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Norway gives NOK 20 million to UNICEF’s work in the Central African Republic

Posted by African Press International on December 14, 2013

Norway gives NOK 20 million to UNICEF’s work in the Central African Republic


OSLO, Norway, December 13, 2013/African Press Organization (APO)/  “The situation in the Central African Republic is now so serious that the UN humanitarian system has decided to operate collectively at the highest level to mobilise staff, equipment and other resources. Norway is therefore allocating NOK 20 million in funding to UNICEF for its efforts to protect children in the country. In wars and conflicts, children are the most vulnerable group of all,” said Minister of Foreign Affairs Børge Brende.


The UN and aid organisations are reporting a dramatic deterioration in the humanitarian situation in the Central African Republic, as a result of the escalating armed conflict in the country. Violence against civilians is on the rise, including in the capital Bangui, and a growing number of people are being driven from their homes.


“Some of UNICEF’s most important work is protecting children from abuses and suffering caused by conflict. UNICEF ensures that families with children have access to water, shelter and food, and it establishes safe, child-friendly spaces where children can take part in activities and receive help to overcome traumatic experiences. Norway is now making a major contribution to this important work,” said Mr Brende.


Norway is providing humanitarian assistance in the Central African Republic through the UN, the International Committee of the Red Cross and Médecins Sans Frontières. Following this latest allocation, Norway’s humanitarian contribution will total NOK 52 million. This sum comes in addition to Norway’s contributions to UN funds and programmes in the country.



Norway – Ministry of Foreign Affairs

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Norway increases its humanitarian support to the Central African Republic

Posted by African Press International on December 8, 2013

OSLO, Norway, December 6, 2013/African Press Organization (APO)/ – “I am very concerned about the security and humanitarian situation in the Central African Republic. Norway welcomes the decision by the UN Security Council to authorize an expanded peacekeeping force, in order to contribute to the protection of civilians and the restoration of security and public order,” said Minister of Foreign Affairs Børge Brende.

The security and humanitarian situation in the Central African Republic (CAR) is steadily deteriorating. Attacks on civilians and violations of human rights are widespread, and law and order is virtually absent. The local population and displaced persons are in urgent need of humanitarian assistance and protection.

The Norwegian Government is therefore increasing its humanitarian support by NOK 20 million, to the International Committee of the Red Cross (NOK 15 million) and Médecins Sans Frontières (NOK 5 million). Norway also contributes to the UN Central Emergency Response Fund (CERF) in CAR. The total humanitarian support to CAR now stands at NOK 32 million. In addition, Norway contributes to other UN funds and programmes in the country.

“I am concerned about the impact of the crisis on the region. There is a risk that the lawlessness we are seeing in the Central African Republic will turn the country into a haven for extremists, armed groups and international organised criminals, thus increasing instability in the region,” Mr Brende said.

The Foreign Minister considers the decision by the UN Security Council to authorise the deployment of an African-led stabilisation force (MISCA), which will be assisted by an expanded French force, to be crucial for the country.

“We are following the situation closely and we will consider further contributions to the humanitarian response early next year,” Mr Brende said, underlining that all parties to the conflict are obliged under international humanitarian law to ensure that people in need have access to humanitarian assistance.



Norway – Ministry of Foreign Affairs

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Is there a sectarian dimension? Terror grips Central African Republic

Posted by African Press International on October 20, 2013

NAIROBI,  – The crisis in the Central African Republic (CAR) is deepening more than six months after a coup by the Séléka rebel coalition. 

Hundreds of civilians have been killed in violence since the March coup, thousands have fled their homes, basic services have been adversely affected and senior humanitarian figures have warned of a possible spillover of violence into neighbouring countries.

Séléka, which propelled the current CAR interim President Michel Djotodia into power, “has since become the main perpetrator of violence against civilians”, says Oxford Analytica in a recent CAR brief.

What kind of rights violations are taking place?

The Fédération Internationale des Ligues des Droits de I’Homme (FIDH), has described human rights violations by Séléka as “international crimes”.

“In the absence of the army, the police and [a] justice [system], these youths who include children, terrorize an unprotected population. Heavily armed, with their pick-up [trucks] and motor bikes, they kill, kidnap, [and] torture for money or to stifle all protest. They burn entire villages and rape the women. These human rights violations qualify as international crimes,” it stated in a report.

The FIDH report highlights human rights abuses by Séléka including: a massacre in the area of Gobongo, in Bangui in June, where rebels shot at a protesting crowd leaving several dead; an upsurge in rape cases since the rebel takeover of Bangui; and the looting and burning down of houses in the provinces.

FIDH calls on the international community to place sanctions on Séléka leaders and warlords, including the freezing of their financial assets and urges International Criminal Court action to address impunity.

In a September report Human Rights Watch (HRW) also highlighted serious human rights abuses by Séléka, including murder and rape. According to HRW, President Djotodia denied that Séléka fighters had committed abuses, and continued to shift blame for the violence onto loyalists of deposed President François Bozizé, “false Séléka,” and bandits – even though at least one Séléka official in the field admitted to HRW responsibility for some attacks.

On 13 September, President Djotodia announced the dissolution of Séléka and allied groups, but some senior Séléka figures are pursuing vendettas against perceived Bozizé supporters, according to Oxford Analytica. “In rural areas, fighters lived off their respective areas of control through looting and violence against local residents…

“With bands of rebel fighters ultimately loyal to their individual commanders, the president’s official dissolution of Séléka provides little incentives for compliance; there is almost no prospect of purely local action controlling armed groups.”

Where is the violence concentrated?

Ouham Province in the northwest is among those worst affected by violence.

“In the last month, we have treated more than 60 people in Bossangoa [Ouham’s capital] for injuries that are the result of violence, largely gunshot and machete wounds, including women and children,” said Erna Rijinierse, a surgeon with Médecins Sans Frontières (MSF). “More than 80 percent of surgeries have been for wounds that are conflict-related. MSF is horrified by what we are seeing, including burnt villages and appalling scenes of murder.”

“When such aggressions occur, the population traditionally flee to their fields located anywhere from one to 30km in the bush surrounding their village or city. There, they spend days, weeks and even months without proper shelter, no safe drinking water, limited food supply and no access to the most basic of healthcare.”

Her remarks were carried in an MSF statement on 16 October calling for urgent humanitarian assistance amid “unprecedented levels of violence”. MSF said it had directly witnessed the execution of one healthcare worker, as well as multiple violent attacks on humanitarian staff.

What are the main humanitarian issues?

The violence in Ouham has pushed at least 170,000 people into the forest or into Bossangoa. In Bossangoa, about 36,000 people are seeking refuge at a church, a provincial administration office, and at a local school, according to a report by the UN Office for the Coordination of Humanitarian Affairs (OCHA). They are living in precarious conditions with limited or no access to shelter, clean water, food and sanitation, according to MSF.

Health care has been adversely affected. “Health structures have been looted, the few qualified personnel have fled, drug supply and logistic means are non-existent or paralysed and even worse is the population which flees violence by seeking refuge in the bush [and] does not have any access to the most basic of health care,” Albert Caramés, an MSF humanitarian affairs officer in Bangui, told IRIN.

Some schools which had reopened have been closed, especially in the provinces of Ouham, Ouham-Pendé and Ouaka due to the insecurity, according to OCHA.

The International Medical Corps (IMC), in a 15 October statement, said the conflict was disrupting agricultural livelihoods in CAR. The looting of cattle, seeds, tools and already-meagre food reserves has compounded the situation.

IMC has recorded global acute malnutrition rates of 15.8 percent (above the UN World Health Organization emergency threshold of 15 percent) in parts of Haute-Kotto District in eastern CAR. Treatment services for malnourished children have been adversely affected with insecurity hindering humanitarian access and the transportation of vital food supplies, added IMC.

