As Aid Workers Return, Liberia Is Unsafe and in Ruins

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"The population is desperate," said Bardou. "The world knows what's happening, but Liberians do not see anything being done to help them."

Water supplies are nonexistent, and aid workers now fear cholera will be the next big killer. The organization in charge of the water supply for Monrovia left Liberia because it had been looted. There are two water trucks in the European Union compound, but the international staff has been evacuated, so no one can drive them.

To stem the spread of cholera, aid workers have to rapidly identify people suspected of having the disease and treat them with rehydration salts.

"Treating cholera is simple," said Mathias Formelius, a German MSF nurse. "Controlling the spread of the disease is not, especially in the extremely poor sanitary conditions existing in Monrovia today." MSF had been treating 350 patients a week until its cholera clinics were overrun by rebel forces in the latest attack, when the town's only water treatment plant was also destroyed.

Rockets and Stray Bullets

When fighting broke out in May, staff and patients had to abandon the 130-bed Redemption Hospital, leaving Monrovia without a single hospital. The International Red Cross runs one surgical ward.

Two MSF residences in the Mamba Point area of the city were transformed into makeshift hospitals with an emergency room, maternity and pediatric wards, and a surgical theater. There are 300 Liberian staff working for MSF in Monrovia, as well as 11 expatriates, including one surgeon.

"At least four stray bullets have landed in the hospital grounds today," Andrew Schechtman, an MSF doctor, wrote in a diary that he keeps on the MSF Web site (www.msf.org). "One fell on the roof; another passed through the metal front gate and bounced off the tire of one of the cars. A third fell in our backyard, puncturing the plastic sheeting roof of the kitchen and landing on the ping pong table that we were using as table. It missed the cooks by a few feet."

One MSF Liberian staff member was killed by a mortar in his home shortly after returning from work. "Shooting and shelling close to our hospitals is making it nearly impossible for us to treat our patients safely," said Alain Kassa, the head of the MSF mission in Monrovia.

Before MSF was forced to evacuate Redemption Hospital, surgeons there performed over 100 cesareans a month. Since the hospital facilities were closed, MSF medics have performed less than 20 cesareans per month.

On The Run

No one really knows what's going on in the countryside. At least 75 percent of Liberia has been inaccessible to aid workers since 2000. Villages are attacked in the middle of the night. Men and boys are indiscriminately shot. Aid workers say the number of women who have been raped is incalculable.

Villagers who escape are often robbed of the few belongings they can carry with them. Liberians who have reached camps in neighboring Sierra Leone and Guinea tell of a severe lack of food for those who are still trapped in Liberia.

"It saddens me to think about how many people must be dying from wounds or from cholera because they have no way to safely get to the very few medical facilities that are still functioning in the city," said Formelius.

The United Nations World Food Program said in a statement it was planning to put international staff back into Monrovia soon to distribute food for up to 450,000 hungry people. The UN personnel would live aboard a specially chartered ship moored in the port.

The UN Children's Fund is moving nearly 60 tons of relief supplies into Monrovia, including blankets, tarpaulins, tents, kerosene, lanterns, water storage bladders, and water purification tablets.

The challenges for aid workers are enormous.

"The majority of aid workers trying to respond in these kinds of circumstances is not there because of the sense of adventure or danger or even some higher calling," said Nick Southern, who has over 20 years of experience in the aid business and now works for CARE in Nairobi, Kenya. "They are people who find they have the temperament and particular commitment to work with people who are in extreme distress and danger, and then crucially are able to make a degree of difference."

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