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The Full Story is a partnership between Fuller and Foreign Policy.

FREETOWN, Sierra Leone—Sonita Kamara is in obstructed labor, a life-threatening complication where the baby cannot pass through the birth canal despite strong contractions. She is rushed to Princess Christian Maternity Hospital in Freetown, the busiest maternity and newborn hospital in Sierra Leone.

Her baby is in distress. “If we don’t operate within 30 minutes, the baby might die,” says Rosetta Cole, a senior obstetrician-gynecologist, as she prepares to perform an emergency cesarean section.

FREETOWN, Sierra Leone—Sonita Kamara is in obstructed labor, a life-threatening complication where the baby cannot pass through the birth canal despite strong contractions. She is rushed to Princess Christian Maternity Hospital in Freetown, the busiest maternity and newborn hospital in Sierra Leone.

Her baby is in distress. “If we don’t operate within 30 minutes, the baby might die,” says Rosetta Cole, a senior obstetrician-gynecologist, as she prepares to perform an emergency cesarean section.

But the operation cannot begin. The hospital has run out of basic surgical supplies: sutures, anesthetic, and IV fluids. Kamara’s family is sent into the city to search for them in pharmacies. More than two hours later, they return, and the operation can finally start.

After an agonizing wait, Kamara’s newborn is safely delivered but is in need of oxygen. Baby Kelvin is transferred to the special care baby unit just down the street at Ola During Children’s Hospital. A few days later, he and Kamara are discharged.

Not every mother in Sierra Leone is so lucky.

Esther meets her daughter, Miracle, for the first time after her emergency C-section at Princess Christian Maternity Hospital in Freetown, Sierra Leone, on Nov. 29, 2025.Video still/On Our Radar, for Fuller

A small nation of close to 9 million people on the west coast of Africa, Sierra Leone is one of the world’s poorest countries and depends heavily on foreign aid to fund essential services, including in health care. In 2023, it received about $500 million in official development assistance, and total aid flows have, at times, exceeded 10 percent of the country’s total economic output.

Sierra Leone once had the highest maternal mortality rate in the world, but since 2000, maternal deaths have fallen by nearly 80 percent. Foreign aid has been credited with helping more Sierra Leonean women and children survive birth.

The special care baby unit at Ola During Children’s Hospital, to which Kamara’s baby was sent, was built—and gets money for supplies—through the Saving Lives in Sierra Leone program.

Started in 2016 with funding entirely provided by the United Kingdom, the work of Saving Lives (which has included training for midwives, the provision of contraceptives, and the establishment of special care baby units) had previously been a source of pride for British politicians. In 2023, it........

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