WORLD HEALTH ORGANIZATION, SIERRA LEONE
MONTHLY SITUATION REPORT/UPDATE
JULY, 2000
NO: 06/2000
I.
INTRODUCTION
1.1
This situation report/update is intended to update WHO/AFRO and
WHO/HQ on the current situation in Sierra Leone with WHO activities
incorporated for information and necessary support to strengthen the
preparedness and response capacity of WHO Country Office.
1.2
The report is divided into sections and sub-sections for convenience and
ease of reference; such as :Current general situation/emergencies dealing with security, political and
military activities; humanitarian situation; health and health-related
situation – general health services, ongoing health programmes, epidemic
prone diseases and surveillance; WHO activities and response to
emergencies including support to ongoing health programmes, etc.
II.
CURRENT GENERAL SITUATION AND EMERGENCIES:Security situation/status and military activities:
2.1
UN security status as of the reporting date remains the same as June, 2000.
Freetown, Bo, Kenema, Port Loko
Elsewhere
-
Phase IV
Phase V
2.2
Hundreds of civilians were reportedly fleeing from the eastern provincial towns of
Gandor, Kwiva, Pendembu and Bunumbu as a result of persistent air
bombardment by the government helicopter gun-ship on July 10.
2.3
Military sources said on July 15 that the government helicopter gunship destroyed
a column of heavily armed rebels who were preparing to attack Kenema from
Manowa in the south. UNAMSIL trucks which had been seized by the rebels in
Makeni in the north and driven to the south were also destroyed.
1
2.4
UNAMSIL staged a "robust" military operation in Kailahun and freed 222
peacekeepers and 11 military observers that were illegally detained by rebels for
about 75 days. The operation's team was drawn from Ghana, Nigeria and Indian
troopers in UNAMSIL and the 11 freed military observers were from Bangladesh,
England, the Gambia, Guinea, Indonesia, India, Malaysia, Pakistan, Russia,
Tanzania and Zambia.
2.5
British Defence Minister Geoff Hoon ended a two-day visit to Sierra Leone on
July 18 disclosing that Britain has provided financial support for the training of an
additional 1000 Sierra Leone soldiers to beef up the restructured Sierra Leone
army. He also said that Britain would supply uniforms, ammunition and other
logistics.
2.6
The self-styled Westside Boys at Okra Hill, 42 miles east of the capital, on July
21 detained a number of local journalists for 10 hours at their jungle hideout
before releasing them unharmed. However, two civilians travelling from Bo, in
the south, to Freetown were abducted by the renegade soldiers, 15,000,000
Leones snatched from them and their car commandeered.
2.7
Nearly 1000 Sierra Leone soldiers were commissioned into the restructured Sierra
Leone Army (SLA) at a passing out parade on July 22 at Benguema in the east of
the capital. They were trained for six weeks by British military instructors.
2.8
About 57 civilians were rescued by pro-government forces on July 29 at Batkanu
in northern Sierra Leone. 14 self-styled Westside Boys surrendered their weapons
to the Jordanian battalion in UNAMSIL at Mile 38 in the east of the capital, also
on July 29.
2.9
UNAMSIL troop strength in the country now stands at 12,500, recently boosted
by the arrival of a Russian aviation unit with four helicopter gunships. The SLAs
have also been expanded, with 1000 troop now undertaking continuation training
after passing out of the Benguema Training Camp. A new group of recruits are
now undergoing training.
Political and Economic Development
2.10
Seven MPs in the Sierra Leone Parliament lost their seats on July 12 for what a
Parliamentary Committee called "persistent absenteeism" from sittings. The
seven were all opposition MPs.
2.11
The Minister of Presidential Affairs declared that the government of Sierra Leone
was still committed to the Lome Accord, and that the government had gone one
step further to outline the conditions for a resumption of peace talks with the
RUF. He appealed to all stakeholders to fully support the DDR process and other
instruments of peace.
2
Humanitarian Situation/Actions
2.12
UN Humanitarian Agencies said at the weekly Consultative Forum that five new
camps are to be set up to benefit 150,000 displaced people in Mile 91, Tasso and
Grafton. The ICRC confirmed that over 1000 people have arrived in Kenema
from Tongo, also in the east.
2.13
PLAN International Board said on July 24, it has approved 9.5 million Dollars for
six projects in the Moyamba District (in the south) for the next three years. The
projects included psychosocial trauma counselling and peace education, rapid
education, school infrastructure and institution capacity building.
