<?xml version="1.0" encoding="UTF-8"?><rss xmlns:content="http://purl.org/rss/1.0/modules/content/" version="2.0"><channel><title>IRIN - Health &amp; Nutrition</title><link>http://www.irinnews.org/</link><description>Updated everyday</description><language>en-gb</language><lastBuildDate>Sat, 25 May 2013 07:32:56 GMT</lastBuildDate><item><title>How To: Get medical aid kits to Aleppo, Syria</title><pubDate>Fri, 24 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201305201430490338t.jpg" />]]>DUBAI 24 May 2013 (IRIN) - Getting humanitarian supplies into conflict zones like Syria is no mean feat, often requiring negotiations with warring parties, braving insecurity and facing repeated delays and logistical challenges.</description><body><![CDATA[DUBAI 24 May 2013 (IRIN) - Getting humanitarian supplies into conflict zones like Syria is no mean feat, often requiring negotiations with warring parties, braving insecurity and facing repeated delays and logistical challenges.

But aid workers can make it happen. In one of the latest examples, 54 tons of much-needed medical supplies arrived in Syria last month, destined for people living close to the frontlines of the conflict in the biggest city Aleppo.

“More than 60 percent of the hospitals [in Aleppo] are out of service. Many are at the frontline and used by armed personnel,” said Fares Kady, medical coordinator for the Syrian Arab Red Crescent (SARC) and the focal point for the World Health Organization (WHO) in Aleppo.

IRIN tracked the shipment, from the first phone call from a WHO official in Switzerland, all the way to the doctors in battle-scarred Syria on 13 April.

Switzerland

Olexander Babanin is a supply officer with the WHO Crises Support team in Geneva. In October last year he made a call to a medical supplies company in The Netherlands to order medical kits to restock the standby supplies at the UN Humanitarian Response Depot in Dubai.

“When the logistic supply chain starts, it is often not known where the medical assistance will in the end exactly go,” Babanin told IRIN.

“[It] all depends on requirement and availability. My job is to make sure that warehouses are full, but of course never too full.” 

The international humanitarian logistical network means emergency stocks can be pre-positioned in key parts of the world for rapid mobilization.

Medical kits like the ones that ended up in Aleppo are standardized packages of drugs and medical equipment, designed to be useful in a variety of regions and situations.

The Interagency Emergency Health Kit (IEHK) is composed of some 90 different types of drugs and 90 medical consumables and equipment packed in 44 boxes.

A single medical kit weighs just over a ton and its content meets the needs of 10,000 persons for three months.

WHO is the coordinating authority for international health within the UN system, and every five years an inter-agency committee consisting of pharmacists and technical staff from different relief organizations decides what essential drugs and medical supplies will be included in the medical kit.

The aim is to meet priority health care needs of a displaced population without medical facilities or a population with disrupted medical facilities.

The Netherlands

At the end of 2012 in the town of Gorinchem in the western Netherlands employees of the Medical Export Group (MEG), a commercial firm, pack the medications, spinal needles, surgical equipment, and other items into labelled boxes.

Like Babanin from WHO, the MEG packers are not aware of the final destination for the aid. The company specializes in providing medical packs internationally for humanitarian organizations.

The IEH Kits are loaded onto a ship at the port of Rotterdam, 40km away, and shipped to Dubai in the United Arab Emirates.

United Arab Emirates

By January the latest emergency shipment is in Dubai, home to the Middle East UN Humanitarian Response Depot (UNHRD) run by the World Food Programme (WFP), which as well as delivering food aid, provides logistical support to much of the UN.

Nevien Attalla is the pharmacist with UNHRD in Dubai, and helped the WHO medical aid along the next part of the journey.

“The request comes in through the UNHRD customer service mailbox. To support any emergency response we manage assets so they are readily available for deployment within a 24/48 hour time frame,” Attala told IRIN.

For this outbound shipment, she has to seek approvals from the UAE’s Ministry of Foreign Affairs, the Ministry of Health and the Narcotic & Precursor Chemical Unit in the capital Abu Dhabi. 

She also arranges WFP supporting letters for each border crossing. As soon as the shipment is cleared the aid items are packed up for transportation by truck to Syria.

The medical aid is stocked at UNHRD’s 22,500 square metre covered storage space in a desert area far from Dubai’s skyscrapers.

The warehouses, part of Dubai’s International Humanitarian City [ http://www.ihc.ae ] are close to Jebel Ali port, the world’s largest man-made harbour, and also Dubai World Central-Al Maktoum airport.

The heat in this place is often unbearable. However, inside the warehouses it is mostly fresh and cool.

“We have 5,000 square metres which are temperature-controlled between 18 and 25 degrees Celsius. There is also a cold room to guarantee the storage for cold chain pharmaceutical goods,” Doris Mauron Klopfenstein, who works in logistics for UNHRD, told IRIN.

Syria

The hardest and final section of the journey begins on half a dozen trucks - driven by Syrian truck drivers, a requirement set by the Syrian government.

The two-year conflict in Syria has caused widespread disruption of the health care system; the 54 tons (52 kits) provide enough lifesaving medicines and supplies to cover emergency health needs for three months for an estimated population of half a million, potentially a tempting target for armed groups [ http://www.irinnews.org/Report/97011/SYRIA-Healthcare-system-crumbling ].

Since the beginning of the conflict WFP has reported more than 20 attacks on warehouses, trucks and cars in Syria.

The truck drivers hired by a WFP subcontractor set off from Dubai and take a route through Saudi Arabia, Jordan and then into Syria.

“The convoy remained several days at the Jordanian-Syrian border because of heavy fighting between Damascus and Dera’a Governorate,” said Elizabeth Hoff, head of the WHO office in Damascus.

Heading to the capital they cross through ever-changing government and rebel zones, and are frequently held up at checkpoints. But regular closures at the airport in Damascus and the length of the sea route mean trucks are the best option.

On 27 March the trucks finally arrive at the WFP warehouse in Alkisweh, rural Damascus. WHO and SARC carry out an assessment of the supplies, and then the aid is dispatched to Aleppo, 360km to the north.

WHO distributes 70 percent of such supplies through the Syrian Ministry of Health and the Ministry of Higher Education, and 30 percent through NGOs.

“Needs in Aleppo are increasing constantly. The health system is reeling due to the lack of medicine and medical instruments, especially for chronic diseases, and poor accessibility [geographical, social, economic and security], raising more challenges to the Syrian dilemma,” said Kady.

About six million people live in Aleppo Governorate, but since the conflict started an additional 1.5 million internally displaced persons have sought refuge in the city.

“This journey [Damascus-Aleppo] usually takes about four hours. Nowadays this road is very important for all parties of the war. The shipment passed almost 60 checkpoints and it took 11 hours,” said Kady.

On 13 April the goods are then distributed to their final destinations - two main hospitals in Aleppo and 10 health centres.

Syrian doctor Kady hopes for more supplies: “Opening new offices for humanitarian assistance and installing a safe road like a humanitarian corridor to Aleppo would be so important to decrease the suffering of people.”

But the possibility of further deliveries from Dubai is slight at the moment given the growing insecurity.

While UN officials continuously urge all parties to respect humanitarian principles and ensure safe access for relief supplies, “for the moment no further shipment of medications is planned from Dubai due to the continuing bad security situation in the entire southern part of Syria,” said Hoff.

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]]></body><pubDate>Fri, 24 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98087/How-To-Get-medical-aid-kits-to-Aleppo-Syria</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201305201430490338t.jpg"/></td><td valign="top">DUBAI 24 May 2013 (IRIN) - Getting humanitarian supplies into conflict zones like Syria is no mean feat, often requiring negotiations with warring parties, braving insecurity and facing repeated delays and logistical challenges.</td></tr></table>]]></content:encoded></item><item><title>Mixed messages on home deliveries in Philippines</title><pubDate>Fri, 24 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201305240953280745t.jpg" />]]>MANILA 24 May 2013 (IRIN) - Varied implementation of a Department of Health (DOH) policy advocating health facility-based delivery under the care of a skilled birth attendant (SBA) has health officials and advocates worried that the policy may be doing more harm than good.</description><body><![CDATA[MANILA 24 May 2013 (IRIN) - Varied implementation of a Department of Health (DOH) policy advocating health facility-based delivery under the care of a skilled birth attendant (SBA) has health officials and advocates worried that the policy may be doing more harm than good.

The DOH policy known as the Maternal, Newborn, and Child Health and Nutrition (MNCHN) [ http://www.doh.gov.ph/sites/default/files/MNCHN%20MOP%20May%204%20with%20ECJ%20sig.pdf ] was issued in March 2011 to address the country’s stagnant maternal mortality ratio (MMR).

“It is clear that having births in a healthcare facility under an SBA is critical in ensuring safety of both mother and child, and thus lowering maternal death,” said Honorata Catibog, director for the DOH Family Health Office.

According to the 2011 Family Health Survey (FHS) [ http://www.census.gov.ph/survey/demographic-and-health ], the number of Filipino women who died from childbirth rose from 162 in 2009 to 221 in 2011.

The 2008 National Demographic Health Survey (NDHS) [ http://www.measuredhs.com/pubs/pdf/FR224/FR224.pdf ] shows that 56 percent of births take place at home under the care of a traditional birth attendant (TBA) known locally as a `hilot’.

With little or no medical training, TBAs are not equipped to diagnose pregnancy complications or carry out emergency obstetric care procedures.

“Let me be clear that there is no such thing as a policy prohibiting home births. This is not realistic. We are simply advocating and encouraging facility-based delivery,” said Catibog.

Carrot…

With healthcare reform [ http://www.rrh.org.au/publishedarticles/article_print_220.pdf ] introduced in 1991, management and delivery of healthcare systems were transferred from the national DOH to local government units (LGU), giving LGUs the autonomy to customize the implementation of national policies such as MNCHN.

In the province of Samar, southeast of the country’s biggest island of Luzon, Samuel Baldono, a municipal health officer, says an incentive of US$8-10 is given to the TBA for referring and accompanying the woman to the health facility to have her baby delivered at no cost to her.

“We have seen a dramatic increase in facility-based delivery since this incentive was implemented and a corresponding decrease in maternal death. For the past two years, facility-based delivery has risen to about 89 percent and we have had zero maternal deaths,” said Baldono.

…and stick

However, some municipalities in other parts of the country have reportedly implemented punitive measures, punishing either the mother or the TBA for pursuing a home birth.

In Sultan Kudirat, in the southern island of Mindanao, a birthing policy pushing for facility-based delivery was passed with an imposition of a $50 fine for home births.

“There was a lot of protest, so the fine was never implemented, but the provision is there,” said Renan Kasan, an area programme officer with the UN Population Fund (UNFPA).

Amina Evangelista, executive director of Roots of Health (ROH) [ http://rootsofhealth.org/ ], an NGO in the island province of Palawan in southwest Philippines, reports similar difficulties.

ROH provides SBA assistance both for homebirths and deliveries in their facility, but Evangelista says they have been getting fewer requests for homebirth delivery. “We’ve been told by patients that homebirths are forbidden…

“It’s incredibly frustrating. Some women are afraid to give birth in a hospital or simply cannot afford it. We can offer SBA assistance to make homebirths safer, but now my clinical staff are afraid they will lose their license if they facilitate home births,” said Evangelista.

Unreported maternal deaths

“We have heard that there are some areas implementing punitive measures, but to date, we know of no one who has been jailed or fined for a home delivery,” said Ugochi Daniels, UNFPA country director.

“However, what we are worried about is maternal deaths that occurred at a homebirth going unreported because of fear and confusion about this policy,” added Daniels.

Junice Melgar, a women’s rights activist and executive director of the Likhaan Center for Women’s Health in Manila, said: “Yes, facility-based deliveries are safer, but a woman should have the right to choose to give birth at home if she is well-informed of its risks. Right now, there is just a lot of confusion. The DOH should be clear about its directives and its provisions.”

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]]></body><pubDate>Fri, 24 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98091/Mixed-messages-on-home-deliveries-in-Philippines</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201305240953280745t.jpg"/></td><td valign="top">MANILA 24 May 2013 (IRIN) - Varied implementation of a Department of Health (DOH) policy advocating health facility-based delivery under the care of a skilled birth attendant (SBA) has health officials and advocates worried that the policy may be doing more harm than good.</td></tr></table>]]></content:encoded></item><item><title>Containing cholera in Niger</title><pubDate>Wed, 22 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201203130651570194t.jpg" />]]>NIAMEY 22 May 2013 (IRIN) - Cholera has struck 248 people in Ayorou in the Tillabéry Region of northwestern Niger, killing six, two of them Malian refugees.</description><body><![CDATA[NIAMEY 22 May 2013 (IRIN) - Cholera has struck 248 people in Ayorou in the Tillabéry Region of northwestern Niger, killing six, two of them Malian refugees.

Among the sick are 31 Malian refugees who are living in Tabareybarey and Mangaize camps near the Mali border, according to the Tillabéry health services and the UN Refugee Agency (UNHCR).

In the camps and in surrounding villages, UNHCR has upped the supply of clean water to refugees, is distributing oral rehydration solution, soap, and disinfectant tabs to clean water, but more drugs are urgently needed, it said in a 21 May communiqué [ http://www.unmultimedia.org/radio/english/2013/05/un-refugee-agency-working-to-contain-cholera-epidemic-in-niger/ ]. NGO Médecins sans Frontières is treating those who have contracted cholera in camps.

UNHCR is worried that cholera could spread quickly due to the high concentration of refugees in the region.

Most of the cases were inhabitants of the town of Ayorou, which hosts a Sunday livestock market frequented by people from all across the region. The Ministry of Health is trying to temporarily shut down the market, which is just next to the River Niger, the suspected source of the contamination. The Health Ministry has also banned anyone from using, or drinking, water from the river, though this is very difficult to monitor.

The World Health Organization is supporting local health authorities to contain the disease’s spread.

Last year 5,785 people contracted cholera in Niger, and 110 of them died, according to UNHCR.

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]]></body><pubDate>Wed, 22 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98078/Containing-cholera-in-Niger</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201203130651570194t.jpg"/></td><td valign="top">NIAMEY 22 May 2013 (IRIN) - Cholera has struck 248 people in Ayorou in the Tillabéry Region of northwestern Niger, killing six, two of them Malian refugees.</td></tr></table>]]></content:encoded></item><item><title>Somalia, beyond the famine</title><pubDate>Wed, 22 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2011/201108160838010687t.jpg" />]]>NAIROBI 22 May 2013 (IRIN) - Over one million people in Somalia are currently food insecure, according to a May report by the Famine Early Warning Systems Network (FEWSNET). This number is a significant drop from the 3.7 million considered food insecure in mid-2011.</description><body><![CDATA[NAIROBI 22 May 2013 (IRIN) - Over one million people in Somalia are currently food insecure, according to a May report [ http://reliefweb.int/sites/reliefweb.int/files/resources/somalia_fsou_05_2013.pdf ] by the Famine Early Warning Systems Network (FEWSNET). This number is a significant drop from the 3.7 million [ http://reliefweb.int/sites/reliefweb.int/files/resources/astern%20Africa%20Humanitarian%20Bulletin%20%2323%20OCHA%20EA.pdf ] considered food insecure in mid-2011.

The improvement has been attributed to good ongoing ‘gu’, the March-to-June rains, and the 2012 October-November ‘deyr’ rains.

Successive droughts and poor rains had culminated in a famine in Somalia in 2011. The famine [ http://www.irinnews.org/Report/93280/SOMALIA-Time-for-immediate-action-on-famine-UN ] led to an estimated 258,000 excess deaths, meaning deaths above normal mortality numbers, according to a 2 May study [ http://reliefweb.int/sites/reliefweb.int/files/resources/Somalia_Mortality_Estimates_Final_Report_1May2013.pdf ] commissioned by the UN Food and Agriculture Organization (FAO), the Food Security and Nutrition Analysis Unit (FSNAU) and FEWSNET.

Most of these deaths were in the Banadir, Bay and Lower Shabelle regions, where 4.6 percent of the overall population is estimated to have died. In the Lower Shabelle region, a death rate of at least 9 percent was recorded among all ages, with 17.6 percent of under-fives there dying between October 2010 and April 2012, the study notes.

“There is consensus that the humanitarian response to the famine was mostly late and insufficient, and that limited access to most of the affected population, resulting from widespread insecurity and operating restrictions imposed on several relief agencies, was a major constraint,” said the study.

Humanitarian workers are keen to avoid a repeat of the famine, which has been described by many as a mainly “manmade” disaster. In this report, IRIN asks Somalia experts and analysts whether the conditions that led to the famine are still in place, and whether another famine could occur in Somalia.

The experts interviewed were: Abdihakim Ainte, a Somali analyst; Abdirahman Hosh Jibril, a member of the Somalia parliamentary committee for human rights and humanitarian affairs; Abdullahi Jimale, chairman of Somalia’s national disaster management agency; Olivia Maehler, operations liaison manager for Save the Children’s Somalia/Somaliland programme; Alun McDonald, Oxfam’s media and communications adviser for the Horn, East and Central Africa; and Daniel Molla, FSNAU’s chief technical advisor.

What have been the key lessons learned from the famine in Somalia?

Daniel Molla: There [was] sufficient and actionable early warning information and analysis provided by FSNAU and FEWSNET [ http://www.fews.net/Pages/default.aspx ] in the lead-up to the declaration of famine in July 2011. However, as widely documented, this did not translate into [a] timely and adequate response on the part of the humanitarian community and donors... Nutrition and mortality surveys should be undertaken outside of the regular calendar when early warning information indicates a deteriorating food security situation, in order to assess the situation and recommend appropriate interventions in a timely manner.

Olivia Maehler: I would think that lessons learned [include]… the need to keep in place a rigorous programme responding to humanitarian needs in normal times so that this can be scaled up [in emergencies]. We were able to scale up quickest in places where we already had a large humanitarian input. Also, the fact that cash transfer programmes proved very successful and stimulated rather than overwhelmed markets, and the need for humanitarian funding to move toward multi-year funding to allow for building resilience.

In the long term, the focus for avoiding hunger crises like this one lies in enhancing the resilience of communities themselves, and national governments have a central role to play. More than aid, government policy, practice and - crucially - investment, are vital to build people’s resilience by reducing disaster risk and protecting, developing and diversifying livelihoods.

Alun McDonald: The biggest lesson is that timeliness of the response is key, and early action saves lives. The humanitarian response saved many lives and helped millions of people by providing them with food, water, medicine and other aid - not only for saving lives but also helping farmers and pastoralists rebuild their livelihoods and support their families. However, the response ultimately came too late for many people.

Abdihakim Ainte: Keys lessons are that [the] absence of coordination from the international relief [community] worsen[ed] the enormity of the famine. Also, lack of preparedness on the part of the Somali government and local organizations [was a] key takeaway from the famine. We’ve also learned that the role of [the] Somalia diaspora in alleviating the famine was critical.

Could the famine have been avoided?

Molla: It is difficult to say famine could have been avoided altogether, but the scale and severity of it could have definitely been curtailed through [a] timely and robust response to the early warning information...

Ainte: [The famine] came at [a] critical time when most of the affected regions [were] run by Al-Shabab, [an insurgent group that] ban[ned] aid agencies… That hostility profoundly worsened the magnitude of the drought. From this point of view, it could have being averted, and it’s safe to say it was [a] man-made disaster.

What went wrong?

Molla: The 2011 [famine was] precipitated by a combination of a severe drought and consequent harvest failures for two seasons, low purchasing power of the poor, high food prices, and reduced humanitarian assistance hampered by insecurity and inadequate funding - all taking place in the context of an already weakened population whose resilience has been eroded by repeated exposure to frequent shocks and persistently high levels of acute malnutrition. The result was widespread excess mortality.

