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from emergency
to recovery
10 years of health care in Liberia

02 from emergency to recovery
From the Liberian Health Minister
I have the honor of expressing my
heartfelt gratitude and congratulations on
Merlin’s 10th anniversary of humanitarian
service in Liberia. Merlin has been
instrumental in the role of transforming
Liberia’s health care system from an
emergency to a development stage.
I am very impressed with what
Merlin is doing today. Not only are
they providing quality health care,
but they are also helping us with the empowerment of our people and
with capacity building. Empowering us to do the work ourselves - that
is of great importance to me.
What I would like to see in Liberia is what we still do not have. In 1978,
when we had our first primary health care conference, we said that we
would like to have health care for all by the year 2000. It is 2007 and
we are so far away from that.
I want people to know how to help themselves to protect their health.
If we had roads to the communities where it takes three or four days to
walk to, then we could deliver health messages there. And once people
have that information, the health care they seek should be accessible
and affordable to them all.
Human resources for health is a big challenge. This year our total health
budget is US$15 million, which is just a fraction of what it would cost
to recruit the number of personnel and to purchase the medicines and
equipment we need to deliver a basic package of health care for all.
The government and the people of Liberia are grateful for the
contribution Merlin has made in helping the Ministry of Health & Social
Welfare to rebuild the national health care system. Merlin has set an
excellent example of effective humanitarian response in providing
health care assistance to the people of Liberia.
Dr Walter T Gwenigale Minister of Health & Social Welfare, Liberia
Merlin first started providing emergency medical
aid in Liberia at a time of great instability, and was
one of the few international agencies to remain
working there during intense fighting at the height
of the conflict. Ten years on, as the West African
nation has moved into a period of relative peace
and optimism, Merlin’s work has evolved to assist
the Ministry of Health in rebuilding a sustainable
health system for a population which suffers some
of the worst health problems in the world. This
report recounts Merlin’s achievements over
the past decade and explores how these
could be built on in the coming years.

03
10 years of health care in Liberia
Two year old Towah Gelah examined
by physician assistant Lorenzo Dorr.
Starting up as fragile
peace is restored
In 1997, seven years of civil war in Liberia came to an end when
former faction leader Charles Taylor won a landslide victory in the
presidential elections.
The conflict had left nearly one million Liberians displaced within
and outside the country. Security was improving as a nationwide
disarmament programme had begun, but the health care system,
along with every other form of infrastructure, had taken a
battering. Clinics and hospitals had been looted or destroyed, and
many trained medical staff had left their jobs or fled the country.
It was against this fragile backdrop that Merlin carried out
assessments of the country’s most pressing medical needs in
1997. The lack of basic health care services was deemed to
be most serious in two counties: Lofa and Nimba.
Several non-governmental organisations (NGOs) were operating
in the capital Monrovia at the time, but few took the risky
decision to venture out of the city. This meant that health facilities
in rural areas like Lofa and Nimba were barely functioning, with
acute shortages of staff and medicines, and were in urgent need
of assistance.
Sarah Hodge, Merlin’s Reproductive Health Manager, explains
why the organisation started off where it did: “Merlin’s team
felt that they had to go to the rural areas. The needs of the poor
in those counties were very high, especially as far as medical
provision was concerned.”
“At the time there were a lot of NGOs in Monrovia and many
were still afraid to go to other areas. People thought if they did,
they might be killed.”
1 Situation Analysis of the National Response to HIV/AIDS in Liberia, World Health Organisation/Ministry of Health
/United Nations Development Programme
Across Lofa, the lack of health care was detrimental, not just for
the local population, but also for hundreds of refugees from Sierra
Leone and Guinea, and displaced Liberians living in makeshift
camps. Merlin moved in and quickly restored services at a number
of health facilities, providing vital health care and distributing
emergency medical supplies.
A similar programme began in Nimba, where Merlin worked with
the health authorities to deliver primary health care and essential
medicines. Maternal death rates in Liberia were among the highest
in the world – estimated at 780 per 100,000 live births 1 – so
Merlin placed an emphasis on strengthening maternal health care.
