Some patients in southeast have to travel by canoe to get healthcare

There are so few working hospitals and health clinics in southeastern Liberia that patients in one district have to be ferried by canoe to neighbouring Cote d'Ivoire to receive any treatment at all, the International Committee of the Red Cross (ICRC) said in a report on medical facilities in the area. The report, based on an assessment carried out by an ICRC team between 15 and 25 July, said the health services in the six remote counties of southeastern Liberia had virtually collapsed during 14 years of civil war. The ICRC report, a copy of which was made available to IRIN, said that in Sinoe county, around the port town of Greenville, there were 33 health clinics operating before the civil war broke out in 1989. Now there were only four, all of which were supported by the British medical charity Merlin, it added. "Urgent attention needs to be focused on the region where major donors should come in with support," one relief worker who has been working in southeastern Liberia told IRIN on Tuesday. The ICRC report said many hospitals and clinics had been stripped bare by looters. There were shortages of drugs, especially to treat malaria and cholera. Those hospitals still functioning lacked proper operating theatres and surgical equipment, it added. The report said residents in Grand Kru county, to the east of Sinoe, were forced to ferry their sick by canoe 75 km along the coast to Cote d'Ivoire or 350 km to the Liberian capital, Monrovia. The county, centred round the town of Grand Cess, is one of the most remote and abandoned in Liberia. A year after the signing of the peace agreement which ended Liberia's civil war, Grand Kru is still controlled by rebels of the Movement for Democracy in Liberia (MODEL). UN peacekeeping troops have yet to establish a permanent presence there because all roads leading to it are still impassable. "There were 11 health facilities in this county, but only three of them are functioning now on an OPD (outpatient department) level," the ICRC said. That means that no major cases, like those requiring surgery, can be handled. "Most of the health workers are out of the county," the report continued. "Most of them, according to the county health officer, are in Monrovia and in Cote d'Ivoire." Like their compatriots from nearby Sinoe, Maryland and Rivercess counties, many residents of Grand Kru who fled to Monrovia for safety say they are still too frightened to return home because of unpaid gunmen who continue to prey on the local civilian population. In Sinoe County, the ICRC reported painted a depressing picture of the Kwitatuson Clinic in Greenville, which still manages to function after a fashion. "It contains five rooms. The doors and windows are made with bamboo stick. The walls are constructed from sticks and mud, with a roof of palm leaf. There are no medical staff present," it said. The ICRC said that in Maryland county, right on the Cote d'Ivoire frontier, the hospital in the port town of Harper only had a cholera clinic and an outpatient department. All serious cases had to be flown to Monrovia by UN plane or helicopter. The situation was slightly better in Grand Geddeh county, where Medecins Sans Frontieres (MSF) Belgium was running the main hospital in Zwedru and Merlin was supporting nine other clinics, it said.