<?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/irin-fp.aspx</link><description>Updated everyday</description><language>en-gb</language><lastBuildDate>Wed, 08 Feb 2012 16:30:41 GMT</lastBuildDate><item><title>COTE D&apos;IVOIRE: Leprosy fight still flagging</title><pubDate>Wed, 08 Feb 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201202071354370157t.jpg" />]]>DIMBOKRO/TOUMODI 08 February 2012 (IRIN) - Côte d’Ivoire’s leprosy programme was consistently under-funded during the civil war (2002-2007) and last year’s political turmoil, say health practitioners, leading to a loss of expertise in terms of detecting or treating the disease.</description><body><![CDATA[DIMBOKRO/TOUMODI 08 February 2012 (IRIN) - Côte d’Ivoire’s leprosy programme was consistently under-funded during the civil war (2002-2007) and last year’s political turmoil, say health practitioners, leading to a loss of expertise in terms of detecting or treating the disease.
 
Not considered a public health priority, the government and donors de-prioritized the leprosy fight over the past decade, with funding dropping to 30 percent of the original total, according to Alain de Kersabiec, Côte d’Ivoire and Benin representative for French NGO the Follereau Foundation (FRF), [ http://www.who.int/buruli/partners/AFRF/en/ ] which helps treat existing and new leprosy patients around the country.
 
The World Health Organization (WHO) considers a disease to be a public health emergency if the prevalence is greater than one case per 10,000 inhabitants (a 0.01 prevalence rate). In 2009, the leprosy prevalence rate was 0.36 in Côte d’Ivoire.
 
While there is enough medicine available to treat leprosy - WHO provides it all - detecting and monitoring new cases in remote areas is difficult given the lack of qualified nurses and means of transport such as motorcycles to reach villages, said Joachim Akochi, one of 70 state nurses trained to detect and treat leprosy countrywide.
 
FRF has in many cases been stepping in to fill the gaps: It provides nurses with petrol coupons to help reach leprosy patients for instance - but now it is trying to ease off, said Kersabiec, hoping state institutions will step in to take responsibility, he told IRIN. 
 
There is good news: The caseload is going down. In 2011 some 770 new cases were detected versus 887 cases in 2009, according to the Côte d’Ivoire Health Ministry, though Kersabiec notes the number of cases being detected is “stagnating”, so it is it is difficult to give accurate figures.
 
Over the past few years the health system’s understanding of leprosy has gradually been eroded, said Kersabiec. “A nurse at a health centre may never have encountered a case of leprosy - they are not accustomed to treating it,” he said. 
 
Too many cases are left to develop into advanced stages, said Kersabiec, who describes the disease as “insidious and silent”: A painless incubation period can last for years, while the first symptoms can take up to 20 years to appear. “The symptoms appear very late. Thus, when a new case is detected, it is very difficult to know where and when the person was infected,” he told IRIN.
 
Another problem is that many people live up to 20km from their nearest health clinic, making it difficult for them to visit.
 
Leprosy can be treated in 6-12 months, at which point the patient will no longer be contagious, but once symptoms such as loss of limbs or blindness have set in, they cannot be reversed.
 
Treatment is particularly patchy in the north, which was ruled by the ex-rebel Forces Nouvelles for a decade, during which time much of the state infrastructure was neglected. Many nurses left northern Côte d’Ivoire to work in the south, according to health practitioners.
 
Many leprosy patients are reluctant to come forward as some associate the disease with having been cursed, said Akochi, who works in the southern central department of Tomoudi. "Once they [patients] start to lose their limbs, many patients become ashamed and hide,” he said.
 
Traditional healers often play into this dynamic, having little medical knowledge of leprosy and giving patients inappropriate treatment, said Akochi. 
 
Shame, poverty
 
Part of the shame may also be linked to poverty: Leprosy mainly affects poor and remote parts of the country, partly because unhygienic living conditions help the bacteria carrying leprosy to spread (it is spread via droplets in the mouth or nose). 
 
"Leprosy is a disease of poverty: it is caused by poverty and throws sufferers into even greater poverty once they contract it,” says Kersabiec.
 
A nun, Sister Pauline, runs a health clinic in Dimbokro, south-central Côte d’Ivoire, and looks after people living with leprosy in the village of Chrétienko 5km away, trying to build their confidence and help them lead productive lives. 
 
"They are encouraged to get to work, not to pity themselves or their situation,” Sister Pauline told IRIN. 
 
"We try to help patients but not so much that they become overly-dependent,” said Sister Pauline. "To be mutilated will always be painful, but people must leave the house, do what they can to survive. They must live,” she said.
 
Former leprosy patient Samuel, lives in Chrétienko, where he is undergoing training to become a shoemaker, making special shoes for people living with leprosy. "I am very proud because it allows me to show the world that despite the handicap, we can do things," he told IRIN.
 
Views on leprosy are changing slowly, said Sister Pauline. "Things are moving in a positive direction, and there is less [societal] rejection than before," she said.

After just eight months in power, it is too early to tell if President Alassane Ouattara’s government will reinvigorate the leprosy fight, said Kersabiec. But, having met the health minister on 2 February, he has hope: “I wait to see if the engagement is real, the resources put in place, and promises kept.”
 
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]]></body><pubDate>Wed, 08 Feb 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94814</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201202071354370157t.jpg"/></td><td valign="top">DIMBOKRO/TOUMODI 08 February 2012 (IRIN) - Côte d’Ivoire’s leprosy programme was consistently under-funded during the civil war (2002-2007) and last year’s political turmoil, say health practitioners, leading to a loss of expertise in terms of detecting or treating the disease.</td></tr></table>]]></content:encoded></item><item><title>PAKISTAN: Quetta&apos;s Hazara community living in fear</title><pubDate>Tue, 07 Feb 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201202070931490115t.jpg" />]]>QUETTA 07 February 2012 (IRIN) - Widespread fear of harassment, discrimination and killings has prompted some Hazara community members living in Quetta, the capital of Balochistan Province in southwestern Pakistan, to consider leaving the country, even by illegal means.</description><body><![CDATA[QUETTA 07 February 2012 (IRIN) - Widespread fear of harassment, discrimination and killings has prompted some Hazara community members living in Quetta, the capital of Balochistan Province in southwestern Pakistan, to consider leaving the country, even by illegal means.

“Over 600 Hazaras have been killed since 2000,” Abdul Qayuum Changezi, head of the Hazara Jarga, a group representing Hazaras, told IRIN. Media reports speak of dozens recently killed in attacks on the community in Quetta [ http://www.thenews.com.pk/TodaysPrintDetail.aspx?ID=9314&Cat=13 ] and in other parts [ http://tribune.com.pk/story/256419/gunmen-attack-bus-in-balochistan-20-killed/ ] of the province.

The Hazaras constitute a distinct ethnic group, with some accounts [ http://www.hazara.net/hazara/hazara.html ] tracing their history to central Asia. Almost all belong to the Shia Muslim sect, speak a dialect of Farsi, and are concentrated in central Afghanistan and some parts of Pakistan. There are some 6,000 to 7,000 Hazaras in the country, according to a Hazara chief, Sardar Saadat Ali.

In Quetta, many of them live in Alamdar Road. Close by, Ali Hassan, 55, and his two sons, both in their 20s, were engrossed in a fierce argument in their small house - when IRIN visited - about leaving the country, even if illegally.

According to the two, there is too much discrimination against the Hazaras for them to have a future. “It is simply too dangerous to live here. Besides, Hazaras get no opportunities in education or for jobs, because of the bias that exists,” said Ibrar Ali, 21, the younger of Hassan’s sons.

However, their parents were terrified of allowing them to try and leave, mainly because of an incident in December last year in which at least 55 Hazaras from Quetta were killed [ http://tribune.com.pk/story/309165/indonesia-boat-tragedy-55-quetta-youth-missing-at-sea/ ] when a boat carrying some 90 illegal immigrants to Australia capsized off the coast of Indonesia.

“The boat was overloaded with over 250 people, including children and women,” said Nasir Ali, whose brother was on the ill-fated boat, but survived.

“Persecution”

Following the incident, the autonomous Human Rights Commission of Pakistan [ http://www.hrcp-web.org/showprel.asp?id=249 ] demanded a government inquiry. In a statement, HRCP chairperson Zohra Yusuf said the fact that “Hazara young men chose to leave Pakistan by taking such grave risks is a measure of the persecution the Hazara community has long faced in Balochistan.” 

The statement also urged the government to act against those illegally ferrying people out of the country in exchange for large sums of money, and demanded it “take urgent steps to find a way to put an end to the persecution of the long-suffering Hazara community”.

The New York based monitoring body Human Rights Watch (HRW) has also condemned the sectarian killing of Shia Muslims [ http://www.hrw.org/news/2011/12/03/pakistan-protect-shia-muslims ] in Pakistan, and has noted: "Research indicates that at least 275 Shias, mostly of Hazara ethnicity, have been killed in sectarian attacks in the southwestern province of Balochistan alone since 2008." HRW Asia director Brad Adams says a start can be made to ending such killings "by arresting extremist group members responsible for past attacks”.

Anger within the Hazara community runs deep, and has been growing.

“The news of the killings and the desperation of the community is terrible. I weep often when I read of what is happening. I want to return to Quetta, because I love my home town; I want to be close to my parents and live there with my own family. But my fiancé and I ask if it will be sensible to raise our children in a climate of death,” Mina Ali, a medical student from the Hazara community currently based in Karachi, told IRIN. 

Her fiancé, also a Hazara, is keen to try and flee the country, whether “legally or illegally”, Mina said.

“Genocide”?

Statements to the media from top government officials, including the chief minister of Balochistan, have also been perceived as insensitive [ http://hazaranewspakistan.wordpress.com/2011/10/05/chief-minister-balochistan-mocks-hazara-killings/ ] in their failure to strongly condemn killings that some commentators have described as a “genocide”. [ http://www.dailytimes.com.pk/default.asp?page=2011%5C10%5C20%5Cstory_20-10-2011_pg3_2 ] Others in Pakistan are demanding that the International Court of Justice look into the matter.

Hazara chief Sardar Saadat Ali, a former provincial minister, told IRIN most Hazaras in the country were based in Quetta but there were “also some in Hyderabad [in Sindh Province] and other Baloch districts”.

Ali, who has lost close relatives including his brother in targeted killings of Hazaras, said: “We can expect nothing from the government; so we act for ourselves. I personally went to Indonesia to bring back the bodies of the young Hazara men who had died in the boat tragedy. They were fleeing because of the security situation and in search of a chance to gain an education.”

Hazaras, he added, were being targeted on “both ethnic and sectarian grounds” by extremist groups - mainly the sectarian Lashkar-e-Jhangvi and Sipah-e-Sahaba, which have origins in the Punjab. [ http://www.irinnews.org/report.aspx?reportid=90760 ] He was also concerned about further persecution if the Taliban returned to power in Afghanistan.

“I don’t understand much about politics, but I worry constantly for my grown children, and their children," said Zareen Bibi, 60, a Hazara resident of Quetta. "Too many Hazaras have died, for no reason - and this inhumanity has to end. We all deserve dignity and the right to life."

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]]></body><pubDate>Tue, 07 Feb 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94806</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201202070931490115t.jpg"/></td><td valign="top">QUETTA 07 February 2012 (IRIN) - Widespread fear of harassment, discrimination and killings has prompted some Hazara community members living in Quetta, the capital of Balochistan Province in southwestern Pakistan, to consider leaving the country, even by illegal means.</td></tr></table>]]></content:encoded></item><item><title>SAHEL: Donors learning funding lessons - slowly</title><pubDate>Mon, 06 Feb 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201202061151210348t.jpg" />]]>DAKAR 06 February 2012 (IRIN) - This year donors are stepping up more quickly to meet Sahel’s humanitarian needs compared to 2010, when they were slow to respond. However, they are still at fault for taking a quick-fix approach rather than addressing long-term disaster prevention and resilience needs, say aid groups.</description><body><![CDATA[DAKAR 06 February 2012 (IRIN) - DAKAR, 3 February 2012 (IRIN) - This year donors are stepping up more quickly to meet Sahel’s humanitarian needs compared to 2010, when they were slow to respond. [ http://www.irinnews.org/InDepthMain.aspx?indepthid=81&reportid=89910 ] However, they are still at fault for taking a quick-fix approach rather than addressing long-term disaster prevention and resilience needs, [ http://www.irinnews.org/report.aspx?reportid=94082 ] say aid groups. 

As of now, over US$150 million has been pledged to respond to food insecurity, drought and nutrition needs in the Sahel, whereas at the same point in 2010 donors were doing “almost nothing”, said Amadou Sow in the Africa coordination division of the UN Office for the Coordination of Humanitarian Affairs (OCHA).

As early as December 2011 aid agencies and national governments campaigned for aid, while OCHA released its emergency appeal - whereas in the 2010 crisis this was not released until April, far later in the lean season.

The European Commission (EC) has directed $138 million to the region, according to Cyprien Fabre, head of ECHO (EU aid body) in West Africa, who says there is “great commitment at the EU level”, with the development and humanitarian commissioners working closely together on the Sahel crisis. The EU is also expected to release longer-term funding soon.

The US Agency for International Development (USAID) meanwhile, has channeled $67 million to the crisis, $25.5 million of it to the World Food Programme in Niger and Chad; France and the UK Department for International Development have each directed $10 million towards five Sahelian countries without yet specifying what is going where; the UN Central Emergency Response Fund has released $16 million of start-up funding; while Sweden, Germany, Austria and other donors have allotted smaller sums. 

Most of these figures are not yet reflected in the OCHA financial tracking system [ http://reliefweb.int/sahel-food-insecurity2012 ] which currently states that the Chad and Niger appeals are respectively 7 and 15 percent funded. 

While such pledges are welcomed, the EC Humanitarian Commissioner, Kristalina Georgieva, recently said a conservative estimate of the needs over the next six months would be 500 million euros [US$654 million], “so there is clearly a considerable gap to fill,” noted Stephen Cockburn, West Africa campaigns and policy manager at Oxfam. 

Avoid repeat mistakes

Donors may fear repeating the mistakes of the Horn of Africa, where everyone responded too late, and may also want to show that they have learned the lessons from past Sahel crises, say aid workers. 

“Donors are more interested in the Sahel now,” said Fabre. “They probably want to make sure they don’t miss the opportunity to have a correct, coherent, quality response this time.”

However, some fear donors are waiting too long to specifically allocate their aid by country, positing they are waiting for more detailed figures on needs to be published. An OCHA Sahel strategy paper with specific needs in each country will be launched imminently.

Donors must not fund Chad and Niger to the neglect of other affected countries, including Burkina Faso, Mauritania, Mali, Nigeria, and Senegal, warns OCHA’s Sow.

Longer-term still under-funded

While pledging has been swifter, the long-term aid that Sahel experts have been pushing for for years is still not prioritized, say Sahel experts.  

“The argument [for longer-term resilience-oriented aid] has “not been won yet”, said Fabre. 

A number of aid agencies are involved in longer-term resilience work, such as Oxfam’s project to give people cash transfers or cash-for-work to help vulnerable families cope with high food prices. “Some donors [the European Union and DFID] are beginning to fund this work, but as an approach it remains under-prioritized,” said Oxfam’s Cockburn.

The prevention and treatment of moderate acute malnutrition is one chronically under-funded sector in the Sahel: While over one million children are expected to face severe and life-threatening malnutrition this year, in a “normal” year the figure hovers around 800,000. 

