over three West African countries – but a heavily alcoholic drink called bitter Kola can cure the virus.”
  • “Some members of the community thought it was a bad spirit, a devil or poisoning.”
  • At the beginning of the outbreak, many did not believe that the disease existed. “I thought it was a lie (invented) to collect money because at that moment I hadn´t seen people affected in my community.”

Community violence

On October 21, there was Ebola related violence and rioting in the eastern town of Koidu, with police imposing a curfew. Local youth fired at police with shotguns after a former youth leader refused health authorities permission to take her relative for an Ebola test.Several buildings were attacked and youth gangs roamed the streets shouting “No more Ebola!”

A local leader reported seeing two bodies with gunshot wounds in the aftermath. Police denied that anyone had been killed. Doctors reported two dead. The local district medical officer said he had been forced to abandon the local hospital because of the rioting.

Effects

Travel restrictions

Health screening room in Sierra Leonean airport

There are various restrictions and quarantines within Sierra Leone, and a state of emergency was declared on July 31, 2014. Countries at higher risk for Ebola in Africa include Benin, Burkina Faso, Côte d’Ivoire, Guinea-Bissau, Mali, and Senegal.

  • In April 2014, The Gambia banned air travel from several West African countries including Sierra Leone.
  • By June 11, 2014 Sierra Leone closed its border with Liberia and Guinea.
  • In July airlines of Nigeria and Togo cancelled flights to Freetown.
  • On August 1, 2014, Ghana banned air travel from several Ebola impacted countries including Sierra Leone.
  • On August 8, 2014, Zambia banned travellers from Sierra Leone and Ebola-affected countries and also banned Zambians from going to those places.
  • On August 10, 2014, Mauritania blocked entry of citizens of Sierra Leone.
  • On August 11, 2014, Ivory Coast blocked travel from Sierra Leone, Liberia, and Guinea. The restriction was lifted on 26 September 2014.
  • On August 12, 2014, Botswana banned travel of all non-Botswanans from Sierra Leone, Guinea, Liberia, and Nigeria; they also added the D.R. Congo later that month.
  • On August 18, 2014, Cameroon banned travellers from several countries including Sierra Leone.
  • On August 21, 2014, South Africa banned travellers from Sierra Leone, Liberia, and Guinea, but its own citizens were allowed to return from these places.
  • On August 22, 2014, a Kenyan airline put temporary restrictions Sierra Leone, saying the Ebola outbreak was underestimated.
  • On August 22, 2014, Senegal blocked air travel to Sierra Leone, Liberia, and Guinea.
  • On August 22, 2014, Rwanda banned travellers who had been to Sierra Leone, Guinea, and Liberia in the previous 22 days.
  • On September 11, 2014, Namibia banned travellers from ‘Ebola affected countries’.
  • In September 2014, bans on the Sierra Leone hosting federation football (soccer) games continued.
  • In October 2014, Trinidad and Tobago banned travellers from the Ebola-stricken West African countries, including Sierra Leone.
  • In October 2014, Jamaica, Colombia, Guyana and Saint Lucia banned travellers from Sierra Leone and other affected West African countries.
  • In mid October 2014, Saint Vincent and the Grenadines banned Sierra Leone nationals and those from some other West African nations.
  • In late October 2014, Panama banned anyone coming from, or had been in Sierra Leone, Liberia, or Guinea in the previous 21 days.
  • On 18 October 2014, Belize banned travellers from Sierra Leone, and also banned those that had been there or Guinea or Liberia in the previous 21 days.
  • Suriname banned travellers who had been to Sierra Leone, Guinea, or Liberia in the previous 21 days unless they have a health certificate.
  • By 21 October 2014, the Dominican Republic banned foreigners who had been to Sierra Leone or other Ebola-affected nations in the previous 30 days.
  • On 11 November 2014, The Gambia opened its borders again to travellers from Sierra Leone, Liberia, Nigeria and Guinea.

Additional effects

Hand-washing station at Lungi Airport

The outbreak was noted for increasing hand washing stations, and reducing the prevalence of physical greetings such as hand-shakes between members of society.

In June 2014 all schools were closed because of the spread of Ebola.

In August 2014 the S.L. Health Minister was removed from that office. (see Cabinet of Sierra Leone) In October 2014 the Defense Minister was placed in charge of the anti-Ebola efforts. The President at this time was Ernest Bai Koroma.

