Sierra Leone is a small west African country whose capital is Freetown. It recorded its first case of mpox in January 2025.
Despite limited resources, the country treats mpox as seriously as outbreaks of Ebola and covid-19, using radio jingles, posters and daily texts for public-health messaging and sending workers to poorly connected areas to identify cases. Military and police hospitals have been converted into isolation centres. The country has been recognised as a model for effective public-health messaging on the continent.
The strain responsible for most of the country's cases is thought to be the older clade IIb, but it spread faster than expected and infected both sexes equally—more like the newer, more lethal clade Ib—puzzling scientists.
Cuts to foreign aid, which has historically helped Sierra Leone pay for lab equipment, contact-tracing and genomic sequencing, could weaken defences against future outbreaks.
Sierra Leone has long been a regional gateway for cocaine and heroin. In the 2010s tramadol, a painkiller, became a popular street drug shipped mostly through Nigeria. Regulatory changes in 2018 in India, where most of it was sourced, made it more expensive, dampening demand.
Kush, a potent mix of synthetic opioids and cannabinoids, has partly filled the gap. It costs just $0.40 a dose and is extremely addictive. Testing by the Global Initiative against Transnational Organised Crime found many varieties contain nitazenes, a class of synthetic opioids that can be 25 times more potent than fentanyl. The psychoactive ingredients are shipped via courier services from China, Britain and the Netherlands, often disguised as mechanical lubricants or "flavour sprays", then dissolved in acetone and sprayed on marshmallow leaves, which are ground into powder and smoked. Users rarely know exactly what they are taking.
Sierra Leone and neighbouring Liberia declared a public-health emergency in early 2024 following a steep increase in deaths and hospitalisations. The mayor of Freetown set up a dedicated burial team to collect the bodies of those who have died on the capital's streets; mass burials and cremations of victims have been held since 2022. A report by the Clingendael Institute, a Dutch think-tank, estimated in February 2025 that kush had killed thousands across west Africa. The country's only psychiatric hospital is treating many more people for drug-related conditions than a few years ago. A government task-force spanning multiple ministries identifies drug users, takes them into rehabilitation facilities and tries to reintegrate them, but drug use is not going down.
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