Women in Sierra Leone

Sierra Leone is a small country situated on the West Coast of Africa along the Atlantic Ocean, between Liberia and Guinea. It has an area of 72,000sq kms with an estimated population of 4.4 million (State of the World Population 1997). It is divided into three (3) provinces (Northern, eastern and southern and the Western Area and thirteen (13) districts. Freetown is the capital and the main seaport situated on the coast of the Atlantic Ocean.

Sierra Leone is endowed with natural resources but it is rated as one of the poorest countries in the world. This is largely due to gross mismanagement of national resources and a destructive and violent war which started in 1991, and in spite of the Lome Peace Accord signed in July 1999 the war is still not completely settled. As a result tens of thousands of people were killed, maimed, abducted and millions have been displaced internally and externally as refugees.

Health facilities have been completely burnt down, destruction of infrastructure and extensive looting of property have characterised the civil war. The Rapid Health Institutions Report of June 1998 revealed that out of 111 health facilities visited - twenty five (25) were completely burnt down and many more almost completely destroyed. The operating theatres and laboratories in all the districts are virtually non-functional.

In such a state of insecurity, international development assistance has not been forthcoming. Economic activity has declined and the level of poverty has increased. In May 1997, a military junta and the rebels forcefully seized power and this was accompanied by extensive atrocities on the population, migration and destruction of physical infrastructure, arson, rape abduction of women and girls.

The ECOMOG, West African Peace Keeping Force reverted the coup d’ etat in February 1998 and returned the country to democratic rule. The Government inherited a country whose people had been severely traumatised, economy ruined and basic infrastructural facilities extensively destroyed.

Whilst the Government was trying to repair all these damages the rebels launched another devastating and forceful attack on the city of Freetown in January 1999 when extensive loss of lives and commitment of the world’s worst atrocities against the civilian population occurred. There were several cases of single and double amputation of limbs, more than 20,000 houses were burnt, some with the families killed and burnt in the houses, others killed and their bodies thrown on the streets.

The capital city suffered an unprecedented level of destruction again of physical infrastructure. Hospitals were burnt and looted, drugs, equipments, beds, mattresses were carried away. Some clinics were used as shelter and displaced camps for many whose homes were burnt. There was massive disruption of all social and essential services. All these caused massive displacement of the population, and considerable migration especially of professionals who became targets for destruction by the rebels. More than 16,000 women and girls were abducted. Some raped and left, others taken with the rebels to the bush.

Many mission, NGO’s are trying to help with this devastating health condition of the country particularly with the returned refugees, the displace and the abductees but there is need for more input by the medical professionals who have had enough courage to remain in the country.

The eight year rebel war in Sierra Leone has created a lot of health problems for women and girls who were abducted during invasion of various parts of the country by the rebels. During the recent and most vicious and violent invasion of the city of Freetown in January 1999 over 10,000 women and children – girls, were abducted, other than many who were raped, and burnt alive in their homes. Some have been relocated after negotiations by the Interreligious Council, the West African Economic Organisation and by the U.N. but there are still over 6000 women and children behind rebel lines.

Many of these women and girls when released were pregnant, some have even delivered and have their young ones on their backs. Some girls of age 12 – 14 were released pregnant and those who had delivered had major pelvic injuries. Many others were used as sex workers, were brutally and sexually abused resulting in pregnancy, sexually transmitted diseases, anemia, malnutrition and pelvic injuries.

In spite of world appeal, national appeal for the release of these women and children only a few have so far been released in crops, in terrible health conditions, malnourished, anemic, pregnant with pelvic infectious, slan rashes, and sores.

Many have no financial resources to obtain proper medical care. Many have lost their parents, husbands and other relatives. Some NGOs are involved in the care of some of these released abductees but the few medical women of Sierra Leone view this as an important role for them to participate. Sierra Leone in normal times had a serious nutrition problem which is now made worse by the war. The anaemic populations like that of Sierra Leone which has been made worse by the war, are associated with high maternal and child mortality.

The 8 –year Rebel war caused great trauma on the civilian population, particularly the abducted women and girls. Even though a peace agreement has been signed in Lome Togo July 7 1999, the atrocities still continue and many women and children are still held in captivity and not released. With continous mounting pressure by the International community, the United Nations, the Economic Commission of West African States Religious leaders, a few women and girls have been released, some after paying some ransom.

