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Archive for July 6th, 2013

Analysis: Where aid can do harm

Posted by African Press International on July 6, 2013

BANGKOK,  – The aid community should proceed carefully to avoid enflaming sectarian tensions in Myanmar’s Rakhine State more than a year after the first wave of inter-communal violence.

“The biggest challenge faced by humanitarian aid groups to operate in contexts of sectarian violence is to be perceived as delivering aid in a biased manner,” said Jeremie Labbe, a senior policy analyst of humanitarian affairs at the UN International Peace Institute (IPI) based in New York.

Since inter-communal fighting broke out between ethnic Rakhines (mostly Buddhist) and Rohingya (predominantly Muslim) in June and October 2012, displacing up to 140,000 people, humanitarian assistance to Rakhine State has totalled more than US$52 million, according to the European Commission’s aid body ECHO.

Aid organizations working in Rakhine State [need to] take a conflict-sensitive approach to providing aid so that they do not fuel existing tensions between communities,” Oliver Lacey-Hall, the acting head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Myanmar, told IRIN.

In recent decades, humanitarian aid has been directed at the Rohingya in western Rakhine State due to systematic state-sanctioned discrimination that has left roughly 800,000 people stateless, according to the UN Refugee Agency (UNHCR). This focus has engendered hostility among some in the majority Buddhist population (ethnic Rakhines), who felt marginalized and threatened by people they consider to be illegal migrants.

Meanwhile, the separation of Muslim Rohingya in nearly 90 official camps and sites for internally displaced persons (IDPs) risks cementing segregation between the two communities, fears ECHO, which has expressed concern that any housing construction in the camps for the displaced may lead to long-term physical division.

Conflict sensitivity

While OCHA encourages humanitarian providers to adopt a “conflict-sensitive” approach to aid distribution, which requires clear communication with communities to explain the basis of aid distribution, past humanitarian interventions in Rakhine State have contributed to an uneasy relationship between aid providers and ethnic Rakhines.

“Without addressing the very real perception among the Rakhine population that assistance has been disproportionately provided to Rohingya, it will be difficult for humanitarian aid groups to decrease tension,” said Anagha Neelakantan, the deputy director for International Crisis Group’s (ICG) Asia programme, speaking from Kathmandu, Nepal.

In order to appear impartial, humanitarian agencies must “have a balanced approach” and reach out to all affected communities, according to Labbe.

While most aid organizations assist both ethnic Rakhine and Rohingya indiscriminately, the Rohingya have disproportionately suffered the consequences of recent inter-communal strife.

Most of the 3,000 previously displaced ethnic Rakhine people have returned to their places of origin, with support from central and local government, according to ECHO.

“Sticking to the principle of impartiality [and providing aid on the basis of need] means that the bulk of aid [is] directed toward the group that suffered the most during the violence and now faces the biggest needs, in [this] case the Muslim Rohingya,” said Labbe.

But it also means that aid risks exacerbating sectarian tension, as well as the insecurity of humanitarian staff working on the ground.

“It is up to aid agencies to redouble efforts to explain and communicate with all segments of the population why aid is distributed in a certain way, and how – in order to mitigate possible negative effects,” said Labbe.

Construction in camps divisive

While IDPs still lack adequate food, housing, and health, focusing on only those immediate needs without addressing broader political concerns may condone a securitized, restrictive IDP camp setting that obstructs livelihoods, freedom of movement and, ultimately, prevents reconciliation, according to activists.

According to Human Rights Watch (HRW), the current situation of “warehousing” – where Rohingya people are “penned in by local security forces” in both official and unofficial camps – is untenable for forging peace in Rakhine State.

“The situation that has evolved, with no freedom of movement for the Rohingya IDPs, follows the plan of the Rakhine extremists; to drive one community out of a place and contain them in camps,” Phil Robertson, HRW’s deputy director for Asia, explained.