Hodge, who joined Merlin in early 1998, recalls her involvement
with the Nimba programme: “We were trying to build the capacity
of the clinical staff by organising refresher courses for them. I
was training traditional birth attendants and community midwives
because at that time, the maternal and infant mortality was
very high.”
By 1998, Merlin had built up its programme to support 22
health centres and two hospitals across Lofa and Nimba. But the
following year, Merlin staff felt the impact of worsening security
when dissidents from Guinea launched a series of attacks in
northern Lofa. Midwife Sara Nam, logistician Dave Heed and
Dr Mike Roe, were among six foreign aid workers kidnapped by
rebels in Kolahun town and taken towards the Guinea border.
“They were initially quite aggressive but once they realised we
were co-operating, that aggression eased off,” recalls Heed.
“We were relatively well treated, and I think part of the reason
was because they recognised who Merlin was. We had a good
reputation, even back then.”

04 from emergency to recovery
Thankfully, after negotiations with British officials,
all the aid workers were freed unharmed several
days later. The incident and the increasing levels of
violence that followed led to the suspension of the
Lofa programme.
In 2000, Merlin identified significant health needs
among refugees fleeing to Liberia from the civil war
in neighbouring Sierra Leone. More than 30,000
had arrived since 1991 and were totally dependent
on humanitarian aid.
Former faction leader
Charles Taylor wins
presidential elections
Fighting resumes;
peacekeeping
forces leave
Merlin focused on improving the knowledge
and practice of health care among the refugee
population in Montserrado and Grand Cape Mount
by training more than 350 Sierra Leonean health
professionals and community health workers. Health
education was also conducted to raise awareness of
malaria, HIV, diarrhoea, breastfeeding, nutrition and
family planning among 4,000 refugees.
Rebel forces from
Guinea launch
attacks in Lofa
In the thick of battle
This photograph was taken just moments after a shell landed
in the Greystone compound at Mamba Point, Monrovia, in July
2003. Pictured at the front left is Dr Clement Peter, Merlin’s
Medical Co-ordinator at the time.
Dr Clement and his team were on the scene attending to the
wounded and shuttling them to the trauma unit at JFK Hospital
for further treatment. “I remember that last shelling very well.
I think 22 people were affected, with six or seven people dying
instantly,” Dr Clement recalls.
After making an immediate assessment of the survivors,
Dr Clement decided that the man on the stretcher should
be his first priority.
“We thought that he had a good chance of survival, so I was
moving him quickly to the ambulance before going back to
get another patient,” says Dr Clement.
Throughout this final year of the war, Merlin co-ordinated
a huge relief effort, which included a city-wide ambulance
service, construction of 400 latrines and the provision of
7 million litres of clean water.
Magnus Wolfe-Murray, Merlin’s Country Director at the time,
explains how they kept going under such difficult circumstances:
“We knew for certain that if we were not there to serve these
people, there would be nobody else to do the job. We saved
so many people every day we had no way of keeping count.”
Liberian forces launch
offensive against
rebels in the north
UN Security
Council re-imposes
arms embargo
1997 1998 1999 2000 2001

05 10 years of health care in Liberia
Security deteriorates, but
Merlin scales up operations
In 2001 Merlin began working in two new counties-
Grand Bassa and Rivercess - as part of a push to
improve access to and uptake of essential sexual
and reproductive health services.
At the time, there were only four certified midwives
in Grand Bassa and one in Rivercess. Merlin took an
integrated approach, by creating and supporting
networks of trained traditional midwives. A
community education programme to reduce high
rates of teenage pregnancy was launched, which
included raising awareness of family planning and
sexually transmitted infections. As well as
constructing four new clinics and renovating 29
existing ones, Merlin installed solar panels at these
health facilities to ensure that mothers could deliver
in safety at night. By the end of the year, the clinics
had recorded 6,400 antenatal care visits and a 20 per
cent increase in uptake of family planning methods.
