Tragically, on August 14th, 2017, the Sugar Loaf Mountain in Freetown, Sierra Leone suffered a massive mudslide. Figure 1 below shows the areas impacted by this disaster. The World Bank has estimated the total economic loss of this mudslide to be approximately 31.65 million USD .
Figure 1- Map of 2017 Sierra Leone mudslides – areas affected
The August 2017 mudslide occurred due to heavy rainfall that led Freetown to become flooded during the rainy season. The flooding caused a series of mudslides in Regent, a town east of Freetown situated on the Sugar Loaf Mountain . Subsequent wasting of mud and debris tore down countless homes and initially left 200 people dead, although casualties would continue to rise in the weeks after, as new bodies were uncovered . A World Bank report estimates that 1,141 individuals have been declared dead or missing from this event .
Fatalities and injuries were extremely high as there is lots of overcrowding due to the dense clusters of homes on the hillside. After the country’s civil war, which lasted from 1991-2002, many families moved to the capital city, Freetown, in search of work, and settled in the nearby hillside town of Regent, leading to overcrowding. During the war, health and economic infrastructure deteriorated as many government-created clinics were demolished . The influx of people coming to Freetown after the war compounded the poor healthcare situation .
Furthermore, human interference with the land impacted the occurrence of the mudslide. The influx of people required the uprooting of a large number of trees for more housing to be built in urbanized areas, and to ensure greater access to basic necessities, such as education and healthcare . This deforestation led to the deficit of protective natural drainage systems, and further made the soil unstable, and more prone to collapse, especially when used as a structural foundation . Several international organizations, governments, media outlets, and United Nations agencies had actively warned of the risks of unregulated construction on hillsides, but not much action was taken . Additionally, Mohamed Bah, the Deputy Director of Sierra Leone’s Environment Protection Agency gave many warnings about the potential of a disaster due to the mass construction of buildings on Sugar Loaf Mountain prior to the incident .
After the mudslide occurred, rice harvesting weekly working hours remained low decreasing the amount harvested . This impacted the country’s GDP, as agriculture constitutes 60.7% of the country’s GDP . The nation is still recovering from the Civil War and the 2014 Ebola Outbreak as this led to decreased trade, mining activities, and investors, which negatively impacted the country’s economy . These events have negatively impacted the healthcare system and the socioeconomic conditions in the country The Ebola Outbreak also exacerbated the shortage of medical staff in the country as many died [10, 11].
Global Health Perspective
It is very unfortunate that there have been many deaths due to this mudslide, and that there are many more people that have been affected by this disaster. Many victims still require aid as they are coping with trauma, injuries, or are internally displaced . A total of 5,951 people were affected by the mudslide and flood, of which 969 were children under the age of five . It is important to ensure that persons affected by this disaster, and those suffering with conditions from the mudslide are receiving life-sustaining aid. Mental health is also very important to address as the civil war and this mudslide have both caused lots of trauma for individuals. Furthermore, maternal and child health are vulnerable due to the difficulty for midwives – a great healthcare asset – to access pregnant women . Sierra Leone has the third highest maternal mortality rate and the tenth highest infant mortality rate in the world and the floods may have worsened these numbers . Prior to the outbreak mothers accessing obstetric care was increasing although these rates have decreased after the Ebola Outbreak and the mudslide .
Notable public health consequences of the mudslide include higher risks of cholera, malaria, typhoid, and certain waterborne diseases in Freetown and its surrounding regions. Mosquitoes lay their larvae in water, so with more water present, there will be more breeding sites for the mosquitos . This means that more mosquitos will grow that will carry the malaria-causing parasite . Furthermore, while increased rates of waterborne diseases are endemic during the rainy season, risks proved to be even greater following the mudslide due to damaged water pipes and related sanitation infrastructure. The many broken pipes that were broken as a result of the mudslide make it difficult to ensure that citizens are getting access to clean and safe drinking water, which has proven to be a major concern in slum locations with limited access to appropriate sanitation facilities . Contaminated water may contain bacteria that may lead to typhoid, cholera, diarrhea, and other illnesses as shown in Figure 2.
