Let’s be completely direct. When you think of Sierra Leone, you may think of its beautiful beaches, its resilient people, and its difficult history of civil war and the Ebola outbreak. You do not think of it as a destination for healthcare. And you would be right. For the vast majority of people, it is not.
Sierra Leone is one of the world’s least developed countries. Its healthcare system reflects this reality: it is severely under-resourced, understaffed, and faces monumental challenges. For expatriates, aid workers, diplomats, and business travelers whose work brings them here, understanding this landscape is not about finding quality care—it is about survival and risk mitigation.
This guide is not for tourists. It is for the few who must be in Sierra Leone for professional or essential reasons. We will not discuss “hospitals in Sierra Leone” in the way one might discuss hospitals in Europe. We will discuss the facilities that exist, their extreme limitations, and the absolute, non-negotiable protocols you must have in place to protect your life and health. This is about managing risk in a high-threat medical environment.
The Hard Reality: A System in Perpetual Recovery
Sierra Leone’s healthcare system was fragile before the civil war (1991-2002) and the Ebola epidemic (2014-2016). These events devastated infrastructure and human resources. While there has been rebuilding with international aid, the system remains critically weak.
The public system is structured around Community Health Centers (CHCs), Community Health Posts (CHPs), and District Hospitals. The top referral facility is the Connaught Hospital in Freetown, the country’s main public hospital. There are also a handful of private clinics in Freetown, such as Choithram Memorial Hospital and Lakka Hospital, which offer a marginally higher standard but are still extremely basic by international norms.
The defining feature of healthcare here is the near-total absence of specialist services, advanced diagnostics (no consistent CT or MRI), reliable blood banks, and consistent supplies of essential medications and equipment. Electricity and water are unreliable even in major hospitals. For an expatriate, the local system exists for one purpose only: emergency stabilization prior to immediate medical evacuation.
An Aid Worker’s Perspective: Mark, a logistician with an international NGO who has completed multiple postings in Sierra Leone, states bluntly: “Our medical briefing is clear: Sierra Leone is a ‘no-plan’ country for anything beyond basic first aid. If you have a fever that could be malaria, you test and treat yourself from your own kit. If you have an accident requiring more than a bandage, you call the medevac number. I’ve been inside Connaught Hospital. The doctors and nurses are heroes working in impossible conditions, but as a foreigner, you cannot rely on it for care. Your kit, your protocols, and your evacuation insurance are your only healthcare.”
Navigating a Fragile System: Know the Landmarks, Plan to Leave
Understanding what exists is only to know where you might be taken in a crisis while evacuation is arranged.
- The Main Public Referral Hospital:
- Connaught Hospital: Located in central Freetown. This is the largest public hospital and the main referral center. It has an emergency ward, surgical theater, and inpatient beds. Conditions are extremely challenging: overcrowded, under-equipped, with frequent shortages.
- Private/NGO-Supported Facilities (Freetown):
- Choithram Memorial Hospital: A private, fee-for-service hospital in Freetown. Considered one of the “best” in the country. It is cleaner and more organized than public options but remains very limited in capability.
- Lakka Hospital: Another private option on the Freetown peninsula.
- Mile 91 Hospital (Magbenteh Community Hospital): An NGO-run hospital in Makeni that provides good basic care by local standards.
- These are not Western-standard hospitals. They may be suitable for managing uncomplicated malaria or a minor wound, but little else.
- District Hospitals & Health Centers: Found in towns like Bo, Kenema, and Makeni. They provide the most basic level of inpatient care. For an expat, they are a last resort in a remote location.
- The Only Acceptable Pathway for Serious Care: Immediate Medical Evacuation: For any serious illness (severe malaria, pneumonia, typhoid) or injury (fractures requiring surgery, head trauma, abdominal pain), the mandatory protocol is evacuation. The nearest appropriate destinations are Ghana (Accra), Morocco (Casablanca), Senegal (Dakar), or Europe.
A Clear-Eyed Look at Medical Facilities
| Facility Name | Location | Type | Realistic Capabilities in a Crisis | Critical Notes for Foreigners |
|---|---|---|---|---|
| Connaught Hospital | Freetown | Public Central Hospital | Emergency stabilization, basic trauma care, malaria treatment, maternity. | The highest-level public facility. For stabilization only while medevac is arranged. |
| Choithram Memorial Hospital | Freetown | Private Hospital | Marginally better environment for minor issues; basic lab, X-ray. | The preferred local point for initial assessment in Freetown, under medevac coordination. |
| Lakka Hospital | Freetown Peninsula | Private Clinic/Hospital | Similar to Choithram; used by some expats. | Another stabilization point. |
| Magbenteh Community Hospital | Makeni | NGO-supported Hospital | Basic surgical and medical care for the region. | Possibly the best option in the Northern Province, but still limited. |
| Pharmacies | Freetown (limited) | Private | Sell basic medications; stock is unreliable. | Do not rely on them for any specific drug. |
What Might Be Manageable Locally (With Extreme Caution)?
