Bandajuma - each one of them hosting between 4,000 and 8,000 refugees - MSF has established a system of home visitors to assist in case of disease and health problems and proactively to seek ill people to prevent outbreaks.
MSF is providing health care and access to health structures to around 30,000 Liberian refugees who are presently living in five camps scattered outside the town of Bo in south eastern Sierra Leone.

Since early 2002, war in Liberia has forced more than 60,000 Liberians to seek protection inside neighbouring Sierra Leone. "At present very few refugees are coming into Sierra Leone from the southernmost border crossing at Zimmi, but further to the north refugees are still coming into the country," said Anne Decoster, an MSF nurse. "During one weekend in mid October more than 3,000 refugees entered Sierra Leone from the crossing at Kailahun."

Decoster is in charge of the MSF health post at Gendema crossing point. "According to the refugees," she added, "there is still fighting in northern Liberia and almost the entire population of Lofa province - accounting for one third of Liberia - has fled." In the camps of Jembe, Jimmi Bagbo, Gondama, Gerihun and Bandajuma - each one of them hosting between 4,000 and 8,000 refugees - MSF has established a system of home visitors to assist in case of disease and health problems and proactively to seek ill people to prevent outbreaks. Home visitors are primarily Liberian refugees with a health care background, trained and supervised by MSF. MSF is responsible for the medical screening of new arrivals to the camps as well. "Generally the refugees are in good shape when they arrive and most cases are common and chronic diseases," Rekha Nielsen, an MSF nurse, explained. She is responsible for the home visitors in the five camps. "Refugees are vulnerable people and we have to respond accordingly. Therefore MSF is presently opening centres for supplementary feeding for malnourished children in the camps. It has clinics in the vicinity of the camps as well to provide medical assistance, and is assisting referrals of acute cases to the public hospital in Bo, partly supported by MSF."

"Our clinics are located in the nearby villages," explained Catherine Ulleberg, field responsible for MSF in Bo. "Our aim is to provide equal access to health care to refugees and to Sierra Leoneans. This is meant to ease possible frictions between the refugees and the host community."

A medical survey recently showed a low immunisation rate against measles among the population in two of the five camps and therefore a vaccination campaign is being planned. "We hear quite a lot of complaints through the home visitors and from the refugees themselves, especially regarding lack of food in the camps," said Nielsen. "Therefore MSF is monitoring the food situation, but also access to water and sanitation is being followed closely because both are essential to the health situation in the camps.

Refugees are provided with a standard monthly food ration consisting of; 13.5 kilo's of bulgur; 1 kilo of corn-soy blend; one bag of lentils or beans; a litre of vegetable oil; and one handful of salt per person. That's it. No fruit or vegetables." People are often selling parts of their rations to get a more balanced diet, buying dried fish and vegetables at the camp markets. If they have nothing left to sell, they have to borrow food from neighbours in the camp but that means they have to pay back a part of their debt after each food distribution - they end up in a vicious circle because of that. Refugees also are complaining about shelter conditions.

The lack of sufficient shelter is not only very unpleasant during the rainy season, it also increases the risk of respiratory diseases. Last month MSF sent a letter to UNHCR addressing these issues. In Bo MSF has 8 expatriate staff and employees 74 local staff on a permanent basis. The organisation has programmes in three districts in the Southern province and in Koinadugu District in the Northern province. MSF began working in Sierra Leone in 1995.