Following the renewal of fighting in Freetown, the MSF team had to leave the capital on 26th December 1998. On the 31st of January, four volunteers were able to re-enter the war-torn city and restart the surgical program in Connaught Hospital. In 12 days, 85 wounded patients were treated, of which 29 were amputees. At that time, the revival of clashes around the Freetown peninsula resulted in the renewed admission of mutilated people to the hospital. Since February, the MSF surgical team working alongside hospital personnel has carried out 713 operations. MSF's surgical activities have been primarily focused on war related injuries. However, MSF has also been working on medical and sanitary care in a camp for 747 displaced war-wounded and amputated people which houses many ex-surgical patients from Connaught Hospital, and their families. MSF began its work in Connaught, Freetown's main hospital, during the military coup d'état of May 1997. Urgent surgical programs were established during crisis periods: from February to March 1998, 960 operations were conducted, and in May 1998, the team had to face a new surgical emergency. MSF pursues other support programs to health structures within Freetown, as well as in Bo and Pujehun. 22 MSF volunteers were working in Sierra Leone at this time.

Since 26th April 1999, the surgical team from the international medical aid agency MSF working in Connaught Hospital in Freetown has witnessed a new rise in the number of mutilated patients: in four weeks, 56 recently war-wounded patients have been admitted of which ten had at least one hand deliberately amputated. Of these 56 patients, 24 were children under the age of 15.

This report details one month of hospital activities, from 26th April to 23rd May 1999. It describes the wounds inflicted on those admitted, and briefly recounts the stories of 17 of these patients. It also contains excerpts from the diaries of MSF expatriate volunteers.

These victims of these mutilations are essentially civilians, originally from the country's interior, and particularly from the regions of Port Loko and Masiaka, where these most recent series of attacks have been taking place.

These testimony accounts only concern the people who survived their mutilations and managed to reach the Connaught Hospital. It is feared that the total number of mutilated persons is far higher than the number of those admitted to the hospital. Indeed, the number of admissions is directly related to the possibility of the wounded to move freely. The team regularly receives new patients suffering from terrible wounds, including people who have gone for weeks without treatment. Given the nature of these injuries, one can imagine that many of those wounded are unable to reach the hospital and are left to die along the road. In fact, many of the patients from whom testimony was taken, mention others who were wounded and of whom nothing further has been heard.

The fact remains that much of Sierra Leone is currently inaccessible to humanitarian aid agencies. It is in these parts of Sierra Leone that the needs of the population are undoubtably the greatest. Under constant threat by armed groups, these people are in desperate need of humanitarian assistance, and most importantly, protection.

Background

In February 1997, after six years of bitter civil war, an elected government took power in Sierra Leone. However in May of the same year a military coup d'état overthrew the government. The regional peace-keeping force ECOMOG was expelled from the capital Freetown, and the leaders of the military coup convinced the RUF (Revolutionary United Front) rebels to join their cause. This alliance was able to maintain power until February 1998, when the ECOMOG forces retook the capital and various other parts of the country. During these events, two MSF volunteers were captured and held hostage by an armed group for two weeks before being released.

In March 1998, armed groups began a campaign of terror in regions they had taken control of in the east and north of the country. This consisted of destroying villages, pillaging harvests, mutilating and executing civilians. Tens of thousands of Sierra Leonean civilians attempted to flee the violence and moved to safer regions and neighboring countries. At the end of 1998, after an active campaign, the 'rebels' succeeded in re-entering the capital, where heavy fighting ensued against the government forces. Since then, the 'rebels' have been forced out of the peninsula around the capital, but still currently control the areas around many roads and towns. This period of status quo has been accompanied by a new campaign of terror including mutilations, kidnappings and the destruction of property.

Human rights violations

Mutilations and other forms of torture are not a new phenomenon in Sierra Leone. Between 1992 and 1999 an untold number of civilians were assassinated or mutilated over the course of attacks undertaken by different armed groups.

In Freetown alone it is estimated that in January/February 1999, approximately 6,000 people died. The terrible wounds suffered by the patients of Connaught Hospital also serve as indications of the level of brutality.