Only consider local facilities for the following, and only under the direct guidance of your professional medevac provider:
- Diagnosis and initial treatment of uncomplicated malaria (confirm with a reliable rapid test from your own kit).
- Cleaning and suturing of minor, uninfected cuts.
- Intravenous rehydration for severe diarrhea, if you can provide your own IV fluids and catheter.
Your Mandatory Health Preparedness & Survival Protocol
If your work takes you to Sierra Leone, treat this list as law. Deviation significantly increases the risk of severe illness, disability, or death.
- Secure Elite Medical Evacuation Insurance with 24/7 Support: This is your lifeline. You need a policy from a top-tier provider specializing in high-risk environments (e.g., International SOS, Global Rescue, Healix). It must guarantee evacuation from Sierra Leone to a pre-agreed facility in Accra, Dakar, or Europe. Coverage minimum: $1,000,000 USD. You must carry the card and have the 24/7 alarm center number programmed into multiple phones and written on your person.
- Assemble a Professional-Grade Medical Kit: You must be your own field hospital. Your kit should be prepared with the help of a travel medicine doctor and include:
- Malaria: Multiple courses of WHO-approved Artemisinin-based Combination Therapy (ACT) like Coartem for treatment. Prophylaxis (e.g., Malarone, Doxycycline) is essential.
- Antibiotics: Broad-spectrum (Azithromycin), quinolones (Ciprofloxacin), and strong options for resistant infections.
- IV Supplies: Sterile IV cannulas, giving sets, and bags of normal saline and Ringer’s Lactate.
- Trauma Supplies: Hemostatic gauze (e.g., Celox), tourniquet, chest seals, pressure bandages.
- Full Pharmacy: A 6-month minimum supply of all personal prescriptions, plus anti-pain, anti-nausea, and steroid medications.
- Diagnostics: Multiple rapid diagnostic tests for Malaria, Typhoid, and Dengue.
- Complete Rigorous Pre-Travel Medical Preparation:
- Visit a specialist travel clinic. Essential vaccinations: Yellow Fever (required), Meningitis ACWY, Hepatitis A & B, Typhoid, Rabies (full pre-exposure series), Cholera (oral vaccine). Ensure all routine vaccinations are up to date.
- Obtain a prescription for a full course of standby emergency antibiotics and discuss scenarios for their use.
- Establish a Clear Chain of Command:
- In any medical situation, your first call is to your medevac provider’s alarm center. They will make all decisions about if/when to go to a local facility.
- Know the location of Choithram Memorial Hospital and Connaught Hospital only as potential stabilization points they may direct you to.
- Register with your embassy in Freetown immediately upon arrival. Provide them your medevac details.
- Establish a local point of contact (your organization’s security officer) who knows your protocol.
- Practice Aggressive Preventive Health Measures:
- Water/Food: Consume only bottled or thoroughly boiled water. Eat only food that is cooked and served hot. Avoid salads, unpasteurized dairy, and street food.
- Vector Protection: Sleep under an insecticide-treated bed net. Use DEET 30-50% repellent daily. Wear long sleeves/pants at dusk and dawn.
- Hygiene: Use alcohol-based hand sanitizer rigorously.
The Critical Importance of Professional and Expat Networks
In an environment with no reliable public information, the knowledge shared within the tight-knit community of aid workers, UN staff, diplomats, and mining company employees is vital. Which clinic has a functional lab this week? What is the real-time status of the medevac plane? Which local doctor can be trusted to assist with a stabilization?
This information is exchanged through professional security channels and trusted community forums.
On MyHospitalNow, our forum for hospitals in Sierra Leone exists as a rare, neutral platform for this specific, critical exchange among those who have experience on the ground.
From a Former UN Medical Officer in Freetown: “The standard operating procedure for all international staff is medevac. The local system is not part of the treatment plan; it’s part of the emergency response chain. The most valuable insights come from other organizations’ medics. On forums like MyHospitalNow, we shared specific, real-world updates: which pharmacy had a shipment of Coartem, which local surgeon at Choithram had experience with trauma, the current lead time for a medevac to Accra. This isn’t general advice; it’s tactical information for staying alive in a medical desert.” – Dr. Sarah, Former UN
If your work requires you to go to Sierra Leone, engaging with this professional community is a key component of your risk assessment.
We host these essential, sober discussions here: MyHospitalNow’s Hospitals in Sierra Leone Community.
Final Word: Acknowledging Risk and Taking Full Responsibility
Working or living in Sierra Leone means accepting a level of medical risk that requires the highest possible degree of personal responsibility and professional-grade preparation. The local healthcare system cannot be relied upon.
Your health and safety depend entirely on your own preparations: a elite medevac plan, a comprehensive medical kit, disciplined preventive practices, and a clear, practiced emergency protocol.