Sumo Goyah, now Merlin's Clinical Supervisor for
Montserrado, oversaw the immunisation programme
in Rivercess. “When we got there, there were only two
More than
50,000 people flee
renewed fighting
Fighting intensifies;
rebels battle for
control of Monrovia
nurses and one physician’s assistant serving 18 health
facilities. There were no doctors at all. It was really
a great task for Merlin to take on.
“We started to educate people about immunisation.
We started training the traditional birth attendants to
strengthen their midwifery skills, and we supplied clinics
with vaccines. I'm proud to say that Merlin was able
to help thousands of people.”
Despite increasing violence in 2002, Merlin scaled up
its operations further in Grand Bassa, Rivercess and
Sinoe counties, where it began renovating clinics and
providing refresher training for local health staff.
As the year progressed, the security situation in the
south and east of the country began to deteriorate
rapidly. Merlin launched emergency responses for
thousands of refugees and returnees in both Grand
Gedeh and Nimba, providing medical care and health
education, as well as chlorinating water supplies.
International donors
pledge more than $500
million for reconstruction
Presidential
elections held
A Survivor’s
Story
Musu Flome was 16 when fighting erupted in her home town
of Buchanan in 2003. For weeks, she had been experiencing
severe pain in her abdomen.
Musu suspects that the poor quality of food she had been
eating was responsible for what culminated in emergency
surgery at the Merlin-supported hospital in Buchanan.
At the height of the fighting, Musu was in so much pain that
she knew she had to get urgent medical treatment. She had
an infected bowel, and was literally hours away from death.
“Outside when there was fighting it was so dangerous - you
couldn't go outside. We had to wait until it was quiet for a time
and then they carried me to the hospital.
“The doctors cut the infected section out. They then sewed
me back together again. They saved my life.”
Now 20, Musu still lives in Buchanan where she is attending
cookery classes.
“I'm learning how to bake,” she adds. “Any type of bread you
want, I can make it. Perhaps I will open a bakery one day.”
Ellen Johnson-Sirleaf
inaugurated as President
Charles Taylor’s war crimes
trial begins in The Hague
2002 2003 2004 2005 2006 2007

06 from emergency to recovery
© Tugela Ridley
Training midwives
for safer deliveries
Maternal mortality rates in Liberia are among the highest in
the world. According to the World Health Organisation, Liberian
women face a one in 16 lifetime risk of dying from pregnancyrelated
causes. This is why maternal and child health has become
an integral part of Merlin's work in Liberia.
Because of the lack of professional maternal care services, leading
female members of the community take on the role of midwife.
These women have had no formal medical training, and rely on
knowledge that has been handed down through generations.
They are, however, well respected, and many women prefer to
seek their services rather than to deliver at health facilities.
Merlin offers a six-month training programme for traditional
midwives, as well as refresher courses for those who wish to keep
their skills up to date, with the aim of reducing maternal deaths.
Over the past decade, more than 20,000 women have received
training through Merlin initiatives.
Trainee traditional midwife Gbatee Kollie (pictured, above
right) says, “The more I can learn, the more I can help my
Liberian sisters.”
The height of the conflict
In 2003, renewed fighting forced the suspension of
Merlin’s programmes in Sinoe and Rivercess. As rebel
groups rampaged through the country, their attention
began to turn towards Monrovia. Merlin’s operations
there in the second half of 2003 have been acclaimed
for the courageous actions of staff during what would
be the culmination of the war.
In June, rebels launched two offensives – later
nicknamed ‘World War One’ and ‘World War Two’ –
on the capital, both of which were repelled by
government forces. July saw the arrival of ‘World War
Three’. A ceasefire agreed upon in Ghana was broken
and chaos ensued. More than 600,000 people fled
their homes and an estimated 1,000 civilians were
killed. The street scenes in Monrovia – frightened
civilians walking amid piles of severed bodies - were
nothing short of horrific.