McDonald: There was a collective failure by governments, aid agencies and donors to act early… There was a reluctance to act and commit resources until there was certainty about the scale of the crisis - by which time [it was] already too late. Many governments don't step up their response until the crisis is in the news - but it's not in the news until people are already dying… Somalia was also an incredibly difficult place for aid agencies to respond effectively. After years of conflict, it was one of the most difficult and dangerous places in the world to work… There are lots of lessons to learn about how best to work and provide aid in such an environment. All our work in Somalia is done with local partners, who can often get better access than international agencies.

Ainte: The belated respon[se] from the international community, together with Al-Shabab’s blockade [of] aid organizations is what went wrong. If Al-Shabab is wiped out of Somalia, and the international community continues to build an early warning system to enable the Somalia government and local organization to forecast drought, chances of [famine] happening again [are] very slim.

Could a famine occur again in Somalia?

Molla: A majority of the rural poor and displaced population of Somalia remains extremely fragile, with its resilience weakened as a result of frequent and repeated exposure to shocks. Under such conditions, the risk of future famines can’t be ruled out unless sustained short-term humanitarian assistance as well as long-term development assistance are provided… [Even so,] the conditions that led to the famine are not there at present. While insecurity continues to pose challenges for humanitarian access, food prices have come down substantially and terms of trade and the purchasing power of the population [are] more stable now. The 2012 ‘deyr’ rains have been good and the current ‘gu’ rainy season is proceeding normally and is expected to yield average to above-average harvest[s] and good pasture and water conditions for livestock.

Maehler: Given how vulnerable communities continue to be to seasonal shocks, future deterioration in their situation could occur unless we continue to respond and build communities’ resilience. We are making progress, but humanitarian funding is dwindling… This could have a potentially devastating impact on the… chances for thousands of families across Somalia.

McDonald: Droughts, food crises and poor rains will definitely continue to happen in Somalia and the wider region. But droughts are natural events, whereas famines are ultimately manmade... [For example,] there was a severe drought in Kenya at the same time, but without the massive loss of life. The tragedy in Somalia happened because of a combination of drought, conflict, poor humanitarian access, a slow response, high food prices and a lack of effective government. If these issues are not addressed, then famine could occur again. Somalia was the first famine of the 21st century, and we need to make sure that it is also the last.

What is the way forward?

Molla: Resolution of the ongoing conflict in Somalia is ultimately a prerequisite to address food insecurity and avert famine in Somalia in [a] meaningful and sustainable manner. In the lead-up to the 2011 famine, insecurity ha[d] adversely impacted both assessment and monitoring of the food security and nutrition situation in several parts of Somalia, as well as humanitarian response. At present, there are several areas in south and central Somalia that remain inaccessible due to insecurity.

McDonald: We need to explore more innovative ways of delivering aid and using new technology - for example one of our partners used SMS and mobile phones to transmit cholera-prevention messages to people in insecure areas. In some areas, there was food available but prices were high and people couldn't afford to buy it - so we need to look at alternative aid such as providing people with cash rather than with food aid… We also need to ensure better links between our short-term humanitarian work and longer-term development work.

Ainte: Three initiatives should be put in place: First of all, building an [early] warning system is very critical. Secondly, strengthening local capacity, including civil society organization[s], is very important. Thirdly, continued engagement and partnership with [the] Somali government and local organization[s] is very crucial.

Is Somalia ready for another food security emergency?

Ainte: [The] government has [laid] down core priorities, and security is at the top of everything. In some respects, despite its international focus and support, the current government is better situated and equip[ped] to address future disasters.

Jimale: I think Somalia will be able to respond to a drought like the one in 2011 if government capacity to provide services is consolidated and [the] international community acts in a timely manner.

Jibril: The government is yet to provide services in liberated towns [where Al-Shabab has been driven out], and many areas are still in Al-Shabab hands, so it is hard to react if drought erupts.

aw-amd/rz

]]></body><pubDate>Wed, 22 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98082/Somalia-beyond-the-famine</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2011/201108160838010687t.jpg"/></td><td valign="top">NAIROBI 22 May 2013 (IRIN) - Over one million people in Somalia are currently food insecure, according to a May report by the Famine Early Warning Systems Network (FEWSNET). This number is a significant drop from the 3.7 million considered food insecure in mid-2011.</td></tr></table>]]></content:encoded></item><item><title>Malaria overstretching healthcare in DRC</title><pubDate>Mon, 20 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2011/201101050950250805t.jpg" />]]>KAMPALA 20 May 2013 (IRIN) - Gaps in the healthcare system in the Democratic Republic of Congo (DRC) are hampering the fight against malaria, a leading killer of children, say experts.</description><body><![CDATA[KAMPALA 20 May 2013 (IRIN) - Gaps in the healthcare system in the Democratic Republic of Congo (DRC) are hampering the fight against malaria, a leading killer of children, say experts.

Malaria accounts for about a third of outpatient consultations in DRC clinics, Leonard Kouadio, a UN Children’s Fund (UNICEF) health specialist, told IRIN. He added, “It is the leading cause of death among children under five years and is responsible for a significant proportion of deaths among older children and adults.”

Kouadio continued: “Recent retrospective mortality surveys have revealed that in all regions of the country, the fever is associated with 40 percent of [deaths of] children under five.”

Malaria is also a leading cause of school absenteeism in DRC, and it may have other adverse effects. “In cases of severe malaria, children who survive face serious health problems such as epilepsy, impaired vision or speech,” he said.

According to UN World Health Organization (WHO) estimates [ http://www.who.int/mediacentre/factsheets/fs094/en/index.html ], out of about 660,000 malaria deaths globally in 2010, at least 40 percent occurred in DRC and Nigeria. 

In DRC, malaria accounts for about half of all hospital consultations and admissions in children younger than five, according to the government’s National Programme for the Fight against Malaria (NMCP). On average, Congolese children under five years old suffer six to 10 episodes of malaria per year, according to UNICEF’s Kouadio.

Other leading causes of death among under-five Congolese children include acute respiratory infections, diarrhoeal diseases and malnutrition, according to UNICEF’s 2013-2017 DRC Country Programme Document. 

A deficient health system 

“It is apparent that major deficiencies in the health system have contributed to the severity of recurrent outbreaks [of malaria],” Jan Peter Stellema, Médecins Sans Frontières (MSF) operational manager, told IRIN via email. 

“Mosquito nets are not being sent to vulnerable areas, and there are shortages of rapid diagnostic test [kits and] drugs and the equipment for carrying out blood transfusions vital for children suffering from anaemia caused by malaria.” 

Other problems include costly care and management challenges.

For example, the treatment of an uncomplicated bout of malaria ranges from about US$22 to $35, and treatment for severe cases can cost $75 to $100, according to NMCP. Such costs are prohibitive for a large number of people, many of whom live on about one dollar a day.

“In DRC, the absence of other healthcare providers and overstretched health systems leave people vulnerable to contracting malaria. Too many health centres lack the supplies necessary for coping with a new outbreak, and as a result children are dying because they did not receive care for malaria,” MSF’s Stellema said.

According to the DRC Country Programme Document, “Governance, management and coordination problems plague the [health] system at the national, provincial and local levels, thereby undermining political commitment, planning, budgetary expenditure, coordination and alignment of partnerships, the accountability and transparency of service providers, and the participation of the population in management of the services.” 

It adds, “Combined with extreme poverty, these factors create financial barriers hampering families’ access to nutrition and services, and weaken the social standards that are essential for keeping families together and maintaining a protective environment for children.”

Investment in healthcare needed

“The absence of government investment and the fragmentation of public assistance have eroded the capacity of civil society and of functional public facilities to maintain quality services,” adds the DRC Country Programme Document.

“The re-mergence and expansion of certain epidemics (polio [ http://www.irinnews.org/Report/91200/DRC-Polio-cases-on-the-rise ], measles [ http://www.irinnews.org/Report/94516/DRC-Measles-immunization-campaign-targets-1-7-million-children ] and cholera [ http://www.irinnews.org/Report/94028/DRC-Fighting-cholera ]) are proof of that. In addition, little has been done to modernize infrastructure. Essential supply systems, such as the cold chain, have not been put in place,” it states.

There is an urgent need to address the struggling health system to fight malaria, experts say.

“The fight against this scourge must remain a top priority of the country, despite the lack of financial resources,” said UNICEF’s Kouadio. “The government and its partners should increase the funding for the fight against malaria in the DRC, in particular, acquisition and universal distribution of mosquito nets to households, provision of essential drugs and rapid diagnostic test [kits], and dissemination of environmental sanitation measures.”

Malaria occurs almost year-round in DRC due its tropical climate and its river and lake system. The country has some 30 large rivers totalling at least 20,000km of shoreline, and 15 lakes totalling about 180,000km, which offer environments conducive to the proliferation of diseases and disease vectors, including the Anopheles mosquito, which spreads malaria. 

According to MSF’s Stellema, the DRC government and national and international health actors need to take rapid and sustainable measures to prevent and treat malaria in order to avoid unnecessary child deaths. In 2012, MSF treated half a million Congolese for malaria, many of them children under five.

“MSF's emergency response is saving lives in the short term. But in the longer term, the organization cannot address the [malaria] crisis alone,” said Stellema.

so/aw/rz

]]></body><pubDate>Mon, 20 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98069/Malaria-overstretching-healthcare-in-DRC</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2011/201101050950250805t.jpg"/></td><td valign="top">KAMPALA 20 May 2013 (IRIN) - Gaps in the healthcare system in the Democratic Republic of Congo (DRC) are hampering the fight against malaria, a leading killer of children, say experts.</td></tr></table>]]></content:encoded></item><item><title>Making WASH work in Burkina Faso’s cities</title><pubDate>Fri, 17 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201305161656290386t.jpg" />]]>OUAGADOUGOU 17 May 2013 (IRIN) - Earlier this year Denis Ouedraogo, a tailor living in the Tampouy neighbourhood just north of Burkina Faso’s capital Ouagadougou, connected his mud-walled home to the water network for the first time. “Even without electricity, having enough water can make you happy,” he said.</description><body><![CDATA[OUAGADOUGOU 17 May 2013 (IRIN) - Earlier this year Denis Ouedraogo, a tailor living in the Tampouy neighbourhood just north of Burkina Faso’s capital Ouagadougou, connected his mud-walled home to the water network for the first time. “Even without electricity, having enough water can make you happy,” he said.

He is among 1.9 million people to have connected to the government water grid since 2001, thanks to major changes in how the National Office for Water and Sanitation (ONEA) delivers water to urban Burkinabés.

In 2001 just 73,000 Burkinabés could access clean water, according to research [ http://www.developmentprogress.org/sites/developmentprogress.org/files/burkina_water_progress.pdf ] by Peter Newborne at the Overseas Development Institute, which is trying to track and communicate examples of progress on development [ http://www.developmentprogress.org/ ].

In 2002 just half of Burkina Faso residents had access to clean water. In 2008 (the latest statistics available) this had risen to 76 percent - 95 percent in urban areas. The plan was to reach the Millennium Development Goal (MDG) to double the number of those with access to clean water, in this case to 87 percent, by 2015. Those tracking water, sanitation and hygiene (WASH) progress in Burkina Faso, say the goal will be surpassed [ http://www.unicef.org/sowc2012/pdfs/SOWC-2012-TABLE-3-HEALTH.pdf ].

How?

A number of factors made this possible: ONEA was nationalized and restructured in 1994 following a period in which it had become unprofitable and poorly functioning. The new national company ran along commercial lines, instilling a culture of performance and efficiency, said Newborne.

The second priority was to find a bulk water supply, in this case by building the Ziga dam 45km from the capital.

A mixture of government grant funds (from France and other European donors) and concessionary loans at low interest rates (predominantly from the World Bank), provided the required finances. This helped them bring costs down: for instance, connecting to the grid now costs a household US$61, down from on average $400 in the 1990s, according to ONEA’s chief operating officer, Moumouni Sawadogo.

Next came the work: building a network of pipes throughout Ouagadougou, including in the city’s unzoned [unplanned]  suburbs, which house one third of the capital’s residents and had hitherto been overlooked in terms of household water supply.

“Even in non-zoned areas, people can pay their water bills,'' said Halidou Kouanda, head of NGO Wateraid in Burkina Faso, citing a 2011 ONEA study noting that financial recovery rates in unzoned neighbourhoods were 95 percent.

Now, with a steady income and an 18 percent leakage rate, ONEA is one of the best-performing water utility companies in sub-Saharan Africa, according to the World Bank.

Targeting the poor

While targeting unzoned areas upped the percentage of urban dwellers who could access clean water (thus helping to meet the MDG), it did not ensure that water was affordable.

Now ONEA needs to try to target the poor, as it pledged to do in an initial equity strategy agreed with the Ministry of Water and Sanitation.

As part of its strategy, ONEA built 17,290 wells and standpipes for some areas without household-level connections. Water from a standpipe costs 60 CFA (11 US cents) for a 220 litre barrel (transported on wheels). But the very poor cannot afford such barrels, turning instead to water vendors who sell the same amount for 200-500 CFA (40-98 cents) depending on the season.

Thus paradoxically, the poorest families pay up to eight times more than others for their water.

ODI is discussing different pro-poor targeting methods that might work, including: subsidizing part of the water supply for certain households; targeting poor areas; allocation by housing type; means-testing; community-based targeting; or self-targeting.

At the moment, all households are charged the same connection tariff. “Is this equitable? We think not,” said Newborne. “You could means-test it; you could waive the connection charge for some; or charge the first X cubic metres at a different rate,” he suggested, adding that lower-income households could pay bills weekly or on a pay-as-you-go basis, to keep track of costs. “Think of how mobile phone companies have fixed their pricing plans to be accessible,” he said.

The concern is that households who experience running water for the first time may use more than they can afford, then falling behind  and drop off the grid, said WaterAid’s Kouanda. This happened to 6.8 percent of Ouagadougou’s ONEA customers in 2009.

Families must be made aware of this risk, said Kouanda. But many customers are so nervous of this happening, that they practice their own careful monitoring.

Ami Sidibé, who lives in Somgandé neighbourhood, which was connected to the water mains three months ago, said she continues to fill jerry cans - using tap water - to monitor her household’s use. “I’ll do anything to avoid returning to the situation before,” she told IRIN.

Reduced disease risk?

No studies have yet been published linking the spread of the water network with the incidence of disease, but some Somgandé residents who were recently connected to the grid said their children were falling sick less frequently. Water-borne illnesses are among the top five reasons for children’ health visits, according to the Health Ministry.

Future challenges will include how to extend such networks to rural areas, which are currently under-serviced in terms of clean water: 72 percent of rural Burkinabés access clean water, versus 95 percent of city residents.

The local authorities are responsible for rural water supply under Burkina Faso’s decentralized governance system.

According to a just-published report Progress on Sanitation and Drinking Water 2013 Update [ http://www.unicef.org/media/media_69091.html ] by UNICEF and the World Health Organization, striking disparities remain between rural and urban water access, with rural communities making up 83 percent of the global population without access to an improved water source.

bo/aj/cb

]]></body><pubDate>Fri, 17 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98054/Making-WASH-work-in-Burkina-Faso-s-cities</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201305161656290386t.jpg"/></td><td valign="top">OUAGADOUGOU 17 May 2013 (IRIN) - Earlier this year Denis Ouedraogo, a tailor living in the Tampouy neighbourhood just north of Burkina Faso’s capital Ouagadougou, connected his mud-walled home to the water network for the first time. “Even without electricity, having enough water can make you happy,” he said.</td></tr></table>]]></content:encoded></item><item><title>Challenges to improving health care in Pakistan</title><pubDate>Fri, 17 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201303281135270775t.jpg" />]]>LAHORE/DUBAI 17 May 2013 (IRIN) - Hamza Mazhar, a 35-year-old teacher from Pakistan’s eastern city of Lahore, says he never wants to see the inside of a government hospital again.</description><body><![CDATA[LAHORE/DUBAI 17 May 2013 (IRIN) - Hamza Mazhar, a 35-year-old teacher from Pakistan’s eastern city of Lahore, says he never wants to see the inside of a government hospital again.

“My mother was taken to the hospital with an upper respiratory tract infection in February this year and doctors said she needed care in the hospital’s Intensive Care Unit (ICU),” he told IRIN.

But the doctors in charge wanted the family to pay a bribe to get into the ICU, which had plenty of spare beds. They could not afford to pay. His mother was unable to get the treatment she needed and in March she died.

Health care in Pakistan is identified as one of the country’s most corrupt sectors, according to surveys by Transparency International [ http://www.transparency.org.pk/documents/NCPS%202009/NCPS%202009%20%20Report.pdf ]; general surveys suggest the majority of Pakistanis are unhappy with the health services they are offered. 

This is just one of the many challenges facing Pakistan’s health system, as identified in the first ever comprehensive assessment [ http://www.thelancet.com/themed/pakistan ] of the sector, published in the medical journal The Lancet and launched today in Islamabad. 

Entitled Health Transitions in Pakistan, the series of articles says Pakistan’s health sector lags behind 12 countries in the region with cultural, economic and geographic similarities.

Pakistan has no national health insurance system and 78 percent of the population pay health care expenses themselves. It is the only country in the world without a National Health Ministry.

The report authors say the recently elected government has a unique opportunity to push through reforms and take advantage of recent constitutional changes that devolve health care to the provinces.

The findings are not entirely negative. Progress has been made on all health indicators in the past 20 years. The rates of child deaths and maternal mortality have fallen, and the community-based Lady Health Workers programme is singled out for praise.

But improvements have been much slower coming than in other similar countries. IRIN picked out four major challenges from the health assessment.

1. Avoidably high child and maternal mortality

The assessment’s authors describe Pakistan’s progress towards meeting the Millennium Development Goals for reducing child and material mortality (4&5) as “unsatisfactory”. 

Pakistan, with its population of 180 million, has more child, foetal and maternal deaths than all but two of the world’s nations.

The report calls child survival “the most devastating and large-scale public health and humanitarian crisis Pakistan faces”.

An estimated 423,000 children under-five die each year, almost half of them new-born babies. Family planning options are also limited and nearly a million women attempt unsafe abortions each year.

Simple measures like training more nurses and midwives (currently outnumbered by doctors 2:1) could save more than 200,000 women and child lives in 2015, the report’s authors say.

2. Nutrition

A lack of adequate nutrition for children contributes to the high number of child and maternal deaths. Nearly 40 percent of children under-five are underweight [ http://www.fao.org/ag/agn/nutrition/pak_en.stm ] and more than half are affected by stunting. 

Poor nutrition weakens the body’s natural defence mechanisms.

But the report also says that malnutrition affects the Pakistani economy, with estimates that it costs the country 3 percent of GDP every year, particularly through reduced productivity in young adults.

3. “Lifestyle diseases”

In Pakistan, as more widely throughout south Asia, non-communicable diseases like cancer, diabetes and heart problems have replaced communicable diseases like malaria and diarrhoea in the past two decades as the leading causes of death and morbidity.

This general trend has not been matched by an adaptation in the Pakistani health system or government policy. Poor road safety, cheap cigarettes and high-levels of obesity (one in four adults) all lead to preventable deaths.

So-called “lifestyle diseases” could cost the country nearly US$300 million in 2025, according to the report’s authors.

They say the right government action, including higher excise taxes on cigarettes, new legislation, and information campaigns could cut the premature mortality rate from cardiovascular diseases, cancers, and respiratory diseases by 20 percent by 2025.

4. Low public spending

Humanitarian crises provoked by earthquakes, flooding and conflict over the past decade have mobilized large sums of money both internationally and within the country.