2.14
The Norwegian Refugee Council announced it is to fund an emergency
resettlement package estimated at 590,000,000 Leones in Port Loko in the north
of the country. Under the project, 500 shelters and 61 will be constructed. The
project will also include the sinking of 10 water wells targeting 24,000 IDPs
from Masiaka, Lunsar and surrounding settlement of Port Loko Town.
2.15
The humanitarian situation in Kenema remains under control despite the latest
population influx resulting from UNAMSIL/GOSL military operations in the east
last month. Existing camps are however overcrowded, straining current facilities
and services. The regional inter-agency committee in Kenema estimates that
more than 7,000 of the new IDPs have settled in IDP camps – (Blama – 747;
Gogor – 2,000; Nyandeyama camp – 1000; Konia – 2000 and refugee returnees
residing in different camps – 2000).
2.16
Within the Port Loko Township, the Norwegian Refugee Council (NRC) has
registered a total of 25,200 IDPs, of which 5,499 arrived between 18 – 31 July.
Upon registration, the IDPs are reporting to the police for further screening and
security clearance. A significant number of the IDPs, 10,831 have been absorbed
into the local communities, while another 10,612 people have taken refuge in the
camp. Due to the congestion in the camp, 3,241 of the IDPs have moved into the
local primary school, while another 516 relocated to the barracks.
2.17
According to WHO assessment team to Waterloo, the current number of IDPs
recorded by the camp management (as at 12 July,2000) was as follows:



IDPs verified, registered and receiving ration
IDPs transferred from National Workshop and
receiving ration
IDPs on transit receiving ration
Sub Total
-
12,238
406
-
210
12,854
3




Unverified new caseload from Waterloo Area
Unverified new caseload from Masiaka
Unverified new caseload from Makeni
Unverified new caseload from Masiaka due to
recent attack
Sub Total
Total caseload
-
3,501
452
962
175
5,093
17,947
It was also learnt that, as at 7 July, 2000, among those registered and receiving ration, the
total number of children below 15 years was 3,725 (487 under 1 year; 2,492, 1-5 years;
and 746, 6-14 years).






2.18
-
2,255 (female 1,156; male 1,099)
3,976
156
199 (breakfast and lunch)
14
50
In the National Workshop IDP camp, during the assessment by WHO team, 20
July, 2000, there were three groups of IDPs that make up the camp population:


III.
School age children
Female, 15-45 years
Currently pregnant
Children on wet feeding
Unaccompanied/separated
children
Child, ex-combatants
registered and verified and provided food ration
registered and unverified
new influx and unverified
Total population caseload
-
9,000
3,359
2,154
14,513
HEALTH AND HEALTH-RELATED SITUATIONS/EMERGENCIES
Internally Displaced Persons(IDPs)
3.1
In Daru, International Medical Corps (IMC) continues to run two clinics – one in
the main town and the other in Malema . They have commenced routine EPI
activities for U5s and women of childbearing age. It is proposed MERLIN and
IMC will organise a Lassa Fever workshop in Daru Town, as Daru is part of the
Lassa Fever belt and could be at greater risk of an outbreak due to recent
population movements.
3.2
As a follow-up to the recommendations of a joint rapid assessment mission,
UNICEF has distributed a consignment of drugs, medical equipment and EPI
supplies to the District Medical Officer of Tonkolili District for IDPs in the
township. Meanwhile, at the U-5 clinic, ICRC/SLRC immunised 1,356 children
(DPT &BCG) and treated 670 children for malaria, Acute Respiratory Infection
4
(ARI) and diarrhoea.
tetanus.
Some 405 expectant mothers were immunized against
3.3
ACF is treating 151 severely malnourished children at its Therapeutic Feeding
Centre in Yonibana, while 654 moderate cases are benefiting from dry ration
programmes at the supplementary feeding centre in Mile 91 Town.
3.4
At Mile 91 area, water and sanitation needs remain acute in the township.
UNICEF is supporting the construction of 25 pit latrines as well as cleaning and
chlorinating of 572 traditional wells in the town.
Waterloo Camp – WHO Assessment Report:(17,947 IDPs)
3.5
In the Waterloo camp, the sources of water supply are pipe-borne from a dam and
protected wells. It was reported that there are 58 water supply points from taps
and 8 protected wells. On site observations of samples of both types indicate that
they are well managed with the surroundings kept clean. However, the
quality/safety of water is unknown and may require quality testing at
intervals.
3.6
There are 108 toilets for the IDPs. Samples of toilets observed were not kept
clean, although cement slabs are used, but full of flies and require greater
attention.