West Africa UN Children’s Fund (UNICEF) nutrition specialist Robert Johnston told IRIN: “It is still difficult to ensure funding from government agencies for long-term preventative activities when there are critical life-saving interventions that they can respond to immediately. It’s much easier [for them] to justify life-saving than long-term.” 

Likewise, it can be hard to get national governments on board: “In areas with low levels of education and poor healthcare systems, it is hard to plant the seed of prevention as an idea.”

However, donor attitudes here are slowly changing, he said. UNICEF programmes now come from the point of view that emergency treatment and longer-term prevention of malnutrition are two sides of the same coin. “Everyone is starting to get the message,” he said. 

Aid agencies and donors should see their response to the Sahel drought as an opportunity to change their approach, said Kazimiro Rudolph-Jacondo, head of OCHA’s West Africa office in Dakar. “This is a window of opportunity to build on lessons learned from the past and to resolve these problems over the long term,” he told IRIN. 

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]]></body><pubDate>Mon, 06 Feb 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94799</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201202061151210348t.jpg"/></td><td valign="top">DAKAR 06 February 2012 (IRIN) - This year donors are stepping up more quickly to meet Sahel’s humanitarian needs compared to 2010, when they were slow to respond. However, they are still at fault for taking a quick-fix approach rather than addressing long-term disaster prevention and resilience needs, say aid groups.</td></tr></table>]]></content:encoded></item><item><title>SAHEL: Displaced Malians burden food-insecure hosts</title><pubDate>Mon, 06 Feb 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2010/201009200747560203t.jpg" />]]>BAMAKO/DAKAR 06 February 2012 (IRIN) - Some 12,000 Malians have fled fighting in the towns of Ménaka and Anderamboucane in northern Mali and reached already food-insecure villages around Tillabéri in western Niger, according to the International Committee of the Red Cross (ICRC) in Niger’s capital, Niamey.</description><body><![CDATA[BAMAKO/DAKAR 06 February 2012 (IRIN) - Some 12,000 Malians have fled fighting in the towns of Ménaka and Anderamboucane in northern Mali and reached already food-insecure villages around Tillabéri in western Niger, according to the International Committee of the Red Cross (ICRC) in Niger’s capital, Niamey. 
 
The Malian refugees are spread across the villages of Mangaizé, Chinégodar, Koutoubou, Yassan and Ayorou in Niger, according to the Malian Ministry of Foreign Affairs, with the bulk of them - an estimated 7,000 - in Chinégodar, which is usually home to 1,500, according to Franck Kuwonu at the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Niamey.
 
Fighting broke out between Touareg rebels and former soldiers from Libya, and the Malian army in mid-January. Rebel groups and former Libya fighters have reportedly acquired fresh weapons as a result of the Libya conflict and have launched a new movement, the National Movement for the Liberation of Azawad (MNLA), which calls for the creation of an independent state encompassing the regions of Gao, Kidal and Timbuktu in northern Mali.
 
Niger’s Tillabéri region has been hardest hit by the 2011 drought and poor harvest and many inhabitants are already facing severe food insecurity, according to the government and aid agencies. Though assessments are still under way, the government estimated late last year that just under half of Niger’s population would be short of food this year.
 
“Chinégodar doesn’t even have enough grain to feed its own small population,” said Kuwonu, noting there are three tons of millet in the cereal bank. Millet prices in the area are 24,000 CFA francs (US$50) per 100kg bag, up from 19,000 CFA francs ($40) this time last year.
 
The ICRC and NGO Médecins Sans Frontières have been quickest to respond to refugees’ needs, the former having repaired water pumps in stressed host towns and distributed some blankets, shelter materials and food; the latter sending a nurse with basic medical supplies to help those in need. 
 
However, logistics are slow said Kuwonu, and more food and shelter is needed. The ICRC spokesperson in Niamey, Germain Mwehu, told IRIN there is enough aid to meet immediate needs but not over the long-term.
 
An inter-agency UN mission evaluated the area last week and agency representatives are meeting tomorrow to discuss their response. Oxfam has also assessed the situation. All agencies will closely coordinate with the government on their response, said Kowonu. 
 
Heading for Mauritania, Burkina, Guinea
 
According to PANA Press, [ http://www.maghrebemergent.info/actualite/fil-maghreb/8612-mauritanie-afflux-de-refugies-maliens.html ] some 6,000 Malians have also fled fighting in Léré, Niafunké and Goundam in Mali’s northern Timbuktu region, and are sheltering in Fassala Néré in Mauritania, some 1,260km east of the capital Nouakchott. A number of the children among them are allegedly severely malnourished, according to local NGO Association for Research and Development in Mauritania.
 
The local authorities and UN Refugee Agency (UNHCR) are currently assessing the situation in more detail, UNHCR spokesperson Elise Villechalane told IRIN from Nouakchott. An unknown number of Malians have also fled east to Burkina Faso and western Guinea, says the ICRC in Mali. 
 
Meanwhile, an unknown number of Malians are fleeing south to Mopti, some 640km north of the capital Bamako, and to Bamako itself. 
 
Amina Coulibaly, a producer with national radio in Gao, eastern Mali, told IRIN from the capital: “Fighting has not yet broken out in Gao [town] but given that it is one of the places the Touaregs want to make part of their republic, I prefer to leave now.”
 
Mali has been struggling for several years to contain rebel groups in the north, the rising power of Al-Qaeda in the Islamic Maghreb (AQIM) factions, and widespread contraband traffickers in its northern regions. [ http://www.irinnews.org/report.aspx?reportid=90703 ]
 
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]]></body><pubDate>Mon, 06 Feb 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94803</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2010/201009200747560203t.jpg"/></td><td valign="top">BAMAKO/DAKAR 06 February 2012 (IRIN) - Some 12,000 Malians have fled fighting in the towns of Ménaka and Anderamboucane in northern Mali and reached already food-insecure villages around Tillabéri in western Niger, according to the International Committee of the Red Cross (ICRC) in Niger’s capital, Niamey.</td></tr></table>]]></content:encoded></item><item><title>HEALTH: Experts pledge to eradicate &quot;neglected&quot; diseases</title><pubDate>Fri, 03 Feb 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201202031118020332t.jpg" />]]>LONDON 03 February 2012 (IRIN) - Ten little-known but debilitating diseases will be high on the agenda of the world&apos;s pharmaceutical chiefs, health ministers and donor governments after they pledged their support for a World Health Organization (WHO) initiative to wipe out guinea worm, river blindness, trachoma, leprosy, bilharzia and intestinal worms, among other &quot;neglected&quot; diseases.</description><body><![CDATA[LONDON 03 February 2012 (IRIN) - Ten little-known but debilitating diseases will be high on the agenda of the world's pharmaceutical chiefs, health ministers and donor governments after they pledged their support for a World Health Organization (WHO) initiative [ http://www.unitingtocombatntds.org/downloads/press/ntd_event_london_declaration_on_ntds.pdf ] to wipe out guinea worm, river blindness, trachoma, leprosy, bilharzia and intestinal worms, among other "neglected" diseases. 

Caroline Anstey, a managing director of the World Bank, told the delegates at the meeting in London: “We are not really talking about neglected diseases; we are talking about neglected people. I think that is very key, and it is all about how and if and whether we value them.”

The participants on 30 January pledged to support the WHO programme [ http://www.who.int/neglected_diseases/en/ ] for controlling or eliminating these diseases by 2020, promising more research and an increased supply of free drugs.

In turn, donor governments and private philanthropists, including Bill Gates, promised to support the delivery of the drugs and strengthen the health systems of the affected countries to run control and eradication programmes. Health ministers from Mozambique, Bangladesh and Brazil attended the meeting.

Working on these diseases has been frustrating because they are not incurable. Drugs to treat them exist. But these drugs have been too expensive or in short supply, or only available in a form that is difficult to use. The key to this initiative is that the organizers, especially Gates, have brought the drug companies on board.  

“The drug suppliers are willing to be generous,” he said, “But they need to know there is a road map which comes from the WHO; they need to know that there is delivery funding which comes from people like DFID [UK Department for International Development] and USAID; and they need to know that the countries involved are going to orchestrate their health systems to make sure that all the drugs really get to the people in need.” The Bill and Melinda Gates Foundation pledged US$340 million over the next five years, partly to fund research into better treatment and partly to support delivery programmes.

Gates managed to persuade the companies to do things they would never normally consider, like giving away their products for nothing. Haruo Naito, president and CEO of the Japanese company Esai, which produces drugs for Lymphatic Filariasis, commonly known as Elephantiasis, set out the problem: “Our company is going to spend something like $35 million for this project. How can we persuade our shareholders? Well, we tell them it is a long-term investment for the people, for societies and for the economies of developing countries, to lift them up to become middle-income countries in the future.”  

The issue of collaborative research was even trickier. Christopher Viebacher, head of Sanofi, which is researching improved drugs for sleeping sickness, said: “We are competitors. It's not that easy for us to work together commercially. And now you are talking about research and development, which is really where the core secrets of companies are. Sharing our libraries of compounds is extraordinarily difficult and it is only because of the great need that we have been able to get together, and this is where Bill Gates has played such a critical role in catalyzing it.”

Voices of dissent 

However, there were warnings that even an unlimited supply of free and suitable drugs would not in themselves be enough. Daniel Berman of Médecins sans Frontières [ http://www.msfaccess.org/sites/default/files/MSF_assets/NegDis/Docs/NTD_briefing_UnitingCombatNTDs_ENG_2012.pdf ] said that while his organization was delighted these neglected diseases were finally getting more attention, “We are concerned that the challenges for some of these diseases are being glossed over.” MSF cited the example of sleeping sickness, which was virtually eliminated in the early 1960s but returned with a vengeance in the 1990s as elimination efforts were not sustained. It wants to see more emphasis on programme support and surveillance capacity in affected countries.

And in a letter to the London-based medical magazine, The Lancet, two academics, Tim Allen of the London School of Economics, and Melissa Parker of Brunel University [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60159-7/fulltext ], raised another issue – the practical problems associated with mass medication. The control or eradication of many of these diseases would entail treating whole villages, even those not infected, sometimes many times over, to wipe out the pool of infection. They found people in Tanzania, where this kind of programme was introduced, were suspicious and often hostile.

“After multiple rounds of mass drug administration for Lymphatic Filariasis, the vast majority of the people interviewed... were unaware of the link between the disease and mosquitoes, and at best had a very limited understanding of the rationale for mass treatment. They asked why people with no visible symptoms should take tablets... It is hardly surprising that rumours circulate about the real purpose of the drugs.” Some of those involved in administering the programme were chased and beaten and had to be rescued by police.

“The provision of free and subsidized drugs,” they conclude, “creates a window of opportunity to make a massive difference.  But the availability of tablets is not enough.”

eb/mw

]]></body><pubDate>Fri, 03 Feb 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94788</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201202031118020332t.jpg"/></td><td valign="top">LONDON 03 February 2012 (IRIN) - Ten little-known but debilitating diseases will be high on the agenda of the world&apos;s pharmaceutical chiefs, health ministers and donor governments after they pledged their support for a World Health Organization (WHO) initiative to wipe out guinea worm, river blindness, trachoma, leprosy, bilharzia and intestinal worms, among other &quot;neglected&quot; diseases.</td></tr></table>]]></content:encoded></item><item><title>CAMBODIA: The impact of truth-seeking on mental health</title><pubDate>Fri, 03 Feb 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201202021632230167t.jpg" />]]>PHNOM PENH 03 February 2012 (IRIN) - On 3 February, judges in the Extraordinary Chamber of the Courts in Cambodia (ECCC) – more commonly known as the Khmer Rouge trials – sentenced Kaing Guek Eav (“Duch”),  the former chairman of the Khmer Rouge’s Tuol Sleng security prison, to life in prison.</description><body><![CDATA[PHNOM PENH 03 February 2012 (IRIN) - On 3 February, judges in the Extraordinary Chamber of the Courts in Cambodia (ECCC) – more commonly known as the Khmer Rouge trials – sentenced Kaing Guek Eav (“Duch”), the former chairman of the Khmer Rouge’s Tuol Sleng security prison, to life in prison. 

This ruling overturned a 2010 sentence of 35 years, which civil party lawyers had appealed. 

Mental health experts are monitoring the impact of such rulings and the entire judicial process on survivors due to the particularities of this tribunal; its rules grant them a larger role than in any previous international criminal tribunal, prompting longstanding questions about whether truth-seeking hurts or heals war wounds. 

In addition to testifying as witnesses to corroborate the prosecution’s case, survivors of Cambodia’s 1975-1979 genocide can also share their suffering with the court as “civil parties” entitled to “collective and moral reparations”. 

“You have two camps, those who say justice can magically heal and others who say there is a risk of re-traumitization, which requires extraordinary measures be taken to protect victims [during proceedings],” said Jeffrey Sonis, a medical researcher from the University of North Carolina in Chapel Hill, who has specialized in the psychosocial consequences of human rights abuses, and mechanisms to promote justice following conflict. 

With support from the US National Institutes of Health, Sonis interviewed 1,800 people in all 24 of Cambodia’s provinces in 2009 and again in 2010, before and after Duch’s trial, to learn whether and how the trial affected survivors’ mental health. 

While unable to discuss his findings before publication, he said they fell between the two extreme views of how justice-seeking mechanisms may affect health. 

In earlier research published in 2009, Sonis found that although most of the 1,000 Cambodians he interviewed hoped the trials would promote justice, 87 percent of those older than 35 believed the trials would bring back painful memories. 

Double-edged sword 

“The trial is a double-edged sword,” said Sotheara Chhim, a psychiatrist and executive director of one of the few local NGOs devoted to mental health,Transcultural Psychosocial Organization (TPO), and an expert witness called before this tribunal for mental health matters. 

“It may be both catharsis and re-traumitization.” 

When survivors retell their stories, listen to others as well as lawyers for the former Khmer Rouge senior cadre, painful memories and emotions may resurface, said Sotheara. But this “dark period” should not last long, he added. 

“But after that, I think they found that the process of testifying had a therapeutic effect. A lot said [that] after testifying, they became relaxed like they [had] let go of a heavy load [they had carried] for a long time.” 

The “bad feelings” can come back, said Sotheara, for example, when an undesired verdict is pronounced, but this is “the normal path in the process toward justice, which is not easy and [can be] a bumpy road”. 

One out of four people who participated in Duch’s first trial reported “quite a bit” or “very much” negativity, such as disappointment and anger, following the announcement of the first verdict, according to a study published in 2010 by the Berlin Centre for the Treatment of Torture Victims, in collaboration with TPO. 

Civil parties 

On 26 July 2010, judges sentenced Duch to 35 years’ imprisonment for crimes against humanity, minus five years for the time he was illegally jailed by the Cambodian military court. Because he had already served 11 years in detention, he would have had less than 19 years to serve of his sentence. 

The verdict also rejected 24 survivors’ applications to be included as civil parties, due to a lack of evidence proving they were affected by the crime. 

After recognizing a photo of her uncle during a 2008 visit to Tuol Sleng, where she said he had been detained and executed, Hong Savath, 47, tried to join the case against Duch. 

But in rejecting her application, judges said “neither this photograph nor any documentary evidence was provided as proof of her uncle’s detention at S-21 [Tuol Sleng]. Party [Hong], who was 11 years of age when her uncle disappeared, has also not provided evidence of any special bonds of affection or dependency in relation to her uncle.” 

Her lawyer, whose work is funded by the German government, appealed. 