Under the leadership of Country Director Magnus
Wolfe-Murray and Medical Co-ordinator Dr Clement
Peter, Merlin worked in extremely intense and, at
times, harrowing circumstances.
Barrie Cherinoh, employed by Merlin as an ambulance
driver at the time, recalls the dangers they faced:
“The Country Director and Medical Co-ordinator were
so courageous. Whenever there was shelling, they
said, ‘Let’s go there’.
“I can’t say how many lives we saved, but it was more
than a thousand. At the time it was very dangerous,
but we were relief workers. We had to do it.
Sometimes we wanted to escape it, because it’s
not easy when you see people dying all around you.”
Sumo Goyah, who had moved from Merlin’s
programme in Rivercess to join the team in the
capital, explains how they responded wherever
they were needed:
“As soon as we saw a group of 1,000 or 2,000
displaced people in one area, we opened mobile
clinics. We were giving water, building latrines,
treating minor illnesses. If people were severely
wounded then we took them to the hospital. We
were also managing outbreaks of cholera, and
helping women deliver babies.”
“We were the only international NGO in the town
centre. It was based on our performance here that
Merlin went on to be regarded as one of the major
NGOs in Liberia.”
Meanwhile in Harbel, Margibi County, Merlin
supported eight mobile and static clinics with
medical supplies, water and sanitation. And in
Buchanan, Grand Bassa County, Merlin was the
only NGO responding to health needs at the
height of the conflict.
Between July and October 2003, Merlin’s operations
directly benefited nearly a quarter of a million people
in these three counties.

07 10 years of health care in Liberia
Recovery and rehabilitation
Liberia’s 14-year war finally ended after Charles
Taylor was forced into exile and a peace agreement
was signed in August 2003. Two months later, a
transitional government was formed and a United
Nations peacekeeping force was deployed.
Since the end of the conflict, Merlin’s operations in
Liberia have expanded significantly and are now
focused on building up the Ministry of Health and
Social Welfare’s capacity. While continuing support
for health facilities in Montserrado, Grand Bassa and
Grand Gedeh, Merlin entered Maryland County in
2004 to help the health authorities to respond to a
cholera outbreak. An isolation unit was set up at J.J.
Dossen Memorial Hospital in Harper, water supplies
were chlorinated and health education was
conducted, thus helping to contain the outbreak
and undoubtedly saving many lives.
After responding to cholera, Merlin turned its
attention to the ruined structure of J.J. Dossen
hospital and undertook extensive renovation and
repairs. The hospital was officially reopened to the
public in January 2006, providing a wide range of
services including outpatient care, 24-hour
emergency services, paediatric and maternity
care, surgery and HIV counselling and testing.
In 2006, Merlin began its tenth year of operations in
Liberia. Although the inauguration of President Ellen
Johnson-Sirleaf had created a climate of increasing
optimism, deep-rooted problems remained, including
a legacy of sexual violence.
Throughout 14 years of conflict, rape was used
as a weapon of war and the problem remains
widespread. A survey conducted in six counties found
that three out of every four women had been raped. 2
From 2006, Merlin began training health staff on
the management and referral of rape cases. As a
prominent member of a government taskforce, Merlin
started helping to standardise reporting and data
collection on sexual violence across the country.
Building up the capacity of Ministry staff has been
one of Merlin's greatest challenges and successes.
In 2006, Merlin organised a workshop to develop
the management capacity of County Health Teams.
This was attended by 30 representatives from all 15
counties, and resulted in a standardised management
manual – an example of how Merlin is helping to build
a sustainable health system.
In early 2007, a new resource centre for the
Ministry, equipped and supported by Merlin, was
officially opened. The centre is used to train health
personnel and to assist in the development of
a national database for health statistics.
2007 also marked Merlin’s return to Sinoe, and
its expansion of activities in Grand Bassa. These
additions meant that, 10 years on from its initial
intervention in Liberia, Merlin’s support of health
services had extended to cover a third of the
population. This included supporting 41 clinics
and four hospitals in five counties.