In May 1998 MSF issued a report regarding atrocities against civilians. At that time, the Connaught Hospital received 115 patients, most of whom were severely mutilated.

One month of activity in Connaught Hospital

Since the 26th April 1999, 271 patients have been operated on at the hospital, 172 of whom have suffered war-related wounds (new cases and follow-up cases). Among them, 56 patients were recently war-wounded. Of these:

• 24 were children under 15 years-old, including one 4 year-old child, who died due to machette wounds to the head
• 10 had suffered amputation by machette (8 having both hands amputated, 2 having 1 hand amputated). The others were suffering from gunshot wounds, cutlass wounds, lacerations, fractures.

MSF team's accounts

The following extracts are taken from the diaries written by MSF expatriate staff working in Sierra Leone.

May 6th 1999

'We visited Songo, Mabang, Mile 38 and Masiaka. We picked up nine patients; three from Masiaka: one pregnant women and two amputees. In Mile 38, there looked to be around 500-700 people in very bad condition: full of skin infections, malnutrition, freaked out and frightened.'

May 8th 1999

'Today we received one man from Port Loko, attacked on Wednesday, carried on a door to Pele and then on a canoe to Freetown. We also received two out of the bush from near Waterloo, after 12 days in the bush. And one woman yesterday evening, suffering from attempted decapitation.'

May 10th 1999

'We received the first 15 from Port Loko (mostly amputees). Seven double amputees, two attempted amputees, the youngest is just four years-old.'

The week of the 16th of May 1999

'Over the week, we have seen wounded continue to arrive from villages around Mile 38. They report a lot of killing and chopping. We are seeing people arriving just butchered (not just the hands). One man had six fractures; including most of his shoulder hacked off by a machete. One family lost everyone. The last child in the family died just after arriving. Her head was completely chopped open with a machete. Many arrived with nothing; all their clothes soaked in blood and puss and no shoes or anything to sleep on, nothing to eat or drink from..'

Patients accounts

Testimony was taken from 17 patients who arrived at the Connaught from 2nd May to 15th May. Most of these patients had suffered severe mutilations. Their names are not given for security reasons.

Interview 01

Sex: F
Age: approximately 8 years old
Date of Admission: 2/5/99
Date of incident: May 1

Wound: Deep laceration to the right cheek. Fracture of the occipital bone.

Description of incident: (Interviewed the mother as the child is mute from birth. The mother ran into the bush at the time of the attack and so was not a witness. The father was a witness but was not present during the interview. He returned to their village to tell the people that his daughter was alive.)

Armed men attacked their village in vehicles around 5 a.m. shooting in the air. They looted everything from the place and there was some burning. They started just chopping at the people as they ran past them. This girl was first struck on the side by a machette which did no real damage. The second cut was on the face.

The father carried the girl for 9 miles through the bush to safety. Her cheek bone was completely broken from the machete blow.

Interview 02

Sex: F
Age: 17 yrs
Date of Admission: 3/5/99
Date of incident: April 17th (approx.)

Wound: Laceration on the right lower leg.

Description of incident: (she is still in shock.)
She and her family and other villagers had been hiding in the bush since before December. On 17th April, armed men entered the village in the morning, and called all the people together for a meeting. When they gathered together, they heard ECOMOG was on its way to attack. There was panic and people starting running. The armed men started chopping at people and also ran after some. She was hit on the leg when she was running.

Her brother and sister were taken by the armed group. She saw 5 dead, and "many wounded in the bush."

Interview 03

Sex: F
Age: Adult
Date of Admission: 3/5/99
Date of incident: April 17, 99

Wound: Fingers of the right hand cut

Description of incident: She and her family and village had been hiding in the bush for over 6 months. Armed men came in the afternoon and began shooting wildly. There were many who came to attack. Everyone started to panic and run. She was caught and they chopped her hand. They told her to go and ask Kabbah (The President of Sierra Leone) to give her new hands.

They pulled her 3-year-old child off her back. A young boy started to kick and beat it and threatened to kill the child. They started to yell at her and told her to take her child and go away. She saw one dead and many others who had been cut.

