Sierra Leone’s current Mpox outbreak began in January 2025, marking the country’s first confirmed case amid a wider resurgence across West Africa. At the start of December 2025, there were 5,442 confirmed infections and 60 deaths reported nationwide. While many Mpox cases resolve simply with supportive medical care, a subset develop complications and chronic wounds that require further intervention. Without appropriate surgical and wound care, these could become life-threatening and contribute to life-long disability.
1. Why were the UK EMT deployed to Sierra Leone?
Most cases have occurred in the Western Area, particularly Freetown and its outskirts, with most infections presenting in adults aged 20–39 years. In response, the Ministry of Health and Sanitation (MoHS), with WHO support, launched a vaccination campaign and by November 2025 around 173,633 vaccinations have been given doses, mainly targeting healthcare workers and urban hotspots.
Although these successful vaccination efforts have significantly reduced the caseload since its peak in April and played a critical role in controlling the spread of disease, Mpox has re-emerged as a significant health concern in Sierra Leone. Numerous cases are now presenting with severe skin lesions and disfigurement, and associated challenges in performing functional activities in daily life, particularly among vulnerable populations. Due to concerns around national capacity to manage these severe cases, the UK EMT has been requested to aid and support the Ministry of Health and National Public Health Agency (NPHA) in a surgical and rehabilitation capacity.
The UK Emergency Medical Team has deployed to Connaught Hospital in Freetown to support the recovery and rehabilitation of Mpox patients, including two nurses, specialising in wound dressing and infection, prevention and control (IPC), two rehabilitation specialists and two surgeons, with specialization in plastic and reconstructive surgery.
2. What is Mpox?
Mpox (formerly known as monkeypox) is an infectious disease that can lead to severe complications in vulnerable populations such as young children, pregnant women, and immunocompromised individuals.
Common symptoms are lesions or a skin rash, which can last for two to four weeks, plus fever, headaches, back pain, muscle aches and tiredness. The virus spreads from person to person through close physical contact and coughs or sneezes.
While many Mpox cases resolve simply with supportive medical care, a subset develop complications that require surgical or procedural intervention. These typically arise from secondary bacterial infections, dead tissue, or severe ulceration of skin. Additionally, individuals that are immunocompromised with diseases such and tuberculosis or HIV, could be placed at increased risk of chronic wounds and associated functional challenges also compounded with stigma and perceptions around the disease.
3. What are the main health challenges?
“The health challenges we’re currently facing include under-reporting of cases due to the stigma associated with contracting Mpox, so it becomes difficult to manage numbers and infection rate as well as pressure on national healthcare capacity.
With only one national plastic surgeon in the entire country, the lack of adequate specialist surgical skills, medical supplies and lack of training to the local staff, local health facilities have not been able to address these Mpox wound complications and patients have been living with severe wounds in their communities. Without the appropriate multidisciplinary interventions, these wounds can be life-threatening, while stigma associated with the disease only deepens the challenges.
While mortality remains relatively low, the outbreak’s scale and persistence highlight limitations in public health infrastructure and the urgent need for sustained vaccination, testing, and public education to curb transmission and further control the outbreak.”
– Fredrick Mate, UK Emergency Medical Team Medical Coordinator
Dr. April Gamble, Senior Health Advisor (Rehab), adds:
“Beyond the physical challenges, individuals often face significant psychosocial impacts. Because mpox lesions may occur in intimate areas and because of stigma and misinformation linking the illness to sexual behaviour, many people experience shame, isolation, and fear of disclosure. This stigma can discourage individuals from seeking care or support and can lead to increased stress, anxiety, and depression. Together, these physical and social challenges can have lasting effects on mental health, resilience, and quality of life.”
4. What are UK-Med’s key concerns?
With this type of disease, wound care is vital and requires in-depth hands-on training. However, with resource shortages this is a challenge, without the correct materials adherence to wound management and infection prevention control (IPC) is hindered. As a result, UK EMT have shipped surgical and IPC supplies over to the team to help support the infection prevention aspects but as well, to deliver the best possible surgical care to the patients.
The team has also identified stigma associated with mpox as a barrier to delivering capacity-building activities, as some national healthcare workers feel nervous or reluctant to engage in mpox care. The team are working to better strengthen this relationship and build trust between UK EMT and national healthcare workers, also being involved in strengthening messaging around the disease
5. What is UK-Med doing to support the health needs?
Through continuous assessment of targeted health facilities, the team are addressing any noticeable gaps and reviewing how they can best support the national health needs. Through this they have identified four key outputs:
- Surgical – The team have been performing surgical wound debridement procedures and specialized plastics reconstructive surgery, while also conducting daily post-operative reviews. They have also delivered a wound management lecture for 26 national healthcare staff and participated in the daily surgical department meetings to strengthen collaboration and build relationships with the national surgical team and discuss technical best practices.
- Wound care – Wound care has been a key priority with the team supporting wound dressing changes, due to the complications from the disease, and collaborating with the hospital to provide nutritional counselling to the patients. The UK EMT surgeons have also been implementing WHO-recommended pain management protocols for Mpox, including the administration of pain killers and pain-reducing techniques prior to wound dressing changes.
- Infection prevention control (IPC) – Wound preparation for surgeries have been carried out interventions of the IPC nurse, demonstrating and supporting correct application of techniques to manage a sterile environment, aseptic technique and providing supplies such as hand-washing soap and disinfection solution. With the local facilities having limited public guidance on IPC for Mpox, the UK EMT provided posters and other messaging and information to support best practices in IPC. Furthermore, the team provided accompanying on-the-job mentoring, for procedures such as hand hygiene and clinical waste segregation as well as surgical site infection practices and ensuring checklists pre operative are adequately used to comply with IPC standards.
- Rehabilitation – The Rehabilitation Team has delivered more than 125 rehabilitation interventions for people affected by mpox, focusing on pain education and management, psychosocial support, functional training, and health promotion. In collaboration with the national hospital’s Counselling Department, the team establish a psychosocial support group for people affected by mpox. This group supports individuals in better understanding their health conditions and developing practical coping strategies to manage stress. In addition, the Rehabilitation Team worked closely with national rehabilitation staff to provide capacity building through on-the-job coaching, strengthening knowledge and skills in rehabilitation care.
These activities serve to safely and appropriately manage, treat and discharge patients with Mpox, through reinforcing and implementing IPC best practices, and ensuring a knowledge transfer with national health care staff at the named facility.
Through training and capacity building, UK EMT are helping to ensure national preparedness, so the health system is better equipped if the outbreak makes a resurgence in future, particularly in what relates to further surgical complications from Mpox.