Gang-raped by the Khmer Rouge – her oldest son is now 31 – and forced to witness her parents killed by bayonet, Hong fell into depression after the July 2010 verdict. “I felt surprised and sorrow I was not selected,” she told IRIN. 

Days before the 3 February court appeal verdict announcement, Hong said she feared the worst of her depression would return in the courtroom. “I am worried Duch will deny his guilt. I am afraid I will lose control. I do not know if I can bear the intense emotion.” 

On appeal, the court accepted her application to be a civil party. 

When asked why she risked rejection and depression repeatedly to join the cases against the Khmer Rouge, she told IRIN: “I am the only survivor in my family and want to show this suffering to the world, especially the UN.” 

Those sharing this conviction may be plentiful, but relatively few of the genocide survivors who are still alive are participating, noted a recent publication by the local Documentation Centre of Cambodia (DC-CAM) on trauma psychology. 

Opting out 

As of May 2010, 8,200 people had applied to join the court’s first two cases. 

“What can the court really do for us?” said Nyrola Ung, 58, who chose not to participate. 

She lost her husband and more than 100 other family members. After escaping to neighbouring Thailand in 1980, and then seeking asylum in the US, she returned to Cambodia last year in an attempt to visit the location where she escaped death and to confront her loss. 

Sareth Mon, 58, also based in the capital, said she did not have time. A mother of two at the time the Khmer Rouge took her husband away in 1979, she lost her one-month-old baby when she could not produce any more breast milk to keep her alive. 

“It is good to have trials, but it seems like a long time ago. The trial can relieve suffering – some people lost their entire families. I know I have a right to tell my story to the court, but I cannot attend because I am busy raising a family.” 

One of the first to submit a testimony to the court, Theary Seng, 40, withdrew as a civil party in late 2011, calling the trials “a political farce” that risked raising expectations and harming an already, as she put it, “cynical public”. 

A US-trained lawyer trying to set up a civic education NGO in Cambodia, Seng was orphaned at eight when her mother was killed in Svay Rieng Province bordering Vietnam. 

Reparations 

For “collective and moral reparations” (because court rules do not allow financial reparations), the court had granted survivors’ requests to compile and distribute Duch’s apologies and “statements of remorse” - but not a state apology, construction of memorials, free healthcare, preservation of former torture sites or a national commemoration day, stating that civil party lawyers had provided insufficient detail, or the request fell outside the court’s jurisdiction. 

This decision was upheld on 3 February, as judges explained how the court as a “unique system” cannot grant anything that requires government input. 

In a 2010 analysis of 4,000 survivors’ official complaints at the court, 18 percent requested medical services, 16 percent improved infrastructure, 16 percent school construction, 12 percent individual reparations and 13 percent religious ceremonies, according to the DC-CAM. 

But even without reparations, eight out of 10 Cambodians surveyed nationwide in 2008 and again in 2010 by the law school at University of California Berkeley said it was important to know the truth and that national reconciliation was impossible without more information gleaned from the trials. 

And while it hurts to listen to testimonies and see history rehashed in the media, graduate management student at Pannasastra University, Ok Pirum, 25, said: “If I had to choose between the pain of knowing and no pain from not knowing, I would choose pain.” 

pt/mw 

]]></body><pubDate>Fri, 03 Feb 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94790</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201202021632230167t.jpg"/></td><td valign="top">PHNOM PENH 03 February 2012 (IRIN) - On 3 February, judges in the Extraordinary Chamber of the Courts in Cambodia (ECCC) – more commonly known as the Khmer Rouge trials – sentenced Kaing Guek Eav (“Duch”),  the former chairman of the Khmer Rouge’s Tuol Sleng security prison, to life in prison.</td></tr></table>]]></content:encoded></item><item><title>HEALTH: Malaria mortality &quot;underestimated&quot;</title><pubDate>Fri, 03 Feb 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2010/201011010851010191t.jpg" />]]>LONDON 03 February 2012 (IRIN) - A new attempt to quantify malaria deaths over the past 30 years suggests the death toll, especially among adults, has been greatly underestimated. The figures also show the fragility of the gains made in fighting the disease.</description><body><![CDATA[LONDON 03 February 2012 (IRIN) - A new attempt to quantify malaria deaths over the past 30 years suggests the death toll, especially among adults, has been greatly underestimated. The figures also show the fragility of the gains made in fighting the disease.

Collecting data on malaria deaths is notoriously tricky; the countries where the disease is most prevalent have the weakest statistics. And even where causes of death were recorded, the researchers found many deaths were simply attributed to “fever” – probably malaria, but possibly not. 

In addition, a malaria infection is often a contributory cause of death along with other health problems.  However, after some complicated number-crunching, researchers, based at the Institute for Health Metrics in Seattle, believe they have produced the best estimates so far of how many people in the world die of malaria.  

The figures, published in the London-based medical journal, The Lancet, [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60034-8/fulltext ] produced some surprises, principally because they are significantly higher than those issued last year by the World Health Organization (WHO) – more than eight times higher in the case of older children and adults in Africa, where most of the deaths occurred.

The difference was smaller in the case of children under five, but the researchers said they believed malaria was a more important cause of death in under-fives than the 2011 World Malaria Report estimated, causing 24 percent of child deaths in Africa.  

Christopher Murray and his colleagues said they believed the fact that almost half a million extra deaths occurred in adults and older children each year had practical implications. “Traditional teaching in most medical schools argues that acquired immunity [in endemic areas] means that adults have clinical malaria, but are not likely to die from it.

Inspection of the basic... data, however, clearly shows a substantial percentage of malaria deaths in individuals aged 15 years and over, even in endemic areas such as sub-Saharan Africa.”  In the light of this they suggest a shift of control strategies to pay more attention to all adults, not just women and children, in the distribution of insecticide-treated bed nets.  

The research also tracked malaria deaths through time, from 1980 to 2010. Global malaria deaths almost doubled between 1980 and 2004; child deaths in Africa almost tripled over the same period. The researchers suggest the HIV/AIDS epidemic and resistance to chloroquine as probable causes, along with an increase in population in malaria-endemic areas.  After that the number of deaths started to fall, although they are still not down to 1980 levels. 

The results of hard-fought campaigns, and the resources provided by the Global Fund to fight AIDS, Tuberculosis and Malaria, do show up in the figures. The authors say “the risk of malaria death in several countries that have scaled up control efforts, such as Zambia, Tanzania, Kenya and Ethiopia, has decreased between 2000 and 2010 figures”.  The reverses of the 1980s and 1990s signal the fragility of the gains in the war against malaria, and the researchers say this underscores the danger posed by the world economic crisis, and the slowdown in health funding. 

They conclude: “The announcement by the Global Fund [in November] that their next round of funding would be cancelled raises enormous doubts as to whether the gains in malaria mortality reduction can be built on or even sustained.”  Sarah Kline, executive director of Malaria No More UK, told IRIN this fragility of funding, especially from the Global Fund, was a big source of discussion and anxiety for the whole malaria community. 

“The total funding gap for malaria, from all sources, if we are going to meet our 2015 targets, is around US$3 billion a year, although we did have some positive announcements at Davos about extra funding from the Gates Foundation, and the governments of Saudi Arabia and Japan.”  The funding gap was also addressed by the Liberian President Ellen Johnson Sirleaf when she was elected to head the African Leaders' Malaria Alliance on 2 February, and urged African countries to step up their own funding for control campaigns and find innovative sources of finance to close the gap.  

eb/mw

]]></body><pubDate>Fri, 03 Feb 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94796</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2010/201011010851010191t.jpg"/></td><td valign="top">LONDON 03 February 2012 (IRIN) - A new attempt to quantify malaria deaths over the past 30 years suggests the death toll, especially among adults, has been greatly underestimated. The figures also show the fragility of the gains made in fighting the disease.</td></tr></table>]]></content:encoded></item><item><title>COTE D&apos;IVOIRE: Meningitis spreads as people scramble for vaccine</title><pubDate>Thu, 02 Feb 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2009/200904201848030218t.jpg" />]]>KORHOGO 02 February 2012 (IRIN) - Eleven people have died from meningitis out of 40 reported cases in four departments across Côte d’Ivoire as of 31 January, leaving people scrambling to access the vaccine for their families.</description><body><![CDATA[KORHOGO 02 February 2012 (IRIN) - Eleven people have died from meningitis out of 40 reported cases in four departments across Côte d’Ivoire as of 31 January, leaving people scrambling to access the vaccine for their families. 
 
The Ministry of Health has declared the outbreaks in the departments of Kouto and Tengrela in the north as epidemics, and is providing free vaccinations in both locations through mobile health teams, with the help of the World Health Organization and UNICEF. 
 
Bacterial and viral meningitis are diseases which cause inflammation in layers of the brain and spinal cord, and the former has a high fatality rate. 
 
Residents of also-affected Saminkro in the centre of the country and Kani in the centre-west must pay US$5 each for a vaccination, or $3 if they come forward as a group. Ivoirians in these departments - and in surrounding areas - are lobbying the Health Ministry to bring down prices as many cannot afford to raise enough money to vaccinate their families.
 
“It’s a question of economics,” Jeremie Ipo, director of the district health centre in the village of Poungbè in Korhogo region, told IRIN. “We can only reduce the price of the vaccine as soon as there are enough people demanding it.”
 
The government recently abandoned the provision of free health care for all because of skyrocketing costs. [ http://www.irinnews.org/report.aspx?reportid=94729 ] While birth deliveries and some immunizations for children under age six are still covered, meningitis is not included. 
 
Côte d’Ivoire is part of the meningitis belt of sub-Saharan Africa, which stretches from Senegal in the west to Ethiopia in the east. A 2009-2010 meningitis outbreak killed over 900 people and infected over 13,000 in Burkina Faso, Mali, Niger and Nigeria. 
 
oa/aj/cb

]]></body><pubDate>Thu, 02 Feb 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94783</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2009/200904201848030218t.jpg"/></td><td valign="top">KORHOGO 02 February 2012 (IRIN) - Eleven people have died from meningitis out of 40 reported cases in four departments across Côte d’Ivoire as of 31 January, leaving people scrambling to access the vaccine for their families.</td></tr></table>]]></content:encoded></item><item><title>TANZANIA: Good results in programme to boost TB detection</title><pubDate>Wed, 01 Feb 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2011/201103231336000697t.jpg" />]]>ARUSHA 01 February 2012 (IRIN) - A pilot community programme to improve TB detection in northern Tanzania has shown good results and could be replicated nationwide as the country seeks to improve its TB treatment and prevention systems.</description><body><![CDATA[ARUSHA 01 February 2012 (IRIN) - A pilot community programme to improve TB detection in northern Tanzania has shown good results and could be replicated nationwide as the country seeks to improve its TB treatment and prevention systems. 

Tanzania has been battling TB for years, a struggle intensified by the parallel HIV epidemic; approximately 47 percent of new adult cases in the country are HIV-positive. Without proper treatment, about nine in 10 people living with HIV who become ill with active TB will die within two to three months, according to UNAIDS [ http://data.unaids.org/pub/PressRelease/2010/20100722_pr_tb_en.pdf ]. 

The programme, which ran from April to September 2011, systemized the way suspected TB cases were reported and handled. It encouraged healthcare professionals to work closely with community leaders to raise awareness of symptoms at every opportunity, such as at village meetings. It also used posters and slogans to make sure high-risk groups were aware of symptoms. This produced more patient referrals to health centres for diagnosis, treatment and follow-up care. 

Another crucial part of the TB pilot project was the creation of a "cough register" in each area, recording who was referred to a healthcare professional for further testing, by whom and the results of that referral. 

Management Science for Health collaborated with the NGO, PATH, and the National Tuberculosis and Leprosy Programme, with financial support from the US Agency for International Development, at 12 health facilities in northern Tanzania's Arusha and Meru district councils. A crucial tenet of the programme was emphasising that TB and HIV treatment must be done "hand in hand". 

Results 

"In both districts the standard operating procedure intervention has improved TB case notification in children and women," said Zahra Mkome, director, TB/HIV projects at PATH in Tanzania. "[It] improved team work, commitment, motivation of healthcare workers, awareness and involvement of communities in TB control activities." 

An evaluation comparing six months of TB case notification before and after the project showed a 54 percent increase in detection of TB in all forms in Meru, while in Arusha it increased by 117 percent. 

The standard operating procedure “rules” were used to provide clear and simple instructions to the health workers on how to improve TB case detection at different units and sections within health facilities, both outpatient and inpatient departments. Each area was provided with a plan and goals to implement their strategy, plus additional equipment to aid diagnosis such as paediatric score charts. Each area appointed a task force for TB treatment and these groups were encouraged to hold regular feedback meetings. 

Little data exists on the scale of the TB epidemic in Tanzania, and experts believe the records created by this system could prove a crucial tool in combating its spread and establishing where it is already most prevalent. 

One doctor based in a rural practice was particularly encouraged by the increased reporting of paediatric cases. He said some children suffering severe respiratory distress had been saved, "who in normal circumstances would have died". A number of the clinicians involved attributed an increase in notification of cases in the under-16 age group specifically to the wider use of paediatric diagnostic score charts. 

However, several challenges were flagged during the pilot: healthcare workers at Arusha's Selian Hospital said there was an urgent need to strengthen laboratory services to help confirm diagnoses; a lack of microscopes in labs and delays in issuing results were also highlighted. 

Challenges to scale-up 

Rolling out the rules on a national scale could also prove challenging as the majority of Tanzanians live in very rural areas and a poor road network means access to healthcare is limited. 

Mobile diagnosis and training centres that offer new methods of testing - for example, with the use of fluorescence microscopes [ http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001057 ] - could make diagnosis much faster and more accurate. 

"Patients in Tanzania often have to travel very long distances as most live in rural areas, which costs them money to travel every day and some are essentially too week to go on their own as a very large number are already suffering from the weakness that comes with HIV," said Alex Schulzer of the Novartis Foundation for Sustainable Development, which runs patient-centred TB programmes with the government. 

A shortage of medical professionals could also hinder the expansion of the programme; Schulzer recommended the use of lower cadre health workers and the community itself to fill gaps. The Novartis programme gives patients the choice to either take the daily treatment at a health facility under the supervision of a medical professional, or at home, supported by a family or community member. In the case of home-based treatment, the patient and treatment supporter are required to visit the health facility once a week during the two-month intensive phase to refill prescriptions and see a medical professional. 

Schulzer said the programme had created a system that gave patients "the freedom not to have to walk miles to the clinic every day. 

"We also needed to relieve some of the healthcare providers who cannot cope with such large patient numbers on a daily basis," he added. 

ah/kr/mw

]]></body><pubDate>Wed, 01 Feb 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94771</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2011/201103231336000697t.jpg"/></td><td valign="top">ARUSHA 01 February 2012 (IRIN) - A pilot community programme to improve TB detection in northern Tanzania has shown good results and could be replicated nationwide as the country seeks to improve its TB treatment and prevention systems.</td></tr></table>]]></content:encoded></item><item><title>MYANMAR: Health concerns for Kachin IDPs</title><pubDate>Tue, 31 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201310745080753t.jpg" />]]>KACHIN STATE 31 January 2012 (IRIN) - Aid workers in Myanmar&apos;s northern Kachin State have expressed concern over the health of thousands of internally displaced persons (IDPs) along the border with China.</description><body><![CDATA[KACHIN STATE 31 January 2012 (IRIN) - Aid workers in Myanmar's northern Kachin State have expressed concern over the health of thousands of internally displaced persons (IDPs) along the border with China. 

