Independent Appeal: Rebuilding lives after Liberia's civil war

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Recalling the day she was shot in the back on her way past the local school, Irene Smith's eyes well up with tears. Rebel soldiers - mere boys who by rights should have been in class - opened fire on her as she wandered into the middle of a chaotic gunbattle. The bullets shattered her pelvis. "Don't cry, be strong," her nurse and friend Anita encouraged her as she told how her fragile life went into freefall in the final ugly phase of Liberia's bloody civil war. Seriously wounded and pregnant, Irene lay bleeding on the ground for hours. No one came to her aid. Even her partner, the father of their young child, had left her for dead. Eventually Irene's mother and an uncle took her to the relative safety of a bush clinic.

Three weeks later, Irene was brought to the main city hospital which was a pathetic shell of its former self. The doctors had all fled, along with most of the staff, leaving looters to take over. Refugees from the war had pulled down doors and furniture for firewood; smoke from cooking stoves had blackened the ceilings.

Rebel soldiers would sell food to the refugees and return at night to steal. Anita, one of the few hospital staff who stayed, says patients and refugees were raped in the hospital grounds. "They came at night to rape and steal and loot, it was terrible," she said.

One remarkable man stayed back, the hospital's anaesthetist Jackson Gbar. Though not a surgeon, he performed more than 300 emergency operations, all of them successful.

"I was the only one who stayed along with a few nurses and a technician," he said. "We did lots of things, surgeries, entopic pregnancies, C-sections, somebody had to save the patients." He often operated by sunlight: "None of my patients died on the table," he proudly recalled.

The hospital suffered many deaths, mostly from malaria and malnutrition. Many also died from cholera and other communicable diseases and there were many gunshot victims like Irene.

After 12 years of civil war, the hospital was on the point of collapse in September 2003 when the British charity Merlin sent a medical team from Monrovia. Merlin quickly set up a cholera treatment centre in one of the hospital wards and started disinfecting wells to contain the outbreak. Over the past three years, with Merlin's backing, the hospital has gradually returned to normal. Although about 90 per cent of the staff have no salary per se, patients are well attended to thanks to an "incentive" of $150 (£75) per month by the charity. The government is often unable to pay the official wage of $30 a month. Medicines and technical support is provided by Merlin and all care is given free of charge.

The average life expectancy in Liberia is 41.5 and a quarter of all children die before the age of five. There are 30 medical doctors in a country of three million. Merlin has been operating in Liberia since 1997 and was one of the few international aid agencies to stay during the worst of the fighting in 2003. Today with an expatriate staff of 25 and support paid to about 800 health workers, it runs almost half of Liberia's fragile healthcare system.

These should be optimistic times for Liberia. Its President, Ellen Johnson-Sirleaf is about to celebrate her first year in office. "But we see development here as extremely fragile," said Sonja Van Osch, who heads Merlin's programme. "Many donors are beginning to pull out of the country, thinking that the emergency is over, but without continued support, life could so easily slip back into chaos."

Back at the nurses' station, wheelchair-bound Irene is putting on a brave face. She lives down a mud track with her mother, with no means of earning an income. But when asked about her hopes, she is eloquent and focused. "I want to make some nice clothes and open a boutique," she said. What will that take to make it happen? "I would need about $1,500," she responded instantly. "That would get me going with a sewing machine, material and a shop to rent."

Everyone in the room knows that Irene will never manage to borrow that amount of money in Liberia's shattered economy. She turns away, a look of wistfulness replacing her broad optimistic smile as the dream collapses.