Interview 04

Sex: M
Age: Adult (20-30)
Date of Admission: 3/5/99
Date of incident: May 2 (?)

Wound: Double amputation of hands, lips and surrounding tissue cut off.

Description of incident: Patient unable to speak and was unaccompanied.

Interview 05

Sex: F
Age: Adult*
Date of Admission: 3/5/99
*with 10 month baby girl
Date of incident: April 17(approx.)

Wound: Lacerations to the middle of the fingers on the right hand.

Description of incident:
On Saturday at around 2pm, armed men entered their village. She only saw one with a gun. All the people ran into the bush when they saw them coming. The men burned all the houses and followed the villagers into the bush. She and her baby were caught. They held her down and chopped at her hand, and told her to ask Pa Kabbah to give her new hands. They then took the child from her back and started beating the baby. They then ran into the bush.

Interview 06

Sex: F
Age: Adult
Date of Admission: 3/5/99
Date of incident: April 16th

Wound: Internal injury of the left arm from beating.

Description of incident: 
Armed men entered in the early morning without shooting. They started looting and burning the village. The people started running to the bush as soon as they heard the looting start. Some were followed by the perpetrators. She and her 13-year-old son were caught. She was badly beated but not cut with a machette. They took her son and he started screaming and crying. She told him to be quiet and go with them or they would kill him. Then the men told her that because she "gave" her son she would not be cut.

They had been in the bush before for about five months living off of palm kernals (nuts) and casava root.

Interview 07

Sex: F
Age: Middle age
Date of Admission: 3/5/99
Date of incident: unknown

Wound: Lacerations on the head, shoulder and back.

Description of incident: 
Unable to interview the patient as she died just after arrival. Others said that her whole family was killed in front of her, and that she died of a broken heart.

Interview 08

Sex: M
Age: Adult
Date of Admission: 6/5/99
Date of incident: April 30(?)

Wound: Deep laceration on the neck (attempted decapitation)

Description of incident: 
After the village of Mile 4 was attacked, groups of armed men attacked Songo. It was around 11 p.m. The man was with his wife and 3 children. They were in bed. The armed group entered town and burst into peoples' homes. When they heard their door being broken down, they jumped out of bed. When the man left his room he saw a man near the door so he ran out the back. The one inside started shooting. As he ran out of the house there was another man with a machette waiting for him. He hit him on the side of the neck with the machette.

He did not see his family anywhere, and he does not know what happened to the rest of the village. He ran to the bush and spent 1 week alone just outside of town.

Interview 09

Sex: M
Age: Adult
Date of Admission: 6/5/99
Date of incident: 4th May (approximately)

Wound: 2 gun shots; one on each leg

Description of incident: 
The man lived in his home village with his 2 wives, four children, his brother, in sisters-in-law and his brother's child. Armed groups would sometimes pass through the village. The people of his village would run into the bush each time they passed. The population was not harrassed, but these groups would take some food.

The day before Christmas, armed men entered the town shooting and he and his family ran to the bush. They spent 5 months there. He prepared a farm and was getting ready to plant. He thinks that the armed groups heard his rooster and they came early in the morning when it was still dark.

Someone gave the alarm when they saw these men coming and they all ran to the bush again. He was trying to gather the little food together that he still had when his attackers came and shot him twice. His brother heard him crying and came to help him. He was shot and killed. Those remaining villagers came out of the bush after the attack and buried his brother.

Interview 10

Sex: F
Age: 8 yrs.
Date of Admission: 6/5/99
Date of incident: 2 weeks ago (around 24th April)

Wound: Amputation of right hand

Description of incident: One month ago, retreating armed groups from Freetown attacked their village of Mafunta. They entered the village and told the inhabitants to leave. Anyone that was difficult was killed or had their hands chopped off. All their food was looted, and the village burned. Three children were taken, all boys aged 9, 7 and 6 years-old. 2 people were killed in this attack.