“More than 390,000 people in CAR are currently internally displaced; almost twice the numbers reported during the height of previous CAR instability between 2006-2008,” notes Melanie Wissing, the Internal Displacement Monitoring Centre’s (IDMC) assistant country analyst for CAR. “Today, estimates suggest that a staggering 10 percent of the population of CAR has been forced to flee since the Séléka movement overthrew the former President Bozizé and his regime in March.”

Is there a risk of regional spillover?

In mid-August, UN Under-Secretary General for Humanitarian Affairs Valerie Amos, in a briefing to the UN Security Council (UNSC) following a CAR visit, noted that the government is fragile and fraught with challenges “including divisions within Séléka, the proliferation of weapons in Bangui and beyond, disarmament, demobilization and reintegration efforts and the absence of state administration outside of Bangui.”

Vulnerable (file photo)

Amos further warned that the CAR crisis, which has affected the entire population of 4.6 million, threatened to spill across the border.

In her blog, Wissing amplifies Amos’s concern, noting that there has been increasing cross-border criminal activity and the presence of fighters from neighbouring countries in CAR.

“Recent reports that both Chadian and Sudanese nationals are found fighting in CAR, along with current reports of refugees arriving in CAR from the war-torn Darfur region of Sudan, suggest there is a risk that armed groups on either side of the border might take advantage of the current situation to further fuel conflict,” she stated.

“With bands of rebel fighters ultimately loyal to their individual commanders, the president’s official dissolution of Séléka provides little incentives for compliance; there is almost no prospect of purely local action controlling armed groups.”

The northeastern CAR region is characterized by lawlessness and banditry. It is also a livestock migratory route for pastoralists from and to Chad, the Democratic Republic of Congo, Sudan and South Sudan. Inter-communal tension is common there too.

“Recent reports claim that such pastoralist groups have sided with Séléka and attacked civilians. This raises concerns that armed groups could exploit these inter-communal tensions to further fuel instability for their own benefit, in a way that would mirror conflict and displacement dynamics in Darfur,” warned Wissing.

However, “a truly ‘regional crisis’ appears unlikely, according to Oxford Analytica. “The norm will more likely prevail: that is, state collapse in mineral-rich peripheries, providing havens for various armed groups.”

Is there a sectarian dimension?

There have also been rising religious tensions between Christians and Muslims in CAR.

Explaining the emergence of religious identity as a driver or perceived driver of tension, Oxford Analytica noted that Séléka originated and recruited in the far north which is predominantly Muslim; Djotodia is CAR’s first Muslim head of state; opportunities for looting and theft in rural areas of CAR have also attracted many foreign fighters, often from countries with larger Muslim communities, particularly Chad; and in reprisal for Séléka activity, Muslims around Bossangoa (in Ouham) have been attacked and killed, with subsequent revenge attacks against non-Muslims.

“Sectarian factors were also at play in August, when elements of Séléka cracked down on supposed Bozizé sympathizers in the Boy Rabe District of Bangui,” it adds. 

Since early September, the nature of the CAR conflict has changed with the proliferation of local self-defence groups in various parts of the country, MSF’s Caramés told IRIN.

“As they [the self-defence groups] target government forces and Muslim populations, whom they accuse of collusion with the ex-Séléka, this drives these new government forces to reply aggressively against the self-defence groups and civilian population who are overwhelmingly Christian,” he said.

“This circle of violence is fuelling this latest conflict… When such aggressions occur, the population traditionally flee to their fields located anywhere from one to 30km in the bush surrounding their village or city. There, they spend days, weeks and even months without proper shelter, no safe drinking water, limited food supply and no access to the most basic of healthcare.”

With the present violence in CAR concentrated in the northwest, as it was during the 2006-2008 instability, IDMC’s Wissing added that: “If history were to repeat itself, criminal gangs coming from as far as Niger and Nigeria would take advantage of both the instability and the porous borders to target civilians in CAR, potentially causing massive displacement.”

What is the UN doing?

On 10 October, the UN Security Council (UNSC)  unanimously adopted a resolution seeking to update the mandate of the UN Integrated Peacebuilding Office in CAR (BINUCA). This will enable BINUCA to support the implementation of CAR’s transition process over the next 18 months – after which presidential and legislative elections are expected.

UNSC also demanded that Séléka and other armed groups participate in disarmament, demobilization and reintegration programmes and called on African countries to speed up the transition of the Mission of the Economic Community of Central African States for the Consolidation of Peace in CAR into the African-led International Support Mission in the CAR.

UNSC has also noted the UN Secretary-General’s recommendation that BINUCA strengthen its field presence by establishing a guard unit to protect UN personnel and installations in CAR.

aw/cb source


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Bolstering access to life-prolonging drugs for people with HIV/AIDS

Posted by African Press International on September 3, 2013

MAE SOT,  – Efforts are under way in Myanmar to bolster access to life-prolonging drugs for people with HIV/AIDS, but tens of thousands will probably still be left out, say health experts.
“All the ingredients are there to make this work, but a comprehensive and integrated plan concerning all actors and activities is needed to ensure a proper and rapid implementation,” Peter Paul de Groote, head of mission for Médecins Sans Frontières (MSF), told IRIN.

In June, the Global Fund to Fight AIDS, Tuberculosis and Malaria pledged more than US$160 million over the next four years to Myanmar to improve access to anti-retroviral (ARV) drugs for patients, including those in neglected border regions and some controlled by ethnic armed groups.

“The challenge is that some of the areas are not directly managed by the government,” Eamonn Murphy, country coordinator for the Joint UN Programme on HIV/AIDS (UNAIDS), explained. “However, I think there is a genuine commitment to provide services in these areas.”

According to UNAIDS, there are about 220,000 people with HIV in Myanmar of whom 120,000 are in need of ARVs. From 2011 to June 2013, ARV treatment coverage climbed from 32 percent of diagnosed patients to nearly 50 percent, inching closer to the government target of 85 percent by the end of 2016.

In 2012, Myanmar officials declared that the availability of ARV treatment had expanded to nearly 100 sites – up from 57 in 2008.

Yet, more than 70 percent of those treated were in the nation’s two largest cities, Yangon and Mandalay, along with Kachin State, while coverage in other areas remained inadequate.

The Global Fund is currently in talks with various stakeholders on access to war-torn border regions and expects to roll out services in 2014.

“We envisage an expansion of services to these areas with life-saving drugs being brought into the conflict zones and other hard-to-reach areas,” said Andrew Hurst, a Global Fund spokesperson.

But despite the Global Fund boost, Myanmar is still looking for other donors to fill a $110 million funding gap in its national response up to the end of 2016, Murphy said.

Furthermore, some health workers claim HIV prevalence – the third highest in the Asia-Pacific region – could be worse than reported as scarce healthcare in border regions, compounded by a fluid migrant population, may have further spread the virus.

“I think that there are thousands of unknown HIV cases,” said Aye Aye Mar, founder of Social Action for Women (SAW), a non-profit group that supports Burmese HIV patients in the Thai border town of Mae Sot. “We will never know if they have the virus and many won’t know themselves because they don’t get tested.”

WHO guidelines could boost ARV demand

MSF, the largest ARV provider in Myanmar, also predicts a greater demand for treatment after the World Health Organization set new guidelines in June stating that adult patients with CD4 (a white blood cell that targets infection) counts of 500 or below should receive ARVs when immune systems are stronger.

Myanmar’s ARV policy of treating adults with CD4 counts of 350 or below will need to be updated, allowing more infected people to access the drugs, MSF officials say.

“For this, many more treatment sites will have to be opened in areas where so far no treatment is available,” de Groote said.

Seeking help in Thailand

Meanwhile, many impoverished Burmese living with HIV/AIDS continue to cross the Thai-Burmese border in the hope of receiving free treatment in Thailand.

Ma Yin Nu left her eastern Karen State village in 2007 when her daughter became severely malnourished after years of being mistakenly treated for tuberculosis.

“She was in very bad shape. I thought she would die and even the doctors expected it,” said Ma Yin Nu, adding that she herself probably transmitted the HIV virus to her daughter at birth after a blood transfusion at a Burmese hospital.