On October 13, the UN’s International Fund for Agricultural Development stated up to 40% of farms had been abandoned in the worst Ebola-hit areas of Sierra Leone.

In October 2014 Sierra Leone launched a school by radio program, that will be transmitted on 41 of the local radio stations as well as on the only local TV station. (See Cultural effects of the Ebola crisis)

September through October is the malaria season, which may complicate efforts to treat Ebola. For example, one Freetown doctor did not immediately quarantine herself because she thought she had malaria not Ebola.The doctor was eventually diagnosed with Ebola and died in September 2014.

Local works derived from the Ebola crisis

Main article: Cultural effects of the Ebola crisis

  • A Sierra Leone DJ, Amara Bangura, shares knowledge about Ebola in his weekly show which is transmitted on 35 stations in Sierra Leone. He takes selected questions from the text messages sent in and gets answers from health experts and government officials.
  • “White Ebola”, a political song by Mr. Monrovia, AG Da Profit and Daddy Cool, centered on the general mistrust of foreigners.
  • “Ebola in Town”, a dance tune by a group of West African rappers, D-12, Shadow and Kuzzy Of 2 Kings warns people of the dangers of the Ebola virus and explaining how to react, became popular in Guinea and Liberia during the first quarter of 2014. A dance was developed in which no body contact was required, a rare occurrence in African dance. Some health care workers from the IFRC had concerns that the Ebola In Town song’s warning “don’t touch your friend” may worsen the stigma.
  • In August 2014, George Weah and Ghanaian musician Sidney produced a song to raise awareness about Ebola. All proceeds from the track been donated to the Liberian Health Ministry.
  • There are a number of Ebola-themed jokes circulating in West Africa to spread awareness.

 

Ebola in Sierra Leone: A slow start to an outbreak that eventually outpaced all others

One year into the Ebola epidemic. January 2015

The funeral of a faith healer ignited an outbreak characterized by innovative response measures, including the Western Area Surge that began in mid-December 2014.

WHO/C: Black

Chapter 6 – In Sierra Leone, the outbreak began slowly and silently, gradually building up to a burst of cases in late May and early June. Cases then increased exponentially in the last quarter of the year, with November seeing the most dramatic jump.

A retrospective investigation by WHO revealed that the country’s first case was a woman who was a guest at the home of the index case in Meliandou, Guinea. When the host family became ill, she travelled back to her home in Sierra Leone and died there shortly after her return in early January. However, that death was neither investigated nor reported at the time.

On 1 April the country stepped up vigilance for imported cases when two members of the same family who had died from Ebola virus disease in Guinea were repatriated to Sierra Leone for burial.Though heightened vigilance yielded a number of suspected cases, all tested negative.

Death of a faith healer: the first two hot spots in Kailahun and Kenema

The burst of new cases seen in early June has been traced to the 10 May funeral of a respected traditional healer held in Sokoma, a remote village in Kailahun district, near the border with Guinea. The healer became infected while treating Ebola patients who crossed the border from Guinea, seeking her healing powers.

“This is a medical war my country is fighting and I believe that the only way to stop this disease is for us, health practitioners, to come on board. We need to identify all sick people and take them out of the community as soon as possible.”

Stephen Kamara, medical student

That funeral sparked a chain reaction of more cases, more deaths, more funerals, and more cases in multiple transmission chains. Local epidemiologists eventually traced 365 Ebola-related deaths to that single funeral, which also seeded cases reported in Liberia.

On 12 June, a state of emergency was declared in Kailahun, calling for the closing of schools, cinemas, and places for night-time gatherings and the screening of vehicles at checkpoints along the borders with Guinea and Liberia.

Kailahun and, to its south, the larger city of Kenema, formed the early epicentre of the outbreak. WHO and other partners concentrated their response teams in that area.

Kenema benefitted from a laboratory and ageing isolation ward set up to manage cases of Lassa fever. That laboratory diagnosed the city’s first Ebola cases, but the poorly-maintained isolation ward was soon overwhelmed with Ebola patients and services collapsed.

At Kenema’s government-run hospital, two wards were converted to serve as an Ebola-designated treatment facility. Unfortunately, eight nurses working there became infected in July, adding to the problem of finding sufficient staff willing to work under life-threatening conditions. As the year progressed, that number grew to more than 40 deaths among doctors and nurses at the single district hospital, dealing a huge blow to the country’s already overstretched health system.

