Sierra Leone

== Health ==

{{main|Health in Sierra Leone}}The [[Central Intelligence Agency|CIA]] estimated that the average life expectancy in Sierra Leone was 57.39 years.<ref name=iuonoa>{{cite web |url=https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html |title=CIA – The World Factbook Life Expectancy |publisher=Cia.gov |access-date=25 June 2014 |work=[[The World Factbook]] |archive-date=29 December 2018 |archive-url=https://web.archive.org/web/20181229134543/https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html |url-status=dead }}</ref>

The prevalence of [[HIV/AIDS]] in the population is 1.6%, higher than the world average of 1% but lower than the average of 6.1% across [[Sub-Saharan Africa]].<ref>{{cite web |title = 2006 Report on the global AIDS epidemic |publisher = UNAIDS |year = 2006 |url = http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/Default.asp |format = PDF |access-date = 24 January 2008 |url-status = dead |archive-url = https://web.archive.org/web/20080117113818/http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/default.asp |archive-date = 17 January 2008 |df = dmy-all }}</ref>

Medical care is not readily accessible, with doctors and hospitals out of reach for many villagers. While free health care may be provided in some villages, the medical staff is poorly paid and sometimes charge for their services, taking advantage of the fact that the villagers are not aware of their right to free medical care.<ref>{{cite web |title=Wealth, but no health |author=Anne Jung |publisher=D+C Development and Cooperation/ dandc.eu |date=December 2012 |url=http://www.dandc.eu/en/article/sierra-leones-health-services-do-not-deliver-official-promises |archive-url=https://web.archive.org/web/20131015195910/http://www.dandc.eu/en/article/sierra-leones-health-services-do-not-deliver-official-promises |url-status=dead |archive-date=15 October 2013 |access-date=17 June 2014 }}</ref>

A dialysis machine, the first of its kind in the country, was donated by Israel.<ref name=Cashman2015>{{cite news |last1=Cashman |first1=Greer Fay |title=Envoys from five countries present credentials to president |url=https://www.jpost.com/Israel-News/Politics-And-Diplomacy/Envoys-from-five-countries-present-credentials-to-president-431856 |work=The Jerusalem Post |date=3 November 2015 }}</ref>

According to an [[Overseas Development Institute]] report, private health expenditure accounts for 85.7% of total spending on health.<ref>DuBois, Marc, and Caitlin Wake, with Scarlett Sturridge and Christina Bennett (2015) [http://www.odi.org/publications/9956-ebola-response-west-africa-exposing-politics-culture-international-aid "The Ebola response in West Africa: Exposing the politics and culture of international aid"]. London: Overseas Development Institute</ref>

=== Emergency medical response ===

Having had no formal [[emergency medical services]] previously, the [[First Responder Coalition of Sierra Leone]] (FRCSL) was formed in June 2019 in [[Makeni]] to facilitate the development of [[Emergency medical responder|emergency first responder]] programs nationwide.<ref name=":10">{{Cite web|url=http://www.thepatrioticvanguard.com/in-makeni-five-national-and-international|title=Makeni: Coalition of First Responders formed|date=2019-07-04|website=The Patriotic Vanguard|language=en|access-date=2019-07-05}}</ref> The founding members of the Coalition included the [[Sierra Leone Red Cross Society]] (the first chairing organisation), [[LFR International]] (proposed the formation), the [[University of Makeni]], [[Agency for Rural Community Transformation]], and the [[Holy Spirit Hospital (Makeni)|Holy Spirit Hospital]].<ref name=":10" /> The establishment of the Coalition was concurrent with the declaration by the 72nd World Health Assembly that emergency care systems are essential to universal health coverage.<ref>{{Cite web|url=https://www.who.int/news-room/detail/25-05-2019-world-health-assembly-update|title=World Health Assembly Update, 25 May 2019|website=www.who.int|language=en|access-date=2019-07-05}}</ref> Between June and July 2019, the FRCSL trained 1,000 community members from Makeni to be first responders and equipped each trainee with a first aid kit.<ref>{{Cite web|url=https://www.thesierraleonetelegraph.com/sierra-leones-road-accident-first-responder-coalition-to-save-thousands-of-lives/|title=Sierra Leone's road accident First Responder Coalition to save thousands of lives|last=Thomas|first=Abdul Rashid|date=2019-07-05|language=en-US|access-date=2019-07-05|archive-url=https://web.archive.org/web/20190705101916/https://www.thesierraleonetelegraph.com/sierra-leones-road-accident-first-responder-coalition-to-save-thousands-of-lives/|archive-date=5 July 2019|url-status=dead}}</ref>