With ARV treatment, her daughter, Phyoe Thandar Win (17), has since seen her CD4 count skyrocket from two to more than 1,000, and is now healthy enough to attend school. She lives at a SAW shelter, which teaches women to sew garments that are sold to pay for their ARVs (about $170 per month).

“I would be happier living in my village,” she said. “But I need to stay here longer to get treatment.”

Under a Global Fund grant, the Thai government offers free ARV drugs to at least 2,700 foreigners nationwide, but many more remain on waiting lists. Only 70 people are eligible in the Mae Sot area, the main hub for Burmese migrants coming into Thailand, health workers say.

sk/ds/cb  source


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“Difficult to live” – Goma`s displaced

Posted by African Press International on August 25, 2013

BULENGO,  – If the Democratic Republic of Congo’s (DRC) North Kivu capital of Goma were a hotel, there would be a sign hanging on the door with the words “sorry – no vacancies.”
From the 1994 exodus from neighbouring Rwanda, in the wake of the genocide, to interstate wars and decades of insecurity caused by a multitude of armed groups, the city has become the end of the line for those fleeing the country’s conflicts.

The latest influx of internally displaced people (IDPs), fleeing conflict with the allegedly Rwandan-backed armed group M23, is pushing the city to its breaking point.

“Goma is full,” Flora Camain, the Goma-based spokesperson for the International Organization for Migration (IOM), told IRIN. “There’s no room left.”

More to come

In response to continued displacements from across North Kivu, about 30 temporary “spontaneous sites” have been established in the province, using venues ranging from churches and schools to marginal land.

NGOs are providing basic services, such as water and sanitation and primary healthcare, to the burgeoning IDP population. IDPs are also staying with host families in the city.

According to the UN Stabilization Mission in DRC (MONUSCO), “Over one million civilians live in the relatively small area of Goma and Sake and along the road that connects them, where amongst others the Mugunga IDP camps, temporary home to 70,000 people displaced by the conflict, are situated.”

Of the more than two million IDPs in the country, about one million are displaced from South and North Kivu provinces. Spontaneous sites have been established in the North Kivu towns of Goma, Masisi, Rutshuru and Walikale. And the robust mandate afforded to a UN intervention force meant to “neutralize” the more than 30 armed groups in the Kivu provinces is expected to see even more displacements.

IOM, other humanitarian actors and local authorities are currently identifying any available land to accommodate new influxes of IDPs, while at the same time preparing for the eventual return of the displaced should there be an improvement in the region’s security conditions.

Although the displaced plight is high on the agenda of donors, IDPs in spontaneous sites – due to their sheer number and extreme need – often have access to only “minimum assistance,” Camain said.

“Difficult to live”

IOM estimates the population of IDPs living in spontaneous sites in North Kivu is about 231,000 people. One such site is Bulengo, on the outskirts of Goma, where about 58,000 people live.

Aziza Kasidika, 19 and three months pregnant, fled there from North Kivu’s Masisi during fighting between DRC’s national army (FARDC) and armed groups in January 2013. She has since lost contact with her family.

Her home is a crudely constructed “bâche”, about 2m long and just more than half as high. Branches provide a framework for thatch, with a patchwork of plastic bags to try to keep the weather out. A piece of cloth is used for a door, and the bed is a thin mattress of grass on top of volcanic rock.

“I sleep very bad because I sleep on the rock. The bad shelter is a problem, and it’s very difficult to live. I get sick,” she told IRIN. “There should be food distribution twice a month, but it’s only usually once a month. I get rice, maize, beans and oil, and there is never enough salt.”

The absence of adequate shelter is a common complaint in Bulengo, as are the security risks associated with foraging for fuel – needed for both cooking and warmth – beyond the site’s perimeter.

“I don’t know how long I will be here. It’s difficult to see the future. Our only future is the next food hand-out… I will return to Masisi when there is peace – but not that regular peace of two weeks and then war again. I live in Bulengo, and I will stay in Bulengo,” Kasidika said.

Illness, uncertainty

Maria Sankia, 60, fled to Bulengo from Walikale in November 2012, after fighting between the armed groups the Democratic Forces for the Liberation of Rwanda (FDLR) and Raïa Mutomboki – Swahili for “angry citizens”. She came with two of her neighbour’s young children, and cites the same concerns as Kasidika: food distribution, security and poor shelter.

“Children don’t have schooling. There are no toys; there is nothing for the children to do. So many children go to the lake, but they don’t know how to swim. Five or six children have drowned [in Lake Kivu] that I know about since I came here,” she told IRIN.

“This is maybe the fourth time I have run away. But this time was definitely the worst”

Goma-based Christian Reynders, of Médecins Sans Frontières (MSF), which has established primary healthcare clinics at spontaneous sites, told IRIN that the medical caseload included diarrhoea and malnutrition, but that the predominant issue was respiratory tract infections, a direct consequence of the IDPs’ inadequate shelter.

At MSF’s Majengo clinic, situated in a Goma school where IDPs have taken refuge, Barikurie Kosi, 35, told IRIN, “This is maybe the fourth time I have run away [from Kibati, after M23 entered her village]. But this time was definitely the worst. There was no chance to take anything.”

She fled her home in May and arrived in Goma after a six day walk. She managed to bring her youngest three children, aged two, three and six, but her three teenage children, 13, 15 and 17, “ran in other directions. I don’t know where they are.”

“I don’t know when I will go back,” she said. “I am staying at the clinic.”

go/rz source



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Tun Aung Kyaw says his TB was misdiagnosed

Posted by African Press International on August 22, 2013

Tun Aung Kyaw says his TB was misdiagnosed

WANGPHA,  – Struggling to breathe, Burmese migrant Tun Aung Kyaw sits up slowly in bed for a routine check-up at a Thai tuberculosis (TB) clinic along the 1,800km Thai-Burmese border.

This is the third round of treatment for the 29-year-old, who believes Burmese health workers misdiagnosed him with regular TB twice when he actually had multi-drug-resistant TB (MDR-TB), a form of the infectious disease harder to diagnose and cure.

“Even though I was on TB treatment I got weaker and eventually I was bed-ridden,” Tun Aung Kyaw told IRIN.

After 14 months of treatment, Tun Aung Kyaw’s condition never improved as the disease had destroyed his left lung. He now faces a two-year regimen of care to see if he can finally defeat the MDR-TB strain, which has a treatment success rate of almost 60 percent in South-East Asia, according to the Global Tuberculosis Report 2012 by the World Health Organization (WHO).

Inadequate detection and treatment are major obstacles and can result in cases of drug-resistant TB (DR-TB) such as MDR-TB, say health experts.

“Drug-resistant TB is a very significant health concern for Myanmar,” Peter Paul de Groote, the country’s head of mission for Médecins Sans Frontières (MSF), told IRIN.

Around 8,900 new cases of DR-TB are reported each year, but only 800 patients had access to treatment at the end of 2012, he said.

TB burden

Myanmar is among the world’s top 22 TB-burden countries with a prevalence rate of 525 cases per 100,000 people, more than three times the global average.

It is also a high burden country for MDR-TB, a complex strain immune to first-line drugs that requires two years of treatment, four times longer than non-resistant TB.

MDR-TB treatment costs nearly US$5,000 per patient, roughly 100 times more than the regular strain, according to an October 2012 WHO report.

From 22 to 23 August, WHO, along with MSF and Myanmar’s Ministry of Health, plan to hold a DR-TB symposium in Yangon aimed at ramping up services throughout the country, including neglected border regions.

“There are immense challenges in providing DR-TB treatment, and health care in general, to the remote border areas of Myanmar,” de Groote said.

Health experts fear countless more cases remain hidden in rural eastern Myanmar where armed conflict, rough terrain, lack of awareness and scarcehealth care can discourage TB-infected people from seeking care.

Proposed approaches for battling DR-TB include counselling to help patients cope with long and toxic courses of treatment, decentralized care in home communities, and rapid diagnosis to treat patients correctly and prevent further cases.

