Liberia

Background
Africa's oldest republic, Liberia was settled in 1822 by enslaved Africans who had been freed from America and the Caribbean. Located on the north Atlantic Coast in West Africa and bordered by Sierra Leone, Guinea, and Cote D’Ivoire, Liberia is one of the world’s poorest countries, with 85 percent unemployment and 80 percent of its people living below the poverty line.

Its current situation is due in large part to a protracted civil war that lasted through much of the 1980s and 1990s, and bankrupted the nation. The brutal conflict claimed almost 250,000 lives and caused hundreds of thousands more to flee their homes. Many of these people still live in makeshift camps, settlements, and the harsh environs of the bush. Fighting also damaged and destroyed the country's hospitals and clinics, and many of Liberia's trained health professionals were forced to flee, resulting in the collapse of the health and social service infrastructure.

Children, women, and the elderly suffered disproportionately from violence, malnutrition, and communicable diseases. Young people in particular were devastated by family separation, forced recruitment into armed groups, widespread violence, rape, and a resultant vulnerability to HIV/AIDS and sexually transmitted infections. The capital, Monrovia, still lacks sufficient clean water for drinking, cooking, and washing, and food supplies remain unreliable.

Critically, in fall 2005, Liberia held democratic presidential elections and voted Ellen Johnson-Sirleaf, Africa's first elected woman head of state, into office on an anti-corruption platform that emphasized rebuilding and reconciliation. While Liberians are experiencing remarkable progress in terms of peace and restructuring, the country faces a lengthy process of rebuilding.

What IMC Is Doing
Since August 2003, IMC has been working to restore health and hope to Liberia. IMC is providing essential primary and secondary health care services in Lofa and Bong counties, including: surgery; pre- and post-natal care; family planning; health education and public awareness campaigns on HIV/AIDS and sexual- and gender-based violence (SGBV); and training programs for local health care professionals.

Lofa County, in northwest Liberia, has been hit hard by continuing violence. Because of security concerns, humanitarian assistance was unavailable in this region for four years. By the time IMC arrived, less than 10 percent of all structures were habitable, and just one barely functioning health clinic remained to serve the county's population of more than 300,000 people. IMC is working in Lofa to improve access to primary health care for returning refugees, internally displaced persons, and the local host communities. IMC rehabilitated and furnished a number of primary health clinics in the area and provides them with emergency supplies and drugs.

IMC manages a hospital that provides surgical and emergency obstetric services and 18 primary health care clinics in Lofa County, and a mobile clinic that provides services to three transit centers in Bong and Lofa counties, serving a total population of more than 221,000. Among the services are out-patient consultations; antenatal care; delivery services; postnatal care; expanded programs on immunization and nutrition surveillance for children under five, pregnant women, and lactating mothers; patient education; and on-the-job training for all levels of health providers.

IMC trains health professionals from its clinics and hospital on SGBV clinical case management, SGBV awareness, and sexual exploitation and abuse prevention. IMC trains social workers and provides community education on SGBV awareness and HIV/AIDS prevention. One hundred schoolgirls (who are SGBV survivors or vulnerable to SGBV) are being supported by IMC with school fees and educational support packages.

IMC provides community health education through the 18 clinics, and outreach through community health promoters (CHPs). Training is provided to CHPs and traditional birth attendants to strengthen their own skills with relevant topics such as breast-feeding, safe motherhood practices, universal precautions, malaria prevention, diarrhea prevention, sexually transmitted infections, and personal hygiene.

In order to ensure program continuity, IMC has involved local communities through village health committees (VHCs) in income-generating activities to support the clinics and to enable communities to take control of their own health. VHCs are currently engaged in livelihood activities such as rice farming, soap making, cloth tie dyeing, cloth weaving, and vegetable gardening. Current activities involve 18 VHCs and over 1,000 beneficiaries who were trained in the management of small business.

IMC is closely coordinating its efforts with host community leaders, Liberian government ministries, other international humanitarian organizations, UN agencies, and donor partners. As the crisis abates and Liberia stabilizes, IMC gradually will transition the administration of medical and water and sanitation projects to the Liberian Ministry of Health & Social Welfare. The training of local health care workers and the repatriation of trained refugees will strengthen Liberia's capacity to provide quality medical services for its people long after the international community withdraws from the region.