Preventable illnesses caused by unsanitary conditions and colder weather are taking their toll on the more than 45,000 IDPs in two dozen IDP camps as sporadic fighting between government forces and the Kachin Independence Army (KIA) nears almost eight months, they say. 

"Many of the children in the IDP camps suffer from diarrhoea and stomach parasites because they have to drink dirty water. When they go to the toilet, there aren't enough," May Li Aung, director of Wun Pawng Ninghtoi (WPN - "Light of Kachin"), a volunteer group comprising eight local NGOs and charity groups, told IRIN. 

In one camp, aid workers report just five latrines for more than 1,200 people. 

"A few people in the camps have already died from this and we are worried that diseases will spread," she said. 

While much of the water supply is trucked into the camps, many of the displaced while on the run have to drink directly from streams or boil pond water 

The WPN assists 16 camps under KIA control in the southern part of Kachin State, where about 20,000 IDPs are housed in temporary bamboo shelters, but there is a growing strain on volunteers and resources [ http://www.irinnews.org/report.aspx?reportid=93708 ] as the conflict continues. 

In the north, another 20,000 IDPs are housed in camps also under KIA control, with about 10,000 in the government-controlled area around the border town of Myitkyina. 

Vulnerable women 

"Women in the camps can use the clinics there; however, many women are not getting the midwife or family support they need," Shirley Seng, a spokeswoman for the Kachin Women's Association of Thailand (KWAT), [ http://www.kachinwomen.com/ ] based in Chiang Mai, said. "Many women feel insecure and at risk of possible assault by Burmese troops." 

"The problem that we face right now is that many women who are pregnant are having miscarriages," explained nurse Di Di Ah Hkaw. 

The pregnant women have no choice but to run from their homes to a safe place while many of their husbands are fighting on the frontline. Many of the women are carrying their household possessions with them, she explained. 

"In December we had three women in our clinic who miscarried," Di Di Ah Hkaw added. 

Meanwhile, as the political dialogue between Myanmar and others in the international community slowly moves forward, international relief groups are calling for faster action to better address the needs of the displaced. 

Earlier this month, Refugees International released a report [ http://www.refintl.org/policy/field-report/burma-opportunity-expand-humanitarian-space ] calling for increased humanitarian aid to coincide with a string of recent political reforms by the country's first nominally civilian government in decades. 

At the same time, Bill Davies of Physicians for Human Rights (PHR) [ http://physiciansforhumanrights.org/ ] described a recent UN inter-agency mission to the KIA-controlled town border town of Laiza in December - which delivered essential household items to the displaced and conducted an initial assessment of the situation – as a positive step, but stressed the need for stronger assistance and access. 

The UN and its humanitarian partners have repeatedly expressed their readiness to support all those affected by the conflict, and the most vulnerable in particular, a statement [ http://reliefweb.int/node/465420 ] by the UN read at the time. 

"There needs to be consistency and more access for bigger organizations to go in and provide better technical support for the people on the ground. 

"Something as simple as diarrhoea could kill someone as the dehydration leads to the immune system breaking down which could lead to respiratory problems and pneumonia - and eventually death," the health worker warned. 

On 9 June 2011, the 17-year-old ceasefire that had been in place between the government and the KIA broke down, in part because the KIA rejected orders to transform into a single border guard force [ http://www.irinnews.org/report.aspx?reportid=91221 ] under Burmese military control. Others still cite the military's desire to widen its control over areas with Chinese energy projects [ http://www.irinnews.org/report.aspx?reportid=93891 ]. 

ss/ds/mw 

]]></body><pubDate>Tue, 31 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94760</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201310745080753t.jpg"/></td><td valign="top">KACHIN STATE 31 January 2012 (IRIN) - Aid workers in Myanmar&apos;s northern Kachin State have expressed concern over the health of thousands of internally displaced persons (IDPs) along the border with China.</td></tr></table>]]></content:encoded></item><item><title>YEMEN: Fighting in north leads to fresh displacements</title><pubDate>Tue, 31 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201310812060713t.jpg" />]]>HAJJAH 31 January 2012 (IRIN) - Ahmad Hussein Naji, 75, and his wife Taqwa, spent three days in the open after fleeing clashes in Kisher District in Yemen’s northern governorate of Hajjah before eventually finding shelter in a school in the neighbouring district of Khairan al-Muharaq.</description><body><![CDATA[HAJJAH 31 January 2012 (IRIN) - Ahmad Hussein Naji, 75, and his wife Taqwa, spent three days in the open after fleeing clashes in Kisher District in Yemen’s northern governorate of Hajjah before eventually finding shelter in a school in the neighbouring district of Khairan al-Muharaq.

“My husband coughs and coughs until he vomits blood… We have no medicine to give him,” Taqwa told IRIN. “It was the hardest trip in my life… We had neither food nor water nor even a blanket to protect ourselves from the cold.”

The elderly couple are among hundreds of families displaced by last week’s clashes [ http://www.irinnews.org/report.aspx?reportid=94724 ] between Houthi-led Shia fighters and Sunni Salafi members in Kisher.

Helene Kadi, an emergency coordinator with the UN Children’s Fund (UNICEF), told IRIN 580 families had been displaced by the fighting. “Over 30 percent of the IDPs [internally displaced persons] have taken shelter in five schools, a worrying trend we have seen with recent displacements in the country… Others have been hosted with families or have no shelter.”

According to Ali Meshaal, a social worker in Kisher, around 230 displaced families - mostly the elderly, women and children - fled to Hajjah Governorate’s Ahim District, while more than 250 families had made it to Khairan al-Muharaq. “The whereabouts of dozens of other displaced families is still unknown,” he told IRIN.

Hajjah Governorate is home to more than 100,000 IDPs displaced by fighting between government troops and Houthi rebels since June 2004, according to a December 2011 report by the UN Refugee Agency (UNHCR).

Kind hosts

People from the al-Khamisein area in Khairan al-Muharaq District warmly received several displaced families. “They are sharing their food and water with hundreds of displaced persons who reached their villages. They also freed up schools in the area so they could be used as shelters for the displaced,” he said.

Meshaal appealed to the government and aid organizations to intervene: “The condition of the IDPs is getting much worse due to lack of food and appropriate shelter,” he said.

Ali al-Dubai with local NGO al-Khair Social Charitable Society (ASCS) said more than 2,000 IDPs had been identified and registered for assistance in Hajjah Governorate.

UNICEF, according to Kadi, has distributed 316 hygiene kits and made efforts to raise awareness about hygiene issues among IDPs and the host community. The construction of 12 latrines has been completed and water trucking to IDPs is taking place in the al-Khamisein area. Seven more 1,000 litre tankers are to be deployed and eight emergency latrines will be constructed, and more hygiene kits distributed. Water, sanitation and hygiene assistance is being delivered by UNICEF's partner ASCS, Kadi told IRIN.

Stranded

However, several families are stranded “either on their way to safer areas or inside their homes after many villages in Kisher District became inaccessible and roads unsafe,” said Sheikh Abdullah Dhahban, a member of a recently established tribal mediation committee which is trying to persuade the warring parties to lay down their arms.

“Several dead bodies are still lying in the mountains… None of their relatives have come to collect them for burial,” Dhahban told IRIN.

Local witnesses who preferred anonymity told IRIN on 28 January that Houthi fighters were attempting to tighten their control of a strategic mountain-top position called Abu Dowar, and fighting was also continuing for control of Mishabah hill, which overlooks Suq Ahim (a local market) in Kisher District.

“If Houthis take over this hill it will be easier for them to control the entire district,” one of the witnesses told IRIN.

Waning central government influence due to political turmoil since early last year, has allowed the Houthis to tighten their control of Sa’dah Governorate and push into eastern parts of neighbouring Hajjah Governorate.

“The whole governorate [Sa’dah] is controlled by Houthis. We only have to deal with one party,” said Beatrice Megevand-Roggo, head of operations for the Near and Middle East at the International Committee of the Red Cross.

The fresh displacements are taking place as Yemen prepares for presidential elections scheduled for 21 February.

ay/cb]]></body><pubDate>Tue, 31 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94763</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201310812060713t.jpg"/></td><td valign="top">HAJJAH 31 January 2012 (IRIN) - Ahmad Hussein Naji, 75, and his wife Taqwa, spent three days in the open after fleeing clashes in Kisher District in Yemen’s northern governorate of Hajjah before eventually finding shelter in a school in the neighbouring district of Khairan al-Muharaq.</td></tr></table>]]></content:encoded></item><item><title>CHAD: Why polio is so hard to eliminate</title><pubDate>Tue, 31 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201311204350177t.jpg" />]]>DAKAR 31 January 2012 (IRIN) - Poor-quality emergency immunization campaigns and low routine polio immunization coverage are helping the polio virus to spread in Chad, with 132 cases reported in 2011 - five times the number in 2010. More commitment is needed across the board, especially from local health authorities, to try to get immunizations right, say aid agencies.</description><body><![CDATA[DAKAR 31 January 2012 (IRIN) - Poor-quality emergency immunization campaigns and low routine polio immunization coverage are helping the polio virus to spread in Chad, with 132 cases reported in 2011 - five times the number in 2010. More commitment is needed across the board, especially from local health authorities, to try to get immunizations right, say aid agencies. 
 
The current outbreak in Chad has been ongoing since 2007, classifying Chad as a “re-established transmission zone” according to the World Health Organization (WHO). [ http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx ] Polio is endemic in Nigeria, Pakistan, India and Afghanistan - in other words, transmission of the disease in these places has never been broken. 
 
While a dysfunctional health system is linked to poor routine immunization coverage, “the primary reason [for the upsurge] is operational,” said Oliver Rosenbauer, spokesperson for the Global Polio Eradication Initiative at WHO in Geneva. “It is not to do with insecurity or lack of infrastructure… The outbreak response has not been sufficient to stop it [the outbreak]… They continue to miss too many children.”
 
Why children missed
 
Immunizers have missed children for a variety of reasons: In some cases government and agency staff or volunteers inaccurately mapped out where they lived; or may have ordered too few vaccines or too few ice packs to cover each district, said WHO. Often communities are not well-sensitized in advance so families remain reluctant to bring their children forward, some resist on religious grounds, or they simply may not know that they can immunize a child even if he or she is sick, said WHO and UNICEF’s West Africa communication for development specialist Irina Dincu.
 
Human error also plays a role, added Dincu, explaining that an ill-trained vaccinator may rest en route, breaking the cold chain, or a team may miss a few houses in a village. 
 
An outbreak of the polio virus would not spread so far if routine polio immunization coverage was better, said Rosenbauer. Polio immunizations are rigorous to administer: vaccinators must go house-to-house, and must give each child four doses over a 6-12 month period, reaching 90 percent of all children to eliminate polio, according to WHO. 
 
Coverage rates are estimated to be 60 percent at most in Chad, partly due to a poor-quality health system: Just 30 percent of health clinics are operational across the country; access to health care is poor; and routine immunization strategies are poorly planned. 
 
The godmother approach
 
To ensure fewer children are missed, immunizers need to make better use of “social data” to find out why and where a campaign is not working, says Dincu. Agencies used to take a purely medicalized approach to polio immunization but this has now changed. “Immunization campaigns are not just a medical intervention. You need to address campaigns from a medical, political and societal angle,” said Rosenbauer.
 
Social data has been used creatively in India and Nigeria to help vaccinators reach more children, according to UNICEF. In Nigeria’s Kebbi State households were assigned “godmothers” who came regularly pre-immunization day to discuss the disease and why vaccination was important. When poring over the data afterwards to find missed children, the “godmothers” could identify them by place, name and age, making them much easier to re-trace. 
 
These are the kinds of approaches that could be adopted in Chad, say practitioners, where despite its weak health system, polio should not be too challenging to control, says Rosenbauer. “We don’t face the same high-population challenges that we do in Nigeria, or insecurity as is the case of Afghanistan and Sudan. Here it is more a question of political and societal will.”
 
In his view, polio could be eliminated in six months if the government committed to doing so at all levels.
 
Government commitment
 
International efforts to combat polio are mounting: the Centers for Disease Control (CDC) [ http://www.cdc.gov/ ] has established an Africa-based emergency operations centre which will tackle public health crises, including polio.
 
Meanwhile, the Polio Eradication Initiative - made up of WHO, UNICEF, CDC, the Bill and Melinda Gates Foundation and the Rotary Foundation - has designated polio a “programmatic public health emergency” until eradication is achieved. 
 
The Chadian government appears to be taking polio seriously: President Idriss Déby has emphasized the importance of fighting it, and catalyzed the development of a six-month polio emergency action plan (which will then be renewed for a further six months). This includes targeting high-risk areas and analyzing what is and is not working. 
 
But commitment at the district and sub-district level in some parts of the country is weak, say aid agency staff. National authorities need to hold “sub-national” staff accountable for their performance, said Rosenbauer. “The virus doesn’t respect district boundaries so we need high commitment in every single one,” he told IRIN.
 
IRIN could not reach anyone in the Health Ministry for an interview.
 
Without local-level government commitment, elimination efforts will fail, says Rosenbauer. The number of cases in Nigeria rose from 21 to 57 between 2010 and 2011 partly due to local authorities focusing on presidential elections; while election-related violence also distracted from efforts to quash 36 cases that broke out in Côte d’Ivoire in 2011. 
 
And until polio is eliminated in Nigeria and in Chad, all West African countries are at high-risk, according to WHO. “There are immunization gaps in many countries - it can strike in the most unexpected places… that is why it is such a dangerous disease.”
 
aj/cb

]]></body><pubDate>Tue, 31 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94769</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201311204350177t.jpg"/></td><td valign="top">DAKAR 31 January 2012 (IRIN) - Poor-quality emergency immunization campaigns and low routine polio immunization coverage are helping the polio virus to spread in Chad, with 132 cases reported in 2011 - five times the number in 2010. More commitment is needed across the board, especially from local health authorities, to try to get immunizations right, say aid agencies.</td></tr></table>]]></content:encoded></item><item><title>PAKISTAN: Disabled by the 2005 quake and still out of school</title><pubDate>Mon, 30 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201300958210387t.jpg" />]]>PESHAWAR 30 January 2012 (IRIN) - Jawad Khan, 15, spends most of his day at home in his village in the remote Battagram District of Khyber Pakhtoonkhwa Province (KP), sometimes glancing at a magazine, or occasionally helping his mother shell peas or cut up potatoes.</description><body><![CDATA[PESHAWAR 30 January 2012 (IRIN) - Jawad Khan, 15, spends most of his day at home in his village in the remote Battagram District of Khyber Pakhtoonkhwa Province (KP), sometimes glancing at a magazine, or occasionally helping his mother shell peas or cut up potatoes.
 
His three younger siblings spend their day in school, and Jawad, a top student in his grade till a year ago, assists them with revision and homework. He has himself refused to go to school for over a year as the new private school set up in the area lacks a ramp to accommodate his wheelchair.
 
Jawad lost both legs after he was trapped for over two hours under the rubble of his public school during the devastating quake of 2005 which killed at least 73,000 people in parts of KP (then known as the North West Frontier Province) and Pakistan-administered Kashmir.
 
That school is still to be built, and Jawad says he “feels too embarrassed” to be carried into his classroom. To add to his problems, his wheelchair, donated soon after his legs were amputated when he was nine, has also virtually fallen apart. “My family cannot afford a new one,” he told IRIN.
 