On 24 June, MSF opened an Ebola treatment centre in Kailahun. As an emergency coordinator with the charity noted, “We came too late when villages already had dozens of cases. We don’t know where all chains of transmission are taking place.” By mid-July, so many people were dying of the disease that teams trained by WHO buried more than 50 bodies over a 12-day period.

The MSF 50-bed treatment centre in Kailahun managed more than 90 confirmed cases in the first four weeks after it opened. To meet diagnostic needs, WHO helped establish a mobile laboratory provided by Public Health Canada. However, the number of new cases continued to outstrip both treatment and laboratory capacity.

In both Kailahun and Kenema, the greatest need was for more treatment facilities backed by greater and faster laboratory support. Pending the availability of those facilities, WHO worked, in collaboration with UNFPA, to reduce the number of new cases by training and equipping hundreds of local volunteers to search for cases, use mobile phones to send alerts to health authorities, and conduct contact tracing.

However, a shortage of experienced staff meant that much of this work was not supervised. In particular, the quality of contact tracing suffered. Too many people with a history of high-risk exposure were missed, cases were not detected and managed early, and chains of transmission continued to multiply.

In July, partners working in Kenema and Kailahun agreed that containment would require an enormous and robust scaling up of response capacity. Much stronger basic health infrastructures had to be quickly put in place and made to function well. As the WHO emergency coordinator in Kailahun noted at that time, “We need to step up the response and we need to do it fast.” Partners further recognized the need for far greater engagement of community leaders, especially paramount chiefs and religious leaders, to promote local acceptance of control interventions.

Death of a national hero: safety issues raised

Tragedy struck on 29 July, when Sheik Humarr Khan, the country’s only expert on viral haemorrhagic fevers, who had been leading the Ebola response in Kenema, died of the disease at the treatment facility in Kailahun. The death of Dr Khan, who was regarded as a national hero, and surrounding publicity removed many public doubts about whether Ebola was “real”, but it also introduced questions about the safety of the area’s treatment facilities.

In August, WHO urged governments and the international community to make available, in all three Ebola affected countries, incentives, protection, and treatment for health personnel to improve their safety and provide the motivation needed to ensure uninterrupted health care services.

Confidence in the safety of medical staff was further eroded in the last week of August when a WHO-deployed epidemiologist working in Kailahun became infected. Just a few days later, three staff at a hotel where foreign medical teams were staying became infected.

Following those events, most foreign medical staff, included those deployed by WHO, suspended operations in Kailahun. A team of logisticians and experts in infection prevention and control was deployed by WHO to investigate exactly how health care workers were being infected and to ensure working conditions were safe. Confidence was gradually restored and operations resumed in early September.

In Kenema, more evidence that capacities were overwhelmed came on 30 August, when health care workers at the government-run hospital went on strike over unpaid salaries and poor and dangerous working conditions. Nurses and burial teams complained that they had not been paid for several weeks, had insufficient personal protective equipment, and were forced to use a single broken stretcher to transport bodies as well as patients. WHO made arrangements to pay their back salaries, but not enough could be immediately done to improve the safety of working conditions.

As the number of patients, doctors, and nurses dying at the Kenema government hospital continued to escalate, rumours grew that something other than a disease was responsible for the deaths. More deaths began occurring in the community as patients fled or avoided the hospital, again undermining the effectiveness of treatment in isolation as a control measure.

The “Kenema tent”: isolation in reverse

Residents of villages near Kenema witnessed how quickly the virus could sweep through crowded households, but saw few alternatives to home care. Weak response capacity meant that people with suspected Ebola were often not moved to a treatment centre until positive test results became available, which could take up to four days. By that time, many more in the household would be infected. Spread within households, where five to six children might share the same mattress, was ruthlessly swift.

In discussions with village leaders, the WHO field coordinator in Kenema learned that what people wanted was a place where uninfected members of a household could go to “self-isolate”. They wanted a low-risk environment to stay in while waiting for the results of diagnostic tests. They had observed the high risk of being infected when people were trapped in a quarantined and crowded household with at least one confirmed Ebola case. The idea of providing a tent, offering sufficient space to keep a safe distance from others, was born.

