With few conventional battles, except those for control of diamond mines or strategic bridges or highways, much of the military action was directed at civilian targets. Looted goods from homes, businesses and farms were openly traded in Freetown and provincial markets. Repeated ambushes of unprotected road traffic and even convoys under military escort created siege conditions in provincial towns and drove up the price of fuel, food and other necessities. Relief supplies (mainly food and medicine but also construction materials, office equipment, cash, vehicles and communications equipment) have also been prime targets for armed raiders. Peasant families fled for towns and cities, adding to food scarcities.
By 1993 relief organisations estimated that about 1 million Sierra Leoneans of a total population of 4.5 million had been displaced within the country or forced to take refuge in Guinea and Liberia. This tremendous uprooting of people produced shattered families, brought agriculture to a halt in many parts of the country, eliminated opportunities for education and put extreme pressure on existing infrastructure in urban areas where hundreds of thousands sought refuge.
Civilian casualties continuously mounted. Current estimates range from 30,000 to 75,000 war-related deaths, although these figures are impossible to confirm. Reliable, comprehensive figures on the numbers of people wounded or psychologically traumatised by the war do not exist. Atrocities such as the amputation of limbs, ears and lips with machetes, decapitation, branding and the gang rape of women and children have been common. In March 2000, the UN's Humanitarian Co-ordination Unit reported that the number of survivors of amputation was approximately 600, rather than previous estimates ranging from 3,000 to 5,000. It is assumed that the survivors represent only about a quarter of all amputees.
An estimated 5,000 under-age combatants, some as young as eight years old, were forced or volunteered into the various armed factions. Many were provided with drugs such as marijuana and cocaine and forced or encouraged to take part in atrocities.
The psychological and social effects of the war on combatants and civilians are only beginning to be systematically assessed. A May 1999 sampling of civilians in Freetown carried out by Médecins sans Fronti'res indicated that almost all of those surveyed had suffered from starvation, had witnessed people being wounded or killed, and half had lost someone close to them.
The psychosocial and mental health consequences of war on civilians are all too often neglected. Even after hostilities cease, the war may continue in people's minds for years, decades, or possibly generations. To address only the material restoration and physical needs of the population denies the shattered emotional worlds, ignores the destruction of basic human trust and benevolence, and leaves the moral and spiritual consequences of war unaddressed.
Another legacy of the war has been an increase in sexually transmitted diseases, prostitution and the social ostracism of rape victims and other women and girls associated with various fighting factions.
In material terms the war has kept Sierra Leone on the bottom rung of the UN Development Programme's Human Development Index. The UN's Food and Agriculture organisation states that the country's Gross National Product, the value of all goods and services produced within the country, declined by an average of 4.9 per cent each year from 1992 to 1998, while the population was increasing by about 2.3 per cent annually. At the time of writing, 90 per cent of the population were said to be living in poverty.
An all-out attack on Freetown by the insurgents in January 1999 left about 150,000 people homeless in the capital. More than eight years of war in the county's provinces had already destroyed many thousands of homes and businesses, as well as schools, health clinics and administrative buildings. The country's road and ferry network, dilapidated before the war, suffered more damage and neglect through the war years.