The girl ran, with 24 other villagers to the village of Mamoni. Around the 24th April, armed men entered the town in the morning and started yelling at people. They had guns but no ammunition. They captured four people; this girl, her uncle and 2 men. The 2 men were killed on the spot. The girl and the man each had a hand amputated. The child and her uncle were told to go ask Kabbah for new hands.

The mother went back after the attack and took the child to the bush. Three days later they were caught by armed men again who stole their food. They moved to another village called Beng for about 3 days, and then came to Masiaka on the 3rd of May.

Interview 11

Sex: F
Age: Adult
Date of Admission: 6/5/99
Date of incident: About 3 weeks ago (no idea or day or time)

Wound: Deep lacerations on right hand

Description of incident: 
Armed men came to her village and told the inhabitants that they had to come with them to another location to do manual work for them (gathering and preparing food, etc.). They were told if they did this work they would not be hurt. There were more than 30 people all together.

After they finished the work they prepared to go back to their village. They started on the bush path and they were ambushed by the "rebels". Some of the people were caught. They amputated some peoples' hands, others were killed. She saw 5 amputees.

After they were chopped, the armed men ran after them yelling that they should go to Kabbah to get new hands. They returned to their village and spent 3 weeks in the bush. They were attacked again and they ran deeper into the bush.

Interview 12

Sex: F
Age: Adult
Date of Admission: 6/5/99
Date of incident: Approximately April 22

Wound: Cutlass wound to the left leg

Description of incident: 
Armed men told them to leave their village (about 6 months ago), but no one was hurt at that time. They stole food and property and left. The people from the village went to the bush.

In the bush camp there were about 50 adults when they were attacked. It was early evening and only the children were asleep. Armed men entered the camp. There was a lot of confusion and the people ran into the bush, leaving the sleeping children behind. She left 6 children behind. The youngest is only 6 years-old. The armed men were chopping at people when they were running away. That is how her leg was injured.

After the attack left, they returned to the camp to check the situation. All the children were gone. They were able to remember at least 40 children that had disappeared.

They stayed in the bush until the 6th of May.

Interview 13

Sex: M
Age: Adult
Date of Admission: 6/5/99
Date of incident: 3 weeks previously

Wound: Right forearm damaged from heavy beating

Description of incident:
He left his home village of Masampa about 1 month ago after an attack on the village. The attack took place at night Ã?­ there were many 'rebels', but they were not using their guns. They started yelling at the people to bring out food and property. They ran around and entered houses, and finally burned the village. His mother was killed and he saw 2 injured.

He ran into the bush in a group of about 20 people. They were followed and the armed men took about 15 of the 20 people (woman, children, men). He continued in the bush and stayed in a place called Malamina. They were again attacked at night. People started to run and the "rebels" started chopping at them. Some were killed and he saw 2 others "chopped" but he did not see them after that.

He was caught and thrown on the ground with 3 other people. They were beaten with sticks. Finally they managed to escape and ran into the bush for 3 weeks.

Interview 14

Sex: M
Age: 26 yrs
Date of Admission: 6/5/99
Date of incident: about two weeks previously

Wound: Attempted amputation of both ears and RUF carved in his chest and back.

Description of incident: 
About 5-6 months ago, 'rebels' entered his village of Ropat when everyone was asleep. They had only knives (cutlasses). They called all the people to the center of town. He could not move from his bed because he was sick.

They took food and clothes. They also took some people with them to the main road - women, children and men. They were abducted. No-one in the village was killed.

They were attacked a 2nd time, this time during the day. This man was lying under the mango tree as he was still not well. He suddenly saw all the people running away. He was the only one left. He saw them coming at him with a big knife. The asked him to go into the bush and fight with them. He said it was not possible because he was sick. They then tied his hands. They beat him and carved RUF in his back and his chest. Then they tried to cut off his ears.

He was somehow untied before they left. He ran into the bush and found his family there. They lived in the bush for 2 weeks.

Interview 15

Sex: M
Age: Adult
Date of Admission: 6/5/99
Date of incident: about three weeks ago (same attack as the interview 10)

Wound: Amputation of the right hand.

