Sierra Leone: Mitigating health risks in the wake of disaster

FREETOWN --- On the morning of 14th August 2017, people in Sierra Leone awoke to tragic news. Following torrential rains, landslides had devastated communities in and around the country’s capital, Freetown. The landslide started in the Regent area, high on the slopes in the eastern part of the city, but flash floods, mudslides and boulders then cascaded down the mountainside, eviscerating everything in their way. It was a tragedy of immense proportions. Overall, 502 bodies, and 139 body parts have since been extricated from the rubble, while about 500 people remain unaccounted for. Close to 6,000 people were displaced with many survivors currently living in camps and temporary shelters.

The health sector responds

With support from partners like WHO and UK Aid, the National Emergency Operations Centre at Sierra Leone’s Ministry of Health and Sanitation was immediately activated. Hospitals were mobilized to provide urgent trauma care and teams assembled to safely bury the dead. Clinicians as well as mobile clinics were deployed to support essential healthcare provision within the affected areas, while mental health nurses walked camp-to-camp, door-to-door, providing vital psychosocial support.

Infection Prevention and Control (IPC) was a further concern, with burial and search and rescue teams trawling through floodwaters to retrieve survivors and bodies. Trainings were quickly provided to support the correct use of protective gear, safe burials and decontamination of the mortuary at Connaught Hospital. Together with the Ministry, WHO also supported psychosocial care and training for staff and volunteers who had been working on the frontline of the response.

Preventing outbreaks of infectious diseases

Beyond emergency care, however, it was essential to take action to mitigate risks of outbreaks of infectious diseases. Assessments done in the days following the disaster showed significant damage to water and sanitation systems. This increased risks of diarrhoeal diseases in affected areas, while malaria remained an ongoing threat. To this end, the Ministry of Health and partners continue to monitor trends of particular diseases and to conduct enhanced surveillance in affected communities.

“Cholera was a particular concern, given that the country has experienced severe outbreaks in the past,” says Robert Musoke, Emergency Preparedness Lead at WHO Sierra Leone. “It was critical to ensure Sierra Leone was not only actively preventing but also preparing for any potential outbreak, and doing everything possible to protect vulnerable and displaced communities from such health risks.”

Accordingly, hands-on support and refresher trainings were quickly provided to hundreds of healthcare workers so that they could know how to detect, report and treat cholera and other outbreak-prone diseases, alongside procurement and distributions of additional diagnostic and treatment supplies. Using existing platforms, communities and camp residents were also engaged on disease prevention, including handwashing, food hygiene, and the need to treat all water before consumption.

Meanwhile oral cholera vaccines (OCV) were quickly deployed to the affected areas, with support from Gavi, the Vaccines Alliance WHO, UNICEF, the UK Government, MSF and hundreds of health workers and volunteers. After a successful application to the International Coordinating Group, the vaccines were received in country and campaign implementation began all within three weeks, aiming to reach 500,000 people across 25 high risks communities in the Western Area Urban and Western Area Rural districts to offer valuable additional protection against the disease.

Sustaining emergency preparedness for greater health security

While the country looks towards recovery, the tragedy reiterated the clear and profound need to sustain strong capacity for disaster risk reduction.

“The health sector response to the floods and landslide has been strong, quick and collaborative but when it comes to emergency preparedness, we must always push to do more,” adds Musoke. “Disasters often strike with little warning but some can be prevented. Efforts to mitigate the effects of environmental degradation, waste disposal practices, planning of housing and prediction of weather patterns require strengthening. All the various tiers of the health system, from communities right up to national and district coordination structures, must also be ready to work together to mitigate and respond to emergencies when they occur.”

Through its new Health Emergencies programme, WHO’s response to the floods and landslides event has been supported by the UK Government (UK Aid), Gavi, CDC, the International Federation of the Red Cross and other health partners. The Organization has provided support in a wide range of areas from case management to IPC, community engagement, mental health, surveillance, laboratory capacity strengthening and more.