The WHO office in Freetown provided the first tent. The International Federation of Red Cross and Red Crescent Societies supplied others, while UNICEF took care of sleeping mats, bednets, and cooking equipment.

This community-initiated innovation proved popular and effective. In the village of Mondema, for example, household contacts of confirmed cases able to self-isolate in the tents experienced no new cases. Though the impact on the overall outbreak was small, that innovation demonstrated one of the most important lessons to emerge during the first year: listen to the community. Communities know what they need. If that need is met in an acceptable way, it will be used.

Freetown: the new epicentre

The first confirmed case in Freetown was reported to WHO on 23 June. Cases in Freetown and the adjacent district of Port Loko initially rose slowly, with patients transferred to Kenema for treatment. Throughout July and August, Kailahun and Kenema remained the districts with the most intense virus transmission, and cases there continued to occur at an alarming rate.

On 6 August, the President declared a national state of emergency, with quarantines, enforced by the military, imposed on the areas and households hardest hit. Also in August, the government passed a law imposing a jail sentence of up to two years on anyone found to be hiding a patient. At the end of that month, the country reported a cumulative total of 1,026 cases, compared with 648 in Guinea and 1,378 in Liberia.

But the real surge in cases began in September as the virus gained a foothold in Freetown. Teams were soon struggling to bury as many as 30 bodies per day. As the situation rapidly worsened, South Africa deployed a mobile laboratory to Freetown and work began to construct Ebola treatment centres, as Kenema’s treatment capacity was quickly overwhelmed.

By the third week of September, the situation had begun to stabilize in Kailahun and Kenema, but Freetown, Port Loko, Bombali, and Tonkolili districts showed a sharp and alarming spike in a situation described by WHO as “continuing to deteriorate”. Nationwide, WHO estimated that more than 530 additional treatment beds were needed.

The biggest challenges in the densely populated capital were limited treatment and diagnostic facilities and the difficulty of undertaking contact tracing. In parts of Freetown, as many as three families occupied the same household in shifts, increasing even further the risks of disease spread within these families.

In early October in Port Loko, no treatment beds were available in any health care facilities. At one health facility, nurses had no personal protective equipment, no food, and no rehydration fluid. WHO organized the transportation of suspected cases to treatment facilities and provided a supply of essential medicines and equipment, but these did not last long as cases continued to mount and the demand continued to overwhelm existing capacities.

By mid-October, WHO described virus transmission in Freetown and the western districts as “rampant”, with more than 400 new suspected cases being reported each week. All administrative districts nationwide had reported at least one case. The impression of stability in Kailahun and Kenema was temporarily lost as cases once again began to rise.

In Freetown, the government and its partners recognized an increasingly urgent, almost desperate situation. On 21 October, the World Food Programme used its unparalleled logistical capacities, supported by funding from the World Bank, to airlift 20 ambulances and 10 mortuary pickup trucks to Freetown to support the government’s efforts to shorten response times. An additional 44 vehicles followed a few weeks later by sea. This support was in addition to the delivery, by that date, of food to more than 300,000 Ebola-affected people nationwide.

Community care centres: invention born of necessity

Although the UK government and other partners were rapidly building new treatment centres, especially in Freetown and the adjacent western districts, inadequate bed capacity remained the outstanding problem for patients and their families. It was also a major problem for outbreak responders, as case detection and contact tracing have little impact in the absence of facilities where infectious patients can be removed from the community and safely treated. As field coordinators in all three countries noted, the different control measures were closely interlinked; the failure of one jeopardized the success of others.

Staff from the WHO country office worked closely with government officials, community leaders, and multiple partners active in the country to find immediate solutions that matched the emergency situation. Although a telephone hotline had been set up, those answering the calls had little to offer – not enough ambulances to collect suspected cases, too few treatment beds, and insufficient burial teams to collect all bodies promptly. People needed at least some form of treatment and care close to their families and homes.

As a first step, WHO staff worked with four communities to construct safe isolation units with eight to twelve beds. These were not hospitals, but community care centres – facilities that could be quickly and flexibly set up in areas with the greatest unmet needs. Strong support from UNICEF and from the UK’s Department for International Development made an immediate large-scale difference in the country’s capacity to care for many more patients close to their homes. In this way, Sierra Leone became the pathfinder in establishing these centres and making them work.

