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Bull World Health Organ vol.81 n.12 Genebra Dec. 2003
WHO supports Liberia's health crisis appeal
Liberia launched an appeal for US$ 16 million to provide emergency health care to its beleaguered population in 2004 and to start rebuilding its collapsed public health system after systematic looting and destruction during the last decade of conflict.
WHO officials said they hoped that the appeal launched on 19 November just a month after the 14-year civil war was officially declared over would be followed by a donors' conference in the new year similar to one in Madrid last month that raised US$ 33 billion in reconstruction loans and grants for Iraq.
Omar Khatib, the WHO representative in Liberia, said that United Nations organizations had started to assess the West African country's reconstruction needs after 2004, to find out how much money to appeal for at a donors conference which they hoped would take place in New York in January or February next year.
Restoring Liberia's public health service is a priority along with agriculture, education, communication and transport, Khatib said. Of more than 200 doctors and 600 physicians' assistants in Liberia before the war, he said that only 25 doctors and 150 paramedics remained in place after hundreds of thousands of people fled for their lives.
"We will have to work very hard to bring back the health system to where it was before the war," Khatib said, adding: "We don't expect funds at the levels of [those donated to] Iraq. We hope donor countries will be as generous with Liberia as they were with Iraq."
Fighting has ceased and the new transitional government combining former ministers under ousted leader Charles Taylor and rebels was sworn in in September, but instability and the absence of law and order throughout the country still hamper relief efforts.
Chaos and violence this year has meant that only nine per cent of the US$ 10 million aid package could be spent on health, leaving the vast majority of people with little, if any, health protection.
WHO is actively supporting NGOs who are filling Liberia's health care void, including Medécins Sans Frontières, Save the Children, Medécins du Monde, International Medical Corps, World Vision and the Red Cross. UK-based NGO, Merlin, is providing health care to 200 000 refugees and displaced persons, while UNICEF is trying to reduce infant and maternal mortality, improve immunization and prevent the spread of HIV/AIDS.
The UN World Food Programme is providing food supplies, as most Liberians can barely feed themselves and suffer from malnutrition. To assess the population's nutritional state outside the capital, an expedition to Tubmanburg, 60 km north-east of Monrovia, found 15 per cent with acute malnutrition and a further 57 per cent with chronic malnutrition.
Despite their dire need only a third of Liberia's three million population, living in and around the capital, Monrovia, can be reached easily by health care workers while many of the remaining two million people in the rest of the country are largely cut off.
Diseases such as cholera and diarrhoea, initially widespread and resulting largely from unclean water supplies, have now been brought under control thanks to a collaborative project between WHO and other international agencies, to routinely chlorinate wells in both Monrovia and Buchanan in Grand Bassa County, Liberia's second largest city.
In August there were 2700 cases of cholera but by October the clean water project had helped reduce these to about 1000. In October 240 cases of bloody diarrhoea a week were recorded also caused by poor sanitation. However, Dr Luzitu Simao, the WHO desk officer in charge of Liberia, said laboratory tests have since shown these were not Shigella type 1 which causes epidemics.
Very little health care work has been possible outside the capital, but WHO and its partners have visited various parts of the country sometimes by boat or plane because of the volatile security situation to get a picture of the nation's health situation. They conducted a health care assessment in Tubmanburg as well as the northern towns of Vonjama and Zwedru in September and Buchanan in October. These visits provided a basis for the November appeal and planned donors conference.
WHO, UNICEF and Ministry of Health staff also completed a measles vaccination campaign in Tubmanburg and the surrounding districts, as only 29 per cent of Liberian children are protected against the killer disease.
An initial US$ 16 million would go towards providing emergency health care for communicable diseases like cholera and to treat people with malaria and diarrhoea and improve immunization for polio, tetanus, measles and yellow fever. The funds would be used to rebuild, staff and equip six strategic hospitals and several primary health care centres and start a massive recruitment and training programme for health workers.
"The most urgent thing now is to address communicable disease and malnutrition and at the same time start thinking about reconstruction," said Simao. "Within the first six months of 2004 we would like to have the communicable disease situation under control, a minimum health service functioning and a minimum picture of what is going on in the country," Simao said.
The November appeal to donors was launched simultaneously in Geneva, New York and Rome with 40 other crisis-hit countries under the annual Consolidated Appeal Process.