According to the UN Children’s Fund (UNICEF), the 2005 quake left 23,000 children disabled. [ http://reliefweb.int/node/269151 ] UNICEF itself is building “child friendly” [ http://www.unicef.org/pakistan/reallives_4676.htm ] schools across the quake zone, complete with facilities for the disabled, and last year opened 16 more such schools. [ http://tribune.com.pk/story/176113/improving-education-unicef-opens-16-schools-in-azad-kashmir/ ]
 
"At the Child Friendly Schools UNICEF is building, we try to mainstream disabled children. Ramps are provided when needed, but issues like access to schools for children in remote areas are huge ones,” Jan Madad, an education specialist at UNICEF, told IRIN.
 
But the 165 schools UNICEF has agreed to build cannot cater for the needs of all the quake-affected children.
 
According to the Earthquake Relief and Rehabilitation Authority, set up by the government immediately after the quake, 5,751 educational institutions damaged or destroyed by the quake needed to be reconstructed [ http://www.erra.pk/sectors/education.asp ]. Some 73 percent had been completed by the start of September 2011. Work continues on others, but this still means many children have lacked access to school. Some still do, while for the disabled it is sometimes impossible to go back to inaccessible classrooms.
 
Difficult terrain
 
Apart from school design, the terrain where the quake struck affects this. Ali Khan, now 12, lives in the Allai administrative unit of Battagram District. With his legs damaged during the quake, he can only hobble about on crutches. But the 4km walk down a steep mountain path to the school nearest his village is too arduous for him to make.
 
Ali, who once dreamt of becoming an engineer, told IRIN: “This is fate. I have to live with it, and I just help my father the best I can around our farm. This is all that is left for me know.”
 
Scattered across the quake zone, other children are in a similar situation. The 5km distance along a rickety path in her village near Bagh in Kashmir cannot be negotiated in the wheelchair used by Asma Sharif, 13, and she receives only occasional lessons at home from her uncle. “He is too busy to help any more, but at least I have kept up some of the studies I had begun before the quake,” Asma told IRIN from Bagh.
 
Zahoor Uddin, a doctor at the Islamabad-based Hashoo Foundation NGO, which has worked with quake victims since 2005, told IRIN: “The problems are exacerbated because wheelchairs wear out quickly in that terrain, and the victims have no funds to replace them.” In some cases he said tutors had been arranged for children unable to reach school.
 
Carried to school
 
The problems for many children are acute. “I have a nine-year-old pupil, Gul Muhammad, who is carried to school on his father’s back. His friends help him to the toilet, and the hard chairs are uncomfortable for him as he has a back problem. I feel sorry to see him and wish our school had better facilities,” said Alimuddin Ali, 35, a school teacher in Battagram. 
 
He told IRIN he knew of disabled children in other villages with no access to school - either because of distance or the way schools were designed. 
 
“I have read of education by radio in some areas of the world for children in remote communities. Perhaps we can use FM radio to offer them broadcasted lessons,” he suggested.
 
“The thing is these children need to go to schools. Radio can’t help them. My son is growing, I am getting older, and I worry about how long I can carry him to school,” said Gul’s father, Hakim Uddin.
 
kh/eo/cb

]]></body><pubDate>Mon, 30 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94752</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201300958210387t.jpg"/></td><td valign="top">PESHAWAR 30 January 2012 (IRIN) - Jawad Khan, 15, spends most of his day at home in his village in the remote Battagram District of Khyber Pakhtoonkhwa Province (KP), sometimes glancing at a magazine, or occasionally helping his mother shell peas or cut up potatoes.</td></tr></table>]]></content:encoded></item><item><title>Analysis: When aid meets arsenic in Nepal</title><pubDate>Fri, 27 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201270913280887t.jpg" />]]>PARASI 27 January 2012 (IRIN) - After the discovery of unsafe levels of arsenic in Nepal’s groundwater more than a decade ago, government officials and aid groups are finally taking a critical look at whether their efforts have made a difference.</description><body><![CDATA[PARASI 27 January 2012 (IRIN) - After the discovery of unsafe levels of arsenic in Nepal’s groundwater more than a decade ago, government officials and aid groups are finally taking a critical look at whether their efforts have made a difference. 

“We didn’t raise money for broken filters,” said US-based geologist Linda Smith, expressing frustration during a recent visit to Nawalparasi District in the southern Terai region, one of Nepal's hardest-hit areas by arsenic-contaminated groundwater, when she came across abandoned water filters. 

At one home, two broken cement water filters were being used as planters, while another filter distributed by the NGO she heads, Filters for Families (FFF), sat dismantled in the yard. 

At a neighbouring home, parts were missing from a two-bucket filtration system from Bangladesh known as a Sono. The filter stand had been converted to a clothes-drying rack. 

Smith retrieved unused filters and reimbursed families for the US$5 they had paid per filter, which has an actual cost of $70. 

“There are people who need filters, and they need to realize this,” she said. 

Some 2.7 million people in Nepal - nearly 10 percent of the population - are drinking water with arsenic concentrations above the World Health Organization (WHO) recommended 10 parts per billion (ppb), according to 2011 government estimates. 

In Nawalparasi District alone, a 2008 government survey of tube wells (shallow wells 14-24m deep controlled by hand pumps) found almost 4,000 wells had arsenic that exceeded national standards (50ppb). 

Another 4,418 met national standards, but not the international 10ppb threshold - altogether affecting nearly 140,000 people who depend on those tube wells for drinking water. 

Not a priority? 

More than half of the country’s 33,000 tube wells that contain unsafe levels of arsenic have been addressed with the distribution of filters, but it does not mean the filters are used or maintained properly, said Madhav Pahari, water and sanitation specialist for the UN Children’s Fund (UNICEF) in Kathmandu, which supports the government with arsenic containment. 

“We have been providing temporary solutions through filters, but that requires changing behaviour, [which does not] occur overnight.” 

A 2007 UNICEF-funded study of 1,000 tube wells in Nawalparasi found that while the filters technically worked, people were not maintaining them properly, which then rendered them faulty and then, ultimately, useless. 

Little has been done to address the problem, in part because arsenic is not seen as a high priority for the government, said Pahari. 

“Microbial parasites are more important,” says Pahari. “Because if your kids have diarrhoea today, they’ll die tomorrow. But arsenic, of course, will take 10 years. It’s dangerous, but slow.” 

Prolonged exposure to unsafe levels of the metal arsenic in drinking water can lead to poisoning, or arsenicosis. 

Symptoms include skin problems, cancers of the skin, bladder, kidneys and lungs; diseases of the blood vessels of the legs and feet; and possibly, diabetes, high blood pressure and reproductive disorders - but the cancer can lay dormant without spreading for years, even decades, notes WHO. 

According to a senior engineer in the government’s Department of Water Supply and Sewerage (DWSS), Dan Ratna Shakya, arsenic is indeed a priority, but the government has lacked funding and the right technology to figure out what works best. 

What works? 

Pahari as well as Shakya said UNICEF and the government have both lagged in evaluating the filters, used for the past six years. 

DWSS has never conducted a comprehensive water quality testing programme before, said Shakya. 

“It’s not a one-time business. It should be periodical. But this is also linked to funding. There are so many… districts that are affected by arsenic and to go to each household for monitoring would be expensive.” 

Pahari said there is a plan to compare the efficacy of Sono filters produced in Bangladesh with locally produced Kanchan arsenic filters. 

Today, the Sono filter remains one of six technologies certified for sale in Bangladesh - one of the most affected countries worldwide in terms of arsenic-tainted drinking water, according to WHO; the Kanchan one failed local certification. 

Until there are scientific tests, Pahari said, he cannot pass judgment on the best way to contain the arsenic crisis, but those tests have languished, as has the government committee in charge of water quality. 

Deeper wells 

The government’s recently reconfigured National Water Quality Steering Committee has only in recent months started “thinking about” permanent solutions to solve arsenic contamination, said Ram Lakhan Mandal, the head of water quality at DWSS. 

“We thought the arsenic problem had been solved because of all these organizations that have implemented temporary mitigation measures like filters.” 

The committee, which includes 19 government and civil society members, has been “passive” and has not met in the past three years, said the government engineer Shakya. 

But things will change soon pledged Mandal. 

“In the past, everyone came for mitigation and they did as they wished. But there was no set distribution of responsibilities. Now we are defining what we must do: tube wells and piped deep boring.” 

The government is investing in a pilot project of “deep boring” wells that go at least 100m deep, below the arsenic threshold, estimated to be at most 55m deep in Nepal, according to Smith. 

An entire deep boring (up to 150m) and water tank (25,000 litres capacity) construction can cost $16,000, of which 20 percent is paid by the community, which is also responsible for building the water tank which funnels the water to village public taps. 

At one water tank construction site IRIN visited in a section of Nawalparasi known as Kunwar-Ward 13, villagers complained that without cash incentives, volunteers who were supposed to be building the tank were, instead, in their fields harvesting sugar cane. 

As permanent solutions still prove elusive, families continue to line up for subsidized filters, said Smith. 

“At the moment we have a waiting list of 700 [requests for] Sono filters,” said Smith. 

Since 2007, FFF has assembled and delivered up to 1,000 filters to households and schools in villages across the district, replacing Kanchan filters previously installed by FFF and DWSS - an example of how a solution can become part of a greater problem, noted Pahari from UNICEF. 

Poor coordination 

Pahari said the number of agencies working to fight arsenic is unclear - as well as the total aid invested in arsenic containment - and the government has little oversight. 

Mandal told IRIN a law in place for the past 20 years requires that any agency or NGO working in the water sector report its activities to the district office, which then informs DWSS. 

“But this is not happening,” he said, while his colleagues cited stumbling on a Japanese International Cooperation Agency (JICA)-funded project of which they were not aware that is raising awareness about arsenic contamination in Nawalparasi. 

“The government is not aware of how this money comes and how it goes. There are no reporting channels… JICA and ENPHO [local NGO, Environment and Public Health Organization ] have a mutual understanding, but they don’t pass on the information.” 

But a senior programme manager with ENPHO, which is implementing a 28-month $400,000 local capacity building project  for arsenic mitigation, said government officials at both the national and local levels had signed off on the project and have been apprised at every step. 

“We had informed [the water quality improvement and monitoring section at DWSS] about our project to responsible personnel there. As far as I know, the chief [of the section] has changed a few months back. At DWSS there are many staff, so it is important whom you had contact with.” 

Meanwhile, in Manari village in Nawalparasi, Smith and her NGO’s technicians visited the family of Ramesh Chaudhary, who died last November from stomach cancer at age 32, six months after his brother Ram Chaudhary, 40, died from similar causes. 

In 2011, arsenic levels in tube-wells in Manari were 600 ppb, 60 times the limit WHO deems safe to drink. 

FFF tested the water filter in use in front of surviving family members to quell their doubts as to its efficacy. Ramesh’s mother, widowed wife and son stood by as a technician tested the water. 

A slip of paper sensitive to arsenic fumes alters in colour to measure the metal in parts per billion. The result was clean, indicating arsenic at less than 10 ppb. 

As the group left the village, a 29-year-old man approached Smith and showed her what has become an image far too familiar in the district: dark spots blotting his chest, a visible symptom of arsenicosis. 

In an August 2011 survey by ENPHO in three sections of Nawalparasi, including Manari, 25 percent of those surveyed had similar symptoms. 

DWSS estimates solving the arsenic crisis here and elsewhere in the country, including the health fallout, will cost an estimated $18.6 million. 

mb/pt/cb

]]></body><pubDate>Fri, 27 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94734</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201270913280887t.jpg"/></td><td valign="top">PARASI 27 January 2012 (IRIN) - After the discovery of unsafe levels of arsenic in Nepal’s groundwater more than a decade ago, government officials and aid groups are finally taking a critical look at whether their efforts have made a difference.</td></tr></table>]]></content:encoded></item><item><title>BURUNDI: Fears of looming food shortage</title><pubDate>Fri, 27 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2011/201101120815280828t.jpg" />]]>BUJUMBURA 27 January 2012 (IRIN) - There are fears of a looming food shortage in Burundi after heavy rains damaged two successive harvests, say officials.</description><body><![CDATA[BUJUMBURA 27 January 2012 (IRIN) - There are fears of a looming food shortage in Burundi after heavy rains damaged two successive harvests, say officials.  

"More than half of the expected harvest was lost in flooding and siltation," Methode Niyongendako, a consultant with the UN Food and Agriculture Organization (FAO), said.  

The rains peaked in mid-September and November, exceeding forecasts in terms of volume and frequency, and were the heaviest since October 1961, according to households questioned, added Niyongendako.  

The most affected provinces include Gitega, Mwaro, Ngozi and Ruyigi, which have many rivers running through them.  

In Makamba, in the south of Burundi, at least 60 percent of the banana, cassava and maize crop was swept away, according to Salvator Sindayigaya, the agriculture provincial director, with the Kayagoro, Kibago, Makamba and Nyanzalac communes the most affected.  

The affected crop accounts for the country's June to December harvest, agriculture season C, which represents 15 percent of the annual production.  

According to the Famine Early Warning Systems Network (FEWS NET) [ http://www.fews.net/pages/remote-monitoring-country.aspx?gb=bi ], the persistence of banana bacterial wilt in the provinces of Cankuzo and Kirundo and the continuation of cassava mosaic disease have further undermined food availability.  

"In Cankuzo, food stocks for the poorest households are quickly depleting because the harvest from the 2011 C, mainly beans and maize, was lower than expected due to excess rains," added FEWS NET.  

At present, the Ministry of Agriculture and partners are assessing the production for season 2012 A, which ends in January and represents 35 percent of the total annual production.  

But there is little hope for good stocks as heavy rains, which started with the planting season in September 2011, continued throughout the cropping season.  

On 11 January, for example, some 45 hectares of crops were destroyed in Buganda, northwestern Cibitoke Province.  

"We were expecting a good harvest but hail destroyed all the crops of cassava and maize," said Ernest Ndayizeye, a local leader. "Our children will die of hunger."  

Rising prices and funding issues  In central Karuzi Province, Isaac Nimpagaritse, an agriculture official, noted that food prices had increased.  A kilogramme of beans is now selling for 800 francs (US$0.62), double the normal price, after the bean crop was damaged at the flowering stage.  

"If they [farmers] plant 50kg of beans they were normally getting 300kg [in harvests] but now they cannot even get [something] to eat. Many now have only a meal per day."  

Food scarcity has also been blamed for primary school drop-outs in Karuzi where 5,000 children left school in the first term of the 2011-2012 school year, according to education officials.  

In response, agriculture and administration officials are calling for help with planting material ahead of the next planting season B, expected to be harvested in June.  

But limited funding is a problem.  

"Emergency needs are not funded; what is provided for the intervention is well below the needs," said FAO's Niyongendako.  

A programme coordinator at the UN World Food Programme, Christian Nzeyimana, said: "There are no pledges; we live on voluntary contributions from donors.  "If the situation worsens with the results of the evaluation of season A, the gap might be even bigger and compromise other programmes." 

jb/aw/mw

]]></body><pubDate>Fri, 27 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94737</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2011/201101120815280828t.jpg"/></td><td valign="top">BUJUMBURA 27 January 2012 (IRIN) - There are fears of a looming food shortage in Burundi after heavy rains damaged two successive harvests, say officials.</td></tr></table>]]></content:encoded></item><item><title>OPT: Boosting protection and tackling food insecurity</title><pubDate>Fri, 27 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201271103120670t.jpg" />]]>RAMALLAH 27 January 2012 (IRIN) - The humanitarian community’s 2012-2013 Consolidated Appeals Process (CAP) for the occupied Palestinian territory (oPt) has a narrower scope than in previous years, focusing on two strategic objectives: improving the protective environment, including access to essential services like health care and education, and tackling food insecurity especially in areas where the Palestinian Authority (PA) has limited access.</description><body><![CDATA[RAMALLAH 27 January 2012 (IRIN) - The humanitarian community’s 2012-2013 Consolidated Appeals Process (CAP) [ http://www.ochaopt.org/documents/ochaopt_cap_2012_full_document_english.pdf ] for the occupied Palestinian territory (oPt) has a narrower scope than in previous years, focusing on two strategic objectives: improving the protective environment, including access to essential services like health care and education, and tackling food insecurity especially in areas where the Palestinian Authority (PA) has limited access.
 