WHO consulted experts in infection prevention and control to establish floor plans that provided space for patient triage and separated high-risk from low-risk areas. To staff them, also safely, WHO trained village volunteers and teams of local nurses in the basics of infection prevention and control and patient care. WHO was assisted in these tasks by medics from the country’s armed forces. WHO also brought in ten experienced health care workers from Kenema, where cases had again declined to almost zero, to take on coordination and supervisory roles.

Though the level of care was not the same as in specialized treatment facilities, patients did receive essential first-line treatments delivered by trained staff – care that was far safer than that provided by family members in a home. The community care centres also responded to the reality of logistical constraints, including poor road systems and a shortage of ambulances to transport patients to distant facilities. Equally important, the centres allowed patients to stay near their homes. For families, low fences let them interact with patients from a safe distance, thus increasing the transparency of care and removing much anxiety about the fate of loved ones.

The Western Area Surge: listen to the community

In the first week of December, Sierra Leone surpassed Liberia as the country reporting the largest cumulative number of cases. The number of new cases reported that week, at nearly 400, was three times as many as in Guinea and Liberia combined. Though cases in Kailahun and Kenema had dwindled to only one or two each month, the country was still reporting new cases from 10 of its 14 districts.

As in Guinea and Liberia, the outbreak in Sierra Leone showed how quickly the dynamics of an outbreak could worsen once cases reached the capital cities. Freetown consistently accounted for around a third of the country’s cases. Other areas experiencing intense transmission were the neighbouring districts of Port Loko and Western Rural and, in the eastern part of the country, Kono district on the border with Guinea.

Against this backdrop, the government responded with a massive Operation Western Area Surge initiative, which was launched in mid-December and ran through the end of the year. As the government explained to populations in and around Freetown, the strategy aimed at correcting past deficiencies in the response and regaining the public’s confidence and cooperation, especially in the early reporting of cases.

Planning was meticulous. A malaria campaign, supported by the Bill and Melinda Gates Foundation, the UK government, MSF, and WHO, was conducted in targeted areas prior to launch of the surge. It involved distribution of anti-malarial medicines, for preventive purposes, to tens of thousands of households in areas where fear of Ebola was causing people to avoid all contact with health services. Among infectious diseases, malaria is one of the biggest killers in Sierra Leone, especially of young children, and the campaign was well-received by the public.

On the technical side, preparations urgently increased bed and laboratory capacities, stepped-up the number of staff trained by WHO and CDC to undertake contact tracing, and made on-site assessments of treatment facilities to improve their safety for staff and patients alike. To support the anticipated surge in requests for testing, WHO added three strategically placed laboratories.

Considerable groundwork also reflected the lesson learned earlier: listen to the community. Well-known religious and traditional leaders were consulted to get a sense of community concerns and expectations. Well-known entertainment personalities were recruited to communicate messages, emphasizing how early detection and treatment greatly improved the prospects of survival.

Thousands of community volunteers came forward for training. This time the government made sure that calls to the Ebola hotline would be answered, with callers referred to local people, local services, local help, and local success stories.

The results of the campaign will be analyzed in January 2015. In a 19 December report, the Ministry of Health and Sanitation could already record a surge in the number of suspected cases being tested in the Western Area. As WHO staff present in Freetown and Port Loko observed, the fundamental systems and capacities for a stepped up response were now in place. Full community cooperation, however, remained a problem and contact tracing suffered as a result.

At year end, that view was shared by the country’s health officials, who noted that denial, traditional burials, and fear were still driving spread of the disease in Freetown and adjacent districts, where transmission remained intense.

The persistence of fear and denial was easy to understand. At the end of December, Sierra Leone – with its population of only 6.2 million – had recorded more than 9,000 cases of what all will agree is a terrible and terrifying disease.

 

Health in Sierra Leone!

In terms of available healthcare and health status Sierra Leone is rated very poorly. Globally, infant and maternal mortality rates remain among the highest. The major causes of illness within the country are preventable with modern technology and medical advances. Most deaths within the country are attributed to nutritional deficiencies, lack of access to clean water, pneumonia, diarrheal diseases, anemia, malaria, tuberculosis and HIV/AIDS.

Health Status!

The 2014 CIA estimated average life expectancy in Sierra Leone was 57.39 years. In 2015, after improvements in health in other poorer countries life expectancy for both men and women was the lowest in the world.

