Medical Assistance Sierra Leone was established in 2003 with the aim of supporting access to health care and urgent medical treatment for communities and individuals in Sierra Leone. The organisation was registered as a charity in 2004. Sierra Leone is the poorest country in the world (UNDP 2004), with high infant mortality and globally the worst maternal mortality rates.

The conflict, wide scale social disruption, population displacement, economic collapse, poverty and very poor living conditions along with limited access to quality health services are the major factors contributing to the current high mortality and morbidity . Life expectancy is just 39 years for men and 42 years for women. Those with rare and complex conditions face little prospect of getting treatment. Sierra Leone's health infrastructure clearly requires support at all levels. However there are specific strategic areas where an input of resources can be expected to begin to save lives, improve health and well-being and better enable individuals to meet the vast development challenges facing their families and communities.

With this in mind, MASL has identified four areas to focus its work on in the longterm:
1) Provision of medical and other support for women with vesico-vaginal fistula (VVF). These severe internal tears usually occur in childbirth and often result in permanent incontinence. It is estimated that every year there are 5,000 new cases of fistula just in Sierra Leone . Many women are forced to leave their communities due to the stigma.

2) Reducing maternal mortality. About 2% of women die in childbirth, largely due to lack of services to manage emergency obstetric care, harmful traditional practices, inadequately trained staff, a weak referral system and high hospital-patient costs. These problems are set within the social context of acute poverty and low knowledge levels.

3) Provision of support to people affected by HIV/AIDS. HIV/AIDS represents a major threat to communities in Sierra Leone, and currently affects three times as many young women as men. The impact of HIV/AIDS on communities affected by the disease is complex and multi-faceted, affecting all areas of home and community life, access to services (including health and education) and resources and creating severe psycho-social distress.

4) Facilitating access to treatment for those with rare and complex medical conditions, who face no prospect of getting treatment in Sierra Leone.

Without urgent support, Sierra Leone looks unlikely to meet the targets for the Millennium Development Goals, agreed at the United Nations Millennium Summit in September 2000.

The necessarily ambitious targets on child mortality and maternal health are looking increasingly less attainable as the country faces its seventh consecutive year as officially the poorest country in the world. MASL will work with others to raise awareness of the key health and development issues facing communities in Sierra Leone - and to generate interest and support in meeting the health needs of the country.

The Eight Millennium Development Goals

• Eradicate extreme poverty and hunger
• Achieve universal primary education · Promote gender equality and empower women
• Reduce child mortality · Improve maternal health
• Combat HIV and AIDS, malaria and other diseases
• Ensure environmental sustainability
• Develop a global partnership for development

For information or to make a donation, please contact Medical Assistance Sierra Leone, 14 Send Road, Caversham, Reading RG4 8EH. Tel 0118 948 1814. Cheques should be made payable to Medical Assistance Sierra Leone. Email: office@medicalassistancesierraleone.org.uk.