To do this, Thandar Lwin, manager of Myanmar’s National TB Programme, has urged the Burmese government to step up efforts to support TB measures, 94 percent of which are donor funded.

TB-infected patients live in these huts for the duration of their treatment at the Wangpha TB clinic

“The government budget is not enough and it is difficult to increase more than the previous year,” she said during an international TB workshop earlier this year. “There is a need for evidence to persuade the government that investment in health is worthwhile.”

In 2013, Myanmar is projected to have a US$22 million funding gap for TB care and control services, the WHO report said. On the other hand, rapideconomic growth may help ease the problem in the longer term.

Border run

Many Burmese are forced to seek TB care at donor-funded clinics along the Thai border, home to roughly one million migrants and displaced persons.

Two health clinics run by Shoklo Malaria Research Unit (SMRU), a Mae Sot-based field station for the Mahidol University-Oxford University Tropical Medicine Research Programme in Bangkok, offer free treatment and are inundated with patients.

From 2010 to March 2013, SMRU supported more than 810 TB patients, but had to refer 70 percent of them, and pay for their care at local Thai hospitals due to limited capacity.

About 18 percent of patients tested for first-line drug susceptibility at SMRU clinics had some form of DR-TB. Almost half have already been successfully treated, with others still on the regimen.

In June 2013, SMRU opened a specialized TB clinic in the village of Wangpha, near the Thai border town of Mae Sot, to handle the overflow. Plans are also under way to expand in-patient care at the second clinic since 60 percent of TB patients, especially those with drug resistance, need to be supervised by clinic staff.

Sein Sein, manager of the TB clinic, said several patients initially came in after showing symptoms for several months, when treatment should be sought if persistent coughing lasts for at least two weeks.

“Many patients only come for treatment when they are really sick, so they stay in the community and continue to spread the disease,” she said.

According to WHO, there were an estimated 650,000 cases of MDR-TB among 12 million TB cases worldwide in 2012.

sk/ds/cb source

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Liberia has indeed made progress, particularly in attracting international investment

Posted by African Press International on August 20, 2013

A busy market in central Monrovia

MONROVIA,  – Liberia is getting back to its feet after a protracted civil war that killed over 200,000 people, displaced over a million, and largely destroyed the country’s infrastructure and institutions. After a decade of peace, the European Commission’s Humanitarian Aid Office (ECHO) is pulling out of the country, saying its needs are shifting from humanitarian to developmental.

Liberia has indeed made progress, particularly in attracting international investment that has led to steady growth in GDP, and most importantly in maintaining peace. But poverty and unemployment remain rife, corruption is pervasive, and little headway has been made towards post-war justice or reconciliation. In short, significant challenges remain.

To mark World Humanitarian Day, IRIN spoke to a few key individuals who worked on ECHO-funded projects – most of them health-related – during and after the war, to learn how far Liberia has come.

Moses Massaquoi, doctor

Moses Massaquoi, doctor:

Moses Massaquoi started working with Médecins Sans Frontières (MSF) after being displaced by a rebel attack in July 1990. He went on to work with the NGO in numerous postings across Africa before returning to Liberia with the Clinton Health Access Initiative (CHAI).

“The main challenge in the post-war [era] is a challenge of building the system, from the point of view of having the necessary human resources,” he told IRIN. “So I would say the big challenge is capacity. How do you build the capacity, with all systems broken down – health, education and everything?”

Massaquoi has committed himself to rebuilding a health system left in tatters by the conflict. In particular, he would like to see Liberia producing its own medical specialists.

He says he wants the country “first and foremost, in my own medical profession, to bring back a system of specialization. We didn’t have control of producing our own specialists. The government had to send people out [abroad], and when they go out, they don’t come back,” he explained.

A sign of progress in this area, he says, is a post-graduate training program currently being established by the government, which will see its first students starting in September 2013.

Barbara Brillant, nurse

Barbara Brillant, nurse:

Another former MSF employee currently engaged in medical training is Barbara Brillant, who runs a nursing school in the Liberian capital, Monrovia.

Brillant first arrived in Sierra Leone as a missionary in 1977. “I arrived here [in Africa] as a young lady… with a lot of enthusiasm, and I was going to cure the world and teach everybody. And I ended up here 38 years later, having learned a lot,” she told IRIN.

“It [the conflict] was very, very sad. For me personally, it was scary, no doubt about it. But as a missionary and having lived with the people of Liberia, the sorrow was more seeing the Liberian people in the condition they were in,” said Brillant.

She says she saw both resilience and pride, but also “evil at its worst” during the conflict.

Sister Barbara, as she is known to the 450 students in the nursing school, is concerned that behind Liberia’s current peace there is no true reconciliation. She sees little improvement in the quality of life of most Liberians.

“It’s a pity, because… the hurt is still there, the anger is still there. You can only pray and hope that time will heal a lot of the wounds. They will never ever forget it, that’s for sure… They’re having a very hard time.”
Despite peace, “it’s a difficult place to live in,” she said, with cost of living having risen steadily over the years. “To rent a house now is insane,” she added.

Nyan Zikeh, programme manager

Nyan Zikeh, programme manager:

Like Massaquoi, Nyan Zikeh began working for MSF while himself a refugee. He returned to Liberia in 1998 and has since worked with the NGOs Save the Children and Oxfam, where he is currently a programme manager. He says he now feels the dividends of Liberia’s lasting peace. “What I’m grateful for is that we have peace, and the chance to raise a stable family now exists,” he explained.

His plans for the future are to leave his job and become an agricultural entrepreneur, which he says will create opportunities for others to work, earn a living and learn. “I will still be working in development, but not in charity,” said Zikeh, who is concerned about the dependence being created by Liberia’s current aid culture.

“It is also to let the authorities know that we can make examples, that we don’t have to sell all of our land to very large companies,” he said. Recent large-scale land acquisitions by foreign businesses have been criticized for exploiting local communities and engaging in corruption in the awarding of concessions.

A recent audit revealed that only two of 68 land concessions awarded since 2009 fully complied with Liberian law.

Nathaniel Bartee, doctor

Nathaniel Bartee, doctor:

When the war broke out in 1989, Nathaniel Bartee was a doctor who had just returned from earning a master’s degree in the UK. He started the organization Merci to deal with the humanitarian situation in Monrovia; it quickly expanded into the provinces.

During the conflict, Bartee was at times separated from his family. “I didn’t want to leave Liberia because of the amount of suffering, and the [numbers] of health personnel were not many. So I stayed to guide a younger generation of doctors.” By the end of the conflict, he was one of just 50 doctors left in the country.

Bartee says there has been clear improvement in the provision of health services since those days. “Today I think health is much better. Most of the health workers have returned, and there are more graduates being produced,” he explained.

But he is concerned that the Liberian government is not sufficiently prioritizing healthcare. For this reason, he intends to become a senator to push for increases in the health budget in parliament.

Ma Annie Mushan, women’s peace activist

Ma Annie Mushan, women’s peace activist:

In late 1989, Ma Annie Mushan was, in her own words, “not a woman to speak of”.
“I was just a housewife” she told IRIN. During the war, Mushan was displaced from her village and ended up living in the town of Totota, where she was approached by the women’s peace movement that had sprung up in Monrovia.

Mushan eventually became the leader of the Totota branch of the women’s peace movement, which ultimately played a significant role in putting an end to the conflict.

Like many Liberians, she is frustrated by the slow pace of post-war development. “Even though there is progress, people in Liberia are looking for jobs up and down… There are so many people that are not working in Liberia – not a day. That has been one of the major problems we’re faced with.”

She now works on the Peace Hut project, which emerged from the women’s movement, and seeks to address the problem of gender-based violence, which she sees as one of Liberia’s biggest challenges. Mushan feels the existing court system in Liberia is unable to effectively deal with cases concerning women’s issues.