Disability

Disability in Sierra Leone

It is estimated that there are about 450,000 disabled people in Sierra Leone, though number could be under-estimated. Common disabilities in Sierra Leone include blindness, deafness, war wounded, amputees and post-polio syndrome.

Emergency medical response

In 2019, having lacked an organised rapid emergency medical response, the First Responder Coalition of Sierra Leone (FRCSL) was established by five national and international organizations in June to develop emergency first responder programs across Sierra Leone. The founding members of the Coalition were the Sierra Leone Red Cross Society, LFR International, the University of Makeni, Holy Spirit Hospital, and Agency for Rural Community Transformation. The establishment of the FRCSL was timely as the 72nd World Health Assembly had declared emergency care systems essential to universal health coverage in May. The Coalition began work in Makeni, training 1,000 community members to be first responders over a two-month period and equipping each with first aid skills and materials.

Endemic diseases

Yellow fever and malaria are endemic to Sierra Leone.

Maternal and child healthcare

Of the 20 countries with the highest incidence of maternal mortality, 19 of them are located in Sub-Saharan Africa, with the highest rates in the world occurring in Sierra Leone. One in seventeen women risks dying during pregnancy or childbirth.

The 2015 maternal mortality rate per 100,000 births for Sierra Leone is 1,360. This is compared with 970 in 2010 and 1032 in 2008. The under 5 mortality rate, per 1,000 births is 198 and the neonatal mortality as a percentage of under 5’s mortality is 25. In Sierra Leone the number of midwives per 1,000 live births is 1 and the lifetime risk of death for pregnant women 1 in 21.

Since the Ebola outbreak of 2014/2015, healthcare facilities have been associated with pain and death. Africans are choosing to reject the safety of hospitals out for any sort of care, especially for childbirth. It is estimated that maternal mortality rates will increase by 74 percent in the coming years. This statistic has been called the “next wave of deaths from Ebloa” due to the potential increase in maternal deaths because of the avoidance of hospitals.

Mental health

Mental health care in Sierra Leone is almost non-existent. Many sufferers try to cure themselves with the help of traditional healers. During the Civil War (1991–2002), many soldiers took part in atrocities and many children were forced to fight. This left them traumatised, with an estimated 400,000 people (by 2009) being mentally ill. Thousands of former child soldiers have fallen into substance abuse as they try to blunt their memories. There is one primitive psychiatric facility in Sierra Leone.[

A situation map of the Ebola outbreak as of 8 August 2014.

Infectious diseases

Sierra Leone suffers from epidemic outbreaks of diseases including cholera, Lassa fever, and meningitis.[8]

HIV/AIDS

Sierra Leone has a prevalence of HIV/AIDS in the population of 1.6 percent.[17]

Ebola

In 2014 there was an outbreak of the Ebola virus in Sierra Leone. As of August 4, 2014, there had been 691 cases of Ebola in Sierra Leone and 286 deaths.[18]

Health conditions and human rights in Sierra Leone

Human rights in Sierra Leone

HIV/AIDS

Discrimination based on HIV status is illegal, but HIV-positive people are highly stigmatized, with HIV-positive children being denied schooling, adults denied jobs, and abandonment by families common. Persons with HIV are often driven to suicide.

Leading causes of death

The leading 10 causes of death in Sierra Leone are:

  1. Malaria
  2. Lower respiratory infections
  3. Neonatal disorders
  4. Diarrheal diseases
  5. Ischemic heart disease
  6. Tuberculosis
  7. Stroke
  8. Congenital defects
  9. HIV/AIDS
  10. Meningitis

Water supply and sanitation

Water supply in Sierra Leone

A 2006 national survey found that 84% of the urban population and 32% of the rural population had access to an improved water source. Those with access in rural areas were served almost exclusively by protected wells. The 68% of the rural population without access to an improved water source relied on surface water (50%), unprotected wells (9%) and unprotected springs (9%).

20% of the urban population and 1% of the rural population had access to piped drinking water in their home.

Access to an improved water source does not give an indication about whether water supply is continuous. For example, in Freetown taps were running dry for most of the year in 2009. People collected water in containers wherever they can and those who can afford it install water tanks on their houses. Even the fire brigade used its trucks to sell drinking water. There were fights between fire fighters and employees of the Guma Water Company, responsible for water supply in Freetown, sometimes resulting in deaths.