3.7
There is a clinic, which was established in 1996. It is operated by ADRA and has
the following components:
OPD – providing services to all visiting patients, mainly IDPs and very
occasionally from surrounding area;
In-patient, with 20 beds (10 surgical; 4 non-surgical general; 6 for dehydration);
Ante-natal care unit
EPI
Laboratory – basic
Pharmacy – dispensing
Injection and dressing unit
Home delivery services by TBAs
The clinic is staffed by various professional/technical staff including the
doctors/surgeons.
5
3.8
Daily attendance at clinic range from 80-120 and morbidity record for 03-07 July,
2000 is shown in the table below:
S.NO
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
TYPE OF DISEASE
Malaria
ARI
Water Diarrhoea
Bloody Diarrhoea
STD
Malnutrition
Skin infection
Pneumonia
Anaemia
Intestinal Worms
Eye infection
Laceration/minor injury
Surgical cases
All others
Total
Source: Waterloo Camp Clinic
AGE GROUP
<5
>5
119
141
71
54
40
37
6
19
32
44
1
33
39
37
10
16
13
37
35
11
22
7
15
0
6
25
76
446
500
TOTAL
260
125
77
25
32
45
72
47
29
72
33
22
6
101
946
3.9
Malaria remains the major cause of morbidity. Review of document for recording
attendance shows that daily record of patients and weekly compilation of data are
sent to ADRA and have not been transformed into usable information. This is the
area where WHO/MOHS can help.
3.10
EPI is routinely carried out in the clinic. The table below shows some examples
of EPI performance at the camp clinic.
Antigen
BCG
Measles
DPT1 + Polio1
DPT2 + Polio2
DPT3 + Polio3
As at July 12
25
2
16
12
3
Month, 2000
June
May
42
21
5
3
30
12
20
7
13
6
April
20
5
20
5
5
Total
108
15
78
44
27
National Workshop IDP Camp; From WHO Assessment Report (3.11 – 3.18):(14,513 IDPs)
3.11
The camp clinic is operated by MSF-Belgium, which provides drugs, medical
supplies and equipment. A few services are provided by the day care clinic.
These include:6
OPD and emergency, first aid during the day
Ante-natal care
Dispensing
Home delivery
3.12
The other health care delivery services were provided by the Cline Town UnderFive Clinic and the Jenner-Wright Clinic at Upgun. Referral is to the Maternity
and Children's hospital and the Connaught Hospital.
3.13
There are five categories of staff at the clinic:
Personnel
Clinic
CHO
Nurses' Aides
MCH Aides
TBA (trained)
Health Promotion Volunteer
1
2
1
1
0
Camp Community
1
0
1
1
15
Only five health workers are given incentives by MSF-Holland.
3.14
The prevalent diseases are mainly malaria, diarrhoea, ARI/Pneumonia and STI.
The STI prevalence was reported to be high among the displaced persons. The
National AIDS Programme has not conducted an awareness campaign in the
camp.
3.15
The Traditional Birth Attendants (TBAs) have carried out antenatal care for 103
pregnant women and delivered 190 cases from June 1999 to date. There are 15
TBAs who conduct home deliveries in the camp.
3.16
For the past 18 months (January 1999 – June 2000), the following persons died in
the camp:
Under-five years
Over five years
3.17
-
15
35 (including 1 pregnant woman)
The water supply is pipe-borne from Guma Valley Water Supply. The NGO
MSF-Belgium supplied 5 water bladders in the camp. Each one is provided with
6 water point taps and the IDPs are supplied with water rationing cans of 5
gallons a day per person.
UNICEF/WATSAN is providing chlorine to purify the water. Water is rationed
in the camp in the morning (7 a.m – 10 a.m.). Unfortunately, some of the hoses
carrying the water are punctured by heavy vehicles. There is a need to change
these hoses to avoid contamination of the water.
7
3.18
Food is rationed to the IDPs when they have been registered and confirmed.
There are about 5,513 IDPs that have not yet been verified and have not received
any food ration. The lack of food has resulted in hardship for children and
pregnant women. There are some malnourished cases in the camp which are
referred to the Children's Hospital Nutrition Programme.
The camp "Health Minister" requested that a dry-feeding or wet-feeding
programme be implemented at the IDP camp.
3.19
A day assessment mission to Kabala indicate the following: (3.19 – 3.22)


Currently, six PHUs are operational (Gbentu, Musaia, Sinkunia, Falaba,
Foria, Dankawali), besides the hospital.