Policies related to Israel’s occupation are still the main driver of serious protection and human rights concerns, according to the CAP.
 
The two-year aid strategy document requests US$416.7 million to implement 149 relief projects in 2012 (17 by local NGOs, 84 by international NGOs and 48 by UN agencies) in fields such as agriculture, water, sanitation and hygiene, cash for work, and food and cash assistance.
 
CAP tackles the most urgent humanitarian needs of 1.8 million vulnerable Palestinians in the Gaza Strip, Area C of the West Bank, East Jerusalem and the Seam Zone - the area between the “Separation Barrier” and the Green Line.
 
“Protecting and preserving the whole range of basic human rights are the focus of this CAP,” oPt Resident Humanitarian Coordinator Maxwell Gaylard told IRIN, including violations of international humanitarian law, and the right to dignity and a normal life.
 
Aid workers in oPt are looking to address the root protection problems that are creating humanitarian needs.
 
Displacement
 
Displacement remains a chief protection concern. Nearly 1,100 Palestinians (over half of them children) were displaced due to home demolitions by Israeli forces in 2011 - over 80 percent more than in 2010, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).
 
CAP programmes address this problem through shelter assistance, legal aid and by campaigning for Palestinian rights, in addition to protection presence programmes.
 
For example, the World Council of Churches sponsors the Ecumenical Accompaniment Programme in Palestine and Israel (EAPPI), bringing internationals to the West Bank to provide a protective presence for vulnerable Palestinian communities, where they monitor the conduct of Israeli soldiers and settlers.
 
The “global protection cluster working group” defines protection [ http://oneresponse.info/GlobalClusters/Protection/Documents/IDP%20Handbook_FINAL%20All%20document_NEW.pdf ] as activities aimed at obtaining full respect for the rights of the individual in accordance with human rights law, international humanitarian law and refugee law.
 
More than physical security, protection encompasses civil and political rights, such as the right to freedom of movement, the right to political participation, and economic, social and cultural rights, including the right to education and health.
 
In situations of conflict that obligation extends to all parties, and according to the UN, in the case of the oPt the state of Israel as the occupying power has an obligation under international humanitarian law to ensure the welfare of the Palestinian population.
 
Food insecurity
 
Some 30 percent of the Palestinian population in the West Banka and Gaza are food insecure, including more than half the Gaza population, according to the UN.
 
The root cause remains the loss of livelihoods and lack of income opportunities [ http://www.irinnews.org/report.aspx?reportid=93211 ] due to Israel’s blockade of Gaza, and its closure regime in the West Bank, according to the Appeal.
 
Aid workers in the region are seeking ways to enable Palestinians to meet their own needs, particularly after the World Bank, the International Monetary Fund and UNESCO announced in spring 2011 that PA institutions were prepared for statehood after the completion of the Palestinian Reform and Development Plan (PRDP - Palestinian Prime Minister Salam Fayyad’s ambitious two-year state-building plan).
 
Palestinian President Mahmoud Abbas’s September 2011 bid for statehood before the UN remains under consideration.
 
The CAP was developed in consultation with the PA, particularly the ministry of planning and administrative development, to ensure coherence with Palestinian development strategies, such as the PRDP. 
 
However, “the PA’s capacity to work as government is hindered by the Fatah-Hamas divide,” said minister of planning and administrative development Ali Jarbawi during the launch of the Appeal.
 
“Serious shortages of drugs - some life-saving - and medical disposables continue in Gaza, due to mistrust between Fatah and Hamas,” said World Health Organization head in Jerusalem Tony Laurance. “If this cannot be resolved, Palestinians may have to look to donors,” he said.
 
CAP funding requests for the oPt reached $804.5 million in 2009, after the Israeli Operation Cast Lead in Gaza, up from $452.2 million in 2008. The 2011 CAP for oPt called for $536.3 million.
 
However, three years after the end of Cast Lead, the UN Relief and Works Agency (UNRWA) has launched an emergency appeal for Gaza and the West Bank worth just over $300 million. [ http://www.unrwa.org/etemplate.php?id=1222 ]
 
“The emphasis on protection interventions is due to the nature of the humanitarian situation in the oPt,” UNRWA spokesperson Chris Gunness told IRIN. “This is very much a protection crisis, whereby access and movement are continuing to be eroded and vulnerability is on the rise,” he said.
 
Most UNRWA projects within the emergency appeal are also part of the CAP. 
 
es/cb

]]></body><pubDate>Fri, 27 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94740</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201271103120670t.jpg"/></td><td valign="top">RAMALLAH 27 January 2012 (IRIN) - The humanitarian community’s 2012-2013 Consolidated Appeals Process (CAP) for the occupied Palestinian territory (oPt) has a narrower scope than in previous years, focusing on two strategic objectives: improving the protective environment, including access to essential services like health care and education, and tackling food insecurity especially in areas where the Palestinian Authority (PA) has limited access.</td></tr></table>]]></content:encoded></item><item><title>HEALTH: The true burden of cancer</title><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2009/200911041028050170t.jpg" />]]>LONDON 26 January 2012 (IRIN) - Breast cancer continues to be misunderstood, under-diagnosed and fatal, particularly in developing countries, say researchers, despite more than one million official annual diagnoses and almost half a million recorded deaths annually.</description><body><![CDATA[LONDON 26 January 2012 (IRIN) - Breast cancer continues to be misunderstood, under-diagnosed and fatal, particularly in developing countries, say researchers, despite more than one million official annual diagnoses and almost half a million recorded deaths annually [ http://globocan.iarc.fr/factsheets/cancers/breast.asp ].  

Even with growing efforts from donors and health agencies to draw more attention to chronic non-communicable diseases [ http://www.irinnews.org/report.aspx?reportid=93756 ], awareness about cancer still lags, said Sara Stulac, clinical director in Rwanda for the US-headquartered Partners in Health NGO.  

"Just bringing up the fact that there are children suffering from cancer in Rwanda, the reaction I often get is 'Oh, cancer - Africa - I never thought about that'."  

"We're victims of our own success, which is very good news," Harvard University's director of Global Equity Initiative, Felicia Knaul, told IRIN, referring to declining numbers of deaths from some communicable diseases in developing countries.  The downside of that success is, "You go on to live through other risks and get other diseases", she added.  

The World Health Organization's (WHO) International Agency on Research on Cancer [ http://globocan.iarc.fr/ ] estimated in 2008 that breast cancer was the most frequently officially diagnosed cancer among women, with an estimated 1.38 million cases.  

It was also the most frequently reported cause of death by cancer for women.  

Eighty percent of up to 3.7 million of deaths by cancer - all types - are reported in developing countries, according to recent research Knaul co-authored with the [ http://ghsm.hms.harvard.edu/uploads/pdf/ccd_report_111027.pdf ] Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries at Harvard University. 

Costly care  

Women who reached Rwinkwavu Hospital in Kayonza District in eastern Rwanda, where Stulac works, may have already unsuccessfully sought care elsewhere - often at informal or ill-equipped health centres, she added.  As a result, they frequently arrive at hospital with advanced stages of breast cancer that are harder, more expensive and more painful to cure, said Stulac. 

An estimated 70-80 percent of breast cancer cases are diagnosed at late stages in lower- and middle-income countries, according to Knaul.  But even with early diagnosis, breast cancer can mean a painful and debilitating death in cash-strapped countries where specialists are few and costs are high, said Stulac.  

"Over the course of just seeking a diagnosis, [patients] have depleted their family's resources."  

Cancer prevention and awareness campaigns are infrequent in low-income countries. And when cancer is diagnosed, treatment options can often include palliative care, which is scarce, expensive and stigmatized, according to 2011 oncology research. [ http://www.futuremedicine.com/doi/abs/10.2217/fon.11.101 ].  

The Vienna-based International Narcotics Control Board says 90 percent of the world's opiate supply for pain relief is consumed in the most developed countries, leaving little for poorer countries. [ http://www.incb.org/pdf/annual-report/2010/en/supp/AR10_Supp_E.pdf ]  

Gathering data  

Knaul urged combating disease with data. "We have to help women to diagnose more, even when we don't have good access to treatment because that's how we'll get to know that the disease exists."  

Since 1980, breast cancer cases globally have risen annually by 3.1 percent on average, according to recent reports [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61351-2/abstract ], and continued rises are predicted by WHO.  

As a complex group of diseases for which there are few national registries, and ones that lack access to diagnostics and treatment, cancer's true burden remains unknown in many developing countries.  

"We need to research at a very basic level of understanding what the disease looks like. We need better data," said Stulac. 

Knaul's report called for public health systems to boost cancer detection alongside anti-poverty, maternal and child health, sexual and reproductive health and HIV/AIDS programming. [ http://www.irinnews.org/report.aspx?reportid=93768 ]  

Breast cancer clinical trials in lower and middle-income countries can help boost tracking and prevention - sorely lacking and almost non-existent in some places, said Ismail Jatoi, chief of surgical oncology at the US-based Texas University Health Science Centre.  "Conducting trials in these countries is a way of setting up infrastructure within [health] centres that are conducting trials."  

While an estimated eight out of 10 cancer cases worldwide are diagnosed in poorer countries, research there only attracts 5 percent of global cancer funding, according to the Global Task Force on Expanded Access to Cancer Care and Control.  

"When research and science have helped us come up with newer and better medications, one of our goals should be to advocate for bringing those medications not just [to] rich people, but [to] poor people as well," said Stulac.  

oja/pt/mw

]]></body><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94726</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2009/200911041028050170t.jpg"/></td><td valign="top">LONDON 26 January 2012 (IRIN) - Breast cancer continues to be misunderstood, under-diagnosed and fatal, particularly in developing countries, say researchers, despite more than one million official annual diagnoses and almost half a million recorded deaths annually.</td></tr></table>]]></content:encoded></item><item><title>INDONESIA: Bird flu deaths raise red flags</title><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2009/200911221029060546t.jpg" />]]>JAKARTA 26 January 2012 (IRIN) - Two recent deaths from bird flu in Indonesia highlight the need for continued vigilance against a possible resurgence of the deadly virus, an official and health expert warned.</description><body><![CDATA[JAKARTA 26 January 2012 (IRIN) - Two recent deaths from bird flu in Indonesia highlight the need for continued vigilance against a possible resurgence of the deadly virus, an official and health expert warned. 

On 16 January, a five-year-old girl from northern Jakarta died after being tested positive for the H5N1 bird flu virus. She was a relative of a 24-year-old man who died on 7 January, the World Health Organization (WHO) said, adding that the two had contact with the same pigeons in their neighbourhood. 

According to WHO, the latest fatalities brought the death toll from avian influenza in the country to 152, out of 184 confirmed cases since 2006. 

The Health Ministry's director-general of disease control and environmental health, Tjandra Yoga Aditama, said there was no evidence that human-to-human transmission was involved in the latest case. 

"As long as there are still birds carrying the virus, there will be cases of bird flu in humans from time to time," Aditama told IRIN. 

In 2011, there were 11 cases in Indonesia, and 60 in the world, Aditama said.

"We have to continue to maintain our vigilance," Aditama said. "The Indonesian government is taking the threat of bird flu seriously and is taking measures like countries in other parts of the world." 

Coordination 

But Marius Widjajarta, chairman of the Indonesian Consumer Empowerment Foundation for Health (YPKKI), cited a lack of coordination among different government departments as hampering efforts to contain its spread. 

"We can see that the Health Ministry, the Agriculture Ministry and local governments are doing their own things," Widjajarta told IRIN. "What if there was a pandemic?" 

"All parties concerned must cooperate to promote changes in people's behaviour and attitude towards the threat of bird flu," he added. 

Public awareness campaigns were done sporadically, he said, and official reporting of bird flu cases in poultry has been spotty. 

The Health Ministry said bird flu was endemic in poultry in all but three of Indonesia's 31 provinces. The ministry has designated 100 hospitals across the archipelago nation as being well-equipped to treat bird flu patients. 

According to WHO, 344 people in 12 countries have died of bird flu since 2003, with Indonesia reporting the most fatalities. [ http://www.who.int/influenza/human_animal_interface/EN_GIP_20120124CumulativeNumberH5N1cases.pdf ] 

WHO said so far, transmission of H5N1 viruses from animals to humans had only resulted in sporadic human cases or small clusters among close contacts, with no evidence of community-level spread. 

"These sporadic human cases and small clusters of human infection with variant influenza viruses are expected and are not considered unusual, and do not change WHO's current assessment of pandemic risk," WHO said in a statement released in December. [ http://www.who.int/influenza/human_animal_interface/avian_influenza/h5n1-2011_12_19/en/index.html ] 

ap/ds/mw 

*This report was updated on the 31 January 2012

]]></body><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94727</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2009/200911221029060546t.jpg"/></td><td valign="top">JAKARTA 26 January 2012 (IRIN) - Two recent deaths from bird flu in Indonesia highlight the need for continued vigilance against a possible resurgence of the deadly virus, an official and health expert warned.</td></tr></table>]]></content:encoded></item><item><title>EGYPT: Anti-bird flu campaign planned</title><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2008/200801131t.jpg" />]]>CAIRO 26 January 2012 (IRIN) - A nationwide campaign to stop the spread of H5N1 avian influenza in Egypt is to be launched by the government in a few weeks, say officials, but details are still sketchy.</description><body><![CDATA[CAIRO 26 January 2012 (IRIN) - A nationwide campaign to stop the spread of H5N1 avian influenza in Egypt is to be launched by the government in a few weeks, say officials, but details are still sketchy.

The new plan, which will involve coordination between the Health Ministry, the Agriculture Ministry and poultry producers, requires close monitoring and various bio-safety measures.

“These measures are just a small part of a more general plan to curb the spread of the virus in our country,” Saber Abdel Aziz, a senior official from the state-run General Organization for Veterinary Services, told IRIN. “We will also offer incentives to poultry growers to look for signs of illness in their animals, report sick ones, and practice bio-security.”

H5N1 has infected 159 and killed 55 people in Egypt since 2006.

The most recent fatalities occurred on 19 January 2012 - [ http://www.who.int/csr/don/2012_01_19b/en/ ] a two-year-old girl from Cairo, and a 31-year-old man from Fayoum Governorate in the Nile Delta. Epidemiological investigations indicated they had both been exposed to backyard poultry.

Abdel Aziz and his colleagues at the General Organization for Veterinary Services say they will work hard to prevent this from happening again by applying bio-security prevention measures.

“Taking commonsense precautions to prevent the disease from coming onto a farm is a cornerstone of keeping the poultry healthy,” he said. “But apart from these commonsense precautions, we will give training to poultry farm workers, make basic infection control, and promote the use of personal protective equipment.”

Aziz said, however, that funding for the plan was still being negotiated with the Finance Ministry.

