Sierra Leone strengthens management of severe mpox complications

Freetown-When Sierra Leone confirmed its first mpox case in January 2025, few anticipated the scale of the health emergency. By November of that year, more than 5400 cases and 60 deaths were reported across the country.

While most survivors recovered with standard supportive care, a small number developed severe complications, including extensive body tissue destruction and chronic, non-healing wounds requiring specialized treatment not widely available in the country.

"I could not move around or do simple things for myself," says Grace Turay, an mpox survivor. "I did not know if my wounds would ever heal."

Gaps in infection prevention and control, shortages of essential wound care items and the fee-for-service model in some hospitals created additional barriers to care. Delays in tracing patients also meant that several people with advanced complications were identified late, increasing the risk of disability.

"Some patients required prolonged hospitalization beyond the expected duration of care," recalls Dr Agnes Bangura, Programme Manager for Case Management at the National Public Health Agency. "We also observed delayed wound healing in several patients, partly attributed to multidrug resistant infections."

To address these gaps, the Government of Sierra Leone requested World Health Organization (WHO) to facilitate the deployment of a United Kingdom Emergency Medical Team (UK EMT). Arriving in mid-November 2025 and concluding its mission in early 2026, this experienced international team, trained to deliver advanced surgery and rehabilitation in health emergencies, provided specialized surgical intervention for complex mpox cases, among other interventions.

Working alongside Sierra Leonean clinicians, UK EMT conducted a comprehensive reassessment of patients previously identified with severe mpox complications. Of the 15 patients initially listed, nine were traced and six underwent full clinical review, including Turay. Based on these assessments, the team developed individualized, multidisciplinary treatment plans that brought together surgery, nursing, advanced wound care, rehabilitation, nutrition and psychosocial support to ensure holistic recovery.

"We supported affected populations with essential health services," says Mr Fred Culley, UK EMT Team Lead. "Through coordination with hospital management and local health authorities, we strengthened health facilities, trained staff and supported wound care, outpatient services and rehabilitation."

As part of the clinical response, the team performed wound debridement (removal of dead skin tissue from the wound to promote healing) in two patients and three complex plastic and reconstructive surgeries for patients with extensive tissue damage. The team also performed more than 50 wound dressing sessions, introducing standardized wound assessment tools and critical preoperative investigations to prevent further deterioration and reducing risks of secondary infection.

Hands-on training and mentorship between the team and local health professionals strengthened infection prevention and control guidelines and practice, improved pain management practices and underscored the importance of nutrition for wound healing, resulting in more consistent care and improved healing outcomes.

Rehabilitation teams delivered more than 90 sessions to 14 patients, helping restore mobility, reduce scarring and improve independence. A "champions of mpox," peer led group was established to support psychosocial recovery, combat stigma and support reintegration of survivors into their communities.

"Because of the services provided, I can perform daily activities like visiting the bathroom and moving around. The UK EMT shared information in a way I could understand, which helped me know how to get better," says Turay.

Hospital teams also report improvements. "The team's engagement across departments has been extremely valuable," says Dr Ibrahim Mark Kapuwa, Hospital Care Manager at Connaught Teaching Hospital in Freetown. "Our capacity has been strengthened, and we are committed to sustaining these gains."

On conclusion of the mission in January 2026, the UK EMT and WHO donated surgical items, test kits and essential medicines to support ongoing care. The work laid a foundation for emergency preparedness, including a new multidisciplinary wound management training programme for health workers in Sierra Leone.

"The support of the UK EMT was timely and critical, strengthening the overall response to the outbreak. I am particularly pleased by the transfer of skills that has taken place between both clinical teams" says Dr George Ameh, WHO Country Representative in Sierra Leone.