Released abductees are in appalling health state, such as teenage pregnancy, teenage mothers with complications and injury during delivery, high incidence of infection – pelvic infection, sexually transmitted diseases, skin infections, skin sores, anaemia, worm infestation. There are still over 6000 women and girls to be released. The Sierra Leone Medical Women will care for about 10% of these women and girls. Providing general medical care and special care to pregnant and nursing mothers, treatment of anaemia, infection, malnutrition and other injuries. Providing counselling services and follow-up services after initial treatment

Presently the United Nations peace keeping forces 11,000 strong are in the country and release of these abductees is expected to be completed in the next three months.

Sierra Leone Medical Women's Association - Interim report on health care to women and children who were abducted or behind the rebel lines.

The Medical Women's International Association is partly funding a project in Sierra Leone, to assist the women released from refugee camps. Members of Sierra Leone Medical Women's Association (SLMWA) still have some 6000 women with the rebels who have not been released. They hope that when the UN Peace Mission are able to deploy fully throughout the country more will be released.

Report

A total of 25 women and girls aged between 4 months and 35 years of were seen over a period of one month(from 28th December 2000 to 29th January 2001). All of the infants were offspring of the older girls and women seen. There were no amputees amongst these females as amputees were all put in special care camps catering solely for their needs.

As the SLMWA has limited funds, the Forum of African Women Educationalists(FAWE) assisted in registering the victims. FAWE is engaged in the welfare and care of such victims so were in a position to send us victims as when they reported to them. The older victims were initially counselled on their initial visit to FAWE by trained counsellors before being sent to SLMWA members. The counselling continued however on a daily basis or weekly basis depending on the needs of the victim. The patients were again counselled by SLMWA members on their initial visit in order to build trust and confidence, so as to enable the patients to talk about their ordeals and allow any form of physical examination to be carried out on them.

Method

A standard form was developed by SLMWA members which was used as a guide to the kind of information to be got from the patients. It also contained a guide as to physical, clinical and laboratory findings of such patients.

Findings

From a sample of 25 women:

24% were aged between 0 - 5 years
4% were aged between 6-10 years, 11-16 years and more than 35 years.
44% were aged between 17 - 25
20% were aged between 26-35
50% of the sample were literate with only 22% having obtained secondary education.

In the sample from ages 17 - 35 years, 55% of this group were married and 45% were single. This excludes the girls of school going age. Three of the singles were unemployed and the married women were house wives engaged in petty trading.

1% were refugees or caught behind rebel lines.
99% of the patients were abducted for periods ranging from one month to four years.
Of the 99% abducted only 16% were not raped.
Of the 83% raped 39% were gang raped and 50% were beaten and physically assaulted.

Only a few of the women were lucky to have single sexual partners during abduction. Most of the patients were suckling mothers or had children previous to abductions. Only one of these had a child as a result of being raped by rebels.

Drug abuse was common. Cocaine and Marijuana being the most used intravenously or by smoking. The older patients from 17 years upwards all presented with lower abdominal pains, offensive discharge, frequency and dysuria. One had vaginal warts and skin rashes was very common. The commonest diagnoses were PID, Cystitis and worm infestation. Three women were discovered with large uterine fibroids. The younger girls presented with upper respiratory tract infections, Malaria, Malnutrition, and Fungal skin infections. Family planning was accepted (OC) by most of the older girls and women above 17 years, except two who refused for cultural reasons.

Problems Encountered

1. At the initial visit some patients were not able to build up enough confidence in order to allow SLMWA members to get all the information needed and even in some cases to allow any sort of physical examination to be done on them.

2. Some patients failed to turn up for a follow up visit.

3. Those who returned expected a constant flow of drugs whether or not they felt better.

4. All refused to have an HIV test done.

5. Some of the cases were major and long term cases,(including surgical cases) and as such they could not be treated due to lack of resources much to the distress of the patients.

6. Most investigative procedures are expensive and so could not be carried out.

Submitted by Drs Olabisi Claudius - Cole and Lynette Palmer.

Contact

Dinah Jarrett
Olayinka Koso – Thomas
National co ordinator SLMWA
Email: ykosot@yahoo.com