2 International Women’s Day: Women in the Developing World factsheet, UK’s Department
for International Development, March 2007
HIV counselling and testing
Accurate data on the prevalence of HIV and AIDS in Liberia
is scant, but there is little doubt that the overall infection rate
is rising. The Joint United Nations Programme on HIV and AIDS
estimates that the HIV prevalence rate among adults in Liberia
is between two and five per cent.
Merlin has been working in close collaboration with Liberia’s
National AIDS Control Programme and has established eight
voluntary counselling and testing (VCT) centres in four counties
to date. A further 11 VCT centres will be established by the end
of 2008.
In Montserrado, Kulubor Wilson (pictured, above left) heads up
HIV and AIDS services at a Merlin-supported clinic. In addition to
offering free testing and sexual health education, the clinic acts
as a referral centre from which people go on to obtain treatment
from hospitals.
“Telling people their result if they are HIV positive can be
very tough. Sometimes people will sit there and start to cry,”
says Kulubor.
“Some people will listen to what I say, but others will look at me
and say, ‘I’m finished’. I tell them that they are not finished, that
they still have a life ahead of them and that they must take
precautions in the future.”
© Tugela Ridley

08 from emergency to recovery
As Liberia has gradually moved from conflict to
relative stability, Merlin has taken advantage of the
opportunities that the post-conflict environment
offers, and has forged a reputation for its
commitment to sustainable development.
“After a major crisis, Merlin stays in place long enough
to rebuild lasting health care systems. It’s one of our
fundamental principles,” says Andrew Martin, Merlin’s
Operations Co-ordinator in Liberia.
“There can often be huge gaps left when
agencies leave a country, but Merlin is trying
to ensure that, through increased capacity
building, this does not happen in Liberia. This is
why we work very closely with the Ministry of
Health and Social Welfare to ensure that when
we do leave, things don't just collapse.”
A mother and child at the Merlin-supported
Well Baby Clinic in Buchanan.
Staff profile
Sarah Hodge, an experienced certified midwife, is one of Merlin’s
longest serving employees. In 1998 she joined Merlin’s inaugural
programme in Nimba County, where she co-ordinated a
traditional midwife training project.
At the height of the 2003 conflict, Sarah was assigned to
camps for displaced people in Monrovia. She recalls an incident
at a football stadium, where an estimated 50,000 people were
seeking shelter:
“There was a pregnant lady who came in with cholera. I was
trying to find a vein to get some fluids into her, but she was
so dehydrated that we couldn’t find one.
“I had to cut the flesh in her feet and find a vein. I had never
done that before, but I did it. I was so happy because I knew
I had managed to save her life.”
Now, as Reproductive Health Manager, Sarah is responsible for
planning and implementing various training initiatives that are
part of Merlin’s overall reproductive health programme.
She believes Merlin’s continued efforts to build the capacity of
local health staff will be vital to ensure sustainable improvements.
“We’re trying to introduce activities in such a way that they
remain, even when we are not here. We need to make sure
that whatever we leave behind is sustainable.”

09 10 years of health care in Liberia
Transforming a hospital devastated by war
Nurse Lawrence Jallah attends to a patient on the surgical
ward at Liberian Government Hospital in Buchanan.
Liberian Government Hospital in Buchanan, which serves
an estimated 600,000 people, has been transformed
over the last four years thanks to the direct support
of Merlin and its donors.
The hospital, which had been severely looted and
damaged during the war, underwent major renovation
in 2003 and 2004.
Electrical and plumbing work was carried out; furniture,
equipment and medicines were supplied; and clinical staff
were recruited to get the war-battered facility back up
and running.
“Before, the condition of the hospital was very bad
indeed. We didn't have the workforce or the equipment
and support needed for proper clinical work," says longstanding
employee Albert Saykpa, a former Nursing
Director of the hospital. “When Merlin came we really
noticed things changing.”
