Sierra Leone


MSF has been supporting Sierra Leone’s Ministry of Health and Sanitation with its COVID-19 preparedness and response plan since February 2020. As a partner at the Emergency Operation Centre, MSF continues to provide advice for case management and surveillance.  

We have assisted in setting up isolation wards and have donated medical equipment, medicines and cleaning materials to a number of healthcare facilities. As the main hospital designated for COVID-19 cases is currently full, we are providing technical guidance in setting up alternative venues to treat asymptomatic or mild cases. 

In Tonkolili, where Sierra Leone’s first confirmed case originated, we are assisting with contact tracing and follow- up for all contacts, referring additional cases, and ensuring isolation preparedness. 

In the capital Freetown, an MSF epidemiologist is assisting with surveillance activities including contact tracing, staff training, and advising on data collection strategies. Meanwhile our water and sanitation and construction specialists have begun work on repurposing a government facility into a 120-bed COVID-19 treatment centre.  

In southern Kenema District, MSF has completed its assessment at Kenema Government Hospital in preparation for opening a COVID-19 treatment centre. We have also donated handwashing stations to 42 villages in the area after meeting with community representatives.   

Our projects in Kenema, Gorama Mende, and Wandor are providing regular donations of infection prevention and control supplies to health facilities as part of their standard operations. Health promotion activities are continuing and are now following physical distancing regulations and focusing on COVID-19. Health messages have been sent out via newspapers and radio stations, including a health promotion song recorded by an MSF clinical health officer.

In the northern regions, MSF has set up isolation wards in Makeni Regional Hospital, Magburaka Hospital, and Hinistas Community Health Centre, Tonkolili.


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Sierra Leone is home to about 16 ethnic groups, each with its own language and customs. Despite the nation’s natural wealth, a vast majority of the population live in poverty.

Sierra Leone experienced substantial economic growth in the years following a decade-long civil war. However, the 2014-2015 Ebola epidemic had a disastrous effect on the country's economy, education system, and healthcare infrastructure.

Médecins Sans Frontières began working in Sierra Leone in 1986, and current projects aim to contribute to the recovery of the health system following the Ebola outbreak and combat high mortality rates among children and pregnant women.

MSF teams work in a number of districts across the country, providing medical care, staff training, and supplies for health units.

Ebola Recovery

Sierra Leone has some of the worst health indicators in the world, especially for maternal and child mortality. Even before the Ebola outbreak, people in Sierra Leone had limited access to medical care and the health system was both under-resourced and overburdened.  

It is estimated that up to 10% of the country’s already limited health professionals were killed by the virus. In Kenema district alone, more than 200 health workers died of the disease.

The deadly Ebola outbreak of 2014-2015 led to many of medical staff either fleeing or falling victim to the disease. Of 1,100 health workers in Sierra Leone, over 300 were infected with Ebola

Sierra Leone was finally declared Ebola-free on 17 March 2016 and the country is now struggling to rebuild its shattered health system. People are still reluctant to visit health centres. In rural areas, most peripheral health units (PHUs) became barely functional. They are dilapidated, with no water or electricity and, more often than not lack staff and medical stocks.

MSF trains, mentors, and supervises Ministry of Health staff and community health workers to improve health promotion, as well as infection prevention and control. Improving water, sanitation and hygiene (WASH) standards are a priority.



30 year old Ebola survivor Demba, photographed with his daughter Haja in his home in Freetown. Sierra Leone is regularly battered by natural and man-made disasters, as well as disease outbreaks, which make it difficult for the health system to recover after each blow it suffers. © Trenchard / MSF

Mother and Child Health

Delivering a child still poses huge risks for women in Sierra Leone. The country’s maternal mortality rate is among the highest in the world.

Malaria is the key cause of death among children under five, and many also suffer from severe or acute malnutrition.

Seeking care often means travelling far and paying for expensive drugs and services without any certainty of being cured. Instead of paying a hefty fee for travel, only to arrive at a health post that has neither the facilities nor the health workers to treat them, many people find it more practical to stay in their villages and turn to traditional healers, who accept gifts such as rice or crops in return for their services.


“We are working towards making the Ministry of Health staff autonomous. To reduce mortality, they should be able to handle complicated cases, detect and refer the cases, and explain to the patients what exactly is happening to their health. If the staff don’t explain it to them, they will not seek healthcare.”

Francis Mbuthi
MSF Project’s Medical Focal Point

To gain people’s trust in the health system, MSF is working alongside the Ministry of Health in training local staff, providing medical stocks and reaching out to far-flung communities, in order to minimise the number of deaths by preventable causes – particularly among women and children.

An outreach team of MSF nurses and midwives take turns working alongside Ministry of Health staff to improve practical skills in diagnosis and treatment.


Residents of Fomaya village listen to MSF health promoter Matu, as she carries out an educational campaign, informing residents about malaria detection and prevention. © Junio / MSF

Health promoters engage traditional healers and birth attendants in discussions surrounding public health, acknowledging their role as first responders who can help speed up the referral of patients. This involves engaging the community on malaria and cholera prevention, good hygiene practices, family planning and teenage pregnancies across villages and townships.

Training human resources is a crucial step in getting Sierra Leone’s health system up to speed. A higher number of skilled health workers will improve the services provided in primary healthcare structures and enable an effective response to disasters and outbreaks.


Find out more about Sierra Leone

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