“My focus will stay on the women, to build their capacity up. I still want to be working for the Peace House [Hut], because it is the Peace House [Hut] that got me where I am today,” she concluded.

tt/aj/rz  source


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“I am deeply concerned over the difficult working conditions for humanitarian workers in Somalia; Says Norwegian Minister

Posted by African Press International on August 16, 2013

“I am deeply concerned over the difficult working conditions for humanitarian workers in Somalia, and the security risks for those seeking to access aid. The population is in need of humanitarian support in many areas of the country, and the right to safely receive aid should be respected by all parts of the conflict,” said Minister of International Development Heikki Eidsvoll Holmås.

Somalis has been suffering from armed conflict for more than two decades. Despite some political progress over the last year, the security situation remains difficult and unpredictable in many areas. Yesterday, Médecins Sans Frontières announced the closure of all its medical programmes in Somalia due to unacceptable working conditions including the killing of staff and attacks on medical facilities. The organisation carried out more than 624 000 medical consultations in the country in 2012 alone, and their efforts will be greatly missed by those in need.

“Médecins Sans Frontières has performed life-saving and courageous work for the people in Somalia for 22 years. The fact that they have now made the tough decision to pull out of the country sends a strong message on the extent that humanitarian space is being compromised. People in dire need should be able to receive the assistance they need and aid workers should be able to carry out their duties without risking their lives,” said Mr Holmås.

Norway provides extensive humanitarian and development aid to Somalia, and will continue its efforts to promote political stability and peaceful development in the country. In 2012, Norway started to cooperate with the International Committee of the Red Cross (ICRC) and the Norwegian Red Cross on the initiative “Health Care in Danger”. The initiative aims to increase awareness of the consequences of attacks on health personnel and facilities in crisis situations, and how this can be mitigated. 



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An estimated 2.3 million people remain displaced as a result of the decade-long conflict and insecurity in Darfur

Posted by African Press International on August 16, 2013

Analysts fear local means of solving disputes in Sudan’s Darfur can still collapse

NAIROBI,  – The UN estimates that the conflict in Sudan’s Darfur region has seen some 300,000 people displaced so far in 2013 – twice as many as in 2011 and 2012, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

“Darfur has seen a new wave of fighting in many areas in 2013. More than 300,000 people have had to flee their homes to escape violence since the beginning of the year, including over 35,000 people who have crossed the borders into Chad and the Central African Republic. The crisis is getting bigger,” Mark Cutts, OCHA head of office in Sudan, told IRIN.

An estimated 2.3 million people remain displaced as a result of the decade-long conflict and insecurity.

IRIN looks at the humanitarian situation in Darfur and the causes of the current wave of conflict there.

What is the humanitarian situation like in Darfur?

UN agency figures indicate there are 1.4 million people living in the main camps in Sudan’s Darfur region.

Cutts, however, told IRIN that the “actual numbers of IDPs [internally displaced persons] in camps are significantly higher as many of the IDPs living in smaller camps/settlements are not included in these figures and many IDPs in the bigger camps remain unregistered.”

Many of those affected by the conflict are unable to receive any humanitarian assistance as insecurity has hampered efforts by aid workers to reach them. In total, 3.2 million people – more than a third of Darfur’s population – are in need of humanitarian assistance in Darfur.

“Road insecurity remains a major problem affecting movement of humanitarian staff and supplies in Central Darfur. The problem has been compounded by recent increased clashes between Misseriya and Salamat tribesmen in different parts of Central Darfur, as well as the reported movement of armed groups in the state,” OCHA said in a recent bulletin.

A recent survey by Médecins Sans Frontières (MSF) revealed that the violence in Darfur was a major cause of mortality among refugees and Chadian returnees crossing into Tissi to escape the violence in Darfur.

According to MSF, “61 percent of the 194 reported deaths were caused by violence, most of them (111 out of 119) by gunshots and linked to specific episodes of violence preceding the two major waves of displacements, one in early February and the other in early April.”

Nine out of 10 deaths MSF recorded during its assessment were caused by gunshot wounds. In east Darfur alone, an estimated 305 people had been killed as a result of violent clashes between the Rizeigat and Ma’alia tribes in August alone.

Peacekeepers, too, have not been spared. In July seven peacekeepers with the UN mission there were killed in an ambush – the worst in the five-year history of the UN peacekeeping operations in Sudan – bringing to 13 the number of peacekeepers killed in Darfur since October 2012.

Some 50,000 Darfur refugees have crossed into Chad. The UN Refugee Agency (UNHCR) has described it as the “largest influx of Sudanese refugees into Chad since 2005”.

“[The] state is not in control of the situation nor is it able to disperse the fighting”

Officials in Darfur have admitted that the violence is now beyond the control of the state.

“[The] state is not in control of the situation nor is it able to disperse the fighting,” Abdul Hamid Musa Kasha, governor of east Darfur, told Radio Dabanga.

What are the challenges facing aid agencies in Darfur?

The deteriorating security situation has meant many aid agencies are unable to keep their staff on the ground in Darfur. Some have had their field offices looted.

In July an international NGO was robbed of an estimated US$40,000 when armed men entered their office in Central Darfur’s capital, Zalingei. In the same month, armed men stopped two buses and five trucks near Thur in Nertiti Locality while on their way from Zalingei to Nyala in South Darfur. The drivers and passengers were robbed of all personal items; one passenger was shot and injured while resisting the attack.

In May, two vehicles rented by an international NGO and carrying seven staff were carjacked in Wadi Salih Locality.

Earlier in February, the rented vehicle of another international NGO was ambushed north of Zalingei. Staff were robbed of all personal possessions.

“Commercial transporters are currently unwilling to transport relief supplies from El Geneina (West Darfur) and Zalingei to areas in the southern corridor localities – mainly Mukjar, Um Dukhun and Bindisi – due to security concerns,” OCHA said in its July bulletin.

Sudanese analyst Eric Reeves, a professor at the Smith College (USA), said in a recent analysis that “over the past year and more… violence has called into serious question the viability of any substantial ongoing relief efforts in the region. Virtually no international (expatriate) staff remain in Darfur, certainly not in the field or in remote locations – either for critical assessment work or to provide oversight for aid distribution. And as the recent killing of two workers for World Vision in their Nyala compound makes clear, there is no place of real safety in Darfur.”

OCHA’s Cutts told IRIN that while aid agencies have access to most of those in need in Darfur, “the continued insecurity and fighting and government restrictions on movement” had clearly affected aid agencies’ ability to operate.

“This has a direct impact on the ability of humanitarian actors to assess humanitarian needs and to ensure that people in need receive the assistance they require, particularly in areas of ongoing conflict,” he added.

In its 2013 World Report, Human Rights Watch said the Sudanese regime “continued to deny peacekeepers from the United Nations African Union Mission in Darfur (UNAMID) access to much of Darfur” and that “lawlessness and insecurity hampered the work of the peacekeepers and aid groups. Armed gunmen attacked and killed peacekeepers, including four Nigerians in October, abducted UNAMID and humanitarian staff and carjacked dozens of vehicles.”

According to Smith College’s Reeves, “opportunistic banditry has grown steadily and become a deeply debilitating threat to humanitarian operations. Fighting among Arab tribal groups has been a constant for a number of years, and has contributed steadily to instability and violence in Darfur.”

The Sudanese government too stands accused: “Khartoum has deliberately crippled UNAMID as an effective force for civilian and humanitarian protection. Opposed from the beginning by the regime, the mission cannot begin to fulfil its UN Security Council civilian protection mandate, and indeed operates only insofar as Khartoum’s security forces permit,” Reeves noted.

Who are the combatants in Darfur?

The conflict in Darfur is being waged on many fronts and by different actors. It involves three main rebel groups fighting the government: the SLA(Sudan Liberation Army)-Abdul Wahid faction, the SLA-Minni Minawi faction, and the Justice and Equality Movement (JEM). And while all these rebel groups are fighting under the auspices of the Sudanese Revolutionary Front, they are also divided largely along ethnic lines, with the SLA-Abdul Wahid faction being drawn mainly from the Fur tribe, and the SLA-Minni Minawi and JEM originally being drawn many from the Zaghawa tribe.