2005 saw the construction of a new outpatients
department (OPD). Previously, outpatient services had
been conducted in the main hospital building, which led
to overcrowding and made it difficult to maintain an
organised service. The new wing was officially opened by
Liberia's president, Ellen Johnson-Sirleaf, in April 2006.
“It has become easier to see more outpatients in any
given day,” says Stanley Otunga, Merlin's hospital
matron. “We have a good emergency room, and a short
stay area where we can observe people. It is making a
big difference to patients and to the operation of the
hospital as a whole.”
In 2005, the OPD saw an average of 4,496 patients
every month. Last year, this figure had risen to 5,008–
more than 500 extra patients per month.
Better organised wards, staff training initiatives and
an incentive scheme have also led to an improvement
in clinical standards over the years.
“In-patient care has definitely got better. Now we
have a lot more nurses who are properly qualified and
who are benefiting from Merlin's incentive payments,”
says Otunga.
“I would also say that because of regular training
sessions we have given to staff – especially on the
management of medical conditions – the physicians
and nurses are becoming much more accurate in their
diagnoses and treatment.”
President Ellen Johnson-Sirleaf officially opened the new
outpatients department at the hospital in Buchanan in 2006.
In a country where many public sector employees
are still not on the government payroll, Merlin’s payment
of monthly incentives is helping to attract and retain
skilled health workers who might otherwise relocate
to Monrovia.
“As well as the regular supply of medicines, one of the
great things that Merlin has done is to offer incentives
to staff here,” says Dr Jerry Brown, the hospital's doctor
and the County Health Officer for Grand Bassa. “If it
hadn't been for Merlin, some of the qualified staff would
not be here.”
There are several other challenges for this rural hospital
to overcome. Perhaps the most immediate concern is the
lack of qualified medical specialists, particularly doctors.
“Currently I'm the only Liberian doctor here at the
hospital, and I also act as County Health Officer,” says
Dr Brown. “It can be a real headache when I have to leave
the hospital to attend meetings.”
Merlin has secured funding to support the hospital until
February 2008 but further donor support will be vital to
ensure that the significant improvements to health care
provision are maintained.

10 from emergency to recovery
Rebuilding
a healthier future
Despite significant progress made in re-establishing primary and
secondary health care services across Liberia, the country still
suffers some of the worst health indicators in the world. Current
projections suggest that Liberia is unlikely to achieve the healthrelated
Millennium Development Goals (MDGs) - to reduce child
mortality, to improve maternal health and to combat HIV/AIDS
and other killer diseases by 2015.
Fourteen years of war have resulted in a chronically underresourced
health sector, with the Ministry of Health and Social
Welfare lacking the funds needed to deliver health services,
provide medicines, pay staff salaries and maintain the country’s
18 functioning hospitals, 50 health centres and 286 health clinics.
Official salaries are poor, ranging from US$15 to US$50
per month 3 . Under-investment in training, combined with
displacement and migration during the war, have led to a
chronic shortage of qualified medical staff. According to the
Liberia Medical Board, there are just 41 Liberian doctors working
for the Ministry, serving a population of 3.2 million 4 . It is
estimated that only 41 per cent of Liberia’s population has
access to health services 5 .
The new government has made health care a priority, and
plans to increase annual health expenditure from US$4.80 per
capita to US$34 per capita by 2015 6 . However, in order to reach
that target, the government will require a significant increase
in revenue.
In 2006, approximately half of Liberia’s total health budget
was financed by international donors 7 . At present, NGOs provide
support to almost two-thirds of health facilities in Liberia 8 .
“The Liberian government faces a huge challenge in terms of
financing and implementing its national health plan over the
coming years,” says Dr Sonja van Osch, Merlin’s Country Director.
“In order to strengthen the capacity of the health sector, Liberia
will require sustainable and predictable funding from international
donors. The majority of current humanitarian funding will be
phased out by the end of 2008, and without additional resources,
many NGO-supported facilities may have to close, leading to an
even greater gap in health service provision.