The following table show morbidity report for the month of June, 2000
(PHUs and hospital):-
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
TYPE OF DISEASE/MORBIDITY
Non-bloody diarrhoea
Bloody diarrhoea
Severe Respiratory Tract Infection
Moderate Respiratory Tract Infection
Malaria
Measles
Skin Diseases
STDs
Anaemia
Cardiac Failure + Hypertension
Malnutrition
War Related Trauma
Other Trauma
Others
Source: Kabala Hospital, July 2000
<5 YEARS >5 YEARS TOTAL
43
69
112
29
92
121
30
39
69
150
232
382
257
536
793
4
2
6
109
120
229
0
42
42
20
73
93
0
9
9
78
0
78
0
3
3
2
2
4
113
534
647
3.20
During the month, 21 surgical interventions were carried out among which
ob/gynaecology was the highest (12), war-related trauma( 4),and others (5).
3.21
13 deliveries were done (1 C-Section). A total of 19 deaths occurred in the underfives, mainly malnutrition (5), the rest are others (5), non-bloody diarrhoea (2),
respiratory tract infection (2), malaria (2), anaemia (3). Three deaths occurred
among the over-fives; respiratory tract infection (20), malaria (1).
8
3.22
Data on EPI activities for the hospital, during the month of June, 2000:-
NO. VACCINATED
ANTIGEN
<1YEAR
<5 YEARS
B.C.G.
85
15
Polio1+DPT1
56
20
Polio2+DPT2
41
15
Polio3+DPT3
20
25
Measles
35
20
Fully immunized
40
15
Source: Kabala Hospital, July 2000
TT
TT1
TT2
TT3
TT4
TT5
-
REMARKS
Same number for both
"
"
Pregnant women
60
21
25
30
15
Only one was vaccinated, 15-44 years.
3.23
The World Bank in co-ordination with the Ministry of Health and Sanitation
(MOHS) intensified a campaign to strengthen the capacity of the District Health
Medical Teams in epidemic preparedness and response in the Moyamba District
in the south. 20 participants were at the three day workshop to ensure that District
Health Medical Teams have the knowledge and capability to manage epidemic at
the district level and to train the PHU staff on how to collect data and report
immediately to the next level. Similar workshops have been organised in Bo,
Kenema and Pujehun.
3.24
The MOHS opened a three-day micro-planning workshop on NIDs in Freetown
on July 12. The workshop, sponsored by WHO, UNICEF, Rotary International
and other partners, was to develop a district plan of action for ECOWAS NIDs,
determine resource requirements for OPV, Vitamin A, personnel, transportation
and cold chain at district level.
3.25
The MOHS noted that out of a total figure of 1,051,247 under-fives for the year
2000, 786,956 children were successfully immunized in the March NIDs round
with a corresponding figure of 826,913 in April. WR/SIL in his statement, said
that though the strategy remains the same, a quality NIDs programme is needed to
consolidate the work of all partners.
9
3.26
Reported epidemic prone diseases for Sierra Leone - 29 May to 2 July, 2000,
Disease Surveillance Unit/MOHS:A total of 56 Lassa Fever cases with 13 deaths, a case fatality ration of 23% were
recorded during the period. All cases were from Kenema.
During the period, 4 cases of meningitis (3 from Koinadugu District, 1 from
Western Area – urban) were reported.
A total of 1,856 cases of shigellosis with no deaths have been reported. The
highest number was from the Western Area – urban- (875) followed by Kenema
(584) Moyamba (164), Kailahun (111), Tonkolili (64), and Koinadugu (58).
There were no reported cases of cholera and yellow fever.
3.27
Epidemic prone diseases reported from Kenema, 1-24 July,2000:
S.NO TYPE OF DISEASE
1.
Bloody Diarrhoea
2.
Lassa Fever
3.
Measles
4.
Suspected AFP
( ) :Deaths
Source: WHO Sub-Office, Bo
AGE GROUP
<5
>5
30
151
7
19
8
6
1
0
TOTAL
181
26 (5)
14
1
A cumulative total of 887 cases of bloody diarrhoea were reported by 11 PHUs of
Pujehun District during the period Jan-May, 2000:January
February
March
April
May
-
217
213
157
137
166
IV
WHO ACTIVITIES AND RESPONSE TO EMERGENCIES
4.1
A detailed situation report for the month of June 2000 (No. 05/2000), was
completed and sent to WHO/AFRO and WHO/HQ on 21 July, 2000. A copy was
also sent to Inter-Country Team, Abidjan.