But corresponding sums have not been spent on underlying health services, which have the potential to save many more lives.

Public health spending has declined from 1.5 percent of GDP in the late 1980s to less than 1 percent, according to the report - equivalent to less than 4 percent of the government budget.

That has left Pakistanis with little support for medical costs, which are responsible for more than two-thirds of major economic shocks for poor families, according to the Ministry of Social Welfare and Special Education.

Rapid population growth [ http://www.irinnews.org/report/96969/Analysis-Tackling-Pakistan-s-population-time-bomb ] only makes what resources are spent on health care produce ever smaller results. 

kh/jj/cb

]]></body><pubDate>Fri, 17 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98055/Challenges-to-improving-health-care-in-Pakistan</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201303281135270775t.jpg"/></td><td valign="top">LAHORE/DUBAI 17 May 2013 (IRIN) - Hamza Mazhar, a 35-year-old teacher from Pakistan’s eastern city of Lahore, says he never wants to see the inside of a government hospital again.</td></tr></table>]]></content:encoded></item><item><title>The making of the Hyogo2 disaster prevention framework</title><pubDate>Fri, 17 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201301111208550461t.jpg" />]]>JOHANNESBURG 17 May 2013 (IRIN) - A month after the Indian Ocean tsunami struck in December 2004, affecting millions, 168 countries signed on to a 10-year plan to make the world safer from natural hazards. Yet the plan, the Hyogo Framework for Action (HFA) 2005-2015, focused primarily on “what to do to prevent disasters, but not enough on how to implement it,” says Neil McFarlane, chief coordinator and head of all regional programmes at the UN Office for Disaster Risk Reduction (UNISDR).</description><body><![CDATA[JOHANNESBURG 17 May 2013 (IRIN) - A month after the Indian Ocean tsunami struck in December 2004, affecting millions, 168 countries signed on to a 10-year plan to make the world safer from natural hazards. Yet the plan, the Hyogo Framework for Action (HFA) 2005-2015, focused primarily on “what to do to prevent disasters, but not enough on how to implement it,” says Neil McFarlane, chief coordinator and head of all regional programmes at the UN Office for Disaster Risk Reduction (UNISDR). 

Countries have since begun discussing [ http://www.preventionweb.net/english/professional/publications/v.php?id=32535 ] what a follow-up action plan, the Hyogo Framework for Action 2 (HFA2), should look like. The results of these talks, a sketch of the HFA2, will be presented at the Fourth Session of the Global Platform for Disaster Risk Reduction, which begins in Geneva on 19 May [ http://www.preventionweb.net/globalplatform/2013/about ].

A draft will be finalized towards the end of 2014, for consideration and adoption at the World Conference on Disaster Reduction in Japan in 2015. 

The HFA2 will need to take on a number of emerging risks and concerns. While the HFA has helped countries reduce the loss of human lives, the economic consequences of natural disasters have continued to rise. For three consecutive years, natural hazards have cost the world more than US$100 billion a year, according to data from the Brussels-based Centre for Research on the Epidemiology of Disasters (CRED) released in March 2013 [ http://www.irinnews.org/report/97655/Tallying-natural-disaster-related-losses ].

Additionally, disaster risks are changing: The effects of the changing climate are expected to prompt more intense and frequent extreme natural events, including floods, droughts and cyclones. Urban populations are growing, as is demand for food, ratcheting up pressure on resources like land and water. 

Accountability 

In tackling the HFA2, experts are discussing how to improve accountability. "We have a framework with options to develop good disaster plans in the Hyogo, but how do we make governments, agencies… ensure it is implemented?" Tom Mitchell, head of the climate change programme at the Overseas Development Institute (ODI), told IRIN. 

Mitchell says one of the major weaknesses of the HFA is its failure to ensure that "well-crafted" disaster risk reduction (DRR) policies were actually implemented. The agreement is voluntary, and there are no penalties for failing to put in place measures to protect citizens. 

"Because it [HFA] is voluntary, we have to ask how… effective it can be," remarked Frank Thomalla, senior research fellow with the Stockholm Environment Institute (SEI) in Asia. 

Some question whether the world should consider a legal disaster-prevention treaty with a provision for penalties. 

The new plan’s timing is significant for the global community; 2015 also marks the end of the Millennium Development Goals and possibly the implementation of new Sustainable Development Goals (SDGs), which are still under discussion. A new agreement on addressing and adapting to climate change is also likely to be put into place around that time. Aid agencies and think tanks are all calling on the global community to consider the synergies among these policy-shaping developments. 

Many observers now question whether DRR policies should become a part of the legal climate deal, which might ensure their implementation. Countries’ DRR activities are increasingly considered part of their climate change adaptation plans, and are being funded as such. 

But there is no appetite for a legal treaty on DRR, says UNISDR's McFarlane. 

Harjeet Singh, ActionAid's international coordinator for DRR and climate change adaptation (CAA), says he is uncertain if a legal treaty “will bring about a dramatic change… After all, we have seen how [the UN’s] climate convention (UNFCCC) … failed to deliver in the last 20 years." 

Besides, the climate change deal will not consider geophysical events such as earthquakes and other triggers of potential disasters unrelated to climate, he added. 

That fact, plus the range of social and economic factors contributing to disaster risk, calls into question the rationale for viewing DRR, CCA and development from a purely climatological perspective, SEI's Thomalla told IRIN in an email. 

But the Cancun Adaptation Framework adopted by countries at the UNFCCC talks in Mexico in 2010 urges countries to implement the HFA, so it does make it a part of a stronger commitment linked to climate change says UNISDR's MacFarlane. 

Taking measurements 

Under the HFA, countries are required to report on how far they have complied with implementing DRR strategies and policies. But how "reliable is this data?" asked Thomalla. "How much opportunity is there for governments to 'manipulate' the information in order to be seen to be doing something?” 

For instance, a country might report to the HFA that it has established an early warning system to reduce hazard vulnerability. “But how can we be sure that the system works…? That people know how to respond to the warnings?” Thomalla said. 

There is no proper baseline at the start of HFA, nor are there specific targets for countries to follow, said Singh. 

"Targets and milestones for implementation should... be relevant and realistic for each country and agreed on through multi-stakeholder consultations," noted Mitchell in a briefing paper co-authored with colleague Emily Wilkinson [ http://www.odi.org.uk/publications/6663-disaster-risk-management-sustainable-development-policy-post2015 ].

McFarlane and Mitchell suggest the development of a peer-review mechanism, which is just taking off in some developed countries, could be an effective way to ensure countries comply. 

UNISDR Chief Margareta Wahlstrom said there has been a change in mindset since HFA: “The most visible signs of this change are summarized by the facts that 121 countries have enacted legislation aimed at reducing the potential impact of disasters, and 56 countries have national disaster-loss databases, which illustrates the growing recognition that you cannot manage risk management if you are not measuring your disaster losses." 

Mitchell’s ODI briefing paper also suggests "a human rights approach, in which countries fulfil obligations to respect, protect and fulfil basic human rights, including the 'right to safety' of vulnerable people exposed to hazards." 

This suggestion has support. Singh says, “Legislation to ensure safety and security of people is a good first step.” But it has to be implemented effectively all the way down to the community level, and must take into account the voices of the poor and women, he added. 

Thomalla says a rights-based approach would be a good way to address DRR "because many of the drivers of vulnerability result from inequality and marginalization, meaning certain regions and social groups are more vulnerable to hazards than others and are more strongly affected by the impacts.” 

But, again, creating global legislation could be problematic, he noted. "Monitoring and enforcement will also be difficult. Rich countries must come forward to provide resources and transfer skills to developing countries to reduce disaster risks." 

Resilience is key 

Most experts pin their hopes on the new-found interest in "building resilience". Resilience [ http://www.irinnews.org/In-Depth/97584/105/ ] is billed as a concept that will better link development, DRR and CCA by bringing the humanitarian aid community, which deals with disasters, closer together with development agencies. A focus on resilience might also help push for the implementation of DRR plans and promote funding. 

“The current separation of what is mainly [a] humanitarian response to disasters, through DRR and CCA, from business-as-usual development funding no longer makes sense," said Thomalla. 

In fact, disasters routinely reverse development gains. For example, floods in Thailand in 2012 cost three percent of the country’s annual GDP, affected education and caused the loss of vulnerable families’ household assets. 

“New development goals must factor in risk, whereby all goals, to the extent possible, are risk- informed,” said Antony Spalton, the DRR specialist with the UN Children's Fund (UNICEF). "Given the significance of the risks posed by climate change, fragility and conflict, a post-2015 framework that better draws together DRR, climate change adaptation and conflict prevention/peace building under a goal or target for resilience could be considered.” 

UNISDR has already drafted a resilience-based disaster plan for the post-2015 development agenda, the Plan of Action on Disaster Risk Reduction for Resilience. It calls for an assurance that “DRR for resilience” is central to post-2015 development agreements and targets. It calls for timely, coordinated and high-quality assistance to countries where disaster losses pose a threat to development, and for making DRR a priority for UN funds, programmes and specialized agencies. 

Singh says countries "should develop a comprehensive resilience strategy rather than a piecemeal …strategy, when ‘pushed’ by donors.” 

Building resilience to a range of changes and risks does make sense, according to Thomalla. But we have a long way to go. 

"While we have made a lot of progress in thinking about resilience as a unifying concept, we need to strengthen our methods and tools to help… develop the institutions and governance structures that enhance resilience and enable them to measure and demonstrate success," he said. 

Ultimately, Singh says, "it all depends on the willingness of country governments to take concrete steps from local to national levels and enhance [the] resilience of poor and vulnerable communities." 

McFarlane says there are lots of ideas and suggestions on the table. Stay tuned. 

jk/rz 

]]></body><pubDate>Fri, 17 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98058/The-making-of-the-Hyogo2-disaster-prevention-framework</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201301111208550461t.jpg"/></td><td valign="top">JOHANNESBURG 17 May 2013 (IRIN) - A month after the Indian Ocean tsunami struck in December 2004, affecting millions, 168 countries signed on to a 10-year plan to make the world safer from natural hazards. Yet the plan, the Hyogo Framework for Action (HFA) 2005-2015, focused primarily on “what to do to prevent disasters, but not enough on how to implement it,” says Neil McFarlane, chief coordinator and head of all regional programmes at the UN Office for Disaster Risk Reduction (UNISDR).</td></tr></table>]]></content:encoded></item><item><title>Tracking vaccine scares</title><pubDate>Tue, 14 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201304020549030977t.jpg" />]]>LONDON 14 May 2013 (IRIN) - Vaccine scares have emerged as a major challenge to global efforts to eliminate preventable diseases, with rumours and conspiracy theories proliferating faster than health authorities can respond to them. Now researchers, led by Heidi Larson of the London School of Hygiene and Tropical Medicine, are developing a tool to identify the first signs of these negative reports.</description><body><![CDATA[LONDON 14 May 2013 (IRIN) - Vaccine scares have emerged as a major challenge to global efforts to eliminate preventable diseases, with rumours and conspiracy theories proliferating faster than health authorities can respond to them. Now researchers, led by Heidi Larson of the London School of Hygiene and Tropical Medicine, are developing a tool to identify the first signs of these negative reports.

Vaccine scares have popped up in both the richest parts of the world and the poorest. Over a decade ago, suggestions in the UK that the combined MMR (measles, mumps and rubella) vaccine could trigger autism led to a dramatic drop in the number of parents having their children vaccinated. Wales, which had one of the lowest vaccination rates, is now in the grip of a major measles outbreak, with young teenagers - the generation that was not protected - particularly affected.

Northern Nigeria saw rumours that the polio vaccine was part of a Western conspiracy to sterilize Muslims [ http://www.irinnews.org/Report/97781/Analysis-Roots-of-polio-vaccine-suspicion ], preventing polio’s eradication in the country and leading to the disease’s reappearance in surrounding countries where it had already been eliminated.

“Bad news stories damage vaccination programmes as much as biological hazards, and these stories evolve over minutes or hours, needing immediate action,” said University of Toronto public health specialists Natasha Crowcroft and Kwame McKenzie, in a comment [ http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70131-2/fulltext ] published this week alongside Larson’s paper [ http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70108-7/abstract?rss=yes ] in the medical journal The Lancet. “By the time a detailed scientific analysis of a vaccine safety issue is completed, the story is no longer newsworthy.”

Crowcroft and McKenzie point out that modern communications, especially the internet, can exacerbate vaccine scares. But Larson’s Vaccine Confidence Project set out to establish whether the internet could also provide the tools to fight misinformation.

Rumour surveillance

Larson’s team set up a media surveillance system covering 144 countries, looking at online articles, blogs and reports about vaccines and vaccine-preventable diseases.

The first stage of the process was automated, using the HealthMap data collection system, which searched for terms such as “vaccine”, “rotavirus” or “measles”. The accumulated material was inspected by real people, who assessed whether it positively or negatively portrayed vaccination, and whether it should be flagged as a cause for concern.

When one report appeared on multiple websites, all copies were counted, “recognizing the fact that replicated reports show the spread of information,” Larson’s paper says.

Although it was a worldwide survey, the researchers paid particular attention to five countries - China, Finland, France, Nigeria and Pakistan - that had seen issues over public confidence in vaccines. They also mapped reports about the human papilloma virus (HPV) vaccine in India, where trial HPV vaccination projects had been suspended in two states.

The Vaccine Confidence Project initially ran from April 2010 to April 2011. At the end of the year, they could see that the system had worked - clusters of reports expressing concern about vaccination correlated with real-world events. Of the reports analysed, 69 percent were assessed as favourable to vaccination and 31 percent as hostile.

“We picked up concerns we already knew were there, but more than that,” Larson told IRIN. “For instance, we saw activity around a narcolepsy/H1N1 vaccine link, and we were picking up early discussions suggesting this might be an issue before the final confirmation (in Finland) that there was indeed a link.

“And in Pakistan, where we were following issues around polio acceptance, we started picking up political tensions and concerns among lady health workers. We certainly didn’t predict the killing of polio workers, but we had seen the tensions growing.”

Waves of information

There are questions about whether internet surveillance, using search terms in English, can spot emerging concerns in rural societies where internet penetration is low and public debate occurs in local languages. Could this kind of surveillance, for instance, have picked up the early signs of polio vaccine rejection in Hausa-speaking northern Nigeria?

Larson, who has worked in that area on behalf of the UN Children’s Fund, says she thinks it would have.

“It was emerging in the local media a bit, and then reports started to circulate on the BBC Hausa service. And since Nigeria has English as an official language, they were soon circulating in English as well. A former Nigerian minister of health, Nike Grange, is on our advisory board, and she says that if they had had a system like this at the time, and had understood the full impact of the rumours they heard, they would have acted much sooner,” Larson said.

“And the world has changed a lot in the last decade. What we are seeing is that you don’t have to have a computer in every household. People hear something on the radio, they tell their neighbour, they tweet it, and there are waves of information. We hadn’t anticipated how ubiquitous cellphones and smartphones were going to be, and that makes this work even more relevant.”

eb/rz

]]></body><pubDate>Tue, 14 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98030/Tracking-vaccine-scares</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201304020549030977t.jpg"/></td><td valign="top">LONDON 14 May 2013 (IRIN) - Vaccine scares have emerged as a major challenge to global efforts to eliminate preventable diseases, with rumours and conspiracy theories proliferating faster than health authorities can respond to them. Now researchers, led by Heidi Larson of the London School of Hygiene and Tropical Medicine, are developing a tool to identify the first signs of these negative reports.</td></tr></table>]]></content:encoded></item><item><title>Uganda grapples with paediatric vaccine shortages</title><pubDate>Tue, 14 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2009/2009030318t.jpg" />]]>KAMPALA 14 May 2013 (IRIN) - Ugandan children are going unimmunized as the country grapples with persistent and widespread vaccine shortages, the result of insufficient funds and inefficient procurement and supply systems, officials say.</description><body><![CDATA[KAMPALA 14 May 2013 (IRIN) - Ugandan children are going unimmunized as the country grapples with persistent and widespread vaccine shortages, the result of insufficient funds and inefficient procurement and supply systems, officials say.

“We are getting reports and calls from all the districts about the stock-outs of all types of anti-immunization vaccines. They don’t have anti-TB [tuberculosis] vaccines, anti-tetanus, polio [vaccines]. The ministry is faced with inadequate funding for most of our programmes,” Asuman Lukwago, permanent secretary in the Ministry of Health, told IRIN.

“The current major problem on the vaccines is the distribution issue. We are working around the clock to have the problem solved and sorted out immediately.”

Most of the health centres across the country are facing critical shortages of vaccines to protect against tuberculosis, polio, tetanus, diphtheria, rotavirus and pneumonia, putting children at risk of largely preventable diseases.

Health officials now fear these frequent shortages could prevent mothers from bringing their children in for immunizations.

“You can’t [ask] mothers to move to health facilities three to four times and they don’t find vaccines. This practice discourages some of them to go back to the hospitals,” said Huda Oleru Abason, chairperson of the Parliamentary Forum on Immunization.

Procurement woes

In 2011, the government of Uganda shifted the procurement of vaccines and drugs from the Uganda National Expanded Programme on Immunization (UNEPI), under the Ministry of Health, to the National Medical Stores (NMS), an autonomous government corporation. The move was intended to inject efficiency into the country’s drug procurement system, but the drug shortages have continued.

Yet officials at NMS are blaming the shortages on late requisitions for vaccines by UNEPI. The procurement of drugs is the responsibility of NMS.

“Placing of orders is not the responsibility of NMS, it’s [the job of] UNEPI,” Dan Kimosho, a spokesperson at the NMS, told IRIN. “So if they don’t put request in time or under-quantified for the supplies, it’s not our problem. Our responsibility is to procure, store and deliver the requested vaccines. We can’t begin delivering vaccines to districts and health [facilities] if the orders have not been placed to us. We have the competency to deliver the requested drugs and vaccines.”

An estimated 48 percent of children under age five in Uganda are either unimmunized or under-immunized, meaning they do not complete their immunization schedules, according to the 2011 Uganda Demographic and Health Survey [ http://www.measuredhs.com/pubs/pdf/PR18/PR18.pdf ].

Uganda has recently experienced a decline in immunization levels, in part due to inadequate funding, health staff shortages and [parents’] poor adherence to vaccination schedules.

In April 2013, the government launched [ http://www.unicef.org/esaro/5440_12563.html ] a countrywide rotavirus and pneumococcal vaccination program targeting over 1.7 million children.

In an interview with IRIN, Director General of Health Services Ruth Achieng noted that, “Uganda is not doing very well in [its] immunization programme… We don’t want our children to die from preventable diseases. We need to act now. Otherwise, we shall get an outbreak of polio and tetanus.”

Uganda’s budget support for the Expanded Programme on Immunization, EPI, - which had been hailed for increased vaccination coverage between 2000-2007 - decreased by more than half in recent years, falling from 7.7 percent in the 2006-2007 financial year to 3.6 percent in 2009-2010 [ http://www.irinnews.org/Report/97413/Uganda-s-immunization-programme-needs-a-shot-in-the-arm ].

Officials say the government has plans to revitalize the country’s immunization programs.
“We have worked out the revitalization plan, and if implemented well, we shall be able to change the low status of immunization in Uganda. The government has mobilized some funds and, with support from GAVI, everything is revisable. We are going to embark on [an] aggressive campaign to ensure there are no vaccine stock-outs in the country and ensure all the children are immunized,” the Ministry of Health’s Lukwago said.

