[an error occurred while processing this directive]
BBC TwoNewsnight
Last Updated: Thursday, 4 January 2007, 16:45 GMT
Sierra Leone's failing health
By Julia Mackenzie

House in Sierra Leone
Around 70% of people in Sierra Leone live below the poverty line

Five years after the end of the civil war and despite a multi-million dollar aid budget, a growing health crisis is developing in Sierra Leone.

This small West African country is heavily dependent on foreign aid, particularly from the UK - with over 60% of its budget supplied from abroad.

It is estimated that up to 40% of the population remain traumatised by the war, yet the country has just one trained psychiatrist.

Despite the aid there is little basic infrastructure, and the largely privatised healthcare system is beyond most people's means, forcing them to seek alternative, potentially dangerous healthcare, such as witch doctors.

New doctrine

The UK's only "successful humanitarian intervention", Sierra Leone continues to be held up by Tony Blair as proof of the success of the "new doctrine of international community" introduced in a 1999 speech which justified later interventions into Afghanistan and Iraq.

In total Sierra Leone receives over $300m per year - although its population is just five million people.

But the country has few roads, little running water and less than 10% have access to electricity.

According to a British assessment Sierra Leone is unlikely to meet any of its Millennium Development Goals.

Life expectancy is 41 years, the 8th worst in the world, and Sierra Leone has the highest maternal mortality ratio and child mortality rates

Life expectancy

The statistics are grim. In 2005 Sierra Leone was ranked 176 out of 177 countries in the UN Human Development Index (HDI). Life expectancy is currently 41 years, the 8th worst in the world, and Sierra Leone has the highest maternal mortality ratio and child mortality rates in the world.

Pa Bassi
Unable to afford medical treatment, many turn to witch doctors
The healthcare system was largely destroyed in the war along with much of the other vital infrastructure. Now the Sierra Leone government is struggling to improve facilities - many of which were burnt down or destroyed.

In some areas there is a skeletal system in place, heavily subsidised by foreign aid, and supplemented by healthcare charities and aid agencies. Foreign non-governmental organisations supply 60% of the Ministry of Health's budget, and spend almost double the amount the government spends on healthcare.

But the system the Government has developed is largely privatised - meaning that patients are charged a fee for treatment they receive. When 70% of the population live below the poverty line, and 26% live in extreme poverty the costs are all too often seen as an unaffordable luxury. Children, pregnant women and the elderly are all supposed to receive free treatment but in practice that doesn't always happen.

Witch doctors

So for many people in Sierra Leone other forms of care have become the norm.

I was taken to visit a local witch doctor, Pa Bassi, on the outskirts of Freetown. The two hour journey to get to his mud built house is regularly undertaken by those who come to visit him. On the day I visited he told me that he had 10 patients waiting to see him. He specialised in the treatment of mental disturbances.

It has been estimated that up to 40% of the population of Sierra Leone have been traumatised by the effects of the war and require psychiatric help. But the country has only one psychiatrist, and only one mental hospital. Only the very disturbed are admitted - so for the many people suffering from less severe mental illness, there is no-where else to go.


Pa Bassi administers perfume eye-drops
Pa Bassi claims putting perfume in people's eyes is "good for the brain"
Pa Bassi offered to show me one of his standard treatments. It was perfume.

At the side of his house his patients waited. Because they were mentally disturbed, many of them had been restrained - chained to heavy objects to prevent them from running away.

Pa Bassi demonstrated - pouring perfume in the eyes of two of the boys waiting to be seen. This, despite their screams, he claimed was good for the brain - as it cleared out the system.

So great is the stigma of mental illness, that people leave their relatives with him, and sometimes never return. My translator told me that Pa Bassi was a humanitarian because he saw patients without charge. A woman I spoke to had paid for treatment by giving vegetables in return.

In a country which is so desperately poor it is little surprise that such forms of health care flourish. People I met in Sierra Leone wonder when life is going to get better. With so much foreign money being committed here one can only hope it is soon.


The BBC is not responsible for the content of external internet sites

Has China's housing bubble burst?
How the world's oldest clove tree defied an empire
Why Royal Ballet principal Sergei Polunin quit

banner watch listen bbc sport Americas Africa Europe Middle East South Asia Asia Pacific