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CMAJ
CMAJ - June 27, 2000JAMC - le 27 juin 2000

The war amputees of Sierra Leone

CMAJ 2000;162(13):1797

Amputations in North America are usually the result of acute trauma or chronic vascular disease. Despite yearly reminders from the War Amps of Canada, Canadians do not tend to think of lost limbs as the direct consequence of war. But limbs are the deliberate targets of land mines and machetes, weapons purposefully used to butcher and immobilize their victims.

Without mobility one is at the mercy of the enemy, and there has been no mercy in Sierra Leone, where thousands of civilians have lost limbs since 1992.1,2 This diamond-rich country, a colony of Britain until 1961, has endured a turbulent history of coups and counter-coups. Civil war has been waged since 1991 as the Liberian-supported Revolutionary United Front (RUF) and (since 1997) the military Armed Forces Revolutionary Council (AFRC) jostle to maintain control of diamond areas and squelch civilian participation in democratic reform.2

As the tragedy of this country has become known to rest of the world, the savagery of the RUF has grown notorious. Boys as young as 7 years old have been abducted into the RUF, supplied with weapons, trained to kill, shot up with cocaine and incited to raid villages throughout Sierra Leone.3 These raids target civilians, especially women and children. Their hallmark is crude amputations: feet, hands, ears, lips and noses.4 Between 1991 and 1999 the war has claimed over 75 000 lives, caused over 500 000 Sierra Leoneans to become refugees, and displaced over half of the country's 4.5 million people.4 Schools, hospitals, government services and normal commerce have ground to a halt, and a generation of children have been lost to warfare and chaos.

In 1998 UNICEF devised a numerical composite of 5 indicators of child welfare to capture in numbers some of the risks a child faces.5 According to this "child risk measure," Sierra Leone was deemed to be the second most dangerous country in the world for children, surpassed only by an equally diamond-rich and war-ravaged African country, Angola.

A recent comprehensive study of the diamond situation in Sierra Leone, produced by Partnership Africa Canada (a coalition of Canadian and African nongovernmental organizations), concluded that the conflicts in Angola and Sierra Leone have been fuelled by illicit diamond smuggling and sustained by organized crime, which feeds off the economic opportunities that arise when law and order break down.4 Despite protestations from the diamond industry6 the numbers don't add up. According to Ian Smillie and colleagues, Liberia (Sierra Leone's neighbour) has an annual diamond mining capacity of 150 000 carats, yet between 1994 and 1998 Antwerp, the routing point for more than half the diamonds produced in the world, imported more than 31 million carats from Liberia.4 Where did all these carats come from?

The informed North American might start to question the intrinsic worth of these bits of carbon, which may have been purchased at the expense of small hands and feet. Diamonds are forever; so are amputations.

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References
  1. Hawley C. Sierra Leone's brutal rebellion [news report on the BBC online network]. 1999 Jan 7. Available: news2.thls.bbc.co.uk/hi/english/world/africa/newsid%5F245000/245657.stm (accessed 2000 May 31).
  2. Pratt D. Sierra Leone: the forgotten crisis [report to the Minister of Foreign Affairs, the Hon. Lloyd Axworthy, April 23, 1999]. Available: www.sierra-leone.org/pratt042399.html (accessed 2000 May 31).
  3. Lueders M. The photographer's diary: hope and horror in Sierra Leone. Available: dirckhalstead.org/issue9902/diary8.htm (accessed 2000 May 31).
  4. Smillie I, Gberie L, Hazleton R. The heart of the matter — Sierra Leone, diamonds and human security. Partnership Africa Canada; 2000. Available: www.web.net/pac/pacnet-1/msg00009.html (accessed 2000 May 31).
  5. The progress of nations 1999. New York: UNICEF; 1999. Available: www.unicef.org/pon99 (accessed 2000 May 31).
  6. S. Leone needs halt to diamond smuggling — Canada NGO [Reuters news report on the ABC News Web site]. 2000 Jan 12. Available: abcnews.go.com/wire/World/reuters20000112_3293.html (accessed 2000 Jan 13).

© 2000 Canadian Medical Association or its licensors