WORLD HEALTH ORGANIZATION, SIERRA LEONE

MONTHLY SITUATION REPORT/UPDATE

JULY, 2000

NO: 06/2000

I. INTRODUCTION

I.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.

I.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 - Phase IVElsewhere - 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.

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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.

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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 - 12,238 IDPs transferred from National Workshop and - 406

receiving ration IDPs on transit receiving ration - 210

Sub Total 12,854

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Unverified new caseload from Waterloo Area - 3,501 Unverified new caseload from Masiaka - 452 Unverified new caseload from Makeni - 962 Unverified new caseload from Masiaka due to -

recent attack - 175Sub Total 5,093 Total caseload 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).

School age children - 2,255 (female 1,156; male 1,099) Female, 15-45 years - 3,976 Currently pregnant - 156 Children on wet feeding - 199 (breakfast and lunch) Unaccompanied/separated - 14

children Child, ex-combatants - 50

2.18 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:-

registered and verified and provided food ration - 9,000 registered and unverified - 3,359 new influx and unverified - 2,154

Total population caseload - 14,513

III. 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

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(ARI) and diarrhoea. Some 405 expectant mothers were immunized against tetanus.

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 unitEPILaboratory – basicPharmacy – dispensingInjection and dressing unitHome delivery services by TBAs

The clinic is staffed by various professional/technical staff including the doctors/surgeons.

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3.8 Daily attendance at clinic range from 80-120 and morbidity record for 03-07 July, 2000 is shown in the table below:

AGE GROUPS.NO TYPE OF DISEASE <5 >5 TOTAL1. Malaria 119 141 2602. ARI 71 54 1253. Water Diarrhoea 40 37 774. Bloody Diarrhoea 6 19 255. STD - 32 326. Malnutrition 44 1 457. Skin infection 33 39 728. Pneumonia 37 10 479. Anaemia 16 13 2910. Intestinal Worms 37 35 7211. Eye infection 11 22 3312. Laceration/minor injury 7 15 2213. Surgical cases 0 6 614. All others 25 76 101

Total 446 500 946Source: Waterloo Camp Clinic

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.

Month, 2000Antigen As at July 12 June May April Total

BCG 25 42 21 20 108Measles 2 5 3 5 15DPT1 + Polio1 16 30 12 20 78DPT2 + Polio2 12 20 7 5 44DPT3 + Polio3 3 13 6 5 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:-

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OPD and emergency, first aid during the dayAnte-natal careDispensingHome delivery

3.12 The other health care delivery services were provided by the Cline Town Under-Five 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 Camp Community

CHO 1 1Nurses' Aides 2 0MCH Aides 1 1TBA (trained) 1 1Health Promotion Volunteer 0 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 - 15Over five years - 35 (including 1 pregnant woman)

3.17 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.

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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. TYPE OF DISEASE/MORBIDITY <5 YEARS >5 YEARS TOTAL1. Non-bloody diarrhoea 43 69 1122. Bloody diarrhoea 29 92 1213. Severe Respiratory Tract Infection 30 39 694. Moderate Respiratory Tract Infection 150 232 3825. Malaria 257 536 7936. Measles 4 2 67. Skin Diseases 109 120 2298. STDs 0 42 429. Anaemia 20 73 9310. Cardiac Failure + Hypertension 0 9 911. Malnutrition 78 0 7812. War Related Trauma 0 3 313. Other Trauma 2 2 414. Others 113 534 647

Source: Kabala Hospital, July 2000

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 under-fives, 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).

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3.22 Data on EPI activities for the hospital, during the month of June, 2000:-

NO. VACCINATEDANTIGEN <1YEAR <5 YEARS REMARKS

B.C.G. 85 15Polio1+DPT1 56 20 Same number for bothPolio2+DPT2 41 15 "Polio3+DPT3 20 25 "Measles 35 20Fully immunized 40 15Source: Kabala Hospital, July 2000

TT - Pregnant womenTT1 - 60TT2 - 21TT3 - 25TT4 - 30TT5 - 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.

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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:

AGE GROUPS.NO TYPE OF DISEASE <5 >5 TOTAL1. Bloody Diarrhoea 30 151 1812. Lassa Fever 7 19 26 (5)3. Measles 8 6 144. Suspected AFP 1 0 1( ) :Deaths Source: WHO Sub-Office, Bo

A cumulative total of 887 cases of bloody diarrhoea were reported by 11 PHUs of Pujehun District during the period Jan-May, 2000:-

January - 217February - 213March - 157April - 137May - 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.

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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 - MOHS500 sachets of ORS and 168 litres of Hartmans solution - IMC10,000 tablets of Nalidixic Acid - MSF

4.5 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 HealthCo-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-

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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.

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5.3 HIV/AIDS control to be organized and system established at district levels with various activities identified.

SOURCES OF INFORMATION:

1. UN-OCHA - Humanitarian Situation Report2. DMOs/MOHS - Reports3. NGOs/Partners. - Reports4. WHO/SIL - Assessment and Mission Reports5. WHO Sub-Office - Report6. Other UN Agencies - Reports7. UNAMSIL - 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.

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