This day in the History of Sierra Leone! The 2017 Sierra Leone Mudslide!

On the morning of August 14, 2017, significant mudflow events occurred in and around the capital city of Freetown in Sierra Leone. Following three days of torrential rainfall, mass wasting of mud and debris damaged or destroyed hundreds of buildings in the city, killing 1,141 people and leaving more than 3,000 homeless.

Causal factors for the mudslides include the region’s particular topography and climate – with Freetown’s elevation close to sea level and its greater position within a tropical monsoon climate. Those factors were assisted by the generally poor state of the region’s infrastructure and loss of protective natural drainage systems from periods of deforestation.

Background

The potential for deadly flooding in Sierra Leone was exacerbated by a combination of factors. Freetown, which sits at the tip of a peninsula, was in 2015 occupied by approximately 1 million people. Freetown’s topography alternates between thickly wooded and partially deforested mountains.These mountains run along the peninsula parallel to the Atlantic for 25 miles. Freetown’s elevation varies from coastal areas which are at or just below sea level to approximately 400 meters (1,300 ft) above sea level.

Freetown suffers from long-term issues involving poor urban development programs. According to Jamie Hitchen of the Africa Research Institute “the government is failing to provide housing for the poorest in society”, and when attention is paid to issues such as unregulated construction, it is received only after a crisis. Because a moratorium on housing construction was not enforced, unorganized settlements and municipal works encroached on flood plains, resulting in narrower water passageways. During floods, Freetown’s drainage systems are often blocked by discarded waste, especially in the city’s poorer communities, contributing to higher levels of surface runoff.

The construction of large homes in hillside areas and unrestricted deforestation for residential purposes weakened the stability of nearby slopes and caused soil erosion.[7] Within a decade leading up to the disaster, Sierra Leone cleared approximately 800,000 hectares of forest cover – the country’s civil war, fought between 1991 and 2002, was also a cause of deforestation. The nation’s Environmental Protective Agency launched a reforesting mission in the region two weeks prior to the floods and mudslides, which was ultimately unsuccessful.

Mudslides

According to the National Weather Service‘s Climate Prediction Center, Sierra Leone experienced a particularly wet rainy season, with the capital city of Freetown, in the Western Area of the country, experiencing 41 inches (104 cm) of rainfall from July 1, 2017, leading up to the mudslides – nearly tripling the area’s seasonal average. Sierra Leone’s meteorological department did not warn residents to leave areas prone to flooding in time; from August 11 to 14, Freetown faced three consecutive days of rain, which led to severe flooding in the city and its surrounding suburbs. Flooding is an annual threat for the area: in 2015 floods killed 10 people and left thousands homeless.

 

Affected regions

Overlooking Freetown, Sugar Loaf mountain partially collapsed, triggering mudslides in the early morning of August 14, which damaged or completely submerged several houses and structures, killing residents – many still asleep – who were trapped inside. The collapse of the mountainside took place in two stages – with the lower slope sliding into the Babadorie River Valley and, 10 minutes later, the upper portion collapsing, resulting in a “tidal wave” of landmass and debris. Highly mobile, the saturated debris flow from the collapse of the upper mountainside, carrying mud, large boulders, tree trunks, and other material, advanced toward the main river channel, Lumley Creek, with a wall of flood water leading in front.

Another mudslide struck the Regent suburban district. A mountainous settlement 15 miles (24 km) east of Freetown, Regent was covered by mud and debris when nearby hillsides collapsed around 6:00 GMT. The suburban districts of Goderich and Tacuguma were also hit by mudslides, but the under-developed areas did not sustain significant damage to infrastructure or loss of life.

Aftermath

The disaster caused damage to property in an area equal to 116,766 square meters.

Accessibility between communities was lost: eight pedestrian roads and bridges connecting Kamayama and Kaningo took moderate or severe damage, and two road bridges on the Regent river channel were impacted; in total, the damages to pathways amounted to US$1 million in costs. Power outages occurred in several communities, partly due to the Electricity Distribution and Supply Authority’s (EDSA) temporarily taking certain areas off the grid to avoid electrical incidents. The damage to EDSA’s infrastructure totalled $174,000.