“The danger is that funding temporary or semi-permanent shelters in the Rohingya IDP camps could contribute to making the ethnic/religious partitioning permanent,” said Mathias Eick, ECHO’s regional information officer for Southeast Asia, which has committed up to $19 million in 2012 and 2013 for humanitarian assistance, including food, livelihoods, household items and health support to IDPs in Rakhine State.

“Our problem is not with shelters per se, but rather with supporting the construction of shelters in the camps, which may result in permanent segregation of the communities… We would rather see those displaced return voluntarily to their home villages and towns where we could provide assistance for rebuilding. Shelter needs in the camps have to be balanced with the humanitarian principle of `do no harm’” he added.

A US-based NGO, CDA Collaborative Learning Projects (previously Collaborative for Development Action) has a training module that examines how assistance in conflicts interacts with conflicts.

“When assistance workers understand the patterns by which assistance can have harmful effects, and the opportunities by which it can also have additional positive effects on overcoming conflict, they can… avoid doing the harm that has sometimes been done in the past, and [help] rebind and re-connect people rather than divide them,” wrote project staff.

Long-term segregation in Rakhine State may make the task of addressing historical tensions between the two communities more difficult, according to ICG’s Neelakantan.

Since January 2013, Rakhine local authorities and the central government have been providing bamboo material for houses in the 89 camps and settlements for Rohingya IDPs. The bamboo is then used to construct barrack-type structures providing accommodation for up to eight families per building.

With the ongoing rainy season from May to September, the UNHCR and OCHA listed shelter as an urgent need and campaigned for $2.5 million in April 2013, the requirements of which have since been covered by the Myanmar government.

 Government needs to do more

While a conflict-sensitive approach may help avoid mutual hostility between the two communities, ultimately the responsibility for addressing turmoil and promoting peace lies with the government, rights advocates insist.

“There is a limit to what humanitarian aid providers can do to defuse conflict and unrest,” said Robertson.

Experts list poverty, marginalization, and discriminatory laws as root causes for deep-seated grievances, requiring government-driven political recognition and protection of human rights for both groups, for example granting Rohingya Muslims citizenship.

“It is the responsibility of the Burmese government to get to the bottom of the unrest, but so far they [have not taken enough action] to promote reconciliation and face down the instigators of violence and unrest,” said Robertson.

While the government established an Inquiry Commission on the Sectarian Violence in Rakhine State in 2012, and a report detailing recommendations was published in April 2013, concrete action to stem violent extremist rhetoric has yet to be taken, according to HRW and ICG.

“Decisive moral leadership is required by both President Thein Sein and [opposition leader] Aung San Suu Kyi to prevent violence from spreading,” said ICG in November 2012, a need largely unchanged today.

“The government must strive to find solutions to the conflict. Community and religious leaders also have a major role to play to defuse tension and promote peace,” said OCHA’s Lacey-Hall.

dm/pt/cb source http://www.irinnews.org

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Surgical circumcision is more complex than PrePex

Posted by African Press International on July 6, 2013

Surgical circumcision is more complex than PrePex

KAMPALA,  – In May, the UN World Health Organization (WHO) announced the prequalification of PrePex, the first non-surgical device for adult male circumcision. Compared to surgical circumcision, the device has fewer complications and is easier and quicker to use, allowing lower-cadre medical workers to be trained to perform the procedure.

Randomized, controlled trials in 2006 found that male circumcision reduced a man’s risk of contracting HIV through vaginal intercourse by as much as 60 percent.

Fourteen African countries in eastern and southern Africa plan on circumcising a total of 20 million men by 2016 in an effort to curb the transmission of HIV. A number of these countries are lagging behind on their targets, and feel the PrePex device will give their programmes a much-needed boost, while others are more cautious.

Studies continue

Malawi’s Ministry of Health plans to adopt and roll out the PrePex device once it has completed safety and acceptability studies targeting 2,000 clients in the districts of Nsanje, Lilongwe and Mulanje. The studies are due for completion in August.

