Independent Appeal: Life-changing aid in one of the world's worst slums

Just west of the centre of Sierra Leone's capital Freetown a filthy river, known as the Crocodile, works its way into the sea. Shanties constructed from corrugated zinc line the banks. Children wade in the water alongside wallowing pigs and small islets of rubbish. Some crouch to defecate in the stream or on the waterfront flats beyond the shanties where accumulated trash is slowing firming into banks of new land. The air can make the outsider gag.

The slum is called Kroo Bay. It is one of the grimmest places in one of the poorest countries in the world. It is home to perhaps 8,000 people, though no one really knows for sure. Save the Children, one of the charities supported by this year's Independent Christmas Appeal, is at work in Kroo Bay and other slums in Freetown.

Water-borne diarrhoea still kills a child somewhere in the world every 15 seconds. In Kroo Bay one in five children die before their 5th birthday. "The environment is not healthy for human habitation," said Sahr Juana, a Sierra Leonean who works as a health programme officer with Save the Children. "The life and living conditions in Kroo Bay are deplorable."

The name Kroo Bay comes from the Kru tribe, an ethnic group from neighbouring Liberia who long ago made their home by the outflow of the Crocodile River. But the slum's population has been massively augmented by the huge exodus from the countryside caused by Sierra Leone's 11-year civil war. So Kroo Bay sits between the banks and shopping streets and the more affluent western districts where expatriates and wealthy Sierra Leoneans live. There a flat with a generator for electricity and running water can easily cost £700 a month. In Kroo Bay monthly shack rental is 20,000 leones, less than £3.

Conditions in Freetown's slums are fetid. They are low lying and the city is one of the wettest capitals on the planet. The rains begin in May and run to October. At their height – in August, known to locals as the "masta rain month" – Freetown receives more rainfall than London does in a year; flooding is a particular problem.

Save the Children is at work in several projects in Kroo Bay. It has started clearing and banking the Crocodile river to stop it overflowing, giving residents the tools and sandbags they need to attempt to reduce wet season flooding.

Sanitation is another major issue. With no adequate lavatory facilities public defecation is the norm for men. Women pick their way to windblown shelters on stilts above the rubbish. Save the Children has built a walkway over the river so children don't have to wade through the filthy water on the way to school.

But the biggest area of need is healthcare. After its civil war Sierra Leone had the world's worst rate of infant mortality. In 2010 free healthcare was introduced for pregnant and breastfeeding women and children under five, but many government health facilities are dilapidated. Save the Children has rebuilt the local health centre, renovating the rundown building and providing equipment and medicine.

Another bridge over the river is under construction for easier access to the health centre.

One of the charity's innovative schemes has been the introduction of Blue Flag volunteers, 270 locals trained and equipped with basic medical supplies to treat diarrhoea. They hang a blue flag outside their house so those who are ill know where to go.

"If somebody gets diarrhoea I prepare the ORS and the SS," said Fatmata Lawo, 47, referring to the oral rehydration salts and sugar-salt solutions used to replenish fluid loss. "When we have outbreak I treat nearly five or six people for the week, children as well as adults."

The charity has also set up a children's health club to give young people the basic knowledge they need to look after their own health better.

So why does anyone live in such an awful place? Because, despite the wretched living conditions, it is a place where people can make a living. Despite its grim character the slum abuts prime commercial real estate. It lies adjacent to the centre of Freetown and has access to the open water of the estuary. Those factors make it an ideal entrepot. And it means that access to electricity – at a perennial premium in Sierra Leone – is better in the slum than in poor areas elsewhere.

Despite the degradation and filth signs of trade are everywhere. Short lengths of firewood are stacked in neat piles in the narrow alleyways. There are also longer branches, still with the bark on, which will be used as scaffolding in Freetown's booming construction industry.

Elsewhere palm oil is packaged in old 1.5 litre water bottles. These trade goods are brought by boat from islands offshore and other settlements further upriver inland. Some come by road, too. Local people sell them on. Their living is meagre, but their location is what allows them to make it. Other residents use their waterside location to work as fishermen.

Many local people do not want to move away, and have resisted previous resettlement offers. Attempts to move them even became a political hot potato in the run up to Sierra Leone's last presidential election in 2007.

"I don't want to leave, I want to stay here," said Musu Koroma, a woman who trades firewood. But she and the other residents do want it to become a safer place in which to bring up their families. With the help of Save the Children she and her neighbours are doing their best to make Kroo Bay a little better a place to do that than it was before.

Appeal partners: Who we're supporting

Save the Children

Save the Children works in 120 countries, including the UK. They save children's lives, fight for their rights and help them fulfil their potential. Save the Children's vital work reaches more than 8 million children each year - keeping them alive, getting them into school and protecting them from harm. www.savethechildren.org.uk

The Children's Society

The Children's Society provides vital support to vulnerable children and young people in England, including those who have run away from home. Many have experienced neglect, isolation or abuse, and all they want is a safe and happy home. Their project staff provide essential support to desperate children who have no-one else to turn to.

www.childrenssociety.org.uk

Rainbow Trust Children's Charity

Rainbow Trust Children's Charity provides emotional and practical support for families who have a child with a life threatening or terminal illness. For families living with a child who is going to die, Rainbow Trust is the support they wished they never had to turn to, but struggle to cope without.

www.rainbowtrust.org.uk

At The Independent we believe that these organisations can make a big difference to changing many children's lives.

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