There is also a legal push to improve immunization. An immunisation bill currently pending in parliament will make it illegal for parents and guardians to fail to have their children immunized. It also seeks to punish health officials who fail to offer immunization services to children.

so/ko/rz

]]></body><pubDate>Tue, 14 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98033/Uganda-grapples-with-paediatric-vaccine-shortages</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2009/2009030318t.jpg"/></td><td valign="top">KAMPALA 14 May 2013 (IRIN) - Ugandan children are going unimmunized as the country grapples with persistent and widespread vaccine shortages, the result of insufficient funds and inefficient procurement and supply systems, officials say.</td></tr></table>]]></content:encoded></item><item><title>Marshalling smartphones, gravediggers to fight dengue in Pakistan</title><pubDate>Fri, 10 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201305091306350487t.jpg" />]]>LAHORE 10 May 2013 (IRIN) - On the frontline in the fight against dengue fever in Lahore, Pakistan’s second largest city, the authorities have a sharp eye for spare car tyres.</description><body><![CDATA[LAHORE 10 May 2013 (IRIN) - On the frontline in the fight against dengue fever in Lahore, Pakistan’s second largest city, the authorities have a sharp eye for spare car tyres.

“When the police show up, we will throw all these tyres into the basement,” said Rohil Ayub, 18, who runs a downtown repair shop.

“The police fine us a lot, thousands of rupees every time,” he said.

Every few days, police inspectors fine anyone who leaves tyres outside - a nuisance, complain the owners of the hundreds of repair shops in the area but essential, health experts say, for combating dengue, a potentially fatal haemorrhagic fever without a vaccine.

Response

In a four-month outbreak [ http://www.irinnews.org/Report/93793/PAKISTAN-Dengue-deaths-mount ] in 2011, the mosquito-borne virus infected 21,000 in Pakistan, 85 percent of them in Lahore, leading to 352 deaths.

At the time, a range of rapidly deployed measures, including using smartphone technology, fumigation and the tracing of larvae breeding grounds, were set in motion by the provincial government to help prevent a worse crisis and keep deaths in the hundreds.

“No one expected this kind of political commitment,” said Qutbuddin Kakar, who oversees programmes to combat malaria and dengue in Pakistan for the World Health Organization (WHO). “In this part of the world, at least, we had not seen this kind of response before.”

The anticipated 1,000-plus deaths did not occur, and since then, dengue fever cases have dropped - 200 in the province (Punjab) last year, without any reported deaths.

So, what was done right, and what do the authorities need to do to make sure solutions are long-term?

The tactics developed to prevent another dengue outbreak were first developed in 2011: information campaigns, data-sharing, and destroying mosquito larvae sites.

Hundreds of government entomologists regularly visit cemeteries, public parks, and gardens, testing for aedes mosquitoes and larvae in any sources of water.

The results they collect are processed on site by specially-designed Android based applications on their smartphones, and uploaded to a centralized dengue prevention centre.

There, analysts match the entomological data with reports from hospitals showing where dengue patients are being treated. Based on the findings, a team is sent to fumigate areas where aedes mosquitos seem to be breeding and infecting people, or to identify and remove sources of standing water.

The key season for infections comes with monsoon rains, when the aedes aegyptus and aedes albopictus mosquitoes, which can carry the virus, begin to appear.

Chronology of an outbreak

In August 2011 heavy monsoon rain dumped 13 inches in a week, leaving parts of Lahore with large bodies of standing water, and raising immediate concerns about disease.

By mid-October, the provincial government in Punjab reported that more than 11,000 dengue cases were recorded.

“It was an exponential increase in number, and it really frightened the government,” said Faran Naru, a consultant hired by the provincial government to tackle the problem. “And the issue was resonating in the media... so it created a panic in the public which had to be contained.”

Most people infected with dengue recovered on their own, said Naru, but once media outlets began reporting on the extent of the outbreak, thousands showed up at hospitals and laboratories to get tested.

An initial team of 70 entomologists conducted 12,000 spot-checks to track where aedes mosquitos were present. By mid-October, this data had been mapped, along with the locations of 11,000 reported dengue patients.

The results surprised the scientists. The worst affected areas were some of the wealthiest neighbourhoods of Lahore: Model Town, Race Course, Mozang, and Gulberg.

“I saw that in Model Town there is a big park, and in Race Course there are two of Lahore's biggest parks… and I believe lots of breeding was happening there and mosquitoes were leaving from there and infecting people,” said Naru.

The mosquitoes need fresh water to lay their eggs, and the large puddles in Lahore's biggest public parks proved to be ideal homes.

Another hotspot was the Mozang neighbourhood, home to one of Pakistan's largest graveyards. The 150-acre area was found to be a major breeding ground for mosquitos. Gravediggers had dug large pits to hold water, which they used to soften the dirt when digging.

“It's fresh water,” said Naur, “from the tap, and there were 70 pits, and all of those were infected, full of larvae.”

Back in the hospital, dengue patients were separated into special areas for treatment. The home of each dengue patient was fumigated, along with 12 surrounding houses, three in each direction.

Sanitation workers unclogged sewers and drains in an effort to clear areas of rainwater; and parks, gardens, and cemeteries were also sprayed. Thousands of Mosquitofish and Garden Carp - fish species known to attack mosquito larvae - were also released into ponds and ditch canals.

Within a few weeks, entomologists detected far fewer aedes mosquitoes, and the prevalence of dengue cases rapidly decreased.

A public awareness campaign also helped - with city residents encouraged to use mosquito repellent and bednets, and schoolchildren instructed to wear long-sleeved clothing, despite the monsoon heat.

Lessons learned?

There have only been two cases of dengue fever reported in the province so far this year, suggesting the anti-dengue measures have had an impact.

But the disease tends to come in 2-4 year cycles, and public health officials worry that if the lessons learned from the 2011 outbreak are not institutionalized, future governments might not handle subsequent outbreaks as well.

In March, an interim government took over in Pakistan to oversee national and provincial elections.

“We must see if the government is able to plan long-term for dengue. This was just a short-term response,” said Kakar from WHO.  He says the teams of entomologists and fumigators, and funding resources devoted to surveillance and data transmission, need to continue to work every season.

He also says Pakistan could devote the same kinds of resources to other mosquito-carried diseases like malaria.  

Pakistan sees more than 300,000 cases of malaria every year according to WHO, a figure that would inevitably drop with a successful long-term anti-mosquito campaign.

“So far,” he said, “a negligible amount is spent on malaria eradication in Pakistan. We should expect that all vector-borne diseases - malaria, dengue... should be brought together under one programme.”

Kakar says malaria is mostly restricted to rural parts of Pakistan, where healthcare facilities are so bad that it is difficult to even get an accurate count of how many people are dying from the disease.

He said if the government provided good sources of water, in both cities and rural areas, he would expect a major impact on mosquitoes, whether they carry malaria or dengue.

uf/jj/cb

]]></body><pubDate>Fri, 10 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98010/Marshalling-smartphones-gravediggers-to-fight-dengue-in-Pakistan</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201305091306350487t.jpg"/></td><td valign="top">LAHORE 10 May 2013 (IRIN) - On the frontline in the fight against dengue fever in Lahore, Pakistan’s second largest city, the authorities have a sharp eye for spare car tyres.</td></tr></table>]]></content:encoded></item><item><title>Hunger projects stalled in Guinea-Bissau</title><pubDate>Thu, 09 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201208141544380935t.jpg" />]]>BISSAU/DAKAR 09 May 2013 (IRIN) - The World Food Programme (WFP) has not received the money it needs to run basic nutrition and food security schemes in Guinea-Bissau, leaving projects in jeopardy or at a standstill.</description><body><![CDATA[BISSAU/DAKAR 09 May 2013 (IRIN) - The World Food Programme (WFP) has not received the money it needs to run basic nutrition and food security schemes in Guinea-Bissau, leaving projects in jeopardy or at a standstill.

The organization needs US$7 million immediately to cover its food security and nutrition programme targeting 278,000 people for 2013; and a further $8 million to extend the project through 2014. The project involves school-feeding, preventing moderate and acute malnutrition, and boosting rice production, and was supposed to start in February this year.

WFP head of programmes Fatimata Sow-Sidibé told IRIN the money is lacking because traditional donors suspended all development cooperation following the April 2012 coup.

“We have some promises [from donors],” said Sow-Sidibé, “but the programme was supposed to start in February and we have no resources to buy the food we need.”

Traditional donors more or less stopped all development funding in Guinea-Bissau following the 12 April 2012 coup d’état, leaving infrastructure projects and basic services at a standstill across the country, but humanitarian funding was supposedly untouched. LINK The problem for WFP is that their project spans development and emergency activities and thus is not just eligible for humanitarian funding.

The African Development Bank also suspended its funding for rural agricultural development projects, following the coup. The cuts “are having a direct impact on food security in Guinea-Bissau, where we already have severe cereal deficits due to inadequate local production,” said a civil servant in the Ministry of Agriculture who preferred anonymity.

Food insecurity in Guinea-Bissau is driven mainly by an inability of people to access food because prices are beyond their reach. Most Bissau Guineans rely on imported rice as they grow mainly cash crops (cashews) and not grains.

Food prices have risen year on year since 2008 (imported rice is currently U$1.20 per kg), and the most recent countryside hunger assessment (2011) cited high prices as the biggest barrier for vulnerable households to access food.

The coup put off a planned countrywide food security assessment in 2012 but a rapid assessment in the regions of Biombo, Oio and Quinara in June 2012 revealed one in five people were food insecure (regions in the east were not included in the survey). Some 65 percent of households at the time had under one month’s supply of food stocks and more people were resigned to further indebtedness, selling animals and producing wine from the cashew fruit, to get by.

Cashew crisis

People’s ability to buy food has been severely hampered by a crisis in the cashew industry: 80-95 percent of Bissau-Guineans depend on cashew sales to purchase food as well as meet other household expenses. Terms of trade for cashews have been deteriorating since 2011: In a good year 1kg of rice can be roughly exchanged for 1kg of cashews; this shifted to 1.5kg of cashews to buy 1kg of rice in 2012, and to 2kgs of cashews for 1kg of rice in 2013, according to Ministry of Agriculture and WFP research. “Everything here is linked to cashews,” said Sow-Sidibé.

The poor terms of trade are linked to a poor 2012 cashew crop, and plummeting cashew prices following the coup (from 80 US cents per kg in May 2012 to 50 US cents one month later), and also linked to low fixed prices on international markets.

Cashew farmers are further stymied by exorbitant petrol prices (US$1.50 per litre) which makes it increasingly expensive for them to get their crop to market.

Ongoing projects

WFP continues to run food assistance programmes where it can. In two districts in Gabu, eastern Guinea-Bissau (Mancadndje Dara, Madina Madinga), and in two districts of Bafata (Djabicunda and Sare Biro), the organization helps villagers improve their farming techniques to boost rice production, including giving them improved seeds and helping them rent animals to get their crops to market. It also helps villagers grow market gardens to improve their food diversity and boost household income.

Mutaro Indjai, head of the village committee of rice producers in Saucunda village in Gabu, told IRIN: “This project helped us improve our production to last through four months, whereas before we only produced enough for one month.”

If the project comes to an end, they will continue to use improved techniques of production, but they would lack the seeds needed to plant next year. “We won’t have access to improved seeds, nor to the animals we need to speed up planting and to help us transport our harvest to nearby villages,” he told IRIN.

Nutrition

Nutrition programmes have also been affected. WFP pushes food diversity, given that feeding practices are a key component of high chronic malnutrition levels in Guinea-Bissau.

The organization tries to push a more varied diet (than the starch-dominated fare given to most infants) including fish soup, peas, carrots, tomatoes, and millet-based cereal. They also support local NGOs to make regular visits to health centres and villages on vaccination days to talk about how to prepare nutrient-rich meals for infants made out of corn flour, peanut powder, bean powder, oil and sugar, among others. Programmes target children in their first 1,000 days of life.

Some 17 percent of children under-five are underweight, and 27 percent are stunted due to inadequate nutrition, according to a December 2012 UNICEF-Ministry of Health nutrition survey.

Hunger specialists fear chronic malnutrition levels will rise if prevention is not stepped up.

UNICEF supports the Ministry of Health to set up nutrition treatment centres; provides therapeutic food for severely malnourished children; and helped update the government’s strategy to manage acute malnutrition, in February 2013. “Lack of funding, very few partners in nutrition, and limited human resources trained in nutrition” are the major challenges facing UNICEF, said Victor Suhfube Ngongalah, head of child survival there. UNICEF needs US$750,000 to implement its projects in 2013 and 2014.

Guinea Bissau is ranked 176 out of 187 countries assessed in the UN Development Programme’s Human Development Report. Political instability has also marred development. Since 1994 no elected president in Guinea-Bissau has finished his mandate.

aj/dab/cb

]]></body><pubDate>Thu, 09 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98004/Hunger-projects-stalled-in-Guinea-Bissau</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201208141544380935t.jpg"/></td><td valign="top">BISSAU/DAKAR 09 May 2013 (IRIN) - The World Food Programme (WFP) has not received the money it needs to run basic nutrition and food security schemes in Guinea-Bissau, leaving projects in jeopardy or at a standstill.</td></tr></table>]]></content:encoded></item><item><title>Semi-synthetic artemisinin promises to boost global malaria gains</title><pubDate>Thu, 09 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2006217t.jpg" />]]>NAIROBI 09 May 2013 (IRIN) - The UN World Health Organization has accepted the first semi-synthetic version of artemisinin, the key ingredient for malaria treatment globally, for use in the manufacture of drugs, boosting hopes that more people will have access to life-saving medication.</description><body><![CDATA[NAIROBI 09 May 2013 (IRIN) - The UN World Health Organization has accepted the first semi-synthetic version of artemisinin [ http://apps.who.int/prequal/info_press/documents/PQ_non-plant_derived_artemisinin_1.pdf ], the key ingredient for malaria treatment globally, for use in the manufacture of drugs, boosting hopes that more people will have access to life-saving medication.

With an estimated 219 million malaria infections and 660,000 deaths – mainly children under five – annually, the disease is one of the world’s biggest killers.

Until now, artemisinin, the key ingredient in the WHO-recommended first-line malaria treatment artemisinin-combination therapy (ACT), has only been available by extraction from the sweet wormwood tree, native to Asia. However, climatic factors have meant it has suffered from uneven supply over the years.

“Normally, artemisinin is sourced from a plant, which is affected by seasonal factors - now, we have a man-made source, which ensures a constant supply of the drug,” Anthony Fake, active pharmaceutical ingredients focal point for WHO’s prequalification of medicines programme, told IRIN.

Funded by the Bill & Melinda Gates Foundation, scientists at the University of Berkeley, California, were able to genetically engineer a strain of baker’s yeast [ http://www.irinnews.org/Report/97924/Smart-science-in-the-fight-against-malaria ] to mass-produce the semi-synthetic artemisinin.

French pharmaceutical firm, Sanofi [ http://en.sanofi.com/Images/32474_20130411_ARTEMISININE_en.pdf ], which manufactures the semi-synthetic artemisinin, recently announced that it planned to “produce 35 tonnes of artemisinin in 2013 and, on average, 50 to 60 tonnes per year by 2014, which corresponds to between 80 and 150 million ACT treatments”.

Agencies involved in fighting malaria say they have big expectations for the new product.

“The production of semi-synthetic artemisinin will help secure part of the world’s supply and maintain the cost of this raw material at acceptable levels for public health authorities around the world and ultimately benefit patients… Having multiple sources of high-quality artemisinin will strengthen the artemisinin supply chain, contribute to a more stable price, and ultimately ensure greater availability of treatment to people suffering from malaria,” Scott Filler, senior technical adviser for malaria at the Global Fund to fight AIDS, Malaria and Tuberculosis, told IRIN via email.

According to Martin de Smet, who heads up Médecins Sans Frontières’ working group on malaria, the uncertainty of natural artemisinin’s availability has led to bulk buying and speculation in the market, leading to the price of the raw product varying widely - from US$400 per kg to $1,000 per kg - over the years.

He noted that the new development would have gains wider than ACTs: “It also opens doors to other forms of artemisinin use other than ACT, for example, artemisinin injections for severe malaria.”

Not a replacement

De Smet said it would be important for the supply of the natural version of artemisinin to continue alongside the semi-synthetic production.

“We hope that the message will not be that it will replace the natural product, because this would act as a disincentive to the farmers, who could stop producing their crops. It should be complementary, with a growing share of the market,” he added. “Hopefully, we will see the price of ss artemisnin matching the lowest price available for the natural product.”

Both WHO’s Fake and MSF’s de Smet say there is no need for concern over differences in efficacy or safety, as drugs manufactured with both versions of artemisinin contained the same active chemical ingredient.

“There is still a lot to do - pharm companies need to formulate the end products that they will produce based on the semi-synthetic artemisinin, and these then need to be prequalified by WHO - a bureaucratic process but one which ensures that the drugs are safe and effective,” he said.

“We don’t expect to see change overnight, but rather a gradual increase in the market share by companies manufacturing drugs using the semi-synthetic artemisinin - even if we see them getting 10 percent and eventually 20 percent, this will help ease speculation about the product’s availability and stabilize prices.”

kr/cb

]]></body><pubDate>Thu, 09 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98006/Semi-synthetic-artemisinin-promises-to-boost-global-malaria-gains</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2006217t.jpg"/></td><td valign="top">NAIROBI 09 May 2013 (IRIN) - The UN World Health Organization has accepted the first semi-synthetic version of artemisinin, the key ingredient for malaria treatment globally, for use in the manufacture of drugs, boosting hopes that more people will have access to life-saving medication.</td></tr></table>]]></content:encoded></item><item><title>Analysis: Towards increased services for Syrian survivors of sexual violence</title><pubDate>Wed, 08 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201304250551050096t.jpg" />]]>NIZIP 08 May 2013 (IRIN) - Turkey&apos;s camps for Syrian refugees are, by many measures, a model of humanitarian assistance. But one important detail appears to have been overlooked: According to aid workers, nowhere in Turkey&apos;s 17 refugee camps can survivors of sexual violence find the level of specialized psychosocial support experts say they so desperately need.</description><body><![CDATA[NIZIP 08 May 2013 (IRIN) - More has to be done to ensure the health and wellbeing of women and children affected by the Syrian conflict, said Babatunde Osotimehin, executive director of the UN Population Fund (UNFPA), on a recent visit to Turkey’s Nizip refugee camp, about 40km east of the southern city of Gaziantep.

One of Turkey’s newest camps, Nizip houses some 10,000 refugees, or “guests” as the government prefers to call them, in white canvas tents and containers arrayed in neat numbered rows along the rocky, sun-bleached banks of the Euphrates. 

It is, by many measures, a model of humanitarian assistance.

Amenities include a laundry facility, a mosque, a health clinic, hot water and hot meals, schools and playgrounds, teahouses, hairdressers and a supermarket where refugees can shop for extras using electronic voucher cards. Kids can play organized football and compete in chess tournaments, watch TV and weave rugs. There is gas and electricity, sanitation and tight security.

But Turkish authorities seem to have overlooked one important detail. According to aid workers, nowhere at Nizip, or at any of Turkey’s 16 other camps, can refugee survivors of sexual violence find the level of specialized psychosocial support experts say they so desperately need.

“I am impressed by what I have seen here,” Osotimehin, a former Nigerian health minister, told a group of reporters gathered outside the camp’s school. “It’s remarkable what Turkey has done at its own expense.” But he had also come, he said, to highlight the urgent needs of pregnant and lactating women as well as victims of the sexual violence said to be on the rise across conflict-battered Syria. 

Sexual violence in Syria

Indeed, as a January report  by the International Rescue Committee put it, “rape is a significant and disturbing feature of the Syrian/civil war” - an assertion supported by surveys of refugees in Jordan and Lebanon who consistently cited sexual violence “as a primary reason their families fled the country” [ http://www.rescue.org/press-releases/syria-displacement-crisis-worsens-protracted-humanitarian-emergency-looms-15091 ].