Peacekeepers and aid workers have not been spared the violence in Darfur

Meanwhile, there is inter-tribal violence between the Misseriya and Salamat, and another conflict between the Reizegat and Beni Hussein ethnic groups.

Cutts told IRIN: “This year we have also seen a new wave of localized conflict, including not only the familiar fighting between Arab and non-Arab tribes [e.g. between the Beni Halba and the Gimir; and between the Beni Halba and the Dajo] but also an increase in intra-Arab fighting [e.g. between the Salamat and the Misseriya; and most recently between the Rezeigat and the Maaliya].”

There have been clashes between government forces and militia too. In July there were violent clashes between government forces and Arab militia in the Darfur capital of Nyala, leaving many dead and many more displaced.

What is driving the conflict in Darfur?

“Underpinning almost all of the conflicts in Darfur are the disputes over land ownership and land use. Indeed, much of what is commonly referred to as “inter-tribal fighting” or fighting over “economic resources” actually relates primarily to disputes over land and access to water and grazing for animals,” Cutts, told IRIN.

The recent clashes in Darfur have mostly been as a result of inter-tribal disputes over grazing land and gold-mining rights.

In January, violence broke out between the Northern Reizegat and Beni Hussein ethnic groups over control of gold mines in the Jebel Amir area of North Darfur State.

“The gold rush in Sudan is further complicating matters. At the beginning of the year there were over 60,000 migrant gold workers in North Darfur alone. In January, disputes over gold mining rights drew two Arab tribes, the Beni Hussein and the Northern Rezeigat, into a conflict that resulted in many deaths and the displacement of over 100,000 people. And this was not the first violent incident related to gold mining in Darfur,” said Cutts.

Analysts fear the competition for other resources such as gum Arabic might lead to future violent inter-communal conflicts.

In July, Human Security Baseline Assessment for Sudan (HBAS), part of the Small Arms Survey, a project of the Graduate Institute of International and Development Studies, noted: “New conflict trends have emerged in 2013. The most prominent of these, resource-based conflict in the Jebel Amir area of North Darfur over control of artisanal gold mining and trade, began in January 2013…

“Other resources have also generated inter-communal violence: in South Darfur, the Gimir and Bani Halba have clashed over the harvesting of gum Arabic,” it added.

What is the status of the peace process?

Numerous peace processes to end the conflict between the government of Sudan and the various armed groups operating in Darfur have not borne much fruit. These include one in Abuja in 2006, and another in 2007 in the Libyan capital, Tripoli. The latest such initiative was in Doha.

Signed between the Sudanese government and armed groups, they have generally been dogged by a lack of legitimacy and deemed not inclusive enough.

“The second challenge concerns poor implementation of the DDPD [Doha Document for Peace in Darfur] and a lack of inclusivity. Promised funds from both the government of Sudan and donors have been slow to arrive, which has further delayed the activities of the Darfur Regional Authority (DRA), established in December 2011 as the lead actor for the implementation of the agreement,” said the HBAS report.

“The third challenge to the formal peace process is the significant deterioration in security across Darfur in 2013, as local peace mechanisms struggle to contain inter-communal violence, exacerbated by government actions.”

Locally, state officials say they are mulling the idea of bringing together leaders of the warring tribes to cease hostilities and bring the conflict to an end.

ko/cb source

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South Sudan is yet to replicate its success in eradicating polio in eliminating other diseases

Posted by African Press International on August 16, 2013

South Sudan is yet to replicate its success in eradicating polio in eliminating other diseases

JUBA,  – South Sudan is doing its bit for global polio eradication efforts, but huge gaps in immunization against other diseases remain.

Targeted polio immunization efforts started in the area more than a decade before the country’s independence in 2011 and have remained a top priority. There has not been a single case of polio for more than four years.

Health officials and humanitarian groups are trying to build on this success to improve other immunization efforts, including neonatal tetanus and measles, but more funding and a better health infrastructure are urgently needed.

To combat the re-emergence of polio, Anthony Kirbak, the director of the country’s expanded programme on immunization (EMI), said the Ministry of Health and humanitarian organizations have had to figure out how to circumvent low routine childhood immunization rates.

Every child in the country is supposed to be vaccinated against tuberculosis, polio, diphtheria, tetanus, whooping cough and measles by its first birthday. Kirbak said that only happens for about 65 percent of the country’s children due to a scant health infrastructure, poor roads and cyclical violence in some areas of the country.

To bump up the vaccination rates for polio, the Ministry of Health sends thousands of volunteers out across the country four times a year to immunize every child they can find who is under six. Kirbak said they regularly reach more than 90 percent of the children.

He said South Sudan’s specific focus on polio vaccination stems from the international pressure to completely eradicate the disease.

“The emphasis is because the whole world is supposed to eradicate polio,” Kirbak said. “The only way to do that where there is fragile health system and weak routine immunization, it has to go in the form of campaigns so that many children are reached in a short time.”

The global public health community was originally gunning for full eradication by 2000. They missed the deadline, but according to the World Health Organization (WHO) polio cases worldwide are lower than ever before – there were only 223 in 2012, down from nearly 2,000 a decade before. Kirbak said South Sudan has an international obligation to stay vigilant until well after that number hits zero.

Emergency campaign

Meanwhile, health officials are rolling out an emergency vaccination campaign next week following polio outbreaks in Kenya’s Dadaab refugee camp in April, and an outbreak in Somalia in May. There are now 110 confirmed polio cases between the two countries.

“Due to our proximity [to Kenya and Somalia] and the low immunization coverage in the country, we actually made an assessment of the risk areas,” Kirbak said. “It was found that we have four states (out of 10) that are at risk of importation, if at all any wild polio outbreak is brought into the country, then we’ll be in danger.”

So vaccines are being distributed to the four states and an additional county in South Sudan where people travelling from Kenya and Somalia are most likely to arrive. For four days next week volunteer vaccinators will immunize every child they can find.

Awareness up

Kirbak credits the country’s efforts to keep polio at bay with strengthening the health system generally. By training volunteer vaccinators and health workers to immunize against polio, they have increased general awareness about the importance of all immunizations.

That does not mean the routine immunizations are always available, even if people want them, either because they are cut off from health centres or because there are no staff to administer the vaccines. Kirbak said there has been improvement – routine immunization rates were up to 65 percent last year from 20 percent in 2007 – but acknowledges that it is still too low, which is why South Sudan will continue to deploy targeted vaccination campaigns until the health system gets stronger.

Officials are borrowing the polio campaign model for an ongoing neonatal tetanus vaccination campaign that has so far reached seven states and a measles immunization outreach that should start next year.

UNICEF provides almost all polio vaccines

Polio eradication efforts are propped up by the UN Children’s Fund (UNICEF) which provides almost all of the vaccines in the country. WHO covers the logistics of transporting them. The government contributes money to cover some of the health workers’ salaries, but Kirbak said the resources simply are not there for the state to do much more. That is why the measles campaign next year is only tentative as EMI waits to see if funding becomes available.

Meanwhile, Daniel Babelwa Ngemera, an immunization specialist with UNICEF, said that as South Sudan searches for funds to launch campaigns or strengthen routine immunization coverage, it is falling further behind other countries in the region, like Kenya. Their basic immunization package includes vaccines against pneumococcal – a strain of pneumonia – and rotavirus, which can cause severe diarrhoea in infants and children.

“Our children in South Sudan, they are not benefiting on that,” Ngemera said. “We are trying our level best to make sure at least the country is able to catch up, to be moving also with the other countries in the region.”

South Sudan will soon submit a proposal to the GAVI Alliance, a public-private partnership that helps countries access vaccines, asking for money to help strengthen the health system. Kirbak would not say how much they were asking for, but said it should boost the health system enough to “avert the issue of campaigns”.

MSF action in refugee camp

In the meantime, state officials ask NGOs and humanitarian organizations to introduce immunization coverage where they can.