===Endemic and infectious diseases===

Sierra Leone suffers from [[epidemic]] outbreaks of diseases, including [[yellow fever]], [[cholera]], [[Ebola]], [[lassa fever]] and [[meningitis]].<ref>{{cite book|author=Donaldson, Ross|title=The Lassa Ward: One Man's Fight Against One Of The World's Deadliest Diseases|publisher=Macmillan|isbn=9781429987073|year=2009|pages=34–35}}</ref><ref name=PHChand>{{cite web |title = The Primary Health Care Hand Book Policing |publisher = Ministry of Health & Sanitation |date = 25 May 2007 |url = http://www.health.sl/drwebsite/publish/healthcare.shtml |format = doc |access-date = 24 January 2008 |url-status = dead |archive-url = https://web.archive.org/web/20080217052144/http://www.health.sl/drwebsite/publish/healthcare.shtml |archive-date = 17 February 2008 |df = dmy-all }}</ref> [[Yellow fever]] and [[malaria]] are endemic to Sierra Leone.<ref name=PHChand/>

=== Maternal and child health ===

According to 2017 estimates, Sierra Leone has the third highest [[maternal mortality]] rate in the world.<ref name="cia.gov">[https://www.cia.gov/the-world-factbook/field/maternal-mortality-rate/country-comparison/  Country Comparison: Maternal Mortality Rate] {{Webarchive|url=https://web.archive.org/web/20210812194652/https://www.cia.gov/the-world-factbook/field/maternal-mortality-rate/country-comparison/ |date=12 August 2021 }}. ''The World Factbook'' [[Central Intelligence Agency]].</ref> For every 100 liveborn children, one mother dies due to complications of giving birth.<ref name="cia.gov"/>

In the Multiple Indicator Cluster Survey (MICS) conducted by UNICEF in 2012, the prevalence of [[female genital mutilation in Sierra Leone]] was 94%.<ref>Sipsma, Heather L., et al. "Female Genital Cutting: Current Practices and Beliefs in Western Africa." Bulletin of the World Health Organization 90.2 (2012): 120–127F. Print.</ref> {{As of|2014}}, Sierra Leone was estimated as having the 11th highest [[infant mortality]] rate in the world.<ref>[https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html Country Comparison :: Infant Mortality Rate] {{Webarchive|url=https://web.archive.org/web/20180207062332/https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html |date=7 February 2018 }}. ''The World Factbook'' [[Central Intelligence Agency]].</ref>

One of the consequences women in Sierra Leone face after a prolonged and obstructed labour that would have required a c-section is [[obstetric fistula]]. This condition often drives women into poverty and isolation.<ref>{{Cite web|url=https://www.kidspot.com.au/parenting/real-life/in-the-news/a-woman-covered-in-urine-taught-this-sydney-mum-a-lesson-about-dignity/news-story/67c2a8b93c9eca1485f663d11eaf69f6|title=A woman covered in urine taught this Sydney mum a lesson about dignity|first=Alys|last=Gagnon|website=www.kidspot.com.au}}{{Dead link|date=June 2020 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

The AWC- Aberdeen Women's Centre in [[Freetown]], the second busiest hospital in Sierra Leone, delivering up to 3000 babies each year.<ref>{{Cite web|url=https://freedomfromfistula.org/projects/sierra-leone|title=FFF|website=freedomfromfistula.org|access-date=4 November 2019|archive-url=https://web.archive.org/web/20191104033208/https://freedomfromfistula.org/projects/sierra-leone|archive-date=4 November 2019|url-status=dead}}</ref> The centre provides free surgery for women suffering from this condition.

The centre provides a variety of maternal and child health services and is supported by not-for-profit organisations such as Freedom from Fistula,<ref>{{Cite web|url=https://www.freedomfromfistula.org/|title=Freedom From Fistula {{pipe}} obstetric fistula caused by obstructed childbirth|website=www.freedomfromfistula.org|access-date=1 January 2020|archive-url=https://web.archive.org/web/20191103103324/https://www.freedomfromfistula.org/|archive-date=3 November 2019|url-status=dead}}</ref> The Aminata Maternal Foundation,<ref>{{Cite web|url=https://aminatamaternalfoundation.org/|title=Aminata Maternal Foundation|website=The Aminata Maternal Foundation|access-date=3 November 2019|archive-url=https://web.archive.org/web/20191103103307/https://aminatamaternalfoundation.org/|archive-date=3 November 2019|url-status=dead}}</ref>{{Better source needed|date=October 2022}} and UNFPA.<ref>{{Cite web|url=https://www.unfpa.org/news/fistula-camp-helps-women-and-girls-sierra-leone-regain-their-dignity|title=Fistula camp helps women and girls in Sierra Leone regain their dignity|website=www.unfpa.org}}</ref>

=== Mental health ===

[[Mental health]]care in Sierra Leone is almost non-existent. Many sufferers try to cure themselves with the help of traditional healers.<ref>{{cite web|url=http://www.channel4.com/programmes/unreported-world/episode-guide/series-2009/episode-4 |title=''Unreported World 2009'' series, ep.4: ''Sierra Leone: Insanity of War'' |publisher=Channel4.com |date=3 April 2009 |access-date=20 May 2012}}</ref> During the [[Sierra Leone Civil War|Civil War (1991–2002)]], many soldiers took part in atrocities and many children were forced to fight. This left them traumatised, with an estimated 400,000 people (by 2009) being mentally ill. Thousands of former child soldiers have fallen into substance abuse as they try to blunt their memories.<ref>{{cite journal|last=Lisk|first=Radcliffe|title=Sierra Leone|journal=Practical Neurology|year=2007|volume=7|issue=3|pages=198–201|doi=10.1136/jnnp.2007.120089|pmid=17515600|s2cid=219201682}}</ref>