Description of incident: 
They left Mafunta about 5 months ago when they were first attacked. He could remember a number of times that they were attacked since the "rebels" were pushed out of Freetown.

The first time, armed groups came at 6 a.m. The village ran away and no-one was killed. Everything was looted and burned. They went into the bush.

In their bush camp they were attacked again. The armed men took 4 people; 3 men and 1 girl (including him and his niece the 8-yr old above). One man was beaten to death, 1 was killed. The armed men started to scream at the people to bring out the rice that they had hidden. They had no food hidden and so he and his niece had their hands chopped off. They then were told to ask Kabbah for new hands, and to tell Kabbah that "we did our job".

They went back into the bush for about two weeks. They were attacked again.

Interview 16

Sex: M
Age: Adult
Date of Admission: 15/5/99
Date of incident: May 13

Wound: Attempted amputation of the left hand

Description of incident: 
The village was attacked in the morning hours. Armed men entered the town shooting in the air. They went from house to house and demanded whatever they had. They took food and clothes. He and his wife and 2 youngest children prepared to leave, and managed to escape. They ran to a small village in the swamp. They saw that the armed men were following them. He wanted to run but they could not with the children.

The perpetrators gathered him and his family along with others to one place and instructed them to carry the looted property. There were many people. They spent one week with them in the bush.

The 'rebels' then decided they were leaving. They said they would kill his two sons and his wife. They started to take people from the group one by one and put a log on the ground. The people were decapitated, and then the next person was called. He saw 10 people killed and then he was called. He begged them to kill him first before the rest of his family. They said they would not kill him, but instead chopped his hand, and then chased him away into the bush.

He ran to the bush alone. After 2 days he returned to the village and then he saw his wife and children dead.

Interview 17

Sex: M
Age: Adult
Date of Admission: 9/5/99
Date of incident: May 7

Wound: Gun shot to the neck

Description of incident:
People came running into the village saying that 'rebels' were coming. They all ran into the bush. Early the next day they went to check the village. Things were quiet. His wife arrived just coming from another village saying that she saw a car full of soldiers - but did not know who it was. They ran into the swamps in fear of attacks. They heard gunshots and then a grenade exploding, so they kept running. They slept one night in the bush, and then moved to the next village.

The following day they heard shots and big explosions close by, so they ran even further. They stayed there for two months. Then they heard that the nearby town had reinforcements and so went there for safety.

They stayed in the town for another two months. One night sitting outside his house, he heard people talking of an attack on a nearby village. Then an armoured vehicle began firing. It was too late in the night to see what was happening and so he went under the bed with his daughter of 10 years.

Armed men entered his house and started looting food, and he heard them saying that anyone left should be shot. Then he heard them say they needed to check the rooms of the house. They entered his room and pointed a torch on his face. They called him out and told him to leave the child.

They started beating him and asking whom he was fighting for? He said he was a civilian and not fighting for anyone. They accused him of lying and ordered him to sit on the ground. His arms were not working properly due to the beating.

Three men came up to him - one quite young. One pointed a gun at him and shot him in the neck. He fell and waited. The men continued to loot the house. On their way out they stepped on his feet to see if he was alive.

When they left he sat up and saw houses on fire so he ran to the bush. He met some neighbours in the bush. They stayed for four days in the bush before making his way to Freetown.

Conclusions and concerns

It is feared that the number of mutilated persons is far higher than the number of those admitted to the hospital. Indeed, the number of wounded admitted to the hospital is directly linked to their possibility to move freely. The team regularly receives new patients suffering from terrible wounds, including people who have gone for weeks without treatment. Given the nature of these injuries, one can imagine that many of those wounded are unable to reach the hospital and are left to die along the road. In fact, many of the patients from whom testimony was taken, mention others who were wounded and of whom nothing further has been heard. The fact remains that much of Sierra Leone is currently inaccessible to humanitarian aid agencies. It is in these parts of Sierra Leone that the needs of the population are undoubtably the greatest. Under constant threat by armed groups, these people are in desperate need of humanitarian assistance, and most importantly, protection.