The latest two avian flu deaths, along with a Health Ministry announcement that 2011 saw the highest number of H5N1 infections ever, has created anxiety across the country. The ministry said 40 people had contracted the virus in 2011, up from 23 in 2010. More shocking still, 16 of the 40 who contracted the virus last year died.

Ineffective government?

Amr Qandeel, head of preventive medicine at the Health Ministry, attributed the rise in virus infections to a weakening supervisory role of the government.

Exactly a year has passed since the start of the Egyptian uprising. During this time there have been three different health ministers; widespread strikes and political unrest; and the police have been either in a degree of  disarray or preoccupied with containing demonstrations: Tackling H5N1 and enforcing bio-safety measures has inevitably, therefore, not been a top government priority.

In 2010, the government took measures to curb bird flu infections, including banning inter-governorate poultry movements and acting against poultry breeders who did not abide by the declared safety measures. But independent health experts like Saeed Aun say more needs to be done.

Egyptians, particularly in poor districts and the countryside, rear chickens and other animals at home. Aun describes this home breeding of birds as “risky”. Unlicensed poultry farms - numbering around 40,000 - are also a challenge.

“These are places the government does not reach,” Aun said. “This means that any talk about preventive measures will be futile as long as this very large number of farms is not part of the process.”

ae/eo/cb

]]></body><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94728</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2008/200801131t.jpg"/></td><td valign="top">CAIRO 26 January 2012 (IRIN) - A nationwide campaign to stop the spread of H5N1 avian influenza in Egypt is to be launched by the government in a few weeks, say officials, but details are still sketchy.</td></tr></table>]]></content:encoded></item><item><title>COTE D&apos;IVOIRE: Government scraps free health care for all</title><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201261102520386t.jpg" />]]>ABIDJAN 26 January 2012 (IRIN) - Côte d&apos;Ivoire is abandoning free health care for all after a brief experiment because of skyrocketing costs.</description><body><![CDATA[ABIDJAN 26 January 2012 (IRIN) - Côte d'Ivoire is abandoning free health care for all after a brief experiment [ http://www.irinnews.org/report.aspx?reportid=93290 ] because of skyrocketing costs. 
 
“In nine months the government had to pay 30 billion CFA francs [about US$60 million] under difficult circumstances," Ivoirian Health Minister Yoman N'dri said in Abidjan on 24 January.
 
As of February, the free service would only be available to mothers and their children. Specifically, this will mean free care for deliveries and free treatment for diseases affecting children under six years old. Consultation fees would drop from 1,000 CFA francs to 650 francs CFA ($2-1.5).
 
Aid organizations say the government move is understandable given the country’s recent political turmoil. "As long as women and children continue to receive care we are satisfied because they are among the most vulnerable," said Louis Vigneault-Dubois, head of communications for the UN Children’s Fund (UNICEF) in Côte d'Ivoire.
 
"Women and children are often exposed to diseases and with so many families living in poverty this is already a major problem solved for them,” said Zana Sanogo, executive director of Community Health and Development, a local NGO collaborating with the UN Office for the Coordination of Humanitarian Affairs.
 
Theft, poor management and rising costs have made the service - introduced by President Alassane Ouattara’s government at the end of civil conflict to ease a dire public health situation - unaffordable. 
 
Health Minister N’dri said implementation of the service had been poorly planned, and the Public Health Pharmacy, the state’s central body for distribution of medical supplies throughout the country, had just 30 percent of its required stock, much of which had been pilfered.
 
"From the start some nurses and doctors, under the pretext of providing free health care, had been taking drugs home which they would then sell,” said Florantin Yao, staff nurse at the government-run Port-Bouët General Hospital in the south of Abidjan.
 
The Ministry of Health says 20 doctors and nurses have been “severely punished”. One received a two-year prison term. 

Community health analyst and consultant Issouf Ouattara said free health care would have been more viable had health authorities spellt out details of the policy. "We fear that practitioners and patients continue to misunderstand the free health care policy. Medical consultation and drugs should be free,” he added.
 
aa/oss/cb

]]></body><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94729</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201261102520386t.jpg"/></td><td valign="top">ABIDJAN 26 January 2012 (IRIN) - Côte d&apos;Ivoire is abandoning free health care for all after a brief experiment because of skyrocketing costs.</td></tr></table>]]></content:encoded></item><item><title>UGANDA: Basua community battles for survival</title><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201261331170493t.jpg" />]]>BUNDIMASOLI 26 January 2012 (IRIN) - The marginalized western Ugandan Basua community is fighting extinction; forcibly removed from their forest home two decades ago, they have struggled to cope with modern life and have been ravaged by health crises, including HIV.</description><body><![CDATA[BUNDIMASOLI 26 January 2012 (IRIN) - The marginalized western Ugandan Basua community is fighting extinction; forcibly removed from their forest home two decades ago, they have struggled to cope with modern life and have been ravaged by health crises, including HIV. 

Uganda has two indigenous forest communities - the Batwa people of the southwest, a larger group originally from Rwanda and Burundi, and the Basua in the west who came from the neighbouring Democratic Republic of Congo (DRC). Already marginalized for their short stature and for being traditional forest dwellers, the Basua have continued to receive less assistance than the Batwa because they are more geographically isolated and have a smaller population, numbering just 100. 

Forced resettlement 

Western Uganda's Semliki Forest - the historical home of the Basua - became a National Park in 1993, and as a result, the community has lost its hunter-gatherer existence; they now have to request permission to fish and collect medicinal herbs and firewood, and are forbidden from hunting. 

The Basua have been moved around ever since, most recently to a village outside the small trading town of Bundimasoli in 2007, after a local NGO won a grant from the European Union to build a village for them, but the project collapsed under corruption allegations before it was completed. The community still has no clear rights to the land where it was resettled, and struggles to access basic services such as clean drinking water and healthcare. 

"Imagine someone is used to maybe going to the office, working, making phone calls, going to the ATM, withdrawing money... then you dump them in the forest instead," said Fred Lulinaki, a programme director at the East and Central Africa Association for Indigenous Rights (ECAAIR). “If they survive, it will be just by luck." 

Some Basua men and women find casual jobs such as hauling wood, but most sit around the village with nothing to do. Some have turned to alcohol. Of the 40 children, Lulinaki said only two attend school, either because they are orphaned or their parents cannot afford the cost of pens and school fees. Fifteen of the community's children are orphans. 

HIV 

Ezekiel Mugisa, local coordinator of the Organisation for the Survival of the Basua (OSIBA), said the first documented case of HIV among them was in 1985, but the virus really established a foothold when the Allied Democratic Forces - a Ugandan rebel group - launched a movement to overthrow the Ugandan government for the DRC in the mid-1990s. The Ugandan troops sent to fight the insurgents set up camp near the Basuas’ home; soldiers and suppliers offered money and goods in exchange for sex with Basua women, or raped them. 

Rumours have long circulated in Uganda that sex with Basua women cured back pain and HIV. Stan Frankland, an anthropologist at Scotland's University of St Andrews, has been working with and advocating for the community since he first visited them as a tourist in 1990. He helped establish OSIBA. 

Frankland said the myths stemmed from a belief that as forest dwellers, the Basua "have some spiritual aspect to them. That they're not fully human... they might transmit this power." 

Even with the troops gone and education campaigns debunking supposed AIDS cures, transactional sex remains common. For many women, it is the only viable way of supporting themselves. HIV is a secondary concern to getting enough to eat. 

There are no official statistics on HIV prevalence among the Basua, but those who do know they are HIV-positive have limited access to, or knowledge about, treatment. Since Save the Children pulled out recently, the nearest source of treatment is a health centre 20km away - few of the Basua can afford the transport costs. Even when they did have access to ARVs, there was no formal process to teach people why the drugs were important or how to take and store them. Instead, many would trade the drugs for food, according to Mugisa. 

"The [Basua] are dying," said Basua King Geoffrey Nzito, who had just concluded a burial ceremony. "I want people to join hands so at least they can come to a solution that is good for us." 

Powerless 

The Basuas’ situation mirrors the problems indigenous groups around the world are facing, says Rebecca Adamson, president and founder of First Peoples Worldwide (FPW), a group that makes small, direct grants to indigenous groups to help carry out livelihood projects that they design and develop. 

Adamson said she had seen many indigenous groups kicked off land they had lived on and cultivated for hundreds of years, so that governments and companies could access it for mining, industry or tourism. Once they are displaced, there is little funding to help the groups integrate into life outside the forests. 

The funding that exists is often driven by NGOs without the input of the indigenous people, so they "remain at the whims of what western society wants for them instead of what they want for themselves", she said. 

Adamson is afraid that "we will be seeing large-scale extinction of certain groups" like the Basua. 

ECAAIR is seeking funding to launch livelihood projects for the Basua community that build on the skills they have from life in the forest – fishing, bee-keeping, growing garlic - and turning them into sustainable businesses. As they wait for funding, association members have already started teaching basic bookkeeping classes to the community. 

"This skills training is aimed at reducing vulnerability and dependence, which will also reduce the HIV and AIDS," Lulinaki said. 

Frankland is also encouraging the community to be more active about protecting their health. In December he led a discussion about the dangers of transactional sex. The lesson seems to have stuck. Since the beginning of the year, Nzito said he and other members of the community have been driving away the men who come at night seeking out Basua women. 

It is a small step, but the community also urgently requires access to HIV treatment and education; other health crises – mainly malnutrition and untreated malaria - are also affecting the community. 

Frankland said the Basua acknowledged their fear that the community would soon die out. "There are only 100 of them. If you can't save 100 people, how are you going to make it work on a larger scale?" 

ag/kr/mw

]]></body><pubDate>Thu, 26 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94732</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201261331170493t.jpg"/></td><td valign="top">BUNDIMASOLI 26 January 2012 (IRIN) - The marginalized western Ugandan Basua community is fighting extinction; forcibly removed from their forest home two decades ago, they have struggled to cope with modern life and have been ravaged by health crises, including HIV.</td></tr></table>]]></content:encoded></item><item><title>YEMEN: Little hope of swift return for Abyan IDPs</title><pubDate>Wed, 25 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2011/201110270718240391t.jpg" />]]>ADEN 25 January 2012 (IRIN) - When Abdullah al-Hasani, 55, fled his home in the Khanfar District of Yemen’s Abyan Governorate eight months ago, he hoped some day to return and grow watermelons.</description><body><![CDATA[ADEN 25 January 2012 (IRIN) - When Abdullah al-Hasani, 55, fled his home in the Khanfar District of Yemen’s Abyan Governorate eight months ago, he hoped some day to return and grow watermelons.
 
But on a visit there in January he found nothing left of his two-storey home and his watermelon farm - the family’s sole source of income - had become a wasteland.
 
“I never expected to see our home in this condition. It is almost completely destroyed and our furniture has been looted,” al-Hasani told IRIN. “Our watermelon farm is littered with spent cartridges and unexploded devices.” 
 
Al-Hasani is one of some 2,500 [ http://yementimes.com/defaultdet.aspx?SUB_ID=35102 ] internally displaced persons (IDPs) who went back to Abyan in mid-January to check on their property and belongings.
 
After the visit, the IDPs returned to Aden, where they have been sheltering since May 2011 following clashes between government troops and armed Islamic militants (mainly Ansar al-Sharia, an offshoot of al-Qaeda in the Arabian Peninsular).
 
According to the government’s Executive Unit for IDP Camp Management, more than 144,000 people have been displaced in southern Yemen since May 2011. [ http://reliefweb.int/sites/reliefweb.int/files/reliefweb_pdf/node-457544.pdf ]
 
Local sources told IRIN armed Islamic groups allowed the IDPs to enter Zinjibar city, the main militant stronghold, and other neighbouring areas. 
 
“We were received warmly by the militants - behaviour we have never seen before,” said Abdulkhaliq Abu Omar, a secondary school teacher in his thirties. “We fear they [militants] just want to seduce us to return and then use as human shields,” he told IRIN.
 
According to IDPs, armed militants and the army share control of Zinjibar city, and in some areas the two warring sides are only metres apart, making further clashes a distinct possibility.
 
Nadheer Kandah, a local journalist who accompanied the IDPs on their journey to Abyan, described Zinjibar as a ghost town, with all shops shut and no water or electricity. 
 
“A number of streets and neighbourhoods are no-go areas because of landmines,” he said. 
 
Compensation unlikely
 
“Our home is a wreck… Our grocery [the family’s sole source of income] has been burned down… How can we survive if we return?” asked Ali Saif, a 35-year-old IDP sheltering with his eight-member family in 22 May School in Aden.
 
“We will not return unless our homes are reconstructed and unless we receive compensation for our livelihood sources, which we lost, and unless security is restored… It is too early for us to think about homecoming.”
 
Edward Leposky, external relations officer with the UN Refugee Agency (UNHCR), told IRIN there has been no assessment of the dangers of mines and other unexploded devices in the Abyan area. The agency, he added, was monitoring developments and continuing to campaign for improvements on the ground to permit a safe return.
 
According to Ghassan Faraj, secretary-general of Zinjibar local council, the destruction of citizens’ homes and other property is huge. “No assessment has been conducted yet, but we can say that several hundred homes and farms have been damaged or destroyed, most notably in Zinjibar and Jaar cities,” he said. 
 
“The government hasn’t compensated Sa’dah IDPs displaced since 2004 [due to fighting between government forces and Houthi rebels]. This makes us pessimistic that it can do so in Abyan to prompt the return of IDPs," Faraj told IRIN.
 
Yemen is due to hold presidential elections on 21 February as part of a deal brokered by Gulf states to end a year of political turmoil that has left hundreds dead.
 
ay/eo/cb

]]></body><pubDate>Wed, 25 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94716</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2011/201110270718240391t.jpg"/></td><td valign="top">ADEN 25 January 2012 (IRIN) - When Abdullah al-Hasani, 55, fled his home in the Khanfar District of Yemen’s Abyan Governorate eight months ago, he hoped some day to return and grow watermelons.</td></tr></table>]]></content:encoded></item><item><title>SOUTH SUDAN: Building a blood bank</title><pubDate>Wed, 25 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201251109040186t.jpg" />]]>JUBA 25 January 2012 (IRIN) - A small fridge in the corner of Juba Teaching Hospital’s laboratory is the only blood bank in South Sudan, the world’s newest nation with some of the worst health statistics in the world.</description><body><![CDATA[JUBA 25 January 2012 (IRIN) - A small fridge in the corner of Juba Teaching Hospital’s laboratory is the only blood bank in South Sudan, the world’s newest nation with some of the worst health statistics in the world. 

Health workers say a lack of blood is the main cause of mortality at the country’s main but extremely under-resourced hospital, and they face the anguish of having to watch patients who could be saved die. 

“Sometimes they bleed until they die and we cannot do anything about it,” said Wani Mena, head of the hospital. “The first cause, the major cause, of maternal mortality in our department is bleeding,” said Chuol Kuma, an obstetrics and gynaecology consultant. 

While the rest of the hospital is sometimes left for days without power due to frequent cuts, capacity to keep more blood is hampered by only having a small fridge in the laboratory - the only room with a back-up generator. 

“The blood bank we have is a very small refrigerator. It only takes around 50 units of blood. This is not enough,” Kuma said. 

A 20-year-old mother of two recently died after suffering complications from a late miscarriage. “She needed an immediate blood transfusion and she needed blood and then she got the blood late and died,” he said. 

This woman, like many others who enter the hospital, was already anaemic. 

“The need for blood is so great in this place because of injuries. Anaemia is one of the most common presentations to our hospitals, both of women who are pregnant and for those who have malaria... and sometimes they die from it,” said Mena. 