10
4.2
A Health Information Bulletin No. 01/2000, was produced for June and
distributed to UN Agencies, NGOs and other partners as a part information
exchange and update on the ongoing health situation.
4.3
Two IDP Camps (Waterloo and National Workshop) were assessed in general and
health situation/status in particular. (Major findings appear in Section III, IDPs).
4.4
In response to ongoing emergencies, WHO has provided the following items to
the MOHS/partners during the month:65,000 Nalidixic Acid
500 sachets of ORS and 168 litres of Hartmans solution
10,000 tablets of Nalidixic Acid
4.5
-
MOHS
IMC
MSF
Following the detection of Lassa Fever cases in Freetown, a sensitization meeting
on the care of patients and prevention of the disease was held in a hospital and
was attended by MOHS authorities and health workers.
Missions
4.6
DPC/WHO has visited Kenema on 13 July, 2000 to assess the general situation in
the area with particular attention to Lassa Fever.
4.7
A day mission was made by WR and EHA to Kabala on 23 July, 2000. The
objective of the mission was to rapidly assess the health situation in the area and
identify WHO's priority support.
Kabala District hospital was visited and discussion was held with the Health
Co-ordinator of MSF-Belgium in Kabala, Dr. F.S. Samura. The hospital lacks
basic surgical equipment, such as suction machine, operating light, etc.
4.8
There was another mission by DPC/WHO and EHA to Bo to assess the current
situation from 31 July to 4 August, 2000, a report of which will appear in August,
2000.
Meetings
4.9
The regular meeting of Emergency Health Task Force was held once during the
month and was attended by WR. Discussions focused in the current emergency
situation and actions taken by UN organisations and NGOs in response to health
emergencies.
4.10
A meeting with Dr. Clifford W. Kamara, Director of Planning and
Information/MOHS was held on 4 July, 2000 and was attended by EHA and Sub-
11
Office Co-ordinator to discuss about the status of information and planning
activities.
4.11
A meeting was held with Dr. P.A.T. Roberts, principal Medical Officer for
Western Area District on 19 July, 2000. The meeting was attended by EHA and
Sub-Office Co-ordinator, Makeni.
The focus of discussion were the current general health situation in the area; the
capacity of the office for emergency preparedness and response to emergency
health problems, and the role of the office in the health of IDPs.
It was found that the office has the capacity to carry out necessary activities in
terms of human resources, but lacks material and financial resources, particularly
data processing and documentation equipment.
4.12
A short meeting was held with UN-OCHA chief on 19 July, 2000 to discuss how
information exchange could be strengthened. It was agreed that WHO
communicate available health information/data to UN-OCHA Information Officer
for inclusion in Humanitarian Situation Report.
4.13
On 25 July 2000, a meeting was held with UNICEF Programme Officers, Health
and Nutrition and discussed strengthening of health information exchange and
support to IDPs health intervention.
The need for strengthening HIV/AIDS and STD, malaria control with attention to
IDPs was also discussed.
4.14
During the month, two WHO professional/technical staff meetings were carried
out. The meetings (18 July and 27 July, 2000) were chaired by the WR and
discussed progress of mid-term review: response to CAP 2000 by donors and
actions needed.
4.15
Two meetings were held with the MOHS, one of which was also attended by
MSF-Belgium to revise the STD syndromic management and to review the
surveillance document to produce as guidelines/manual for surveillance and tools
for data collection. Meetings will continue to finalise both.
V.
CONSTRAINTS/RECOMMENDATIONS
5.1
Security still remains fluid with IDPs on the increase. WHO will initiate
contingency planning with the Government and other partners identifying
scenarios.
5.2
Strengthening of district hospitals is identified as a priority intervention, Kabala,
Bo and Pujehun.
12
5.3
HIV/AIDS control to be organized and system established at district levels with
various activities identified.
SOURCES OF INFORMATION:
1.
2.
3.
4.
5.
6.
7.
UN-OCHA
DMOs/MOHS
NGOs/Partners.
WHO/SIL
WHO Sub-Office
Other UN Agencies
UNAMSIL
-
Humanitarian Situation Report
Reports
Reports
Assessment and Mission Reports
Report
Reports
Press Releases, etc.
CORRIGENDA
Monthly Situation Report No. 05/2000
Page 4: Paragraph 3.2, second line ........ 163 should read 154 health institutions
and 87 should read 78.
The table.... Hospital OPD, Tonkolili please delete 11 and replace with 2, on the
same line, delete 21, total and replace by 12.
Last line, total table.... Tonkolili, delete 26... and replace with 17... delete 163 and
replace with 154.
13