Weeks later, Erika Feller, assistant UN High Commissioner for Refugees, echoed, those concerns, warning of reports that “the conflict in Syria is increasingly marked by rape and sexual violence employed as a weapon of war.” [ http://www.un.org/apps/news/story.asp?NewsID=44230#.UWQlm_Vfo3G ]

And writing in the Atlantic last month, Lauren Wolfe, director of the Women Under Siege Project, which documents the incidence of rape in conflict zones, described how Syria’s “massive rape crisis” is “creating a nation of traumatized survivors” [ http://www.theatlantic.com/international/archive/2013/04/syria-has-a-massive-rape-crisis/274583/ ].

To date, Turkey has taken in around 193,000 refugees in 17 camps, and six new camps are currently under construction. Stretched to capacity, the country has been lauded for its open-door policy and generous aid. But at least one gap remains [ http://www.irinnews.org/Report/97851/Is-Turkey-s-approach-to-Syrian-refugees-sustainable ].

“From what we have been able to learn, there is virtually no trained psychosocial support [specific to survivors of sexual violence] currently available in the camps,” said Leyla Welkin, a clinical psychologist and gender-based violence consultant working with UNFPA.

Specific services for survivors of SGBV are rarely at the top of the priority list in emergency settings, said Meltem Agduk, a gender programme officer with UNFPA. Like others have done elsewhere, Turkish officials first focused on providing adequate food and shelter to a spiralling number of refugees.   

“You can see that our camps are in better condition compared to Jordanian camps,” said a senior Turkish official. “The people are very happy.”

The government has informed the UN Refugee Agency (UNHCR) that specialized staff are available to the Syrian refugees, who can be treated inside the camp or referred to hospitals outside the camp where necessary, UNHCR's office in Ankara said. 

But as Welkin told IRIN after a meeting with women `mukhtars’, or village leaders, who teared up when asked about sexual violence, “there is a significant need for professional support.” 

Psychosocial services, more generally, are available to both women and children in the camps, but a lack of private space makes it difficult for women to talk about their experiences of sexual and gender-based violence (SGBV), perpetuating a culture of silence that severely impedes efforts to address it.

Building capacity

That dearth of psychosocial support for survivors of sexual violence in Turkey’s refugee camps is a function of its scarcity in the country at large, said Welkin, who is based in UNFPA’s office in the Turkish capital Ankara. “When it comes to SGBV, Turkey is very underserved.” 

Lack of personnel is a challenge for the Ministry of Family and Social Policy more widely, Agduk added. In some cities, there is just one psychologist and one social worker to deal with both the normal Turkish caseload, as well as the influx of Syrian refugees (an additional 130,000 have been registered outside the camps). 

In recent years, Turkey has focused on increasing its ability to respond to domestic cases of SGBV, opening one-stop centres where survivors of SGBV can access counselling, legal advice, and other kinds of support all in one place. But Turkey has less experience in treating SGBV in the context of disasters, in which trauma is multiplied, Agduk said. 

The Turkish government has been keen to address the issue of disaster-related SGBV, she added, and has turned to UNFPA for technical expertise.

Together with the Turkish Ministry of Family and Social Policy, UNFPA has designed a pilot programme to prepare and train 24 health care workers to conduct preliminary psychological assessment and treatment in the camps. The programme will also provide general public education on SGBV, said Welkin, including an intervention specifically targeting men, “some of whom will be perpetrators”.

UNHCR has also given Turkish officials its guidelines, or standard operating procedures, for the prevention of and response to SGBV "to be shared among their staff working with Syrian refugees in the camps."

UNFPA has already trained Turkish health care workers in the clinical management of rape, including emergency contraception, prevention of sexually transmitted infections, and collection of forensic evidence. But in the absence of access to counselling, said Welkin, victims are unlikely to present for medical treatment, largely because of the stigma surrounding the issue. Cultural differences and language barriers have also posed challenges, Agduk said.

The new training will begin within a couple weeks, with services likely to be up and running within two months, she said. This first phase of the programme targets health care workers, psychologists and social workers at the municipality and governorate level, with the aim of building capacity inside institutions that can be carried forward. 

“My hope is that this catastrophe can serve as an opportunity for Turkey to take a step forward in SGBV prevention and intervention - that the professionals we train will be able to take these skills from the camps to their own communities,” Welkin said. 

Indeed, government officials see this programme as “opening a door” through which they can establish new services that will be available not only for Syrian refugees, but in case of future disasters.

“It is important that they are now taking it seriously,” Agduk said.

New legislation, passed last year, has significantly improved the laws governing SGBV, for example by expanding the definition to include non-married victims of domestic violence or divorced women who are assaulted by their ex-husbands.

Understanding the needs

Still, the task ahead is not easy, and not least for the fact that the UN now faces a major funding shortfall. Of the US$1.5 billion pledged by international donors to cover Syrian refugee needs for the first half of 2013, just over half has been committed. UNFPA requirements for the Syrian crisis, across the region, for the same period were $20.7 million, but so far, say representatives, the agency has received less than half of that [ http://www.irinnews.org/Report/97877/Promised-aid-funding-for-Syria-reaches-half-way-point ].

Another challenge is that the scale and range of SGBV-related needs among Syrian refugees are not fully clear. 

“Our concern is not about the number of psychologists trained, but the lack of information about the reality on the ground,” said Ayman Abulaban, Turkey representative of the UN Children's Fund (UNICEF). He said UNICEF does not currently have information about this, but hopes to in the near future when project activities begin. 

Abulaban said there was a need to assess the gaps, to increase comprehensive prevention and response services, and to create a standardized referral system. He said he hoped a new UNICEF project to increase resilience among children and youth in the camps would help support the government in addressing the needs. (According to a recent Save the Children report, sexual violence in conflict disproportionately affects children and teenagers) [ http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/UNSPEAKABLE_CRIMES_AGAINST_CHILDREN.PDF ].

“It is of utmost importance that Syrian refugees can access SGBV services,” he said in a written statement.

In the lead-up to its training, UNFPA, the Ministry of Family and Social Policy and AFAD, the government’s disaster and emergency management unit, will conduct a large assessment of the needs, Agduk said.

Meanwhile, as the fighting in Syria rages on, refugees continue to pour over the border, with some 7,000 new arrivals registering each day across the region. By the end of the year, warned UNHCR’s regional coordinator for Syrian refugees, the number of Syrian refugees in the region could surpass four million [ http://www.un.org/apps/news/story.asp?NewsID=44602&Cr=syria&Cr1=#.UXjrJiuPgjU ].

The Ministry of Family and Social Policy did not answer IRIN's request for comment. 

pa/ha/cb

*This article provides additional information to an original version published on 2 May 2013. 

]]></body><pubDate>Wed, 08 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97953/Analysis-Towards-increased-services-for-Syrian-survivors-of-sexual-violence</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201304250551050096t.jpg"/></td><td valign="top">NIZIP 08 May 2013 (IRIN) - Turkey&apos;s camps for Syrian refugees are, by many measures, a model of humanitarian assistance. But one important detail appears to have been overlooked: According to aid workers, nowhere in Turkey&apos;s 17 refugee camps can survivors of sexual violence find the level of specialized psychosocial support experts say they so desperately need.</td></tr></table>]]></content:encoded></item><item><title>Analysis: Sending the right message on mHealth</title><pubDate>Wed, 08 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201208091451120607t.jpg" />]]>NAIROBI 08 May 2013 (IRIN) - We’ve read the stories: From bedridden patients sending text messages to their health workers, to young people receiving HIV prevention messages via SMS, the mobile phone seems to have morphed from communications device to essential life-saver. But is the evidence there yet that mHealth is an effective health delivery intervention for the developing world?</description><body><![CDATA[NAIROBI 08 May 2013 (IRIN) - We’ve read the stories: From bedridden patients sending text messages to their health workers, to young people receiving HIV prevention messages via SMS, the mobile phone seems to have morphed from communications device to essential life-saver. But is the evidence there yet that mHealth is an effective health delivery intervention for the developing world?

IRIN, like others, has been reporting for years on mHealth’s potential: This communication technology could provide the answer to distant and under-resourced health services, in particular for Africa’s poor. Kenyan health workers have recounted [ http://www.irinnews.org/Report/88653/KENYA-R-U-OK-2day-SMS-check-up-takes-off ] how mobile phones have made it easier to track their patients’ progress; there have been anecdotal reports of lower maternal mortality rates as a result of Ghanaian mothers [ http://www.irinnews.org/Report/87261/GHANA-Cell-phones-cut-maternal-deaths ] being able to call for ambulances during labour.

In Africa, with some 63 mobile phones per 100 inhabitants (compared to Asia and the Pacific’s 89 per 100 inhabitants), the cell in your pocket can become a direct channel [ http://www.irinnews.org/Report/91287/AFRICA-Mobile-phones-for-health ] for receiving public health messages, improving communication between patients and health providers, boosting data collection and, increasingly, assisting in diagnosis.

But a systematic review - published in January in PLOS Medicine [ http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001363 ] - into the effectiveness of mHealth technology in improving health delivery found mixed results from 42 trials of mHealth interventions. SMS appointment reminders, for example, were found to have modest programmatic benefits, while using phones to send digital images for diagnosis actually led to a drop in the correct analysis in two trials examined.

A 2012 study by the mHealth Alliance [ http://mhealthalliance.org/images/content/baseline_evaulation_report2013.pdf ], which advocates the use of mobile technologies in health care, found that sub-Saharan Africa had a higher number of mHealth projects compared to Asia and Latin America, with more than half of all mHealth projects related to communicable diseases such as HIV and malaria.

Insufficient evidence

Despite the rapid growth, "there is currently a gap in terms of evidence linking mHealth to improved health and operational benefits, and this is particularly true when it comes to studies in low- and middle-income countries," Patricia Mechael, executive director of the mHealth Alliance, told IRIN.

The PLOS review found that “none of the trials were of high quality - many had methodological problems likely to affect the accuracy of their findings - and nearly all were undertaken in high-income countries.”

Rajesh Vedanthan, an assistant professor at New York’s Mount Sinai Medical Centre who is currently working with AMPATH [ http://www.ampathkenya.org/ ], an academic health programme involved in research and health care in Kenya, told IRIN via email that some of the practical challenges with the use of mHealth technology included “optimizing the user interface, ensuring that users have an easy and error-free working experience with the mHealth device, not impeding the workflow of clinicians, issues related to network connectivity, access to a central server, coordination of individual devices with a central coordinating office, systems integration, etc…

“mHealth has the potential to assist with several aspects of the ‘supply chain’ of care for non-communicable diseases - including screening/diagnosis, linkage to care, treatment/decision support, retention and follow-up, systems coordination, etc.,” he added. “Whether mHealth will be effective in all of those arenas is still not robustly known, and rigorous research is still required.”

A need for standards

The mushrooming of mHealth pilot projects has caused concern around monitoring. Uganda has declared a moratorium on pilot mHealth initiatives as it seeks to bring them in line with national health policies.

“We first needed to study them [mHealth and mHealth initiatives]… Some of these people are duplicating what is already there,” Asuman Lukwago, the permanent secretary in Uganda’s Ministry of Health, told IRIN. “As a ministry, we only implement innovations that have been tested and approved. At the moment, we are suggesting reforms to put into practice for these new innovations.”

The mHealth Alliance recently released a review [ http://www.mhealthalliance.org/images/content/state_of_standards_report_2013.pdf ] of standards in the use of mHealth among low- and middle-income countries, which found that as mobile health systems “move towards scale, existing guidelines and strategies will need to be revised to reflect new demands on executive sponsorship; national leadership of eHealth programmes; eHealth standards adoption and implementation; development of eHealth capability and capacity; eHealth financing and performance management and eHealth planning and architecture maintenance”.

Scaling up mHealth

Mechael noted that mHealth could only meet its potential if it was fully integrated into general health programmes, becoming “so much a part of health systems that we no longer need to use ‘m’ as a designation”, something that cannot happen unless mHealth projects move beyond the pilot phase and really reach scale at a national or regional level.

Importantly, experts say, the use of mHealth and other humanitarian technology should be allowed to be driven by the communities who benefit from it.

“There has been a recognition - belatedly, in some cases - of the ways beneficiaries are using technology, voting with their wallets and their feet... We can see that the most innovative models of humanitarian technology are driven by communities themselves,” Imogen Wall, the coordinator of communications with affected communities for the UN Office for the Coordination of Humanitarian Affairs, told IRIN.

She noted that humanitarian agencies would increasingly need to increase their engagement with the private sector as partners in preparedness and response, recognizing that the private sector is no longer merely a support system, but a humanitarian service provider as well.

OCHA recently released a report, Humanitarianism in the Network Age [ https://ochanet.unocha.org/p/Documents/WEB%20Humanitarianism%20in%20the%20Network%20Age%20vF%20single.pdf ], which stresses the importance of information and communication in humanitarian work and urges new ways of thinking that adapt to the changing realities of communities around the world.

“In order for humanitarian technology to meet its full potential, there must be a willingness - an openness - to innovate, to think outside the box, to test new ideas and to risk failure and success in both the processes and the deliverables - essentially, a willingness to accept change,” Wall said.

kr/so/oa/cb

]]></body><pubDate>Wed, 08 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98001/Analysis-Sending-the-right-message-on-mHealth</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201208091451120607t.jpg"/></td><td valign="top">NAIROBI 08 May 2013 (IRIN) - We’ve read the stories: From bedridden patients sending text messages to their health workers, to young people receiving HIV prevention messages via SMS, the mobile phone seems to have morphed from communications device to essential life-saver. But is the evidence there yet that mHealth is an effective health delivery intervention for the developing world?</td></tr></table>]]></content:encoded></item><item><title>“Super-fly” threatens “Rambo” cassava, food security</title><pubDate>Tue, 07 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2008/2008030531t.jpg" />]]>JOHANNESBURG 07 May 2013 (IRIN) - A tiny, rapidly breeding cyanide-munching insect, dubbed a “super-fly” by scientists, is threatening the food security of millions of Africans.</description><body><![CDATA[JOHANNESBURG 07 May 2013 (IRIN) - A tiny, rapidly breeding cyanide-munching insect, dubbed a "super-fly" by scientists, is threatening the food security of millions of Africans.

The Bemisia tabaci - one of several whitefly species - carries lethal viruses that cause cassava brown streak disease (CBSD) and cassava mosaic disease (CMD), which have decimated the hardy cassava plant.

Cassava, a tropical root crop, is the third most important source of calories in the tropics, after rice and maize. According to the UN's Food and Agriculture Organization (FAO), it is the staple food for nearly a billion people in 105 countries, where it comprises as much as a third of daily calories consumed. The cheapest known source of starch, cassava is grown by poor farmers - many of them women - often on marginal land; for these people, the crop is vital for both food security and income generation.

The threat to cassava is particularly alarming as the plant is often called the "Rambo" root for its ability to withstand high temperatures and drought. With climate change expected to take a major toll on maize in the coming decades, many hope cassava will offer an alternative route to food security in Africa. Cassava may also prove to be an important source of biofuel [ http://www.irinnews.org/Report/95694/CLIMATE-CHANGE-Cassava-key-to-food-security-say-scientists ].

Experts plan to take aim at the whitefly this week, at a conference of the Global Cassava Partnership for the 21st Century (GCP21), at the Rockefeller Foundation Bellagio Center in Italy. The conference is dedicated to "declaring war on cassava viruses in Africa."

Pandemics

From the 1980s to the mid-2000s, CMD ravaged more than 4 million square km in Africa's cassava-growing heartland, stretching from Kenya and Tanzania in the East to Cameroon and the Central African Republic in the West. But in recent years, the scientific community developed cassava varieties resistant to CMD.

James Legg, a leading cassava expert at the International Institute of Tropical Agriculture (IITA), who works out of Tanzania, told IRIN, "The premature celebrations for this apparent victory were very soon squashed, however, as sinister new reports were received of the occurrence and apparent spread of CBSD in southern Uganda."

Until then, scientists had assumed that the viruses causing CBSD could not spread at medium-to-high altitudes; the disease had previously only been reported in coastal areas of East Africa and the low-altitude areas around Lake Malawi. "The spread recorded from Uganda instantly cast doubt of the validity of that earlier theory," said Legg. "Worse still, the disease spread out from Uganda over following years, and into the neighbouring countries of Kenya, Tanzania, Burundi and Rwanda."

CBSD is now a pandemic, threatening Nigeria, the world's largest producer and consumer of cassava. The cassava starch industry in Nigeria generates US$5 billion per year and employs millions of smallholder farmers and numerous small-scale processors.

Only in 2005 were scientists able to confirm that the whitefly responsible for spreading CMD was also responsible for spreading CBSD.

"With this realization, it became clear that the spread of these two disease pandemics was really only a consequence of the fact that East and Central Africa was experiencing a devastating outbreak of the whitefly that  transmits both of them," explained Legg.

He told IRIN that in the 1980s, researchers recorded an average of less than  one fly per plant, but by the mid-1990s, the number of whiteflies had  increased a hundredfold.

Arms race

It seems Bemisia tabaci has been assisted by climate change: The warmer temperatures occurring in higher altitudes have created optimal conditions for the insect to breed rapidly, speeding its adaptation and evolution. More  importantly, said Legg, is the fact that these flies seem to have worked out how to do better on cassava plants, whose cyanide production deters all but  a very small group of insects. As the whitefly population has exploded, rapid spread of the viral diseases - CMD and CBSD - was an inevitable consequence.

What makes a bad situation even worse, however, is that these diseases, in  turn, may promote the whitefly. "These insects also seem to have a close  relationship with the viruses that they transmit, and some evidence has  shown that the insects do better on virus-diseased plants, leading to an 'I  scratch your back, you scratch my back' type of mutually beneficial relationship," Legg said.

Scientists are working towards solutions. A member of Legg's team is examining the impact of climate change on the whitefly in search of ways to  deal with the pest. Other planned projects are working to control whiteflies  directly, either through introducing other beneficial insects that kill  whiteflies, or through producing varieties that combine whitefly and disease resistance.

Efforts to breed high-yielding, disease-resistant plants suitable for  Africa's various growing regions will involve going to South America, where cassava originated, and working with scientists at the cassava gene bank of  the International Center for Tropical Agriculture (CIAT), IITA's sister  organization, in Colombia. CIAT is the biggest repository of cassava cultivars in the world.

Experts at the conference in Italy will also discuss a more ambitious plan to eradicate cassava viruses altogether. The aim will be to develop a regional strategy that gradually replaces farmers' infested cassava plants with virus-free planting material of the best and most disease-resistant cultivars. Approaches to developing these cultivars will include new molecular breeding and genetic engineering technologies to speed up selection. The hope of the team is that by joining forces, and employing the whole range of technologies available, a lasting impact will be made in tackling a crop crisis that poses the single greatest challenge to the future of Africa's cassava crop.

jk /rz

]]></body><pubDate>Tue, 07 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97986/Super-fly-threatens-Rambo-cassava-food-security</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2008/2008030531t.jpg"/></td><td valign="top">JOHANNESBURG 07 May 2013 (IRIN) - A tiny, rapidly breeding cyanide-munching insect, dubbed a “super-fly” by scientists, is threatening the food security of millions of Africans.</td></tr></table>]]></content:encoded></item><item><title>Less dependent on food rations</title><pubDate>Tue, 07 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2010/201011150703500206t.jpg" />]]>BAGHDAD/DUBAI 07 May 2013 (IRIN) - The number of Iraqis without secure access to food dropped by more than a quarter of a million people between 2007 and 2011, part of a generally positive trend of increasing food security in Iraq over the last decade.</description><body><![CDATA[BAGHDAD/DUBAI 07 May 2013 (IRIN) - Food security in Iraq has improved in the last decade, as the American-led invasion brought an end to sanctions and a resumption of open relations between Iraq and the rest of the world.