“As the Ministry of Health and Social Welfare continues to take
on more responsibility for the management of the health sector,
it will require significant resources to enable it to implement
the national health plan and to develop sustainable health
financing mechanisms.
“Merlin hopes that equitable initiatives for raising funds at the
local level will be explored,” concludes van Osch. “It is crucial that
any new financing system will ensure that everyone has access
to health care, including the most vulnerable sections of
the population.”
Over the next few years, Merlin’s work in Liberia will focus
on two priority areas while supporting the Ministry in building
a sustainable and effective health system:
• Training and developing health workers and support
staff, to build up their clinical and management capacity
• Supporting research into and development of health
financing systems, at both county and country levels
3 Roberts, J. Human Resources for Health: A Study for Merlin. Internal document, March 2007.
4 Draft Emergency Human Resources for Health Plan, Liberia’s Ministry of Health & Social Welfare, 2007-2011.
5 Government of Liberia’s Interim Poverty Reduction Strategy, 2006.
6 Liberia’s Ministry of Health & Social Welfare, August 2007.
7 World Bank, 2006.
8 Liberia Partners Forum, Liberia’s Ministry of Health & Social Welfare, February 2007.
Key Achievements
10 years of health care in Liberia
Over the past 10 years,
Merlin has supported health
services for an estimated
catchment population of
1.7 million people in Liberia.
Total spent £16.6 million
More than 10,000 consultations
each month at Merlin-supported
clinics since January 2007

332 health workers
trained, and health
messages delivered to
4,000 Sierra Leonean
refugees in 2000
SIERRA LEONE
91,536 patients
treated, 400 latrines
constructed and
7 million litres of
water provided in
camps during the
2003 war
Over 56,000
consultations
in 2006-7 at
hospital’s new
outpatients
department
in Buchanan
GUINEA
Merlin’s first intervention in Liberia
starting in 1997: 22 clinics and
2 hospitals supported
CÔTE D’IVOIRE
664 patients to
hospital in Zwedru
by Merlin ambulance
service in 2004-5
24,140 children
vaccinated against
measles in 2004
388 traditional midwives/birth
attendants and 304 community
health workers trained in 2001
Cholera outbreak in
Harper controlled and
300 wells chlorinated
in 2004
33 clinics equipped with solar
panels in 2002 for electricity
to facilitate deliveries at night

On behalf of all the people who have been
helped over the past 10 years, Merlin would
like to thank the following donors for their
generous support in Liberia:
• The AquaLung Trust
• BUZA (Buitenlandse Zaken – Dutch Ministry of Foreign Affairs)
• DFID (UK’s Department for International Development)
• DGDEV (Directorate General for Development)
• ECHO (European Commission’s Humanitarian Office)
• Irish Aid
• Jersey Overseas Aid
• Medicor Foundation
• Merlin individual supporters in the UK
• OCHA (United Nations Office for the Coordination
of Humanitarian Affairs)
• OFDA (The Office of US Foreign Disaster Assistance)
• Stichting Vluchteling (Netherlands Refugee Foundation)
• UNHCR (United Nations High Commission for Refugees)
• UNICEF (United Nations Children’s Fund)
• USAID (United States Agency for International Development)
Merlin is the only specialist UK charity
which responds worldwide with vital health
care and medical relief for vulnerable people
caught up in natural disasters, conflict,
disease and health system collapse.
12th Floor 207 Old Street London EC1V 9NR UK TEL: +44 (0) 20 7014 1600 FAX:+44 (0)20 7014 1601
EMAIL: hq@merlin.org.uk WEB: www.merlin.org.uk Registered charity number: 1016607
from emergency
to recovery
10 years of health care in Liberia
Contributors
Research and writing: Steve Wrelton
Photography: Merlin staff,
Steve Wrelton, Tugela Ridely
Editor: Ju-Lin Tan
Printed on 100% recycled paper
Cover image
Eight year old Christopher and his six
year old brother Prince Harris during
a routine check-up at the People's
United Community Clinic, Monrovia.