“We hope that the results will assist us to scale-up the services, because already more males have been asking for this device,” said Henry Chimbali, health promotion and communications officer for HIV prevention and behaviour change at the Ministry of Health. “It is also most likely going to reduce costs of providing VMMC [voluntary medical male circumcision], because currently we use VMMC disposable kits, as well as costs of human resource and also perhaps adverse events.”

As of March 2013, a total of 42,700 Malawian men had been circumcised since the October 2011 start of the programme – an estimated 350,000 adult males were circumcised prior to the programme. The ministry aims to reach some 1.8 million adult males by 2015.

In Kenya, the Male Circumcision Consortium (MCC), in collaboration with the National AIDS and STIs (sexually transmitted infections) Control Programme (NASCOP) and the Nyanza Reproductive Health Society (NRHS), welcomed the approval of PrePex, but called for more studies to assess its acceptability and safety in local healthcare settings. The organizations are currently conducting the second phase of study to assess the efficacy of PrePex-assisted male circumcision among 425 men in routine health-care settings in western Kenya’s districts of Kisumu and Rachuonyo; results are expected by September.

“The outcome will provide the government with information and recommendations on the adoption of this device,” MCC project manager Mathews Onyango told IRIN. “There are some issues that have not been addressed by the WHO prequalification, such as cost, acceptability… These might vary from country to country and, thus, like in Kenya, our study will address its safety and acceptability, especially within a larger population.”

“Different countries have varying needs and they would need to ensure that they introduce the non-surgical devices to fit within their context,” he added.

The first phase of the Kenyan study assessed 50 men to ascertain the safety of the device in Kisumu. The committee of independent experts reviewed the results, found no safety concerns, and recommended that the study proceed to the second phase.

Kenya’s programme aims to reach 80 percent of men between 15 and 49 years old – some 860,000 men. Since the programme was launched in 2008, it has reached more than 420,000 men.

In Rwanda, the government plans to roll out the device and scale it up to health facilities, following its successful trials at Nyamata and Kanombe military hospitals. Officials say it saves both time and money. Following the research, Rwanda announced in 2011 that it would be rolling out its VMMC programme using PrePex.

Photo: PREPEX
PrePex promises less pain and less time

“We believe that the PrePex is the only circumcision method that will allow us to meet the goal of [circumcising] over 1.5 million men in two years,” Vincent Mutabazi, lead investigator in the Rwandan PrePex studies. “Several campaigns and numerous training[s] of new PrePex healthcare providers have taken place. Some 5,000 men were circumcised outside of [the] clinical environment in Rwanda since [February 2012]… In the upcoming months, more than 200,0000 procedures are expected.”

“Safer, faster and reduces discomfort”

In Botswana, the health ministry, in collaboration with the US Embassy, the African Comprehensive HIV/AIDS Partnership (ACHAP) and Jhpiego, an affiliate of the US’s Johns Hopkins University, are carrying out pilot research at Nkoyaphiri Clinic, Mogoditshane and Block 8 Clinic in the capital, Gaborone. The study targets 1,000 HIV-negative men aged 18 to 49 to evaluate the effectiveness and safety of PrePex; so far 330 adults have been circumcised in the study, which ends in September.

“The results of this study will determine its roll out in the country. There is no doubt that the PrePex and any other acceptable and safe circumcision device will boost circumcision not only in Botswana but in all countries involved in the programme,” said Benjamin Binagwa, VMMC programme manager at ACHAP. “The advantage of having these devices is that they can be used by other health staff other than doctors.”

He continued: “Any device that makes a surgical procedure safer, faster and reduces discomfort or pain is always a welcome component of the health service. From current experiences with the PrePex, the device provides the aforementioned to a great extent. Therefore its incorporation in the Safe Male Circumcision programme… is a welcome development.”

