Feature No 196
GUINEA: INFLUXES PUT HEALTH WORKERS ON HIGH ALERT
A new crisis in Guinea has raised the prospect of large numbers of Sierra Leonean refugees returning back across the border into their home land. But international health agencies are worried that such a new influx will be a step too far for already overburdened displacement camp facilities, both clinics in the camps and local health facilities that are struggling to re-establish themselves in the face of high disease burden and years of collapse.
Attacks by dissidents in the Guinean-Sierra Leonean border area last week have been condemned by President Lassana Conte of Guinea, and they have been linked to the 500,000 Sierra Leonean refugees spread in camps along the border. Last weekend Guinean government officials called for them to leave.
However, the return of large numbers of refugees in Guinea to Sierra Leone at this time would put health services in the country under intense pressure, and not just those serving displaced people or insecure areas, say aid workers in Sierra Leone.
Dr Sandra Simmonds, medical co-ordinator for Médicins Sans Frontières Belgium, says her team were shocked by the level of illness and malnutrition they found when they opened a hospital into the safe, southern town of Mattru Jong in June this year.
"Mattru Jong has been one of the most secure places since 1997. But if you saw what came through the door when we opened the hospital, you would almost say it is an emergency. Our therapeutic feeding centre has 50 severely malnourished children. Everyday we send an ambulance to Bo Hospital with people in terrible condition. No one would declare an emergency here because it is so secure, but it is an emergency because these people have never had access to health care."
WHO Representative to Sierra Leone, Dr William Aldis, says the fact that large numbers of displaced people have been absorbed into the community, and are relying on the help of family and friends who are often little better off than those displaced, exacerbates the effects of transport and financial constraints in accessing health care.
"It is a misunderstanding if people believe that the crisis has only caused problems for the people in the camps. There is urgent need to develop the health sector as part of the emergency response" says Dr William Aldis. who believes what is crucially needed is a combination of immediate health aid and health sector reform.
"In these circumstances, there are two solutions for the huge health problems: one option is to supply dedicated medical care for those with most obvious needs such as internally displaced people and victims of war atrocities. Another is to work with Sierra Leonean partners to help everyone in need through such things as training to develop health skills, and systems for healthcare financing that offer hope of some sustainability. The second approach requires more effort, but gets better results in the long run. It's what I would want if my own home town was affected."
In the frontline town of Kenema in Eastern Province, OCHA humanitarian co-ordinator Mike Swarray says over 10,000 people have already flooded the town in the past six weeks in the aftermath of military activities to free captured UN peacekeepers in Kailahun and militia consolidation around the new RUF headquarters town of Segbwema, just a few kilometres away.
Populations in displacement camps have swollen by almost 15%, but the town itself is also at bursting point. Hygiene and sanitation is the most pressing problem with rats abounding and communicable diseases a constant concern. Kenema is in Sierra Leone's Lassa fever belt and high numbers of cases of the highly infectious rat-transmitted virus are worrying health workers.
Dr Anuri Conteh, Lassa expert and head of the Kenema specialist treatment unit which is being supported by British NGO Merlin and the European Community Humanitarian Office (ECHO), says the unit is still seeing up to 50 cases a month, when normal the rainy season would see numbers down to single figures.
Overcrowding is not confined to the east. Half an hour's drive from Freetown, the population of Waterloo Camp run by the NGO ADRA has more than doubled in the past month.
Assistant camp manager Samuel Hubbard told a WHO assessment team last week the camp currently has 12,854 "registered and verified" people for whom food supplies are available, and 13,100 who have been registered by the camp process but not yet verified by the World Food Programme and therefore cannot receive food distribution.
"Some come to beg at the distribution lines or from relatives, some sell firewood or make gardens."
International Medical Corps medical co-ordinator Elizabeth Manga has spent months working with women in various camps. She reports that such difficult conditions force around 10 per cent of the women she has met to perform sexual favours for men in the camps in order to get the basic essentials like soap and kerosene for their families.
But it is not an easy task to verify who is genuinely eligible for food and medical aid. Many of the resident families are as penurious as the displaced. Separating the two groups is a difficult and painful task for aid workers. Many of the organizations offering assistance are only permitted to help those who are genuinely displaced, although their staff see a huge need among the resident population, too.
And the sudden forced return of even a proportion of the half a million Sierra Leonean refugees in Guinea will make everything even more difficult.
For further information, journalists can contact Ms Hilary Bower, Media Officer, WHO, Geneva. Telephone (+41 79) 249 3528. Fax (+41 22) 791 4858. Email: firstname.lastname@example.org or Dr William Aldis, Representative, the World Health Organization, Freetown, Sierra Leone, Tel: (+232) 22 24 12 59 or 22 31 88; Mobile: (+232) 23 50 05 63; Email: email@example.com or firstname.lastname@example.org All WHO Press Releases, Fact Sheets and Features as well as other information on this subject can be obtained on Internet on the WHO home page http://www.who.int