Sierra Leone: The Aftermath of Cholera

This past year Sierra Leone suffered the worst cholera outbreak in its history. A waterborne disease that infects the intestine and is transmitted through contaminated water and food, cholera has ravaged 12 of the country’s 13 districts. The World Health Organization reported 20,736 cases with 280 deaths since the beginning of 2012.

I arrived in Freetown, the capital, at the tail end of the rainy season. The outbreak had declined, thanks in large part to the response of international aid organizations to ensure chlorination of water sources and the promotion of hygiene practices. I wanted to take measure of the aftermath, to examine how living conditions in the slum settlements made them the worst hit of all the areas.

Freetown is a coastal city, sitting on a peninsula jutting out into the Atlantic and built to support less than half the current population of 2 million. The Western Area where Freetown is located accounted for 50 percent of all the cases in the outbreak. These slum settlements, strung out along the city’s bay, share a number of characteristics: extreme poverty, overcrowding, and unemployment. Homes are typically constructed of corrugated metal, possessing open dirt floors and makeshift roofs. Sources for water in the slums are consistently insufficient for the population and a consortium of non-government organizations have supplemented the supplies with tap stands.

“Cholera spreads quickly through such conditions,” says Foday Sessay. Born and raised in the Susan’s Bay slum, he is a 33-year old volunteer working in his community and at a health clinic built by the non-government organization Save The Children. “People are eating, drinking, relieving themselves in the same place. In one home, twenty people share three rooms. Two became sick with cholera.”

Living space is not only crowded but the intense proximity of the slum extends into the households themselves: In Susan’s Bay, I met a family of 86 that occupies a 10-room flat with no bathroom. Open defecation is common while public bathrooms are generally in poor order and are costly to use. To use a toilet costs around 500 Leones, or $0.11 cents, which is striking when according to statistics from the World Bank the majority of the 6 million people of Sierra Leone live on less than $1.25 a day.

Sanitation on the whole is consistently poor or nonexistent. On a hot afternoon in Kroo Bay, youths employed by Masada Energy clean up the main street. Cars and motorcycles crisscross and weave by. The Masada youths dig trash from the clogged drainage near a bridge, fill their wheelbarrows and then promptly dump the waste into the river below. They spend an hour repeating this process before leaving.

The dumpsites used by government trucks and private companies reside within the city. In the center of Freetown is the Kingtom dumpsite in Grey Bush, a community of 12,000. It receives a large portion of the city’s garbage including human waste, which is then used by farmers to grow vegetables and provide income. Young men stand in a wasteland burning garbage for copper. In the rainy season that stretches from May to December, shanty houses at the base are flooded with water and refuse. In the dry season, stagnant pools of water build up and are used as alternative sources of water to wash.

Daniel Bob Jones walks through the dumpsite overlooking his community. He is a resident of Grey Bush who manages the area’s only latrine and a coal business and is also the area’s health management committee chairman.

“Each year the rain arrives and each year we flood,” he says. “Most of our water has no way out. They are a breeding ground for mosquitoes and malaria.”

He points to a small pool of water where children splash. In the center is a private latrine on stilts.

“This is not safe, you see? Cholera is not our only problem.”

Later, Mr. Jones stands at the edge of White Man’s Bay, a small fishing wharf. This is one of the main sewage outlets. To his right, fishermen unload mackerel and snapper. To his left, a dark stream of sludge empties into the bay.

Unsafe water sources and poor sanitation create a dangerous combination for waterborne diseases to spread rapidly. Claire Seward, advocacy campaigns coordinator for Oxfam, sees the recent outbreak and the measures taken to contain it as short-term benefit versus long-term gain.

“The tragedy with having a cholera response is that $10 million dollars was pumped into this country for short-term activities that have no long-term benefits. We spent a whole lot of money chlorinating buckets of water. That won’t help people a week after we finish. What needs to happen is to focus on the people who don’t have clean drinking water and don’t have proper toilets and people will continue to get sick until that gets addressed.”

Fatima Bangura, 58, lost her eldest son to cholera in July, a month after the disease saw a resurgence. Her voice is slow and lilting in Krio, the English-Creole lingua franca. Sitting in the shade of her home, she recounts the speed with which she lost her son Idrissa Turry, 35.

“He was feeling sick in the morning,” she says of that Sunday in July.

She had taken Idrissa to the community center hospital.

“They gave him some treatment and went home,” Fatima says. “We buried him the same day.”

Across from the Bangura home, separated by a small patch of barren dirt, is Mariatu Kamara, 33. She also lost her 4-year-old son to cholera the same day.

“It is only left to God. Only God can rescue. The only aid we’ve received is from NGOs. We have never received anything from the government before.”

When I arrived the streets were celebrating the peaceful re-election of President Ernest Bai Koroma. He had declared a national emergency in August to deal with the cholera outbreak, close to seven months after it started.

While the outbreak has receded, the danger for another remains. The core of the problem lies in an infrastructure unable to cope with a large urban population. Until the issues of water and sanitation are seriously addressed by the new government, the poorest of the world’s poor will remain vulnerable to nineteenth-century diseases like cholera.