“Training of both nurses and doctors on use of the PrePex device is less technically demanding since it does not involve use of injections to prevent pain, there is no cutting of live tissues and thus no need to control bleeding, and no need for stitches,” Adrian M Musiige, safe male circumcision programme manager for Jhpiego, told IRIN. “The same technical properties of the device also address some important barriers to male circumcision for some men who still associate conventional male circumcision surgery [with] pain because of the involvement of injections, surgical blades, some bleeding and stitches.”

A total of 75,604 men aged 13 to 49 years have been circumcised in Botswana since the campaign was launched in 2009; the national target is 385,000 men by 2016.

Operational challenges

In Tanzania, where some 415,000 people out of the targeted 2.8 million had been circumcised as of March 2013, participants in one ongoing study in the country’s central-western region of Tabora are already showing high levels of acceptability. But rolling out the procedure using PrePex may face operational challenges.

“I am definitely sure that the use of device in Tanzania will be approved,” said Jackson Lija, head of biomedical prevention in Tanzania’s Clinical STI, HIV and Circumcision Services. “Our main problem to scale it up will be funding. We are struggling. Currently, we have a funding problem that is affecting the conventional male circumcision. PrePex is likely also to be affected with the same.”

In South Africa, the health department plans to have “formal talks” with traditional leaders about the possibility of introducing a Prepex device to circumcision ceremonies, Thobile Mbengashe, national HIV director, told the Mail & Guardian.

He said the country was behind on its male circumcision targets – 4.3 million men by 2016 – and was “unlikely to achieve its goals if additional modalities that can help to scale up the medical circumcision process are not introduced”.

Ugandan officials say WHO prequalification of PrePex was anxiously awaited and will boost the country’s programme, which has, since 2010, reached 380,000 men – a fraction of the 4.2 million men it aims to have circumcised by 2015.

“The National Task Force [on safe male circumcision] and the ACP [AIDS Control Programme] welcomes the approval and will go through the process of including its use in the guidelines,” said Alex Ario, programme manager for the ACP. “The device will definitely lead to increased access and acceptability of safe male circumcision among young males.”

so/kr/rz source http://www.irinnews.org

 

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Landslides take toll on key PNG highway

Posted by African Press International on July 6, 2013

Okuk Highway is PNG’s main highway

PORT MORESBY,  – A vital highway, long regarded as the single most important road in Papua New Guinea (PNG), is slowly being destroyed by landslides.

“It’s not a highway any more,” Peter Kama, a businessman and community leader in Chimbu Province, a mountainous region in PNG’s central highlands, told IRIN. “The landslides are destroying the road and threatening the livelihoods of the people around it.”

Landslides affecting the 700km Okuk Highway have been common in the past decade. Engineers say the road is outdated and poorly maintained, and that its drainage system has deteriorated.

Torrential rains during the annual rainy season from November to April, deforestation from farming, along with increased volumes of traffic due to resource development have compounded the problem,” Godfree Umba, managing director of Kaia Works, a civil engineering company working on the highway, told IRIN.

Chimbu Province, through which the road runs, has seen seven major landslides in the past decade, experts say.

On the night of 9 May, at least 200 families lost their homes and livelihoods when a major landslide left a 300-metre wide gap in the highway at Waigar in the Kerowagi District of Chimbu. Andrew Pera his wife and two children lost the only coffee trees they had and were left with no fertile land to plant new ones, he said.

In 2012, a landslide in Hela Province, in which dozens lost their lives, affected more than 2km of the highway, which connects the mountainous highlands to the coastal city of Lae.

The PNG National Department of Works, which is responsible for road maintenance, says landslides are not only destroying the highway, but also food gardens and homes, in a country where 85 percent of the population rely on subsistence farming.

The government says it is well aware of the problem and is in the process of taking action.

“We are not waiting for the entire infrastructure to collapse and slow down the economy before we take action in addressing this enormous challenge,” PNG Prime Minister Peter O’Neill told the Australia-Papua New Guinea Business Council at its recent forum in Port Moresby.

In February, experts predicted that up to 35,000 people were affected by landslides and flooding during the last rainy season.

pk/sk/ds source http://www.irinnews.org

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