Médecins Sans Frontières (MSF) started a three-part pneumococcal vaccination campaign in Yida refugee camp in South Sudan’s Unity State last month. The camp holds more than 75,000 refugees, mostly Sudanese who have fled violence in Sudan’s South Kordofan region.

“They’re living in makeshift structures,” said Christopher Mambula, MSF’s country medical coordinator. “It’s more densely populated. They’re not living under normal conditions in buildings and structures like that, which makes for easier propagation of pneumococcus from one person to another.”

Roughly a quarter of all in-patient treatment in the camp last year was for lower respiratory infections.

Mambula said in the first round of the campaign vaccinators were able to reach about 4,300 children under two. They will go back out this month to administer the second dose and the third will follow in September.

Kirbak said the pneumococcal vaccine is one of many on the list of vaccines he plans to introduce to the country as soon as he can find the money.

Immunization data in South Sudan is patchy. WHO and UNICEF’s “estimates of immunization coverage” for 2012 note that immunization rates “are based on data and information that are of varying, and, in some instances, unknown quality”.

ag/cb  source

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Small-scale traders face constant harassment from security forces and corrupt government officials

Posted by African Press International on August 14, 2013

Goma, the capital of the Congolese eastern province of North Kivu, continues to face serious challenges

GOMA, – Three years ago when Jean*, 41, applied for a license to open a hardware shop in Goma, capital of North Kivu Province in the Democratic Republic of Congo (DRC), he had to pay a fee of US$1,500 to the General Tax Directorate, and the whole process took a year.

“Every time I went to the [tax] office, they denied I ever paid the money, yet I had an official receipt from the General Tax Directorate. I had to pay a bribe to get the license,” he told IRIN.

Since opening, Jean has had to contend with different people claiming to be government officials coming regularly to his shop asking him to pay additional taxes.

“Here nothing works because all the time, people come to you saying they are from the General Tax Directorate but they have no identification at all. You just have to pay them. The tax they ask for is never uniform and depends on the mood of the person who comes to collect it,” he added.

Jean’s experience highlights the incapacity, or virtual absence, of state institutions and endemic corruption in this part of DRC.

Another example: The UN Children’s Fund (UNICEF) estimates that two thirds of children in North and South Kivu provinces do not have a birth certificate, though you have to have one (in theory at least) to be enrolled in school in the DRC.

But it is not just the lack of an effective state bureaucracy that worries some observers – many health and education services in eastern DRC are funded or controlled by aid agencies.

A March 2013 paper by Koen Vlassenroot and Karen Büscher of the Conflict Research Group argues that in Goma and elsewhere in eastern DRC, power, authority and state sovereignty have been transferred to aid organizations.

“Due to a lack of means, capacity, motivation, vision, corruption and mismanagement, state services have been constantly hollowed out and have increasingly been replaced by new coalitions of local and international development actors.”

One effect “of the humanitarian sector’s presence and interventions is the encouragement of state withdrawal from public services and a transfer of power and legitimacy to the advantage of international actors. This sector has largely taken over education and health care, and even the rehabilitation of road infrastructure,” they said.

For instance, in the provinces of North and South Kivu, Médecins Sans Frontières (MSF) runs 40 health centres, nine health posts, and four referral clinics and supports 11 government-owned health clinics.

The UN Children’s Fund (UNICEF) appealed for nearly US$6 million to fund educational activities in North and South Kivu in 2012; and $9 million for education and 2.8 million for nutrition and water, sanitation and hygiene services for the whole of DRC in 2013.

According to Büscher and Vlassenroot, international aid agencies have replaced the state in key sectors. They say development “is understood locally as a responsibility of the humanitarian sector” – meaning that citizens see development, or the lack of it, as the effort or failure of aid organizations operating in the area.

“Governance by substitution”

Marc-Andre Lagrange, Central Africa senior analyst at the International Crisis Group (ICG), told IRIN: “The Congolese administration based in Kinshasa has chosen governance by substitution in managing the affairs of the country’s eastern region” in which the government appears to have handed over the responsibility of providing services to aid organizations.

Small-scale traders face constant harassment from security forces and corrupt government officials

This, Lagrange argues, is not “something new in DRC as it was the Mobutu regime that introduced that practice of weakening the state apparatus and handing over social services to humanitarian and charitable organizations. Education and health care have long since been taken over by the Catholic Church in most of the country. Organizations such as MSF were present in DRC long before 1994 [and have provided health care since].”

Problems are many

Pacifique Borauzima Buluhukiro, a programme officer in Goma with International Alert, told IRIN: “The roads are in disrepair; electricity is irregular in town and absent in rural areas. Schools and health facilities are in poor condition and are in inaccessible areas [even] for humanitarian organizations.”

Armed groups continue to control large swathes of the region. A result of these conflicts has been the internal displacement of an estimated 2.7 million people, the third largest internal displacement in the world.

“The government doesn’t provide anything”

Those who live in camps around Goma, uprooted from their homes by armed rebel groups, say they do not receive any assistance from the government.

Nadia, a 27-year-old mother of three from Ruthshuru, told IRIN from Mugunga 3, a camp for internally displaced persons (IDPs) on the outskirts of Goma: “We have no food, water or even [security] and the government doesn’t even visit to see how we live. Only NGOs at times come here to help.”

Lack of access to clean water has made cholera and waterborne diseases endemic. The absence of government investment in the health sector has meant the few clinics, operated mostly by aid agencies, are overstretched and unable to cope.

“At times people come and we just look at them because we don’t have any way of helping them. We have no drugs. At times some organizations offer to help but it is too little and it runs out quickly. The government doesn’t provide anything,” a nurse at a government-owned health facility, told IRIN.


A Congolese human rights activist who preferred anonymity told IRIN that even though taxes are levied through the General Tax Directorate, the revenue ends up in the pockets of government officials.

“Corruption in DRC is endemic. The country has an undemocratic, authoritarian and untransparent governance system that supports patronage networks based on the exchange of favours and murky resource transfers”

“Corruption in DRC is endemic. The country has an undemocratic, authoritarian and untransparent governance system that supports patronage networks based on the exchange of favours and murky resource transfers,” Marta Martinelli, a programme officer at the Open Society Initiative for Southern Africa (OSISA), said in a recent report.

A senior civil servant in the North Kivu governor’s office told IRIN political leaders are focused more on retaining political power than providing services.

“The resources available are used to extend political patronage. In the eastern part, the conflict is a good excuse for government officials to say `when there is peace, we will come to help’,” he said.

Francois Rumuzi, a 24-year-old trader in Goma, told IRIN that seeing the poorly paid local police, who do little to protect residents from criminals, is the closest he gets to feeling the government’s presence.

“When you listen to the radio, you hear government officials talk about this or that, but the government doesn’t help people here. Even the police here say they can’t protect us because the government doesn’t pay them,” he said.

Fidel Bafilemaba, a Goma-based researcher with the Enough Project, said the absence of an effective state presence has made eastern DRC the “nerve centre” of what he called DRC’s “non-state status”. He said conflict had exposed “the government’s failure in security, health and education sector reforms”. He said the situation had led many to declare the DRC “a failed state”.

Traditional chiefs

Analysts have accused the government of leaving governance and development to traditional leaders in rural areas, something they say has failed because local chiefs have no constitutionally defined roles.

In a July 2013 analysis entitled Understanding Conflict in Eastern Congo (I): The Ruzizi Plain, ICG said; “The government remains ineffective in rural areas, leaving customary chiefs, whose role is recognised by the constitution but not fully defined, virtually in charge. They use their key position between the state and communities to benefit from any state and international investments and to protect their own interests. This fuels conflict, with intercommunal rivalries playing out in state institutions and among local and national politicians.”

To solve this problem, ICG said the Congolese authorities should “disseminate the laws on customary powers to the population and customary authorities, and train customary chiefs so they can assume their functions in accordance with the law.”