Historically, Iraq’s vulnerability to food insecurity has been largely due to barriers to international trade - caused by two decades of wars and sanctions - which hindered the export of oil and import of food commodities. These barriers also affected Iraq’s ability to modernize the agricultural sector and employ new technologies; local production could not meet the country’s growing food needs.

As such, even during the worst years of sectarian violence in the last decade, access to food improved on average, compared to the years under sanctions.

Recent history

According to the Food and Agriculture Organization (FAO), in 1980, just four percent of Iraqis were undernourished or “food deprived”, meaning they consumed less than the minimum energy requirement, which in Iraq is currently estimated at 1,726 kilocalories per person per day. Despite years of war with Iran in the 1980s, agricultural subsidies and food imports from the US and Europe helped keep the level of food deprivation low [ http://www.fao.org/NEWS/1999/img/SOFI99-E.PDF ].

But when the UN leveled sanctions against Iraq in August 1990, and US government credits for agricultural exports to Iraq ceased, Iraq - almost completely dependent on imports for its food needs - saw food deprivation rise to 15 percent by 1996, according to FAO. Throughout the 1990s, food deprivation continued to climb, reaching a peak of close to one-third of the population in the late 90s, by some counts.

Humanitarian food supplies delivered through the UN’s Oil-for-Food Programme, initiated in 1995, helped ease the strain, but during the early to mid-2000s, the Public Distribution System (PDS) - the government’s subsidy scheme created in 1991 - remained “by far the single most important food source in the diet” for the poor and food insecure population, according to a 2006 report by the government and the World Food Programme (WFP) [ http://home.wfp.org/stellent/groups/public/documents/ena/wfp193132.pdf ].

Post-2003

Food deprivation levels began to fall just before the turn of the century, and the decline increased with the toppling of former president Saddam Hussein, which saw Iraq regain the ability to import freely. In the last decade, the country has experienced a “huge transformation”, as one observer put it.

In 2003, months after the invasion, a WFP survey [ http://www.japuiraq.org/documents/122/wfp086624.pdf ] found that 11 percent of the population lacked secure access to food, a large drop from the high of the 1990s.

While food insecurity was found to have risen slightly, to 15.4 percent, in a 2005 WFP-government survey [ http://home.wfp.org/stellent/groups/public/documents/ena/wfp193132.pdf ], it fell right back down shortly afterwards.

Joint government-UN analysis [ http://www.japuiraq.org/documents/1110/Food%20Deprivation%20in%20Iraq.pdf ] of 2007 survey data [ http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/MENAEXT/IRAQEXTN/0,,contentMDK:22032522~menuPK:313111~pagePK:2865066~piPK:2865079~theSitePK:313105,00.html ] found that 7.1 percent of the population was food deprived; this dropped to 5.7 percent in 2011, according to the Iraq Knowledge Network (IKN) survey [ http://www.japuiraq.org/documents/1685/IKN_S8_FoodSecurity_en.pdf ].

The government credits an improvement in security, economic growth and increased humanitarian aid.

PDS

Whereas aid workers estimated 60 percent of the population was food aid-reliant during Hussein’s reign, the PDS is now essential only to the poor [ http://www.irinnews.org/Report/24110/IRAQ-Food-security-still-problematic-WFP ].

Sa’ad al-Shimary, a government employee from Baghdad, said his family used to be dependent on the PDS. “I don’t even need the food supplies we get from the ration card now,” he said. “I can buy good quality food from the markets, as everything is available now.”

But while the value of the PDS basket has diminished for most Iraqis (it now represents only 8 percent of the total cash value of food expenditures), it remains a major source of wheat and rice for 72 percent and 64 percent of households respectively, according to the 2011 IKN survey. (Iraq’s PDS is the largest in the world, according to the US Agency for International Development, providing virtually free basic food rations to any Iraqi; as such, it is not only utilized by the poor.) [ https://www.inma-iraq.com/sites/default/files/11_transforming_the_iraqi_public_distribution_system_2011jan00.pdf ]

The PDS is the source of more than one-third of Iraqis’ calorie consumption, and more than half of the poor’s consumption.

And at 35 percent, food continues to comprise the highest proportion of Iraqi household expenditures. Nearly one-quarter of IKN respondents said they used coping strategies to eat enough in 2011. In addition to the 5.7 percent of Iraqis now considered to be undernourished, an additional 14 percent would become undernourished if the PDS did not exist, according to the IKN.

Malnutrition

Malnutrition indicators paint a blurrier picture.

While the percentage of children under five who are underweight nearly halved from 15.9 percent in 2000 to 8.5 percent in 2011, according to the Multiple Indicator Cluster Surveys (MICS), conducted by the government and the UN Children’s Fund (UNICEF), chronic and acute malnutrition indicators look less positive.

The percentage of children under five who are moderately or severely stunted (too short for their age) or wasted (underweight for their height) both increased - if only slightly - over the same period, a “worrying” trend, aid workers said, given the long-term impacts of malnutrition on mental development.

According to UNICEF, one out of every four Iraqi children suffers from stunted growth. High levels of chronic and acute malnutrition are a sign that mothers and children do not have access to quality food. While access to food has improved, stunting and wasting are difficult trends to reverse in a short period of time. As such, it may take years before improved access to food reflects in malnutrition rates across the board.

Impact of violence

Although the last decade has seen overall gains in food security, the sectarian violence of 2006-2007 [ http://www.irinnews.org/Report/97905/The-forgotten-displacement-crisis ] did have a negative impact. For example, a WFP report based on 2007 data found that levels of food deprivation differed by area: in Diyala Governorate, one of the most volatile during the conflict, 51 percent of the population was deprived of food, while in the northern autonomous Kurdistan region, largely spared the consequences of the invasion, just one percent of the population suffered from food deprivation [ http://www.japuiraq.org/documents/1110/Food%20Deprivation%20in%20Iraq.pdf ].

Here, too, there has been change. While in 2007, insecurity had a huge bearing on food security, the food insecure today are traditionally vulnerable groups - the illiterate, the unemployed, the displaced and female-headed households.

Iraq also faces new challenges to its food security, according to Edward Kallon, WFP’s director in Iraq, including rising global food prices, poverty, climate change, desertification and drought.

For more, check out this UN fact-sheet on food security [ http://www.iauiraq.org/documents/1824/ExecutiveSummer.pdf ] and this presentation by UNICEF comparing the child indicators in Iraq over the last three to five decades [ http://www.unicef.org/equity/files/PMACEquitypresentation.pdf ]. The bulk of statistics come from WFP/government surveys in 2003 [ http://www.japuiraq.org/documents/122/wfp086624.pdf ], 2005 [ http://home.wfp.org/stellent/groups/public/documents/ena/wfp193132.pdf ] and 2007 [ http://www.japuiraq.org/documents/227/WFP_VAMSurvey_2007_CFSVA%20final.pdf ]; and UNICEF/government surveys in 2000 [ http://www.childinfo.org/files/iraq1.pdf ], 2006 [ http://www.childinfo.org/files/MICS3_Iraq_FinalReport_2006_eng.pdf ] and 2011 [ https://www.yousendit.com/download/UVJneFlUY1M1bmo1SE1UQw ]. This 2010 report [ http://www.japuiraq.org/documents/1110/Food%20Deprivation%20in%20Iraq.pdf ] on food deprivation analyzes 2007 data collected in a survey by the government and the World Bank [ http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/MENAEXT/IRAQEXTN/0,,contentMDK:22032522~menuPK:313111~pagePK:2865066~piPK:2865079~theSitePK:313105,00.html ], just as this 2012 report [ http://www.japuiraq.org/documents/1824/WFP-final-view.pdf ] analyzes food security data from the 2011 IKN survey [ http://www.japuiraq.org/ikn ]. The FAO has its own figures on food deprivation [ http://www.fao.org/docrep/016/i3027e/i3027e.pdf ]. The government has also tracked statistics [ http://cosit.gov.iq/english/AAS2012/section_19/2.htm ] on underweight children from 1991 through 2009.

For other development indicators, visit IRIN's series: Iraq 10 years on [ http://www.irinnews.org/Report/97897/Iraq-ten-years-on-the-humanitarian-impact ].

af/da/ha/rz

-----------------------------------------------------------------------------------------------------------
A decade after US-led forced toppled Iraqi President Saddam Hussein, IRIN examines the progress in basic living standards.
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]]></body><pubDate>Tue, 07 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97991/Less-dependent-on-food-rations</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2010/201011150703500206t.jpg"/></td><td valign="top">BAGHDAD/DUBAI 07 May 2013 (IRIN) - The number of Iraqis without secure access to food dropped by more than a quarter of a million people between 2007 and 2011, part of a generally positive trend of increasing food security in Iraq over the last decade.</td></tr></table>]]></content:encoded></item><item><title>Zimbabwe short on climate change funds</title><pubDate>Tue, 07 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201305071409390879t.jpg" />]]>HARARE 07 May 2013 (IRIN) - Inadequate funding and limited resources are frustrating Zimbabwe’s efforts to develop plans to deal with the impact of climate change, says a government progress report.</description><body><![CDATA[HARARE 07 May 2013 (IRIN) - Inadequate funding and limited resources are frustrating Zimbabwe’s efforts to develop plans to deal with the impact of climate change, says a government progress report. 

Zimbabwe has been facing political and financial turmoil for more than a decade, derailing the government’s ability to function and respond to crises. 

Sparse and erratic rains have already caused the water table to drop, affecting the country’s ability to produce food and contributing to the spread of water-borne diseases. In 2008, the country experienced one of the worst cholera outbreaks recorded anywhere in recent years; the outbreak killed at least 4,000 people and infected 100,000 others [ http://www.irinnews.org/Report/97312/Zimbabwe-s-climate-change-policies-need-an-urban-focus ].

The government report, Strengthening the National Capacity for Climate Change, says Zimbabwe lacks the funds needed to hold a workshop to identify a National Implementing Entity, an accredited body able to receive direct financial transfers from the Adaptation Fund in Zimbabwe [ https://www.adaptation-fund.org/page/implementing-entities ]. The Adaptation Fund, set up under the UN Framework Convention on Climate Change (UNFCCC), is the most important source of funds to help developing countries adapt to climate change. 

The government also lacks sufficient funds to devise a national strategy, review the work of its technical team on climate change or conduct advocacy work to raise awareness of climate change, the report says. 

Funds short 

In 2012, the UN Development Programme (UNDP) commissioned a three-year, US$8.3 million project with the government, aiming to incorporate climate change issues into the country’s national development plans and to leverage funds from the global finance mechanisms. 

Veronica Gundu, a principal environment officer in the Ministry of Environment and Natural Resources Management, told IRIN that when the idea to craft a national climate change response strategy was proposed, UNDP agreed to provide funds, but “as we went on to develop the strategy, the funds were not enough, so we sourced additional funding from COMESA [Common Markets for East and Southern Africa]”. 

COMESA is said to have agreed to complement the UNDP funding with $170,000, which is meant to go towards the projected $400,000 needed for the national response strategy. COMESA has yet to release the funds. 

Additionally, Gundu said the government had, for the first time last year, released funds for climate change; she did not disclose the figures. 

Sara Feresu, director of the Institute of Environmental Studies at the University of Zimbabwe, the institution leading the climate change strategy-formulation process, told a workshop in early April that still more funds were needed. 

The government has put together a draft national response strategy with the money that was available, conducting consultations in select urban centres. But the draft strategy needs feedback from provinces and districts. Consultations with civil society, most of whom have yet to see the draft, are also needed. 

In spite of the funding gaps, Gundu is optimistic that by the end of the year the first draft, which the government says is in circulation, will be ready for adoption. 

Short on development aid 

Climate change pundits say fundraising for climate change adaptation has proved difficult due to the global economic crisis, which has seen donors minimizing funding to NGOs and governments. Advocates insist on more government involvement in fundraising efforts. 

Leonard Unganayi, who manages a climate change project administered jointly by the government-owned Environmental Management Agency (EMA), the Global Environment Facility (GEF) and UNDP, says there can never be enough funding for such a mammoth task. 

He says that even at the global level there are major outcries for funding and resources [ http://www.irinnews.org/report/96893/CLIMATE-CHANGE-Underfunding-leaves-poor-unable-to-adapt ].

The development agency Oxfam said an analysis of new figures of Official Development Assistance [ http://www.irinnews.org/Report/97785/Global-aid-drops-as-rich-nations-struggle ] by the members of the Organization for Economic Cooperation and Development’s (OECD) Development Assistance Committee shows a staggering 40 percent drop in funding focused on climate change adaptation. 

Shepherd Zvigadza, chairperson of the Climate Change Working Group, a coalition of NGOs, said most NGOs were making efforts to fundraise for adaptation, but that most of the money coming in is just for pilot projects that do not have the desired impact. 

“Zimbabwe has been under sanctions, and so many donors have been shying away from supporting us, both as government and NGOs... Besides sanctions, the country has not been able to tap into the global funding windows because emphasis is on supporting least developed countries, and Zimbabwe is not classified as one,” he said. 

After flawed elections in 2002, European governments placed targeted sanctions on the leadership of ZANU-PF, which was the ruling party at the time, and on development aid to the government. In 2012, the European Union suspended some of the sanctions on assistance to Zimbabwe, but it has yet to [ http://www.irinnews.org/report/96289/Analysis-Zimbabwe-crisis-over ] reinstate development aid to the government. 

To overcome the funding issues, Gundu says government is working towards the establishment of a National Climate Change Fund, which will be administered under the Green Climate Fund, also set up under the UNFCCC [ http://gcfund.net/about-the-fund/mandate-and-governance.html ]. But the fund has yet to become operational. 

Unganayi says Zimbabwe should try to identify innovative ways to raise money locally. 

tnm/jk/rz

]]></body><pubDate>Tue, 07 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97994/Zimbabwe-short-on-climate-change-funds</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201305071409390879t.jpg"/></td><td valign="top">HARARE 07 May 2013 (IRIN) - Inadequate funding and limited resources are frustrating Zimbabwe’s efforts to develop plans to deal with the impact of climate change, says a government progress report.</td></tr></table>]]></content:encoded></item><item><title>Mary Venerato Laki, South Sudan returnee: &quot;We want to go to our own homeland&quot;</title><pubDate>Mon, 06 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201304301659420536t.jpg" />]]>RENK-UPPER NILE STATE 06 May 2013 (IRIN) - Years ago, Mary Venerato Laki fled conflict in South Sudan, moving north to Sudan, where she worked as a teacher for 42 years. But after a January 2011 referendum paved the way for South Sudan&apos;s independence, Mary, now a 60-year-old widow and sole guardian of four nieces, decided to move back home.</description><body><![CDATA[RENK-UPPER NILE STATE 06 May 2013 (IRIN) - Years ago, Mary Venerato Laki fled conflict in South Sudan, moving north to Sudan, where she worked as a teacher for 42 years. But after a January 2011 referendum paved the way for South Sudan's independence, Mary, now a 60-year-old widow and sole guardian of four nieces, decided to move back home.

To prevent the family's savings from being stolen by officials, she converted their money into material goods, which she transported as luggage to South Sudan's border port of Renk.

That was over a year ago.

Since then, Laki has been living in a squalid transit camp in Renk County, along with 20,000 other returnees [ http://www.irinnews.org/Report/97981/The-long-road-home-to-South-Sudan ] - some of whom have been waiting there for two years. Without the means to transport their luggage onward, they are faced with the difficult choice of remaining in Renk or selling off all that remains of their families' assets to proceed to their final destination.

Laki, like many, has been waiting with her possessions in Renk. She told IRIN her story.

"I am 60 years old, and I come originally from Juba. We went [to Sudan during the] war. Then, [we learned] there is peace in the south, and we had to return home with our children.

"I have the children of my sister, as all of [my family] died. My two sisters, my husband, my brother and my parents are all dead. I am left alone.

"[With] the little money we had, we had to rent the big vehicles that brought us here. I arrived on April 2, 2012.

"It's a terrible life here - there are so many snakes coming from the river. It's terrible. First of all, rain, wind, mosquitoes - we have been suffering with this.

"And since we came here, we have not been given any food. Some of us have been given that, and some of us not.

"There are no services. Since I came here, it's only [in the] last month I got grain and some oil. There is even no plastic sheeting for the houses.

"We are going - we want to go. We want to go to our own homeland. Our children are suffering there, and we are suffering here.

"They said there will be steamers coming to collect us. They used to tell us. that we will be going, we will be going. But until now we are waiting.

"Our money in the north, they don't use it in the south. [For] many of the people, [with] the little money they have, they bought things. If they bring money, it will be taken on the way. This is why the boat [transport barges along the Nile River] has to come to take the things.

"As a family, how can I go to start [a new life] there in Juba? I am an old woman; I'm now 60 years [old]. There's no money. I'm taking this [luggage] for the children. Also, in Juba, if there is nothing, I will sell [our possessions].

"In fact, we have to sell [some now], but [we will earn] little money, and we have to buy food with it. I have already sold some chairs and a bed.

"The clinics here are no good. I have cancer and some back problems, and they cannot help me."

hm/rz

]]></body><pubDate>Mon, 06 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97980/Mary-Venerato-Laki-South-Sudan-returnee-quot-We-want-to-go-to-our-own-homeland-quot</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201304301659420536t.jpg"/></td><td valign="top">RENK-UPPER NILE STATE 06 May 2013 (IRIN) - Years ago, Mary Venerato Laki fled conflict in South Sudan, moving north to Sudan, where she worked as a teacher for 42 years. But after a January 2011 referendum paved the way for South Sudan&apos;s independence, Mary, now a 60-year-old widow and sole guardian of four nieces, decided to move back home.</td></tr></table>]]></content:encoded></item><item><title>Little support, no justice for Mali rape survivors</title><pubDate>Mon, 06 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201305061358090140t.jpg" />]]>GAO/BAMAKO 06 May 2013 (IRIN) - During the rebel takeover of northern Mali in April 2012, many women said they were subjected to rape or sexual assault. Since then, little or no support has come through for these women, say aid workers.</description><body><![CDATA[GAO/BAMAKO 06 May 2013 (IRIN) - During the rebel takeover of northern Mali in April 2012, many women said they were subjected to rape or sexual assault. Since then, little or no support has come through for these women, say aid workers.

Aminata Touré* was on her way to her uncle’s house in the city of Gao in June 2012 when she was stopped by two men on a motorbike. “I had no choice. They were armed and threatened to kill me,” she said. While one of the men held her baby, the other took her to a nearby bush. “They took me and they did everything they could do, they raped me. Afterwards, they left me in the bush,” she told IRIN.

Since the insurgency began in the north soon after the March 2012 military coup, the UN Refugee Agency (UNHCR) has registered 2,785 cases of sexual and gender-based violence, though its Mali spokesperson, Eduardo Cue, says the real figure is much higher. Most of the cases involved rape; others included forced marriage and sex work.

When insurgents entered Gao they systematically went through each neighbourhood, stealing from some and assaulting others, said residents.

Local journalist and activist Ami Idrissa managed to stay safe by hiding in her house. Others were not so fortunate, she said. “Everyone has a sister or cousin who was raped. Daughters were assaulted in front of their fathers, women in front of their husbands. Many are still traumatized by what they saw or experienced that day,” Idrissa told IRIN.

Many residents told IRIN that members of the National Movement for the Liberation of Azawad (MNLA) were usually the perpetrators. MNLA spokespeople in France were unavailable for comment.