Fight for blood 

But most of the time, the small amount of blood in the family-sized fridge cannot be touched even in emergencies, as it has been donated for specific patients due for surgery. 

“Currently the system that exists is that somebody gets sick, relatives come and donate blood. That is not a good system. We should have a stock of blood that we can give to any patient in need of it, and immediately,” said Mena.

Cultural taboos and a lack of awareness about the risk-free benefits of giving blood also mean that getting relatives to give blood to save a life is often a struggle that staff do not win. 

“In some tribes, somebody cannot, for example, give blood to his in-law, or somebody cannot receive blood from a foreigner, things like that,” said lab supervisor Charles Stanley Mazinda. 

Other staff say families avert their eyes or want to know their loved one will make it before committing themselves. Amin Gerald, a nurse at Torit Hospital, about four hours’ drive from Juba, said he had come to give blood for his wife. 

He understands the importance of giving blood, but would not do it for a stranger. 

Gerald says he often comes across people who believe that giving blood will make them ill or weaken them, or that blood should never be mixed as it could kill the patient.  

But Mazinda said that when there is an emergency, people rush to the laboratory expecting blood, only to find it cannot be touched. 

Fighting fear 

Technician Charity Ritti said the laboratory used to divert blood to emergency patients whose relatives promised to donate afterwards, but when they did not come back, staff faced a backlash from donors.   

“The owners of the blood will come and quarrel and sometimes they even want to beat us,” she said. 

Ritti is concerned that often the bank only has one unit of key blood types, such as O-negative, but says changing people’s mindsets to build up reserves is extremely difficult. 

“They are afraid of donations - we have people coming here from Kenya, Uganda and Khartoum [Sudan] and giving blood... but our people here cannot face free donations,” she said. 

“Sometimes we screen them, then we say go and have breakfast and they never come back,” she said. 

Changing attitudes Hospital staff say awareness campaigns and better medical education are needed, among the huge challenges facing a nation where only 16 percent are literate and very few have access to health facilities. Even local doctors admit they too are scared to donate. 

“There’s just not a lot of cultural education about giving blood and still being healthy. I think in the US and UK and Europe we are very educated about that,” said Matthew Fentress, an American doctor working at Juba Hospital. 

In addition, Mazinda said getting people to the blood screening stage was a challenge, as people feared finding out they were HIV-positive. 

“Sometimes we screen some blood donors, and when they are [HIV-]positive, we tell them to go to the VCT centre down the road, but some of them don’t reach there [and flee],” he said.  

Bridging the gap The government is planning to build a national blood bank here this year that will hold up to 200 pints (113 litres). 

Meanwhile, doctors from the Harvard Initiative in Massachusetts have set up a “virtual blood bank” to try to beat storage and power problems. 

The bank is made up of a database of pre-screened volunteer donors who are willing to come in and replace a unit of their blood type. 

Fentress said this would free up blood for emergencies and when the hospital cannot get blood from patients’ friends and families. 

“Right now we’re really focused primarily on foreigners, as their attitudes are already changed,” he said. 

The hospital is advertising on the internet and in community centres, such as churches, until a government campaign hopefully ensures South Sudan’s first “real” blood bank is filled. 

“It is just the beginning and I hope it will succeed. But I think they need assistance from the communities. There must be medical education or health education for the communities so that they accept to come and donate freely so that we may have enough blood in our blood bank,” said Kuma.  

hm/mw

]]></body><pubDate>Wed, 25 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94719</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201251109040186t.jpg"/></td><td valign="top">JUBA 25 January 2012 (IRIN) - A small fridge in the corner of Juba Teaching Hospital’s laboratory is the only blood bank in South Sudan, the world’s newest nation with some of the worst health statistics in the world.</td></tr></table>]]></content:encoded></item><item><title>PAKISTAN: Malnutrition undermining battle against polio</title><pubDate>Mon, 23 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201201314570935t.jpg" />]]>LAHORE 23 January 2012 (IRIN) - A sense of despondency, perhaps even desperation, has been encountered in official Pakistan health circles as 192 cases of polio were reported in 2011, according to the Global Polio Eradication Initiative, despite the launch of a National Emergency Action Plan for Polio Eradication at the start of the year</description><body><![CDATA[LAHORE 23 January 2012 (IRIN) - A sense of despondency, perhaps even desperation, has been encountered in official Pakistan health circles as 192 cases [ http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx ] of polio were reported in 2011, according to the Global Polio Eradication Initiative, despite the launch of a National Emergency Action Plan for Polio Eradication [ http://www.thenews.com.pk/TodaysPrintDetail.aspx?ID=27528&Cat=2 ] at the start of the year. 

The plan was launched after 144 cases [ http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx ] were recorded in 2010 - the highest in any nation in the world. The president announced at the time that the purpose was to make the nation “polio free”. 

The initiative, however, has not been successful, with more incidents of polio reported, and a complete failure to match the success [ http://www.polioeradication.org/ ] of neighbouring countries such as India, which this month completed its first 12-month period without a single case of polio.

The national coordinator of the prime minister’s Polio Eradication and Monitoring Cell, Altaf Bosan, told IRIN from Islamabad that while the programme was an “extensive and elaborate one”, the poor figures showing up were a result of “refusals by households” to have children vaccinated, mainly due to a lack of awareness. 

Chairing a meeting [ http://www.pakistantoday.com.pk/2011/11/pm-warns-officials-showing-laxity-in-polio-eradication/ ] in November on polio eradication, as it became clear that the figures for 2011 would be higher than for 2010, the prime minister said officials failing to deliver should be “sacked rather than transferred”. 

But there has been emerging evidence that the problem of eradicating polio may be more complex than simply a matter of “refusals” or administrative laxity. 

Chairperson and Professor of Paediatrics and Child Health at the Aga Khan University Hospital (AKUH) in Karachi Anita Zaidi told IRIN: “Malnutrition among children in our country is a significant factor in the problems with the anti-polio campaign.” She said data from India and some data “that had not yet been published but had been shared with the WHO [World Health Organization]” from Pakistan showed that the immune response to polio vaccinations was about four percent lower in malnourished children than in nourished ones. “With some 40 percent of our children undernourished, this means a large number may not be responding adequately,” she said. 

According to official figures, Pakistan has 25 million children under five.

Poor campaigns

Zaidi, who is an expert in infectious diseases, also said the problem was aggravated due to poorly run campaigns which meant all children did not get all doses of the polio vaccine. “When only four or five doses are received rather than the full seven, there is a greater chance of a lack of response, especially among poorly nourished children.” 

She said there was a need to improve campaign quality and also focus on routine vaccination campaigns as a whole, protecting children against various preventable diseases, rather than focusing exclusively on offering vaccination against polio. 

“Because of the concentration on polio, the routine vaccination levels have really slipped and this affects children very badly,” she said. ”The polio drops must be administered as part of the full immunization plan,” she said. 

Jehanzeb Khan, health secretary in Punjab Province, where eight cases of the virus were detected this year, told IRIN: “Experts are looking at the possibility that a poor immune response caused by malnutrition may be a factor in the cases.” He said polio had occurred among children who had received multiple vaccine doses. 

The problem of vaccines not working due to widespread malnutrition has been taken up by medical professionals studying the polio epidemic in Pakistan. At a seminar at AKUH in Karachi, widely reported in the media [ http://tribune.com.pk/story/319424/a-drop-in-the-bucket-polio-campaigns-fail-because-of-malnutrition/ ] paediatric specialists discussed the problem in depth, with Zulfiqar Ali Bhutta, chief of the Division of Women and Child Health at AKUH, stating that the finding that 24 percent of polio cases reported in the country till November 2011 occurred among vaccinated children needed to be investigated further. 

“Malnutrition, Vitamin A deficiency, and diarrhoea in children, could be the reasons why the vaccines were ineffective. It is twice as likely that the polio vaccine does not convert in malnourished children,” Bhutta said.

Malnutrition has been identified as a major problem among children, notably in Sindh Province, [ http://www.irinnews.org/report.aspx?reportid=93365 ] but also exists elsewhere in the country. 

Food insecurity

Baseer Achakzai, the national nutrition focal person at the National Institute Health in Islamabad, told IRIN a recent survey conducted by the Ministry for Health in collaboration with AKUH had found 60 percent of the population was food insecure. “Yes, food insecurity and malnutrition are growing. Poverty is certainly a factor but there has also been a failure to put adequate policies in place,” Achakzai said. 

The impact of widespread malnutrition on the problems Pakistan is facing with its polio campaign are only now beginning to be discussed. “We see so many cases of diarrheoa, but the root cause behind this is malnutrition. Polio drops administered during a bout of diarrhoea may simply leave the system and not work,” Afzal Ahmed, a paediatrician based at a private hospital in Lahore, told IRIN.

And there is no sign the polio menace is at an end. The first case in 2012 [ http://www.dawn.com/2012/01/16/fresh-case-this-time-in-lahore-polio-another-blow-to-health-dept-after-dengue.html ] was reported this month from Lahore, bringing growing concern over what the figure will be by the end of the year.

kh/cb

]]></body><pubDate>Mon, 23 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94700</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201201314570935t.jpg"/></td><td valign="top">LAHORE 23 January 2012 (IRIN) - A sense of despondency, perhaps even desperation, has been encountered in official Pakistan health circles as 192 cases of polio were reported in 2011, according to the Global Polio Eradication Initiative, despite the launch of a National Emergency Action Plan for Polio Eradication at the start of the year</td></tr></table>]]></content:encoded></item><item><title>HEALTH: Learning from Saudi experience on risks of mass gatherings</title><pubDate>Mon, 23 Jan 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201201231347140455t.jpg" />]]>LONDON 23 January 2012 (IRIN) - The world’s great mass gatherings - from religious pilgrimages like the annual Haj to Saudi Arabia and India’s huge Kumbh Mela, to major sporting events like the Olympic Games and the Football World Cup - present important health challenges to organizers and participants alike.</description><body><![CDATA[LONDON 23 January 2012 (IRIN) - The world’s great mass gatherings - from religious pilgrimages like the annual Haj to Saudi Arabia and India’s huge Kumbh Mela, to major sporting events like the Olympic Games and the Football World Cup - present important health challenges to organizers and participants alike. 

Now, with London expecting more than five million visitors to attend Olympic events there this summer, the British medical journal, the Lancet, has published a special series of studies [ http://www.thelancet.com/series//mass-gatherings ] on mass gatherings and global health.

Every mass gathering is a medical disaster waiting to happen, each with its own particular selection of risks. The winter Olympics brings people together from all over the world, usually at the peak of the northern hemisphere’s annual flu season, and after a couple of weeks of close contact, disperses them back to their own countries. 

The Haj attracts pilgrims from some of the world’s poorest countries, with poor disease surveillance and inadequate health care. In addition, many of them may be old or sick, but desperately anxious to fulfil their religious duty before the end of their lives. 

In India, the Kumbh Mela has less of an international dimension but can bring together as many as 60 million people and involves mass bathing in the holy, but not necessarily very clean, River Ganges.

The biggest pop and rock music festivals bring the additional hazards of drink and drugs, and young people camping in muddy fields with more interesting things on their minds than hand washing and proper sanitation.

Sharing expertise, exploiting technology

Now a new public health specialty is developing around these major international events, allowing organizers to share their expertise, and exploit new technologies to manage risk and track disease outbreaks in real time. 

A common thread in the Lancet papers is a stress on the need for international collaboration, and a move away from the old definition of mass gathering medicine as “concerned with the provision of emergency medical care at organized events with more than a thousand people in attendance”. 

Organizers have to know where their participants will be coming from and how they will travel; this, combined with a knowledge of current disease outbreaks in the world, will help them plan for possible risks, and to decide whether they need to demand pre-vaccination, set up airport checks or make any special on-the-spot provision.

But currently this information is held in lots of different places - ticket sales offices, airline schedules, national health ministries, the World Health Organization. As the lead author of one of the papers, Kamran Khan of the University of Toronto, remarks: “Although the scientific and technological components and data sources needed to generate real-time intelligence that could mitigate the risks of infectious diseases during mass gatherings exist, their integration is suboptimum.”

The responsibilities of the organizers do not end when the participants leave for home. Another paper, by Ibrahim Abubakar of the UK Health Protection Agency and colleagues, cites the examples of an endurance race held in Borneo. Ten days after the event ended one of the athletes - by then in London - developed the water-borne disease leptospirosis. This was picked up by the Geosentinal health tracking system along with two similar cases the same day, one in New York, the other in Toronto. An immediate alert warned participating athletes and eventually identified 68 who had contracted the potentially serious disease.

Haj experience

The country with the greatest experience of holding international mass gatherings is Saudi Arabia. The authorities there take their responsibility during the Haj very seriously and a team from the Preventative Medicine Directorate in Riyadh contributed the leading paper in the series. Saudi Arabia tries to ensure that pilgrims have the necessary vaccinations before they set out - something which the Lancet suggests is in itself a useful contribution to global health. A special airport terminal has facilities for the health screening of pilgrims on arrival and departure.

Saudi Arabia has also been using new technologies to ensure the pilgrims’ health. Kamran Khan documents the Saudi response in 2009, when the annual pilgrimage coincided with the H1N1 bird flu pandemic. Realizing that traditional, paper-based reporting was going to be too slow to track an influenza outbreak, they set up a mobile phone based system, with field investigators, armed with smartphones and laptops, reporting any cases of nine infectious diseases in real time to an emergency operations centre. Among the cases they reported were two of dengue fever and 73 cases of H1N1 influenza.

Centre of expertise

Now they plan to set up a pioneering centre of expertise in the medicine of Mass Gatherings. Ziad Memish of the Preventive Medicine Directorate in the kingdom’s Ministry of Health told IRIN: 

“It is hard to say for sure that this is the first, but we know from hosting the largest ever conference on mass gatherings that there was a feeling among experts from all over the world that this was needed and Saudi Arabia would be the ideal place to host it. So the Saudi Centre for Health Specialities was tasked with developing a diploma course in Mass Gathering and Disaster Medicine, which will be starting this year and will be based in Jeddah. This will create a good nucleus to establish a specialty and train people.”

The initial one-year course will have 25 students, all of them physicians or paramedics working in the main pilgrimage centres of Mecca and Medina. But Memish says the intention is to develop an international centre which will train people from all over the world.

The Lancet authors are clearly excited about the potential use of new technological tools in mass gathering medicine. One constant problem is that national governments are often reluctant to admit to outbreaks of infectious illness. The internet allows organizations like HealthMap [ http://healthmap.org/about/ ] to draw on a much wider range of informal sources, even references popping up in Twitter, to track outbreaks of human and animal disease. 

Meanwhile in London, preparations are going ahead for this year’s summer Olympics, and the Saudi Arabian authorities have already been consulted by the UK Health Protection Agency. “They have been in touch about organizing some joint training activities in the run-up to the Games,” says Memish. “We have to be clear that the Olympics and the Haj are very different events, and attract very different kinds of people. But it is always good to be in touch and to share our experience together.” 

eb/cb

]]></body><pubDate>Mon, 23 Jan 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=94709</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201201231347140455t.jpg"/></td><td valign="top">LONDON 23 January 2012 (IRIN) - The world’s great mass gatherings - from religious pilgrimages like the annual Haj to Saudi Arabia and India’s huge Kumbh Mela, to major sporting events like the Olympic Games and the Football World Cup - present important health challenges to organizers and participants alike.</td></tr></table>]]></content:encoded></item></channel></rss>