More than 3,000 people were left homeless by the disaster. An initial estimate of the death toll placed the number at 205, but rescue and aid workers cautioned that the survival rates for many of the 600 people still missing were slim. By August 27, local government and ministry officials reported 1,000 fatalities during religious services honouring the victims. The final official death toll declared 1,141 dead or missing.

Response

Local organizations, military personnel, and the Red Cross of Sierra Leone contributed to immediate excavation and recovery efforts, working amid rainfall. The continued downpours and damaged passageways disrupted relief efforts, as did the topography of affected areas. The Red Cross and the federal government contributed fifteen vehicles, including three ambulances, to assist in travelling to isolated areas, while the United Nations Office on Drugs and Crime (UNODC) sent a joint team of forensic officers and specialized rescue units with trained dogs. The Connaught Hospital mortuary in Freetown was overwhelmed by nearly 300 bodies in the first day alone, forcing workers to lay victims on floors and outside the building to be identified. Due to the lack of manpower and threat of disease, bodies were buried in mass graves on August 15 at two sites in Waterloo.

Sierra Leone’s Office for National Security (ONS) advised survivors to evacuate flood-prone areas. Additional evacuations took place when aerial images of a hillside adjacent to Sugar Loaf revealed the threat of another mudslide which could impact a much wider area. Response teams were deployed to two voluntary relocation centres, the Old Skool compound in Hill Station and Juba barracks in Lumley, where workers distributed sanitation and medical supplies.[22] By August 16, workers in Regent and Kaningo began constructing emergency latrines and four 10,000-liter water harvesting systems.[23] Unsanitary waters raised fears of cholera; however, workers provided storage tanks, purification tablets, and instructional courses on hygiene to help prevent an outbreak of waterborne diseases.[24][25] The government of Sierra Leone also launched its first ever cholera vaccination campaign on September 15, targeting over 500,000 citizens in the Western Area.[26] After the disaster, affected areas faced water shortages; as a result, UNICEF distributed 26,000 litters of drinking water each day.

President Ernest Bai Koroma addressed Sierra Leone in a national broadcast August 15, declaring a state of emergency and announcing the establishment of a relief centre in Regent. He urged the nation, still recovering from the aftermath of the Ebola outbreak, to remain unified: “Our nation has once again been gripped by grief. Many of our compatriots have lost their lives, many more have been gravely injured and billions of Leones‘ worth of property destroyed in the flooding and landslides that swept across some parts of our city.” He also addressed the coordination of registries in Freetown that provided aid for residents left without shelter. On August 15, the president declared seven days of national mourning, which would begin immediately.

Foreign assistance

Koroma made an appeal to the international community for relief. Already in the country, numerous international organisations acted immediately, providing basic supplies and services – from food and shelter to personal counselling and mobile phones. Among others, Action Against Hunger, CARE International, GOAL, Handicap International, Muslim Aid, Plan International, Red Cross, Save the Children, Street child, Trocaire, UK Aid, World Vision and various UN agencies were involved.

Several European countries responded with donations: the United Kingdom provided £5 million for clean drinking water and medicine, Ireland donated €400,000, Spain donated €50,000 and assembled a technical forensic team, and Switzerland spent CHF400,000 to provide sanitation and first-aid kits. West African country donations included $500,000 from Togo, medical supplies distributed by Liberia, and pledges for support by Guinea and Nigeria. Other governments such as China donated $1 million through their embassy in Freetown, and Israel sent an envoy supplying food and medical supplies. In response to the disaster, the United Nations (UN) arranged contingency plans to mitigate potential outbreaks of waterborne diseases.The UN’s migration agency allocated $150,000 in initial-response aid and mobilized personnel in Sierra Leone to assist in rescue operations and distribute supplies to survivors. The World Food Programme (WFP) provided rations for 7,500 people. The European Union (EU) authorized €300,000 for humanitarian aid on August 16. On August 17, the International Federation of Red Cross and Red Crescent Societies (IFRC) approved CHF4.6 million worth of aid to be distributed through the Sierra Leone Red Cross agency for use over a 10-month period.

Three months removed from the disaster, the Sierra Leone government announced the closure of emergency camps, which housed many families awaiting financial assistance. About 98 families from the UK-Aid and World Food Programme-sponsored camps received assistance, yet nearly 500 families housed in informal refuges had not prior to the November 15 deadline.

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