By James Tamba Lebbie
Mariatu Sesay was seven when her lungs began to fail. Pneumonia, the doctor said, a disease that should have been treated easily. Her mother clutched her hand as they waited for the hospital’s single oxygen tank to be wheeled in. But when the nurse returned, she whispered the words that still haunt the ward, “It is finished.”
No backup tank. No functioning ambulance to transfer her. No portable ventilator. Within the hour, Mariatu’s small chest rose for the last time. Her mother’s cry cracked through the corridors, another reminder that in Sierra Leone, the absence of basic medical equipment is not an exception: it is the rule.
Now, amid this crisis, the government insists the way forward is to split Freetown into two cities.
This is the wrong approach, but officials argue that creating two councils will improve “service delivery”. The question is, what service was denied Mariatu? Oxygen does not flow from city boundaries. Ambulances are not dispatched by new council names. Health services remain under the Ministry of Health, funded centrally, staffed centrally, and failing centrally. Drawing a new map of Freetown cannot conjure the oxygen tank that might have saved her.
What true reform requires if decentralisation is to mean anything is that it must come with real transfers of resources:
ü Budgets for equipment and medicines,
ü Staff authority for hiring doctors and nurses,
ü Emergency systems that guarantee every hospital has working ambulances and trained personnel.
Instead, the government offers lines on a map. These are cosmetic changes and political engineering disguised as reform. The human cost of this is that every headline about “two cities” diverts attention from the real emergencies: the children gasping for air, the mothers bleeding in delivery wards, and the men dying from treatable injuries. Service delivery is not about boundaries. It is about lives. And lives are being lost.
Mariatu’s story is not isolated; it is a mirror for thousands of families across Sierra Leone who know the agony of losing loved ones to a health system that stumbles where it should stand.
Citizens must demand honesty: will dividing Freetown save a child’s life, or will it merely redraw a political map? Until the government answers this, no consultation, no meeting, and no notice can be called legitimate.
In Mariatu’s name, and in the name of all those gone too soon, Sierra Leoneans must say, oxygen, not boundaries; ambulances, not divisions; real services, not illusions.
