2
Simon Rushton
Introduction
In so far as it has captured the attention of the developed world at all, Sierra
Leone is known primarily for three things: diamonds, a brutal decade of civil war, and
extremes of poverty and poor health. This is, of course, no coincidence: the accessible
alluvial
diamond
deposits
fuelled
the
civil
war,
and
severe
economic
underdevelopment both contributed to and was exacerbated by the conflict. The
fighting itself was widespread, prolonged, and shocking in its brutality. The health
impact was dramatic, with severe effects from the fighting itself, the displacement of
half of the country’s population and the breakdown of the existing health
infrastructure. As a result Sierra Leone lies at the wrong end of almost every ‘league
table’: the World Health Organization’s figures show that it has the world’s lowest
life expectancy (34.0 years) and the highest level of child mortality (332 males per
1,000 and 303 females per 1,000 die before the age of 5).
1
It ranks 177
th
(and last) in
the United Nations Development Programme’s ‘Human Development Index’.
2
In the
aftermath of the conflict the (re)construction of a functioning healthcare system
represented one of the central challenges facing the government of Sierra Leone and
its international partners. It was clear from the outset, however, that any sustained
improvement in public health would be contingent upon the establishment of a stable
and lasting peace.
This paper briefly considers the background to the civil war in Sierra Leone,
and makes the case that the failure of successive governments to provide adequate
public services and economic opportunities for a significant part of the population was
one of the major underlying causes of the conflict. Given that the inadequacy of
public service provision – not least in the health sector – was not merely a symptom
of the conflict but also a cause, it would seem to offer a prospect of post-conflict
health assistance going beyond a “palliative” function and actively contributing to the
peacebuilding process. The paper addresses two of the ways in which it may be
claimed that health-sector initiatives can play a part in post-conflict peacebuilding.
The first of these is what has come to be known as “Health as a Bridge for Peace”
1
2002 figures. WHO, World Health Report 2004: Changing History (World Health Organization,
Geneva: 2004), p.117.
2
UNDP, Human Development Report 2004: Cultural Liberty in Today’s Diverse World (UNDP, New
York: 2004), p.142.
Convention