The rusty diesel generator that fuels the only hospital in Moyamba District sputters before clicking off. There’s only enough fuel for it to run for four hours, twice a day.

In this southern region of Sierra Leone, there are no incubators for premature babies, no oxygen supplies for ailing patients, no resuscitation or surgical equipment – and no power to run them. While the world’s attention has justifiably been focused on reducing Ebola cases to zero, another health emergency has silently erupted in West Africa. The diversion of resources and interest away from general healthcare means more people are dying of preventable conditions than they ever were from Ebola.

A new report by Doctors of the World found that, in one region of Sierra Leone, as many deaths have been recorded in four months as in previous one-year periods. Forty per cent of the dead are children younger than five. The cause: lack of general care for largely curable conditions.

‘When it is most needed, the healthcare system in Sierra Leone was forced to look in a different direction,’ Dr James Elston, the report author, says. ‘Huge numbers of people are dying from avoidable causes.’

As the Ebola risk decreases, other threats to public health ballooned. Among the worst is increased susceptibility to outbreaks of preventable diseases like measles and polio as well as infectious diseases like cholera. The rainy season, which begins in June, will bring with it increased numbers of malaria cases and washed-out roads that make it even harder to get treatment. Teenage pregnancy and transmission of TB and HIV are also growing.

‘Any of these alone could prove catastrophic to a population that’s already extremely vulnerable and health system that’s incapacitated,’ James Elston continues.

Why are people in Sierra Leone getting sicker? One reason is plummeting attendance at healthcare facilities – the report found drops of up to 73 per cent compared to pre-Ebola turnout. People living with malaria, malnutrition, HIV and other chronic health conditions are afraid of contracting Ebola from doctors or at hospitals.

Even the number of pregnant women presenting in labour has halved, dramatically increasing the risk of complications and harm to both mother and child. Paediatric malaria treatment has decreased by 80 per cent.

‘What happens to children with severe malaria whose parents are too afraid to seek treatment? Many of them die,’ explains Elston. ‘Sadly, this is also representative of the rest of the country. In areas hit harder by Ebola, it’s even worse.’

Lack of healthcare facilities and equipment are another ever-present hazard. In Moyamba, only two non-Ebola ambulances remain in operation. Health facilities don’t have clean water, a consistent power supply, basic equipment like x-rays or essential medicines to treat common conditions.

‘We lose most of our premature babies,’ one maternity matron in Moyamba says, pointing to the lack of incubators in the district’s only hospital.

Adds Elston: ‘The reality inside these healthcare facilities is shocking. With almost no surgical, resuscitation or basic neonatal capacity, a hospital is not a hospital.’

The culture of fear and the lack of equipment destroy the morale of healthcare workers, many of whom were diverted from TB and malaria teams to combat Ebola. At the same time, local health volunteers report feeling marginalized after being overlooked by international Ebola responders. Many of these workers left their posts and new recruitment is flagging.

This combination of shortages – of doctors, of equipment, of medicine, and of trust between patients and caregivers – highlights the urgency of this latest health crisis. What’s more, these conditions set the stage for the unthinkable: another Ebola outbreak.

‘It’s like needing to use both hands to stem a bleeding wound, while a bear creeps up behind you. Sierra Leoneans cannot wait for zero Ebola cases before they receive basic healthcare,’ says Doctors of the World’s International Programme Manager Gareth Walker.

The report – commissioned to determine how best to prioritize health issues in the region – was compiled based on fieldwork that included 40 interviews, eight focus groups, site inspections and data collection in the district. It paints a desperate picture of the state of the health system in Sierra Leone and highlights the need for immediate investment in healthcare facilities.

‘Not enough was done to support the day-to-day health system during the Ebola response, but that’s no reason to not do it now,’ according to Elston. ‘Blood tests, for instance, cost pennies, but first they need the machines to perform them. An immediate injection of basic hardware would have a massive impact.’

Read the full report here.

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