In the Heart of the Outbreak: Treating Mpox in Sierra Leone’s Hotspot
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Sierra Leone is presently experiencing an outbreak of mpox, averaging 29 new cases each day in the last week (23 – 30 June 2025).
Médecins Sans Frontières/Doctors Without Borders (MSF) has responded in Freetown, (the country’s hotspot zone) and Kenema, Bombali and Tonkolili districts, in the Eastern and Northern provinces of the country. Agnes Dama, MSF’s medical referent for the response, tells us about her daily work and the challenges of treating a disease that is stigmatised, like mpox.
I am from the Bonthe district of Sierra Leone’s Southern province, and I have been working with MSF in the country since 2018, supporting medical coordination. I am presently the medical referent for the mpox response. This is not my first experience working with infectious diseases; I was also involved in the response to the 2014 Ebola epidemic.
Mpox is not new to Sierra Leone. This is the fourth time that we are recording cases. The current outbreak is hitting the Western Area Rural district and the capital city the most, which are densely populated areas with over 1 million residents. On 16 January this year, the Ministry of Health declared mpox a public health emergency. Presently, all districts in the country have recorded cases with over 4,000 cumulative cases being recorded since the outbreak started.
Mpox is endemic in around ten countries in Central and West Africa, and it is a contagious viral disease, which can spread between animals and people, as well as through close contact between individuals. When the disease is not treated on time, it can lead to complications and death for affected people, especially if their immune system has been compromised by other diseases. With mpox, you can tell that patients are in a lot of pain. I feel terrible seeing them suffer like this. For some of them, fortunately a minority; their bodies are covered with swollen pustules, and it makes it hard to sit or lay down. There are instances where the pustules entirely cover the genitals which is extremely difficult for the patient.
There are a few government hospitals in Freetown, the capital, that are receiving people who have mpox. Initially, mild cases of mpox were being managed through self-isolation and severe cases were admitted in a health facility. However, because of stigmatisation, lack of awareness and fear, many people do not report to treatment facilities. We see instances of complete denial by patient, with mpox being referred to as chicken pox and being treated with alcohol, local clay, and traditional herbs.
The Ministry of Health has been focusing on vaccination for high-risk individuals, social distancing regulations, increasing public awareness, and ensuring everyone, regardless of the severity of their diagnosis, receives treatment in a health facility.
MSF’s response to the outbreak
To support with the response, MSF rehabilitated the infectious isolation wards of Connaught hospital, which is the national referral hospital, and Kenema government hospital. We also trained Ministry of Health staff on cost-efficient measures like the production of chlorine using water, salt and electricity.
Following a spike in the number of confirmed cases, we set up a 50-bed capacity mpox treatment centre for moderate and severe cases in Calaba Town neighbourhood of Freetown.
We received our first patient in the centre on 11 June. I could tell there was a mixture of emotions among my team because for some of them this is their first time providing care for patients with an infectious disease. I had a wave of different emotions seeing this patient myself. He had several swollen pustules on his body.
Some patients arrive at the centre feeling as though they have no hope of getting better, and they have seen a lot of misinformation about mpox. It is hard for them to accept that they have mpox and inform their family or friends because of the stigmatisation that they might receive in their communities, and their traditional beliefs about treatment. With the psychosocial counselling we are providing in the centre, I am seeing more acceptance, and patients are slowly getting an understanding of their diagnosis and regaining trust that they can be cured.