When Islamic militant groups arrived soon afterwards, they perpetrated different kinds of abuse, said Idrissa, who was forced to quit her job as a radio host by Islamists who would not tolerate a woman’s voice on the radio.

“MNLA raped women. MUJAO [the Islamist rebel Movement for Oneness and Jihad in West Africa] instead forced women to marry them; in the end their marriages resulted in another system of rape when only one man married the woman and many men participated in the marriage,” she told IRIN.

Undocumented

The number of forced marriages among northerners and insurgents has not been fully documented. A UN Children’s Fund (UNICEF) protection team found one case of forced marriage when questioning 105 displaced people in Mopti who hailed from Gao, Kidal and Timbuktu. They also uncovered eight rapes, including that of a 13-year-old girl, and 44 cases of sexual abuse.

Gao resident Mouna Awata, whose daughter was arrested for not wearing the hijab, told IRIN: “Girls were arrested, brought to the mayor’s office and then transferred to the prison. That’s where they raped the women. They had mattresses there and everything.”

One father who withheld his name told IRIN his 15-year-old daughter called him from inside the prison in Gao. “She told me there was a naked man waiting for her on the roof. She escaped... that’s when she called me.”

Gao resident Miriam Cissé*, 18, was forced to marry a man twice her age in mid-2012. When she moved to her husband’s house she found out what she had feared all along - that he was part of MUJAO. “He forced me to sleep with him. When I refused he beat me,” she told IRIN. When she finally managed to escape she took a bus to Bamako. Afraid her husband will follow her to the capital she is hoping local NGO Sini Sanuman can help her to find a place to stay.

With little to no administration in the north [ http://www.irinnews.org/Report/97892/Plea-for-return-of-officials-to-northern-Mali ], there is insufficient support for women who have been abused. Local and international NGOs and UN agencies such as UNICEF, are helping women in the north and south, but resources are limited. UNICEF is supporting community-level child protection committees and is raising awareness of protection norms among social workers to try to avert further incidents of abuse.

Gao-based local NGO GREFFA has set up a clinic giving medical help to survivors of abuse, and help in preventing sexually transmitted diseases at the regional hospital. Survivors also receive medical attention in local clinics, said Gao midwife Mariam Maïga.

Meanwhile, women who fled south to Mopti and Bamako often face financial as well as medical problems. In Bamako Sini Sanuman provides medical and psychological help to survivors of abuse, but its director, Alpha Boubeye, said they could not help northerners who arrive in the capital with their food or rent requirements, "something that they desperately need".

The organization is struggling to keep up with the scale of need. In one Bamako neighbourhood Sini Sanuman identified over 300 cases of sexual assault among women who had arrived from the north since April 2012.

“Before the conflict no one was really tending to women who were victims of sexual abuse. We have had to set up a whole new strategy, training social workers and psychiatrists,” Boubeye told IRIN.

Stigma

Uncovering the extent of abuse continues to be very difficult in a country where rape is considered shameful.

“Many women do not dare to talk about being raped. They are afraid that their husbands will leave them and that they will be segregated from society,” journalist Idrissa told IRIN. “Before MNLA and MUJAO rape outside the house was not a problem in Mali. The rebels made it an issue.”

“Being raped is a very shameful thing in Mali and our social workers often visit the women many times before they open up," said Boubeye.

And pursuing justice is not even considered an option by many abuse survivors. Touré returned home to her husband in Gao, but she has not pursued a case against her attackers. “I want the men who raped me to go to jail, but I’m ashamed for everyone else to see me,” she told IRIN.

Her focus is to support her family in increasingly difficult humanitarian conditions, she added.

According to Daniel Tessogué, state prosecutor in Bamako, only one case of sexual assault linked to the 2012 conflict is being prepared to go to court.

*not their real names

kh/aj/cb

]]></body><pubDate>Mon, 06 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97983/Little-support-no-justice-for-Mali-rape-survivors</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201305061358090140t.jpg"/></td><td valign="top">GAO/BAMAKO 06 May 2013 (IRIN) - During the rebel takeover of northern Mali in April 2012, many women said they were subjected to rape or sexual assault. Since then, little or no support has come through for these women, say aid workers.</td></tr></table>]]></content:encoded></item><item><title>Innovative ICT helps aid workers in Afghanistan</title><pubDate>Thu, 02 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201304281046160354t.jpg" />]]>KABUL 02 May 2013 (IRIN) - As Asia’s poorest country and the deadliest for aid workers, rugged Afghanistan offers a considerable challenge to humanitarian work.</description><body><![CDATA[KABUL 02 May 2013 (IRIN) - As Asia’s poorest country [ http://data.worldbank.org/indicator/NY.GDP.PCAP.CD?order=wbapi_data_value_2011+wbapi_data_value+wbapi_data_value-last&sort=asc ] and the deadliest for aid workers [ http://www.irinnews.org/Report/97874/Afghanistan-the-world-s-most-dangerous-place-for-aid-workers ], rugged Afghanistan offers a considerable challenge to humanitarian work.

But just as in parts of Africa, the only other area of the world with similarly poor infrastructure, rapid advances in information and communications technology (ICT) have had a profound impact on humanitarian activities over the past decade.

To make a phone call in 2001, the only option for many Afghans was a trip to neighbouring Pakistan. Now 85 percent of the population enjoys mobile phone coverage, and aid agencies are taking full advantage.

Despite the remoteness of many regions (with three-quarters of the population living in rural areas), the mobile phone network has expanded rapidly and by 2010 a USAID survey [ http://www.altaiconsulting.com/docs/media/2010/Afghan%20Media%20in%202010.pdf ] estimated that 61 percent of the population owned or had access to a mobile phone.

The country's four major operators (Roshan, AWCC, Etisalat and MTN) share 18 million subscribers, according to a 2012 report by Research and Markets [ http://www.marketresearch.com/ISA-International-Strategic-Analysis-v2697/Afghanistan-ISA-Country-7489601/ ].

Five Afghan tech initiatives

Mobile Money, one of the most commonly used ICT services, allows Afghans to safely and securely transfer money, in some cases internationally [ http://www.roshan.af/Roshan/Media_Relations/News/News_Details/12-05-21/Roshan_and_Western_Union_Launch_International_Mobile_Money_Transfer_Service_in_Afghanistan.aspx ], using mobile phones. Currently all four of Afghanistan's major telecommunications operators provide money transfers. In March, USAID [ http://afghanistan.usaid.gov/en/USAID/Article/2948/Public_School_Teachers_Salary_Payment_Goes_Mobile ] partnered with other agencies to promote a new electronic salary payment programme. The project aims to disperse salaries to more than 30,000 teachers in about 200 schools across Afghanistan by 2014.

SMS or Interactive Voice Response (IVR) messages give Afghan farmers and traders information on crop and livestock prices in specific locations. In partnership with USAID and Mercy Corps, Roshan launched the Malomat service in 2010 - currently nearly 600 farmers and 19 traders are participating in 15 provincial markets. Malomat provides farmers and traders with wholesale prices for agricultural commodities - aiming to improve farmers’ livelihoods and thus providing a disincentive to farmers to engage in opium production.

Telemedicine: Afghan doctors are starting to use a new ICT service [ http://imaginationforpeople.org/en/project/afghanistans-telemedicine-project/ ] to access e-learning, training, management tips and tele-radiology (the electronic sharing of patient scans). Hospitals can have real-time access to medical experts outside the country. “In many areas, people cannot reach hospitals or clinics safely. And the end of winter is likely to bring renewed fighting, making the problem worse,” said Gherardo Pontrandolfi, head of the International Committee of the Red Cross delegation at a press conference in Kabul last week. “Fighting, roadblocks, roadside bombs and a general lack of security prevent medics and humanitarian aid from reaching the sick and wounded, just when they need it most,” he said.

Emergency hotline services: WFP's Beneficiary Feedback Desk is an example of how such a service can improve the distribution of aid. The hotline was launched through a series of radio adverts in three provinces last year. The mobile phone hotline operators told IRIN they quickly started getting calls from all over the country. Operators call back those who hang-up after a couple of rings, in case they lack phone credit. They say they receive complaints and suggestions on aid delivery. One young Afghan woman used the phone line to expose a man in her village who had set up fake literacy classes to benefit from WFP aid. In another case, in an insecure and impoverished part of Ghor Province, students were able to use the hotline to negotiate the safe delivery of WFP aid - something that had not been possible for eight years.

Mobile teacher software: Ustad Mobil was designed to help tackle the country's illiteracy problem. A UN Assistance Mission in Afghanistan (UNAMA) project [ http://unama.unmissions.org/Default.aspx?ctl=Details&tabid=12254&mid=15756&ItemID=36716 ] aims to improve literacy among the police force, an estimated 70-80 percent of whom are illiterate. The app adapts the national literacy curriculum so it can be taught on camera mobile phones, with slides, videos and quizzes. “The feedback has been positive,” said Mike Dawson, CEO of Paiwastoon Networking Service, the designers of Ustad Mobile software. “We expect students will reach level three, which means they will be able to read and write.”

Advantages and challenges

Though many of these new technologies lack integration and are generally stand-alone operations, ICT has helped aid organizations improve monitoring, transparency and accountability, and provided greater access to vulnerable populations.

“Access is one of the biggest issues in a country like Afghanistan. We can only help those who we can access. There is always conflict in this country so we can't visit every part of the country to see who is vulnerable and who needs assistance,” said WFP information officer Wahidullah Amani.

“We have also been able to prevent food diversion and better monitor our food distributions, which in turn gives us opportunities to be more transparent and accountable to the people.”

But such developments in Afghanistan have not been entirely benign.

Mobile phones are frequently scrutinized at Taliban checkpoints to see if people have links with government officials or Western organizations. Being caught with a suspicious phone number or contact can lead to the loss of the phone, and in some cases a beating.

bm/jj/cb

]]></body><pubDate>Thu, 02 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97936/Innovative-ICT-helps-aid-workers-in-Afghanistan</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201304281046160354t.jpg"/></td><td valign="top">KABUL 02 May 2013 (IRIN) - As Asia’s poorest country and the deadliest for aid workers, rugged Afghanistan offers a considerable challenge to humanitarian work.</td></tr></table>]]></content:encoded></item><item><title>Conflict and returnees strain South Sudan food security</title><pubDate>Thu, 02 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201304040942080142t.jpg" />]]>NAIROBI 02 May 2013 (IRIN) - Food security in South Sudan is deteriorating in the face of ongoing conflict, high food prices, and the large-scale return of refugee and internally displaced families.</description><body><![CDATA[NAIROBI 02 May 2013 (IRIN) - Food security in South Sudan is deteriorating in the face of ongoing conflict, high food prices, and the large-scale return of refugee and internally displaced families.

Lakes, Western Bahr El Ghazal and Unity states are the most affected, with at least 1.15 million people expected to face food insecurity as the rainy season progresses, the UN Food and Agriculture Organization (FAO) office in South Sudan told IRIN.

At present, 2.86 million people in South Sudan are being targeted with food and livelihood assistance, including some 670,000 refugees and internally displaced persons (IDPs), according to the UN World Food Programme (WFP).

Insecurity

Rampant insecurity is affecting access to food and livelihoods. In Jonglei State, for example, insecurity is restricting “access to wild foods and income sources such as collection and sale of firewood, charcoal and grass,” notes the Famine Early Systems Network (FEWSNET).

FAO noted, “Continued insecurity in parts of Jonglei has led to displacement of populations and limited access to land at a critical time when farming households are undertaking preparations for the coming growing season.”

Insecurity in Jonglei [ http://reliefweb.int/sites/reliefweb.int/files/resources/South%20Sudan_Humanitarian%20Snapshot_March%202013.pdf ] “has affected tens of thousands of civilians caught in clashes or fleeing from their homes in search of safety and assistance,” according to an update [ http://reliefweb.int/sites/reliefweb.int/files/resources/Humanitarian%20Bulletin%20%2324%20OCHA%20EA.pdf ] by the UN Office for the Coordination of Humanitarian Affairs (OCHA), which added that the scope of displacement remains unknown due to access constraints .

Insecurity is also hampering efforts to control outbreaks of the often fatal haemorrhagic septicaemia [ http://www.fao.org/ag/againfo/programmes/en/empres/disease_haemo.asp ] and East Coast fever [ http://www.galvmed.org/2012/04/east-coast-fever/ ] in cattle. Cattle-rearing is an important livelihood activity in Jonglei.

In addition, several important roads in Jonglei remain closed.

“The increased insecurity in Jonglei (especially the Bor-Pibor road where movement by humanitarian organizations has been suspended) and other parts of South Sudan could deter commercial transporters from agreeing to carry food along routes where there have been attacks. This could have an impact on our ability to preposition stocks to cover areas which will become inaccessible during the rainy season,” Andrew Odero, WFP’s food security and livelihood cluster coordinator in South Sudan, told IRIN by e-mail.

On 9 April, a UN convoy was attacked between Bor and Pibor, resulting in the deaths of nine UN personnel and three civilian contractors.

Between 1 January and 31 March, at least 109 violent incidents were recorded in South Sudan, with some 12,433 people being newly displaced, according to OCHA [ http://reliefweb.int/sites/reliefweb.int/files/resources/OCHA%20South%20Sudan%20Weekly%20Humanitarian%20Bulletin%208-14%20April%202013.pdf ].

Abyei IDP returns

There are food security fears in the contested Abyei area, as well, amid high food prices and an influx of IDP returnees. Abyei straddles the Sudan/South Sudan border; which of the countries Abyei is part of may be determined in an October referendum.

“Improved security and the anticipated referendum have prompted the IDPs to begin returning to [the] Abyei area,” states an Abyei Food Security Assessment report by FEWSNET [ http://reliefweb.int/report/sudan/special-report-abyei-food-security-assessment-april-2013 ].

The IDP returns started after the deployment of the UN Interim Security Force for Abyei in mid-2011. From then until February 2013, at least 60,000 returnees from Warrap and Northern Bahr el Ghazal states have been registered. A further 30,000 IDPs are expected to return between March and June; “this is likely to increase levels of food insecurity because of further strain on already weak services and inability [of] people to meet their livelihoods needs,” notes FEWSNET.

A limited market supply has kept food prices high in Abyei , it adds.

Despite the relative calm there, some 3,700 people have been affected by livestock migration-related insecurity, adds an OCHA report [ http://reliefweb.int/sites/reliefweb.int/files/resources/OCHA%20South%20Sudan%20Weekly%20Humanitarian%20Bulletin%208-14%20April%202013.pdf ]. “The problem is most acute in the north of the area, where there is a direct interface between Misseriya and Dinka communities. In these areas, communities compete for water and pasture, in particular towards the end of the dry season.”

Returnees from Sudan

An influx of returnees and refugees into parts of South Sudan is also a challenge.

“Upper Nile faces some of the most challenging issues in South Sudan. It hosts some of the largest populations of returnees, refugees (fleeing from insecurity and conflict in Sudan), and IDPs (from neighbouring state Jonglei),” Joanna Dabao of the International Organization for Migration (IOM) in Juba, told IRIN by email.

“This has put a substantial strain on the limited resources of the host communities. This complex situation has created a barrier to sustainable reintegration, leaving thousands of returnees in dire need of emergency assistance,” she said.

At present, at least 20,000 returnees are in Upper Nile State - about 19,800 in Renk County and 840 in Malakal County - Dabao said. “With persisting violence over the past two years along the other border[s] (Blue Nile, South Kordofan, Abyei, Darfur Region) Renk was, and continues to be perceived as, the safest point of entry into South Sudan.”

“The majority of returnees arriving into South Sudan through Renk, however, report intentions of settling in the Greater Bahr el Ghazal area but hav[e] no means to get there,” she added.

Since 2011, IOM has helped at least 40,000 returnees get home from Sudan, and registered at least 1.88 million returnees in South Sudan since 2007.

But the returnees from Sudan  often lack the skills, experience and social networks needed to cope with the burdens of rural life in South Sudan, notes FAO, adding that “food security in areas of return is poor due to increased pressure [on] social services, poverty, unemployment and a lack of productive assets.”

aw/rz

]]></body><pubDate>Thu, 02 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97957/Conflict-and-returnees-strain-South-Sudan-food-security</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201304040942080142t.jpg"/></td><td valign="top">NAIROBI 02 May 2013 (IRIN) - Food security in South Sudan is deteriorating in the face of ongoing conflict, high food prices, and the large-scale return of refugee and internally displaced families.</td></tr></table>]]></content:encoded></item><item><title>Conflict cuts off civilians in DRC&apos;s Katanga</title><pubDate>Thu, 02 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2010/201010210751260211t.jpg" />]]>KATANGA 02 May 2013 (IRIN) - Tens of thousands of displaced people in the Democratic Republic of Congo&apos;s (DRC) Katanga Province have received little or no humanitarian aid in the months since having fled ongoing conflict.</description><body><![CDATA[KATANGA 02 May 2013 (IRIN) - Tens of thousands of displaced people in the Democratic Republic of Congo's (DRC) Katanga Province have received little or no humanitarian aid in the months since having fled ongoing conflict.

In one territory, Malemba Nkulu, the number of displaced is estimated to have risen from 12,000 to 42,000 between December 2012 and January 2013, and no food distribution has yet been organized. The UN Office for the Coordination of Humanitarian Affairs (OCHA) says, "The global acute malnutrition rate is above 19 percent, and the severely malnourished need treatment.”

"Nineteen percent global acute malnutrition is nearly twice the emergency threshold level," Quoc Nguyen, head of operations for the UN Children's Fund (UNICEF) in Katanga, told IRIN, adding that seven territories in Katanga have acute malnutrition rates above the 10 percent level.

UNICEF is assisting children and pregnant and lactating women suffering from acute malnutrition in several territories, including Pweto and Manono, where the rate is also above 19 percent; however this treatment is still not available in Malemba Nkulu. "There's no programme in Malemba Nkulu because of lack of funding, lack of access, insecurity and a lack of partners who can implement a programme," said Nguyen.

Malnutrition is a major contributor to the under-five mortality rate in the province, which UNICEF's latest survey put at 188 per 1,000. In its 16 April bulletin for DRC, OCHA said that in Malemba Nkulu "no humanitarian intervention has been implemented mainly because of difficulties of access and lack of funding".

Displaced people in the neighbouring territory of Manono - recently estimated to number 31,000 - have not had a food distribution since September, the UN World Food Programme (WFP) told IRIN this week, although a convoy of food trucks has just been sent there. WFP has distributed food in the past month at or near most of the other major population centres in Katanga where large numbers of displaced people have gathered.

But of 17,000 people who were displaced this year in the territories of Kalemie, Moba and Manono, most have not yet received any aid, nor have the 747 families living on the route from Mitwaba to Kisele, OCHA reported on 23 April.

Continued displacement

The total number of displaced in Katanga is estimated by the Commission on Population Movements (CMP) - an official body which collects data from aid workers - to have risen from 64,082 in December 2011 to 353,931 currently. 

"Needs are… enormous both among the displaced and the host population," OCHA said in a report published on April 10 [ http://reliefweb.int/report/democratic-republic-congo/dr-congo%E2%80%99s-neglected-%E2%80%9Ctriangle-death%E2%80%9D-challenges-protection ]. "Many IDPs have become more vulnerable due to repeated displacements, often across vast distances."

An upsurge in violence by Mai-Mai militia groups has been causing waves of displacement since late 2011. WFP's head of operations in Katanga, Amadou Samake, said the so-called 'triangle of death' between Mitwaba, Manono and Pweto had been emptied of most of its population - 75,000 households - by April 2012. By the end of last year, the displaced already numbered more than 300,000. 

