As Aid Workers Return, Liberia Is Unsafe and in Ruins

Stefan Lovgren
for National Geographic News
August 11, 2003
Shells falling outside the hospital gates. Volunteers shuttling war wounded in wheelbarrows into the emergency ward. Surgeons dodging stray bullets inside the operating room.

Being an aid worker in war-shattered Liberia may be the toughest job in the world.

As fighting intensified in the middle of July, scores of aid workers were evacuated from the small West African nation. Now, with a lull in the fighting—and President Charles Taylor's expected exile from Liberia—many of the aid workers are coming back.

They're finding a country in complete ruins. The needs are overwhelming. One million Liberians have been displaced. Malnutrition is soaring. Perhaps worst of all, a cholera epidemic is lurking around the corner.

With fighting bound to reignite at any time, delivering the help that Liberians so desperately require will be almost impossible.

"The real difficulty is the insecurity caused by the fighting—rocket fighting, stray bullets—and by the behavior of some of the fighters, who are totally out of control," said Fredèric Bardou, head of the Liberia mission for the French aid agency Action Against Hunger. "Some of them can loot our car if we cross them. We must always evaluate the importance of danger."

Tenuous Truce

The fighting, which has pitted government militias loyal to President Charles Taylor against a murky rebel group known as Liberians United for Reconciliation and Democracy, is only the latest installment in a civil war that started in 1989 and has claimed at least 80,000 lives.

In the last week, the presence of a slowly building West African peacekeeping force—and Taylor's promise to resign—have brought a weak truce to Monrovia, the capital, while fighting continues in the countryside.

Only four aid agencies—Doctors Without Borders (or MSF as it's known by its French acronym), Action Against Hunger, the Irish group Merlin, and the International Red Cross—have stayed in Liberia throughout the fighting.

When United Nations personnel returned to Monrovia this weekend for the first time since evacuating in late July, they found UN warehouses, which once held 10,000 tons of wheat, corn meal and other goods, completely looted.

According to a survey carried out by Action Against Hunger, almost 50 percent of children living in camps in Monrovia suffer from acute malnutrition.

"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 ( "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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