Figure 2-Transmission of Waterborne Diseases
These waterborne diseases are further exacerbated by climate change as fluctuating weather patterns in the nation are leading to more unexpected rainfall and rising temperatures. Rising temperatures and increased precipitation expand the breeding sites for vector-borne diseases, and lead to a higher risk of water-borne diseases .
International media played a role in the coverage of the mudslide. It particularly focused on those who lost their lives, as well as development contributions from international state donors [2,4,19,20]. Little emphasis, however, was placed on the experiences of survivors following the disaster, and what could have been done to support them as they recovered from this disaster. Even in present day Freetown, many persons affected by the mudslide have still not received financial support that was promised by the incumbent president . One survivor, Senessie, was told he could not be verified as a resident of the area, while others received a small portion, but not the entire sum that they had been promised .
The August 2017 mudslide highlights areas such as housing, healthcare, and environmental protection in Sierra Leone, which must be improved. As of 2014, the government spent 11.4%  of its GDP on healthcare, which is close to reaching the 15% goal that the African Heads of States committed to in 2001 during the Abuja Agreement . Moreover, the government has also taken some steps to ensure free healthcare to those that desperately need it. As of 2010, free healthcare was introduced for children under 5 and for lactating mothers .
Currently, donors and international organizations help to finance the healthcare system but the government aims to one day manage its own system . In addition to financial challenges, there are also infrastructural challenges. Only 8% of the roads in Sierra Leone are paved, which makes it easy for them to flood, and bridges are not regularly maintained, which makes them more prone to collapses . These infrastructural challenges made it difficult to provide resources to people affected, as it was difficult to access these people in the aftermath of the mudslide.
Along with structural changes, the Ministry of Health and Sanitation needs to properly address the issues of broken pipes, and ensure that citizens are receiving safe drinking water and the medical attention that they require. The issue of slums, overcrowding, and sanitary toilet facilities needs to be addressed, as these have been the underlying determinants of where public health emergencies will most affect citizens. Better urban planning needs to be administered as there is an abundance of land, but the population is clustered in very few areas as shown in Figure 3.
Figure 3- Population Density of Sierra Leone
Citizens have taken action to bring positive change to the country. Bah was 17 years old when the mudslide occurred, and most of his family members died during the disaster . This mudslide led to an environmental awakening for the teenager leading him to invest his $20 into making recyclable bags from banana leaves and selling them to local businesses . Bah now has a company that also produces an eco-friendly alternative to charcoal, as charcoal is used in most households for cooking and heating . Charcoal is also a main contributor to deforestation and land degradation. The alternative that he produces is briquettes, which last four hours longer than charcoal . This is one step to an eco-friendly approach to reduce environmental damage, which will help to prevent another disaster like this from occurring. While Sierra Leone is still reeling from the effects of the August 2017 mudslide, stories like Bah’s bring hope for a better Sierra Leone.
 World Bank. (2017, November 9). Sierra Leone – Rapid damage and loss assessment of August 14th, 2017 landslides and floods in the western area. Retrieved from http://documents.worldbank.org/curated/en/523671510297364577/Sierra-Leone-Rapid-damage-and-loss-assessment-of-August-14th-2017-landslides-and-floods-in-the-western-area
 Erakit, J. (2017, August 15). Freetown Flooding Raises Concerns About Maternal Healthcare. SDGs For All. Retrieved from https://www.sdgsforall.net/index.php/goal-3/415-freetown-flooding-raises-concern-about-maternal-healthcare
 World Health Organization. (2010). WHO | Sierra Leone’s long recovery from the scars of war. Retrieved 21 April 2020, from https://www.who.int/bulletin/volumes/88/10/10-031010/en/
 Sierra Leone mudslide: What, where and why? (2017, August 22). Al Jazeera. Retrieved from https://www.aljazeera.com/indepth/features/2017/08/sierra-leone-mudslide-170816053741558.html.
 Trenchard, T. (2018, August 8). Life doesn’t go on after the mudslides in Sierra Leone. National Public Radio. https://www.npr.org/sections/goatsandsoda/2018/04/08/599526907/life-doesnt-go-on-after-the-mudslides-in-sierra-leone.
 Africa Research Institute. (2015, November 6). Flooding in Freetown: a failure of planning? Retrieved from https://www.africaresearchinstitute.org/newsite/blog/flooding-in-freetown-a-failure-of-planning/.
