Sierra Leone's Long Recovery from the Scars of War: The Civil War That Ravaged Sierra Leone from 1991 to 2002 Destroyed the Country's Infrastructure Including Its Health Systems. Angel Desai Talks to Dr Muctarr Jalloh about the Effects of the War on Health Services in His Country
Desai, Angel, Bulletin of the World Health Organization
Q: What happened to medical services during the civil conflict in Sierra Leone?
A: The civil war brought all of the health and economic infrastructures down to zero during the 10 years. Many clinics that had been established by the government were completely demolished. Many people moved from the countryside into main cities and towns, which compounded the poor health and sanitation situation. It was extremely difficult to really get things moving at that time. We are still recovering from the effects of the war today.
Q: How did the Red Cross operate when part of the country was held by rebels?
A: At the height of the conflict, the government and the rebels controlled different towns and villages. In those that were government-controlled, the healthcare system continued to function. Even though the quality of care was lower than before the war, at least there were health facilities that functioned with a few health workers. In areas held by rebels it was extremely difficult. However, we managed to hold discussions with the rebels that allowed health workers to provide limited services, including childhood immunization, to some of the people behind rebel lines.
Q: Were medical staff in danger during the conflict?
A: Anyone who was suspected of supporting the government was targeted by the rebels. The maiming that the rebels unleashed on the population was almost beyond belief. Red Cross staff members were often targets for the rebel factions and many volunteers had limbs amputated or were shot and killed. A lot of people suffered. I was also targeted by the rebel groups that entered Freetown because I was affiliated with the Red Cross. In 1999, my family and I were brutally attacked in our house and we suffered severe injuries. The rebels attempted to amputate my hands. I still have nightmares about it. I had to be evacuated along with my family to England where I had reconstructive surgery to save my hands. The Red Cross and our partners undertook the cost of that operation. Today I am able to talk to you and hold a phone in my hand because of their support. I will be obliged to the Red Cross for the rest of my life.
Q: In the face of such an experience, what motivated you to return to Sierra Leone?
A: It was a very traumatic event for me and my family but I have only one country and that is Sierra Leone. And besides, I come from a very large family. The responsibility of the eldest son of the family is enormous in our society. So after my treatment in England I decided to come back and continue to work as a specialist in charge of the children's hospital and as the President of the Sierra Leone Red Cross.
Q: How has the war affected medical staffing in hospitals and clinics?
A: A lot of our health professionals left the country because of fear or to look for greener pastures. We hope that some of these people will return now that there is peace. We really have an acute shortage of human resources. We are managing with the few we have. The commitment and dedication of staff are extraordinary and we continue to receive support from the international community and partners.
Q: What are some of Sierra Leone's most pressing health problems?
A: According to the United Nations Development Programme (UNDP), Sierra Leone is third from the bottom in the Human Development Index. Our indices are something to be ashamed of. Our infant and child mortality rates are among the highest in the world. There are many causes--namely diarrhoeal diseases, acute respiratory infections, malaria and others. …