Post-crisis country

Wealth, but no health

Pregnant women in Sierra Leone have a legal right to free medical care. But the country lacks hospitals and midwives to provide it. The government refuses to use enough revenue from the extractive sector for health care. The reality of mining makes a mockery of any social policy agenda. By Anne Jung
Those working for  a pittance in the extractive sector are excluded from social services: washing diamonds in Sierra Leone. Anne Jung Those working for a pittance in the extractive sector are excluded from social services: washing diamonds in Sierra Leone.

In 2009, Sierra Leone’s President Ernest Bai Koroma proclaimed the dawn of a new era and reaped international applause for a piece of legislation. To lower the West African country’s extremely high maternal and infant mortality rates, the government promised free care for pregnant women, nursing mothers and children under the age of five. It seemed a necessary step. One in eight mothers in Sierra Leone die in childbirth.

Koroma’s move raised high hopes. In view of his country’s wealth of natural resources and an economy growing at more than six percent a year, implementation of the law would certainly have been affordable. Today, however, there is widespread disappointment.

Three years after the law was passed, the problems are not solved. According to Amnesty International, the majority of mothers-to-be are still unaware that they have a right to free medical care. Poorly paid healthcare workers continue to flaunt the law by charging high fees that only few families can afford. The cost of medical care in Sierra Leone is among the highest in Africa.

What is more, few mothers have access to ante­natal care at a health centre or hospital. “What good does it do a pregnant women to be entitled to an ultrasound scan if the nearest scanner is out of reach, hundreds of kilometres away?” asks Joseph Pokawa, who heads the Makeni office of the Network Movement for Justice and Development NMJD. This human rights organisation has spent more than 20 years working for better living conditions in Sierra Leone. There are 12,000 people for every doctor across Sierra Leone as a whole, as Pokawa points out, and the ratio is even worse in rural areas.

Mere propaganda

Frustration over shocking healthcare shortages occasionally leads to violence between healthcare workers on one side and patients and their families on the other. The NMJD sees such incidents as an expression of impotence on both sides. The acclaimed law will remain a paper tiger, it says, unless the government finally channels more revenues from the extractive sector into the healthcare system.

Koroma was recently re-elected. In the electoral campaign, health policy was a controversial issue. In 2007, the government set up the formally indepen­dent Health for All Coalition, which is largely financed by a fund headed by the president’s wife. In 2012, the Coalition published a study proclaiming medical successes that were no more than government propaganda. If its figures were correct, Sierra Leone would have a higher rate of medical consultations per head than Germany. Another statistic contained in the study suggests an extremely high level of public satisfaction with the government’s health policy. On the other hand, the authors make absolutely no mention of problems of access to health care services enshrined in legislation. The government is covering up a scandalous state of social affairs.

Civil society groups have warned for years that militarily pacified Sierra Leone is heading for renewed conflict. After a civil war that claimed more than 20,000 lives from 1991 to 2002, a gulf is now opening between the desperate majority and a minority which profits from the government’s economic liberalisation policies.

Blessed with fertile soil and abundant natural resources, Sierra Leone is actually a rich country. But diamond, gold and rutile mining has raised only few people’s living standards. And things are unlikely to improve when oil production starts in the near future. The government tends to sign contracts that absolve the managers of private-sector companies from any social responsibility. The result is modern-day slavery and massive environmental damage. Expropriations and evictions are a daily occurrence. At the same time, the government hardly levies export taxes, thus forsaking state revenues in favour of fast private profit. Private interests thus take precedence over social services for ordinary people.

The contrast between the supposed right to health and actual exploitation is particularly stark in the diamond-rich Kono District around the regional capital of Koidu. Kono is both the richest and poorest part of Sierra Leone. This is where the civil war started. At the beginning of the 1990s, the Revolutionary United Front effortlessly recruited thousands of frustrated young men who felt they had no prospects. Both sides in this war financed arms deals by trading in conflict diamonds. The fight for Koidu was accordingly fierce.

Since the end of the war, international corporations have been able to export the precious stones without having to spend large amounts of money on the protection they needed during the civil war. Since 2006, local mining rights have been held by the diamond group Koidu Holdings. To reach deeper rock strata, the company is blasting ever larger holes in the landscape close to local communities. Koidu has nearly 90,000 residents, one in ten of whom are reckoned by NMJD to have been directly or indirectly affected by evictions in the concession area.

The mining operations create lots of dust; people suffer from headaches, watery eyes and respiratory disorders. Outside the town, new homes are being built, but there is no land for farming to provide a livelihood. The massive domestic violence perpetrated against women and children since the war is even worse where thousands of people have been compulsorily resettled.

Making matters worse, up-to-date equipment is making human labour redundant in the diamond industry. Subsequently, the majority of the people today lead marginalised lives with scarce access to clean water, electricity or employment. Before Christmas, the NMJD reported of strikes in the diamond mines. The NGO pointed out that mining companies did not keep promises of raising wages and improving social security.

Redistribution is necessary

During public protests against Koidu Holdings in 2007, two demonstrators were shot to death by employees of the company. In 2011, two teenagers looking for diamonds at night were killed on the company’s premises. President Koroma’s government responded to these shocking events by investing millions of dollars in staffing and equipping the police force. Koidu is only one example. Elsewhere, environmental damage by rutile mining or the expropriation of huge areas of land for growing bio-fuel crops also bear witness to an economic and social policy that is fuelling conflicts instead of solving problems.

Around diamond-rich Koidu, NMJD members keep up their efforts to make local residents aware of their rights. Legal advisers help people who have been dispossessed or evicted; they broker out-of-court settlements and provide support for destitute citizens with domestic problems – because troubles do not always stem from land conflicts; many women and children seek refuge from domestic violence. The lay lawyers hold local meetings and explain basic rights – such as the right of pregnant women to receive free medical care. But the activists know that lasting peace in Sierra Leone is only possible if wealth is distributed more fairly and if the right to a decent life exists on more than just paper. Without that, the future holds more mass poverty and renewed violence.

medico international
Network Movement for Justice and Development NMJD

Related Articles


Achieving the UN Sustainable Development Goals will require good governance – from the local to the global level.


The UN Sustainable Development Goals aim to transform economies in an environmentally sound manner, leaving no one behind.