The flow outwards from conflict zones has continued, and Mai-Mai violence has spread west and south, to Malemba Nkulu, Lubudi and Kambove territories.

On 17 February, a gang from the newly created Mai-Mai militia known as Kata Katanga (meaning 'cut off Katanga') killed three officials and drove out the population at Kinsevere, only 40km from Lubumbashi, the provincial capital. 

On 23 March, some 400 lightly armed Kata Katanga members marched from the bush to the centre of Lubumbashi, unopposed, before they were forced to surrender after a shootout with the elite Republican Guard. 

Amid the persistent insecurity, fewer than the 10 percent of the displaced have returned to their villages, Samake estimates. 

WFP assisted 250,000 people in Katanga last year, he said, but has not had the resources to guarantee the displaced three months of rations, the standard the agency aims for in North Kivu. Currently, he said, the agency has 5,915 tons in stock or en route and would need an additional 10,383 tons to feed 320,000 displaced people in Katanga through the second quarter of 2013.

If the displaced do not soon return to their villages, Samake added, another year of missed harvests will worsen food security across the province. 

UNICEF's Nguyen commented that much of Katanga was already in the grip of a food security crisis before the Mai-Mai’s resurgence in 2011. "There is a lack of basic services in every sector - health, water, nutrition and agriculture - and the conflict and displacement make an already bad situation much worse," he said.

Deteriorating security

OCHA reports the security situation worsened in April in Pweto, Manono and Mitwaba territories, with attacks by Mai-Mai groups on a dozen villages. 

The national army, FARDC, recently retook the town of Shamwana, at the centre of 'the triangle of death', but International Crisis Group (ICG) analyst Thierry Vircoulon says the military seems to be having little success in suppressing the Mai-Mai. At the start of 2013, the army had only 1,000 men available in Katanga, but their number is now up to 2,500, UN sources told IRIN. 

Central Katanga has been unstable since Mai-Mai commander Gedeon Mtanga escaped from prison in September 2011. He and more than 1,000 of his followers were freed from Lubumbashi's central jail by eight armed men in broad daylight; there was speculation that the jail break was arranged by local power holders. Gedeon had led a Mai-Mai group known for its brutality and attacks on civilians from 2002 to 2007. Africa Confidential reported on 1 March that "his ambition is to root out the old order" and "his men have killed at least 15 traditional chiefs in Nord Mitwaba alone".

According to OCHA, the other main driver of instability in the province is Kata Katanga, which has also been fighting FARDC.

Like the brutal Mai-Mai group Morgan [ http://www.irinnews.org/report/97314/Rainforest-riches-a-curse-for-civilians-in-northeast-DRC ], in DRC's Orientale Province, the Kata Katanga and Gedeon Mai-Mai seem to get much of their income from poaching, rather than minerals or agriculture. Therefore, they may not need much support from the local population.

There are no recent figures for the Mai-Mai in Katanga, but ICG estimated they might have numbered 5,000 to 8,000 in 2005 [ http://www.crisisgroup.org/en/regions/africa/central-africa/dr-congo/103-katanga-the-congos-forgotten-crisis.aspx?alt_lang=fr ].

Following the bloody suppression of a Kata Katanga rally in Lubumbashi on 23 March, a report by local civil society activists accused senior members of the regime of providing the group with arms and funding. 

ICG's Vircoulon told IRIN he believes that several local “barons” are behind the Kata Katanga. 

The DRC's former police chief General John Numbi - a native of Malemba Nkulu who built his career as a political organizer among the Balubakat, President Joseph Kabila's ethnic group - may have held the key to security in the province. ICG reports that Numbi was supplying Gedeon with arms from 2002 to 2004. Later, he organized the manhunt that led to the Mai-Mai leader's capture. 

In 2010, Numbi was suspended as police chief following allegations that he was responsible for the murder of human rights defender Floribert Chebeya. 

Significantly, Gedeon and many of his followers were captured in 2007, after Kabila had won elections with support from a broad coalition in Katanga and elsewhere in the country. That coalition is now crumbling, allowing armed groups to be reactivated in many areas of eastern DRC. 

Protection needs

An April report [ http://reliefweb.int/sites/reliefweb.int/files/resources/Final%20version%20Protection%20Report%20Katanga%2011.04.pdf ] by OCHA in Katanga concludes: "Given the duration of the current conflict, humanitarian actors do not expect to see any improvements in terms of displacement numbers or humanitarian needs in the coming months."

The report highlights alleged abuses by the army as well the Mai-Mai, including allegations that 50 women and 20 girls were detained for two days and repeatedly raped by soldiers in February 2012. 

"Without an increased presence" of the UN Stabilization Mission in the DRC (MONUSCO), says OCHA, "such abuses will continue and may even increase, as will further displacements". 

Currently there are 450 blue helmets in Katanga, an area the size of France.

The report also calls for a political solution to the conflict in Katanga, for the government to reinitiate its programme to disarm, demobilize and re-integrate the Mai-Mai, and for humanitarian actors to establish contact with Mai-Mai groups so as to facilitate humanitarian access and sensitize the combatants on international humanitarian law.

nl/kr/rz

]]></body><pubDate>Thu, 02 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97963/Conflict-cuts-off-civilians-in-DRC-apos-s-Katanga</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2010/201010210751260211t.jpg"/></td><td valign="top">KATANGA 02 May 2013 (IRIN) - Tens of thousands of displaced people in the Democratic Republic of Congo&apos;s (DRC) Katanga Province have received little or no humanitarian aid in the months since having fled ongoing conflict.</td></tr></table>]]></content:encoded></item><item><title>War leaves lasting impact on healthcare</title><pubDate>Thu, 02 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201208310937080561t.jpg" />]]>DUBAI 02 May 2013 (IRIN) - Of all the areas of Iraq’s development that were affected by the US-led invasion 10 years ago, healthcare has probably taken the biggest hit. And much of the damage incurred in the first few years of the invasion continues to have an impact on health indicators today.</description><body><![CDATA[DUBAI 02 May 2013 (IRIN) - Of all the areas of Iraq’s development that were affected by the US-led invasion 10 years ago, healthcare has probably taken the biggest hit. 

The impact of the 2003 invasion and subsequent conflict on Iraq’s healthcare system has been well-documented [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61399-8/fulltext ]. (Check out consistent coverage of the health consequences of Iraq’s conflict by the Lancet medical journal here [ http://www.thelancet.com/search/results?searchTerm=iraq&fieldName=AllFields&journalFromWhichSearchStarted= ].) The conflict shattered Iraq's primary healthcare delivery, disease control and prevention services, and health research infrastructure. Attempts to resurrect Iraq's healthcare system remain hindered by a number of factors, including fragile national security and lack of utilities like water and electricity.

Much of the damage incurred in the first few years of the invasion continues to have an impact today. 

Lasting legacy 

Iraq had prioritized healthcare at least since the 1920s, when the Royal College of Medicine was formed to train doctors locally. By the 1970s, Iraq’s health care system was “one of the most advanced” in the region, according to researcher Omar Al-Dewachi, a medical doctor who worked in Iraq during the 1990s before emigrating to the US [ http://costsofwar.org/sites/default/files/articles/17/attachments/Dewachi,%20Public%20Health%20Impacts,%20Iraq.pdf ]. Health indicators improved quickly and significantly in the 1970s and 1980s, only to deteriorate again after the first Gulf War of 1991, which destroyed health infrastructure, and during a decade of sanctions, which drastically reduced government spending on health and led to a brain drain in the medical profession.   

After the 2003 invasion, the healthcare situation deteriorated considerably, and Mac Skelton, a contributor to the Costs of War project [ http://costsofwar.org/ ], fears it may never recover. Between 2003 and 2007, half of Iraq’s remaining 18,000 doctors [ http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=3&ved=0CEQQFjAC&url=http%3A%2F%2Fwww.medact.org%2Fcontent%2Fviolence%2FIraq%2520Commission%2520Medact%2520submission.doc&ei=PrJhUcfsMMH-rAeCyoGABQ&usg=AFQjCNGlxW-aKXzPKiWiWv04q7Ln6pFc2A&sig2=F3p8IseTAaoOkp4HxchaCg&bvm=bv.44770516,d.bmk ] left the country, according to Medact, a British-based global health charity. Few intend to return [ http://www.ncbi.nlm.nih.gov/pubmed/20349702 ].

“Getting back to that robust, excellent standard [of healthcare] is not going to happen anytime soon,” Skelton told IRIN. “Unlike buildings that can be rebuilt, migration patterns aren’t reversed easily.” 

In 2011, according to the World Health Organization (WHO), Iraq had 7.8 doctors per 10,000 people - a rate two, if not three or four times lower, than its neighbours Jordan, Lebanon, Syria and even the Occupied Palestinian Territory. In the Muslim world, Iraq’s doctor-patient ratio is higher only than Afghanistan, Djibouti, Morocco, Somalia, South Sudan and Yemen [ http://applications.emro.who.int/docs/RD_Annual_Report_2011_country_statistics_EN_14587.pdf ].

In a recent article in the Lancet, the aid group Médecins sans Frontières (MSF) said that “until now, it is extremely difficult to find Iraqi medical doctors willing to work in certain areas because they fear for their security.” [ http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673613606649.pdf ]

According to MSF, many remote areas were excluded from state reconstruction and development efforts, “leaving thousands of Iraqis without access to essential healthcare to this day.” 

Nearly all families - 96.4 percent - have no health insurance whatsoever and 40 percent of the population deems the quality of healthcare services in their area to be bad or very bad, according to the Iraq Knowledge Network (IKN) survey of 2011.

As a result of the poor quality of care in their country, many Iraqis now seek healthcare abroad, increasingly selling homes, cars and other possessions to afford to do so, according to Skelton, who interviewed Iraqis seeking healthcare in Lebanon [ http://costsofwar.org/sites/all/themes/costsofwar/images/Health_and_Health%20Care.pdf ].

And researchers are still questioning the degree to which white phosphorus and depleted uranium, the armour-piercing, radio-active metal used in British and American ammunition, has increased cancer rates and caused birth defects [ http://www.ikvpaxchristi.nl/media/files/in-a-state-of-uncertainty.pdf ]. 

The environmental damage caused by the war - degradation of forests and wetlands, wildlife destruction, greenhouse gases, air pollution - will also have a longer-term impacts on health, according to the Costs of War project [ http://costsofwar.org/article/environmental-costs ].

Mental health 

A 2007 survey [ http://www.who.int/mediacentre/news/releases/2008/pr02/2008_iraq_family_health_survey_report.pdf ] by the government and WHO found that more than one-third of respondents had “significant psychological distress” and presented potential psychiatric cases. A 2009 government mental health survey concluded that mass displacement and a climate of fear, torture, death and violence have contributed to the high ratio of mental illness in the country.

In a new report released last month, MSF said mental health continues to be a major problem in the country. 

“Many Iraqis have been pushed to their absolute limit as decades of conflict and instability has wreaked devastation,” Helen O’Neill, MSF’s head of mission in Iraq, said in a statement [ http://www.msf.org/article/iraq-mental-healthcare-helps-iraqis-rebuild-their-lives ].

“Mentally exhausted by their experiences, many struggle to understand what is happening to them. The feelings of isolation and hopelessness are compounded by the taboo associated with mental health issues and the lack of mental healthcare services that people can turn to for help.” 

Improvements?

The statistics, as always in Iraq, tell a story that is less clear-cut [ http://www.japuiraq.org/documents/491/Stocktaking%20of%20existing%20indicators%20and%20information%2013%20March%202008.pdf ].

The number of fully immunized children, for example, dropped from 60.7 percent in 2000 to 38.5 percent in 2006, then rose to 46.5 percent by 2011 - still less than pre-invasion levels, according to the Multiple Indicator Cluster Surveys (MICS) conducted by the government and the UN Children’s Fund (UNICEF). Acute and chronic malnutrition trends for children under five also showed a slight regression.

However, other indicators show some improvement over pre-2003 levels - unsurprising, some say, if you consider the “semi-starvation diet” of many Iraqis during the sanctions. 
According to the UN’s Human Development Reports, life expectancy at birth rose from 58.7 before 2000 to 69.6 in 2012. (These figures are quite similar to those of WHO [ http://rho.emro.who.int/rhodata/?vid=2639 ], but differ significantly from those of the World Bank, which show a regression from 70 to 71 years during the mid-1990s and early 2000s, to 69 years in 2011 [ http://data.worldbank.org/indicator/SP.DYN.LE00.IN?page=2 ])

The last decade undoubtedly saw a great reduction in infant mortality rates, not only over pre-invasion levels, but even compared to the early 1980s, when about 80 infants died per 1,000 live births [ http://www.unicef.org/equity/files/PMACEquitypresentation.pdf ]. By the year 1990, this figure was down to 50, and decreased further to 31.9 in 2011, according to a 2012 government report monitoring progress towards the Millennium Development Goals (MDGs) [ http://unami.unmissions.org/LinkClick.aspx?fileticket=bgHcDIXr8-s%3D&tabid=2790&language=en-US ].

Still, this rate remains more than double the national target of 17 per 1,000 by 2015; and while Iraq’s rate in the early 1980s was among the best compared to other countries in the region, today, it is among the worst.

The mortality rate of children under five also dropped from 42.8 per 1,000 births in 2000 to 37.2 in 2011, well ahead of 1960s levels, but far off the national target of 21 by 2015, according to the government report, which monitored MDG indicators at the governorate level. The percentage of births attended by skilled personnel also rose from 72.1 percent in 2000 to 90.9 percent in 2011, according to the MICS.

(WHO shows a similar trend of decrease in mortality rates, but its statistics are quite different, showing a much larger drop in infant mortality [ http://rho.emro.who.int/rhodata/?vid=2644 ] from 108 deaths per 1,000 in 1999 to 21 per 1,000 in 2011, and a decrease in child mortality [ http://rho.emro.who.int/rhodata/?vid=2645 ] from 131 in 1999 to 25 in 2011.)

Government expenditures on health have increased in the last decade. From a high point in 1980s, they dropped significantly due to the 1991 Gulf war and sanctions. But spending jumped from 2.7 percent of GDP in 2003 to 8.4 percent in 2010, according to the World Bank. According to Yasseen Ahmed Abbas, head of the Iraqi Red Crescent Society, government allocations for health spending have risen from $30 million a year under former president Saddam Hussein to $6 billion a year today. 

af/ha/rz

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A decade after US-led forced toppled Iraqi President Saddam Hussein, IRIN examines the progress in basic living standards.
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]]></body><pubDate>Thu, 02 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97964/War-leaves-lasting-impact-on-healthcare</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201208310937080561t.jpg"/></td><td valign="top">DUBAI 02 May 2013 (IRIN) - Of all the areas of Iraq’s development that were affected by the US-led invasion 10 years ago, healthcare has probably taken the biggest hit. And much of the damage incurred in the first few years of the invasion continues to have an impact on health indicators today.</td></tr></table>]]></content:encoded></item><item><title>Mapping the world’s trachoma hotspots</title><pubDate>Wed, 01 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201304291616370589t.jpg" />]]>LONDON 01 May 2013 (IRIN) - When Iyabo Dolarin’s trachoma mapping team conducts surveys in Nigeria’s Kaduna State, they begin with a ritual: They go to the centre of the community and spin a bottle on the ground to determine which household will first be checked for signs of this painful and disabling disease.</description><body><![CDATA[LONDON 01 May 2013 (IRIN) - When Iyabo Dolarin’s trachoma mapping team conducts surveys in Nigeria’s Kaduna State, they begin with a ritual: They go to the centre of the community and spin a bottle on the ground to determine which household will first be checked for signs of this painful and disabling disease.

The activity always attracts a crowd. “When they see it, they laugh,” said Dolarin, an eye nurse. “But we make them understand that, although it’s not every house we visit… we are not choosing one and leaving another. And we explain that after we finish mapping, if anyone has eye disease, we will see them later.”

The mapping project - led by the charity Sightsavers, with funding from the UK’s Department for International Development (DFID) and support from other agencies - is part of an ambitious plan to eliminate trachoma, a bacterial infection spread by flies that causes blindness. 

“We had been mapping slowly, but now it’s all about speed,” Simon Bush, the Sightsavers director for neglected tropical diseases, told IRIN. “The international community has set out to eliminate blinding trachoma by 2020. We have to get the mapping completed and start the treatment programme by 2015, otherwise we are just setting ourselves up, once again, to fail.”

SAFE

The mapping project sets out to determine the prevalence of disease in each district.

In places with low prevalence, where fewer than 10 percent of children have trachoma, the World Health Organization recommends focusing efforts on hygiene to prevent the disease - for example, building latrines and encouraging face washing. Places with high prevalence, where more than 10 percent of children have trachoma, receive a more aggressive intervention, including mass treatment with antibiotics.

The protocol is called SAFE, which stands for: Surgery (for those whose eyes are already damaged), Antibiotics (to treat those infected), Facial cleanliness, and Environmental improvement (to prevent the spread of the disease).

The bacterium itself, Chlamydia trachomatis, is unlikely to be eradicated the way smallpox was, but the harm caused by the disease can be minimized. Trachoma causes damage over time, with repeated infections in childhood causing eyelid scars that turn the lashes inwards. The lashes scratch the eye, leading to blindness. The aim, therefore, is to reduce incidence of the disease and to treat cases before scarring and damage take place.

“If you implement SAFE over five years, you will eliminate blinding trachoma,” Bush said. “Ghana and the Gambia have already reached the elimination stage, where trachoma is no longer a serious public health concern.”

Backlog

Those whose eyes are already damaged can be treated with surgery.

“The backlog,” said Bush, “is my constant worry. We estimate that there are around eight million people needing surgery, some three million of them in Africa. And if we don’t operate on them, they will go blind.”

But to treat so large a caseload, many more health workers will have to be trained in the surgical procedure - and surgeons of any kind are in short supply in the countries most affected by trachoma. 

“It is important that we don’t divert attention from things even more important than trachoma,” the project’s chief scientist, Anthony Solomon, of the London School of Hygiene and Tropical Medicine, told IRIN. “Trachoma causes blindness, but, finally, it doesn’t kill you. I wouldn’t want it to stop obstetricians doing caesareans or other surgeons draining liver abscesses.”

But Solomon says others can be trained in the procedure: “We are also going to be training eye nurses to operate, and they will do it in addition to their other duties.”

Mapping tool

The mapping project collects data with a smartphone app. Collectors like Dolarin, the eye nurse, take global positioning system (GPS) readings for every household surveyed. 

Soloman, who worked on the app’s development, says organizers have been pleased with it: “It’s very robust because the data is stored on the phone’s micro SD card. If you drop the phone out of a window, run over it in a car or drop it in the river, we can recover the card, and the data will still be readable.”

Dolarin says the tool is a great improvement over old-fashioned disease mapping. “It’s much better, much faster. There’s no need for moving about with lots of papers, and immediately after we do the work we send the result, so it doesn’t waste time at all.”

She has also been pleased to find fewer trachoma cases in the areas she surveyed. “When we did this before, there were many [cases]. The living condition of the people then was very bad. Most of the communities didn’t have boreholes. Now, most communities have them, so there is water now, people are cleaner, and there’s much less trachoma.”

eb/rz

]]></body><pubDate>Wed, 01 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97948/Mapping-the-world-s-trachoma-hotspots</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201304291616370589t.jpg"/></td><td valign="top">LONDON 01 May 2013 (IRIN) - When Iyabo Dolarin’s trachoma mapping team conducts surveys in Nigeria’s Kaduna State, they begin with a ritual: They go to the centre of the community and spin a bottle on the ground to determine which household will first be checked for signs of this painful and disabling disease.</td></tr></table>]]></content:encoded></item></channel></rss>