Guinea refugees threatened from all sides
The refugee situation in Guinea is becoming increasingly chaotic and unstable as a result of
attacks on previously accessible and secure sites. WHO representative in Sierra Leone, Dr
William Aldis reports that access to basic health services, crucial care for mothers and children,
and preparedness and prevention activities for communicable disease outbreaks including yellow
fever are priority concerns
The scope for outbreaks of communicable disease has escalated dramatically in Guinea and
Sierra Leone, and simple human acts such as giving birth have become life threatening. Aid
agencies are increasingly unable to reach refugees and displaced people trapped by fighting or
taking refuge in the forests. Returnees to Sierra Leone are entering communities where health
services are already stretched to the limit.
In Guinea UNHCR estimates it is presently reaching with basic services about 65,000 refugees in
or near the string of refugee camps in south eastern area of Guinea which borders both Sierra
Leone and Liberia, leaving more than 150,000 unaccounted for. Some 70,000 Guineans have
also been displaced by fighting in the area.
The agency is readying sites for about 140,000 people at more secure locations removed from
the border areas, while at the same time assisting those wishing to return to Sierra Leone or
Liberia (for latest information on refugee movement, please go to
http://www.unhcr.ch/refworld/cgi-bin/newshcr.pl)
In Sierra Leone, roughly 29,000 refugees have returned from Guinea so far. Some 3,000
refugees are now in transit camps and many of the remainder have been re-settled into
communities in Loko Massama chiefdom in Port Loko District. Others have drifted into Freetown.
It is estimated a further 50,000 will return by end June. But in the worst case scenario – the return
of up to 150,000 returnees in a few short months is a real possibility.
Visiting several of the resettlement communities in Loko Massama, where UNHCR is trying a new
approach of settling returnees within communities and assisting the community to host them, and
I was hugely impressed by the obvious advantages over the usual encampment. But the
absorptive capacity and cost of resettlement in this way is unknown, and it is likely that,
considering the volume of returnees, a combination of strategies including absorption into host
communities, encampment and return to home areas where feasible will be required. All three
strategies put immense strain on already depleted health services.
Immediate priority health concerns in Guinea and Sierra Leone, therefore include:
 Ensuring access to basic health care, particularly for women and children, through
emergency response and support to community services in Guinea and Sierra Leone.
Expectant mothers and children suffering from common childhood diseases are at most risk
of preventable death in emergency situations.
 Preparedness for potential outbreaks of epidemic disease among refugees and displaced
from camps in very difficult to access areas.
 Action to prevent entry of yellow fever into Sierra Leone, since many of the refugees are
arriving from known epidemic areas, and the re-occurrence of last year’s outbreak in Guinea.
Though the Guinea outbreak is considered to be under control, less than half the I million
people living in the outbreak area and targeted for protective vaccination have been reached
because of vaccine shortage
We need to be prepared for an urban epidemic in Freetown, among other possibilities.
Vaccination should be done on the refugee boats, transit centres and before community
settlement. There are currently only 58,000 doses of yellow fever vaccine in Sierra Leone,
but a minimum of 300,000 doses need to be on hand. WHO has identified supplies of this
scarce vaccine but needs funds to purchase.
WHO is sending a two-person team comprised of public health doctor, backed up by information
officer to support the activities of the country teams in the affected countries, to do the following
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Assess the health situation, needs of the refugees, and current response activities of WHO
and other actors.
Identify immediate needs and short term priorities for the delivery of the emergency response
Review the coordination mechanisms of health activities targeting the refugees both at
country level and regionally
Prepare a plan of action for the development of emergency public health response to the
changing situation
To participate to the first meeting of WHO West Africa Emergency Co-ordination team –
taking place 5th Feb in Freetown
For further information, please contact Dr Rayana Buhakah, WHO desk officer for West Africa,
ph: +41 22, 791 3748, email buhakahr@who.int; Media enquiries to Gregory Hartl, WHO
spokesperson, +41 22 791 4458, email hartlg@who.int.