 World Bank Group. (2020). The socio-economic impacts of Ebola in Sierra Leone : results from a high frequency cell phone survey (round three) (English) p. 21. Washington, D.C. Retrieved from http://documents.worldbank.org/curated/en/873321467999676330/The-socio-economic-impacts-of-Ebola-in-Sierra-Leone-results-from-a-high-frequency-cell-phone-survey-round-three
 Central Intelligence Agency. (2020). Africa :: Sierra Leone — The World Factbook – Central Intelligence Agency. Retrieved 21 April 2020, from https://www.cia.gov/library/publications/the-world-factbook/geos/sl.html
 Copley, A. (2014). Understanding the Economic Effects of the 2014 Ebola Outbreak in West Africa. Retrieved 21 April 2020, from https://www.brookings.edu/blog/africa-in-focus/2014/10/01/understanding-the-economic-effects-of-the-2014-ebola-outbreak-in-west-africa/
 Robinson C. (2019). Primary health care and family medicine in Sierra Leone. African journal of primary health care & family medicine, 11(1), e1–e3. https://doi.org/10.4102/phcfm.v11i1.2051
 Sylvester Squire, J., Hann, K., Denisiuk, O., Kamara, M., Tamang, D., & Zachariah, R. (2017). The Ebola outbreak and staffing in public health facilities in rural Sierra Leone: who is left to do the job?. Public health action, 7(Suppl 1), S47–S54. https://doi.org/10.5588/pha.16.0089
 World Health Organization. (2017, August 21). Preventing spread of disease in wake of mudslides is vital, says WHO. WHO Regional Office for Africa. Retrieved from https://www.afro.who.int/news/preventing-spread-disease-wake-mudslides-vital-says-who-0.
 United Nations Disaster Assessment and Coordination. (2017, August 31). Sierra Leone: Landslide and floods situation update no. 8, 31 August 2017. Reliefweb. Retrieved from https://reliefweb.int/sites/reliefweb.int/files/resources/Sierra%20Leone%20Sit%20Update%20no%208.pdf.
 Brolin Ribacke KJ, van Duinen AJ, Nordenstedt H, Höijer J, Molnes R, Froseth TW, et al. (2016) The Impact of the West Africa Ebola Outbreak on Obstetric Health Care in Sierra Leone. PLoS ONE 11(2): e0150080. doi:10.1371/journal.pone.0150080
 World Health Organization. (2001). Water-related Diseases. Retrieved 21 April 2020, from https://www.who.int/water_sanitation_health/diseases-risks/diseases/malaria/en/
 World Health Organization. (2020, January 14). Fact sheet about malaria. Retrieved from http://www.who.int/mediacentre/factsheets/fs094/en/.
 Agence de Presse Africaine (2017, August 21). Sierra Leone risks major health crisis after deadly mudslides. Retrieved from http://apanews.net/en/news/sierra-leone-risks-severe-health-crisis-after-deadly-mudslides.
 Climate risk profile: Sierra leone. (2016). Climatelinks. https://www.climatelinks.org/resources/climate-change-risk-profile-sierra-leone.
 Busari, S., & Clarke, H. (2017, August 19). Death toll mounts in Sierra Leone mudslides. CNN. Retrieved from https://www.cnn.com/2017/08/18/africa/sierra-leone-mudslides/index.html.
 Fernandes, C. (2017, September 8). Sierra Leone mudslides. https://www.humanitariancoalition.ca/sierra-leone-mudslides.
 World Health Organization. Sierra Leone. Retrieved 21 April 2020, from https://www.who.int/countries/sle/en/
 World Health Organization. (2010). Now it’s free, how to pay for it? Sierra Leone’s dilemma. Retrieved from https://www.who.int/bulletin/volumes/88/12/10-021210/en/.
 Brima, A. (2019, August 8). Infrastructure in Sierra Leone: Fixing the road to nowhere. Africa at LSE. https://blogs.lse.ac.uk/africaatlse/2019/08/08/infrastructure-in-sierra-leone-fixing-the-road-to-nowhere/.
 Reynolds, E. (2019, December 3). How a deadly mudslide inspired a teenager to protect his environment. CNN. Retrieved from https://www.cnn.com/2019/11/25/africa/sierra-leone-environment-intl-c2e/index.html.