=== Potable water supply ===

{{Main|Water supply in Sierra Leone}}

The water supply in Sierra Leone is characterised by limited access to safe drinking water. Despite efforts by the government and numerous non-governmental organisations, access has not much improved since the end of the Sierra Leone Civil War in 2002, stagnating at about 50% and even declining in rural areas.<ref name="JMP water">WHO/UNICEF [[Joint Monitoring Programme for Water Supply and Sanitation]] (updated March 2010) {{cite web |url=http://www.wssinfo.org/fileadmin/user_upload/resources/SLE_wat.pdf |title=Estimates for the use of Improved Drinking-Water Sources, Sierra Leone |access-date=6 August 2011 |url-status=dead |archive-url=https://web.archive.org/web/20111226083443/http://www.wssinfo.org/fileadmin/user_upload/resources/SLE_wat.pdf |archive-date=26 December 2011}}</ref> It is hoped that a new dam in Orugu, for which China committed financing in 2009, will alleviate [[water scarcity]].<ref name="Orugu">{{cite web |url=http://www.ooskanews.com/middle-east-africa/china-lends-288-million-usd-sierra-leone-orugu-dam |title=China Lends $28.8 Million USD to Sierra Leone for Orugu Dam |publisher=OOSKAnews |date=15 June 2009 |access-date=20 May 2012 }}{{Dead link|date=October 2022 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

According to a national survey carried out in 2006, 84% of the urban population and 32% of the rural population had access to an [[improved water source]]. Those with access in rural areas were served almost exclusively by protected wells. The 68% of the rural population without access to an improved water source relied on surface water (50%), unprotected wells (9%) and unprotected springs (9%). Only 20% of the urban population and 1% of the rural population had access to piped drinking water in their home. Compared to the 2000 survey access has increased in urban areas, but has declined in rural areas, possibly because facilities have broken down because of a lack of maintenance.<ref name="JMP water"/><ref name="Pushak">{{cite web|title=Sierra Leone's Infrastructure. A Continental Perspective |url=http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2011/06/29/000158349_20110629104032/Rendered/PDF/WPS5713.pdf |work=Policy Research Working Paper 571|publisher=World Bank|access-date=6 August 2011|author=Nataliya Pushak|author2=Vivien Foster |pages=31–35|date=June 2011}}</ref>

With a new decentralisation policy, embodied in the Local Government Act of 2004, responsibility for water supply in areas outside the capital was passed from the central government to local councils. In Freetown, the Guma Valley Water Company remains in charge of the water supply.

[[File: Guinea Liberia Sierra Leone Ebola Map August 8 2014.jpg|thumb|upright=1.6|A situation map of the [[2014 West Africa Ebola outbreak|Ebola outbreak]] as of 8 August 2014]]

=== 2014 Ebola outbreak ===

{{Further|Ebola virus epidemic in Sierra Leone}}

Ebola is prevalent in Africa where social and economic inequalities are common. The central African countries are the most prevalent of EVD, like the Democratic Republic of Congo, Sudan, Uganda, and Gabon.<ref>Agyepong I. "A Systems View and Lesson from the Ongoing Ebola Virus Disease Outbreak in West Africa". ''Ghana Medical Journal'' [serial online]. September 2014;48(3):168–172. Available from: Academic Search Complete, Ipswich, MA. Retrieved 28 October 2014.</ref>

In 2014 there was an outbreak of the Ebola virus in West Africa. As of 19 October 2014, there had been 3,706 cases of Ebola in Sierra Leone, and 1,259 deaths, including that of the leading physician trying to control the outbreak, [[Sheik Umar Khan]].<ref>"[http://apps.who.int/iris/bitstream/10665/137091/1/roadmapsitrep22Oct2014_eng.pdf Ebola Response Roadmap Situation Report]". WHO (22 October 2014)</ref><ref>[[Ebola virus epidemic in Sierra Leone#cite note-Ebola WHO 22 oct-1]]</ref> In early August 2014 [[Guinea]] closed its borders to Sierra Leone to help contain the spreading of the virus, which originated in Guinea, as more new cases of the disease were being reported in Sierra Leone than in Guinea. Aside from the human cost, the outbreak was severely eroding the economy. By September 2014, with the closure of borders, the cancellation of airline flights, the evacuation of foreign workers and a collapse of cross-border trade, the national deficit of Sierra Leone and other affected countries was widening to the point where the IMF was considering expanding its financial support.<ref name="IMFebola">{{cite news|url=http://www.bignewsnetwork.com/index.php/sid/225466201|title=The economic impact of Ebola may kill more people than the virus itself|date=6 September 2014|access-date=8 September 2014|publisher=Big News Network.com}}.</ref>