In its 2012 report Ending the Deadlock: Towards a new vision of peace in eastern DRC International Alert argues that for the state to have more legitimacy there needs to be better access to, and management of, land in rural areas; a more rational division and management of political power; better management of returning refugees and IDPs; and recognition of the importance of security.

According to OSISA’s Martinelli, DRC has serious flaws in its democratic system, a weak justice sector, deeply entrenched corruption and a “neglected or non-existent infrastructure, which prevents the effective delivery of public services”.

*not a real name

ko/am/cb source

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Landmines and fear – Bringing peace, stability and aid

Posted by African Press International on July 27, 2013

SANA’A,  – More than three years after a tentative truce between the Houthi-led Shia movement in the north of Yemen and the government, humanitarian access is starting to open up in the areas still under the control of the Houthi militant forces.

Despite repeated skirmishes, the Qatar-supported ceasefire has largely held since February 2010, not least because of a shift in the military’s focus to the south, where Islamist forces seized parts of Abyan Province in 2011, and the end of President Ali Abdullah Saleh’s 33-year rule in 2012.

While delivering aid in areas under the control of the Houthis, or Ansar Allah as they now call themselves, has never been straightforward, there are signs that the current peace is tentatively leading to better humanitarian access.

“The openness has happened in a gradual manner as trust has gradually been rebuilt,” said Hélène Kadi, head of field operations and emergency operations at the UN Children’s Fund (UNICEF) in Yemen.

“Thanks to structured discussions, we have been able to increase our work in Sa’dah, even if there can still be issues with security, coordination delays and the unpredictability of the situation.”

In June, UNICEF started training 50 female volunteer teachers from rural areas in Sa’dah Governorate to work in girls’ schools. They have also trained 60 community leaders on nutrition, health, and water and sanitation (WASH), gave training to 22 communities’ midwives, and helped set up 25 new temporary classrooms in 10 districts in the governorate.

The International Committee of the Red Cross (ICRC) has had a sub-office in Sa’dah since 2007 and last year extended work to remoter areas of the governorate, said their spokesman in Yemen, Marie-Claire Feghali.

“We have started a better conversation with the Houthis in the north who, in the past, were very difficult in terms of accepting international assistance and particularly assessment,” said Ismail Ould Cheikh Ahmed, the humanitarian coordinator for Yemen.

“But now there is much more opening and better discussion, and trust is building up in the north.”

Landmines and fear

The Houthi movement has “de facto control” on the ground in Sa’dah Governorate, with their influence also spilling over into parts of Hajjah, Amran and Al-Jawf governorates.

Since the 2010 truce, Sa’dah has seen ups and downs in humanitarian access, with occasional outbreaks of violence between the Houthis (Shia) and Salafist (radical Sunni) groups.

Aid agencies have had difficulty carrying out assessments, faced restrictions on movement, and have had access limited by insecurity. Medical NGOs Médecins Sans Frontières (MSF)-Spain and MSF-France stopped operations in Sa’dah in late 2011.

“There is no open fighting. But there are risks from landmines, and there is still the fear of what might happen next”

The UN Humanitarian Air Service is sometimes unable to land in Sa’dah because of insecurity. On the ground, things are frequently tense, particularly in Kitaf District and Dammaj village on the outskirts of Sa’dah town.

“There is no open fighting. But there are risks from landmines, and there is still the fear of what might happen next,” one aid worker, who asked not to be named, told IRIN.

There are almost weekly reports of blasts from landmines and unexploded ordnance (UXO). Initial survey work on these explosive remnants of war has just started, according to this year’s Humanitarian Response Plan.

“We continue to see improvements in terms of access, and the authorities are cooperating. I wouldn’t say it’s improving day by day, but at least now we can sit down to plan an issue and address the situation,” the aid worker said.

At least 10 UN agencies and NGOs work in Sa’dah, with 67 projects planned for this year, mainly focusing on WASH, health, shelter and protection in 2013.

Too soon to return

The six rounds of fighting from 2004 to 2010 affected more than a million people. Some 227,000 continue to need humanitarian assistance in Sa’dah this year.

The conflict officially displaced 103,014 people (IDPs) within the governorate, and around 190,000 IDPs to surrounding regions.

Unlike in Abyan, where more than 90 percent of the 200,000 people displaced by the violence in 2011-12 have returned home, the IDP situation in the north is proving more protracted. Despite the truce, so far only 69,772 IDPs have returned.

Many of those reluctant to return cite security concerns, including revenge attacks and fears of a seventh round of fighting. Landmines also need to be cleared, homes rebuilt and livelihoods re-established.

“The displaced are hoping and willing to go back. But they don’t have livelihoods at the moment. They are really suffering. In the north, infrastructure, houses and farms have been destroyed – everything needs to be rehabilitated. The displaced cannot go back to nothing,” Mohamed Saad Harmal, assistant to the head of government’s Executive Unit for IDPs/camps, told IRIN in Sana’a.

Many in Sa’dah depended on seasonal work or smuggling over the nearby border with Saudi Arabia, but employment restrictions and the tightening of controls are making such work scarce.

If the provision of humanitarian aid in Sa’dah improves, and stability returns, large-scale returns could begin. But the lack of basic services is given by many IDPs as a key reason why they have not yet returned home.

Health facilities in Sa’dah struggle to attract qualified doctors and nurses, and there is little equipment to work with.

Around 8,000 families have returned to Sa’dah from Haradh, in neighbouring Hajjah Governorate, but they return to the Haradh area each month to pick up monthly food rations.

“One of the key issues back there is that there are no schools,” Mudhish Yahya, an IDP from Sa’dah now living in al-Mazraq Camp 1 near Haradh, told IRIN. “Some were destroyed. In some areas, there just weren’t any schools anyway.”

Save the Children is planning to include 15 schools in Sa’dah in their Child-Friendly School programme, which launches in September. They have also rehabilitated several health clinics, and they expanded health and nutrition programmes by 40 percent in 2012.

“The needs are huge here and are largely a consequence of destruction resulting from the six Sa’dah wars,” Save the Children’s country director, Jerry Farrell, told IRIN. source

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South Sudan: Food fears in Jonglei

Posted by African Press International on July 26, 2013

JUBA/BOR,  – Tens of thousands of people face severe food insecurity as they hide in the bush in South Sudan‘s Jonglei State following another wave of violence that ha s cut off aid to them.

“We believe these people need food now and cannot wait for much longer after hiding in the bush for weeks,” said Chris Nikoi, the UN World Food Programme’s (WFP) South Sudan country director, in a statement on 23 July. “We need more food supplies in the country and more helicopters to take this food to those who most need it.”

More than 100,000 people are out of reach of humanitarian support following violence that broke out in July between the Lou Nuer and Murle communities and following clashes between the government and a rebel movement led by David Yau Yau. Over the past six months, around 120,000 people have fled to the bush as insecurity gathered pace.

Insecurity, rains and a lack of roads or useable airstrips make it very difficult to reach the neediest, especially with heavy foodstuffs.

“The delivery of food aid poses extra logistical challenges as trucks are unable to move along water-logged roads, and we do not have enough helicopters to fly sufficient food to the swamp-like areas,” Toby Lanzer, the humanitarian coordinator in South Sudan, said in an 18 July statement.

WFP said it was providing food assistance to the displaced in areas it could access, but required US$20 million to purchase food and hire helicopters for an operation to feed 60,000 people until December. Humanitarian agencies in South Sudan are facing an overall funding shortfall of $472 million.

Extreme coping strategies

Murle communities have already resorted to extreme coping strategies, with some eating wild fruits and leaves; following cattle raids, thought to be in the tens of thousands, the population is slaughtering female cattle for meat, even if this means they cannot replenish stocks.

Women who have been hiding in the bush with children for days or weeks have walked into towns to collect food, but those IRIN spoke to said they would return to the swamps, where they have no shelter, healthcare or clean water, as they feared security forces more than disease or hunger.

“Even prior to the start of armed conflict, the UN and the Famine Early Warning System Network (FEWSNET) reported [Jonglei’s] Pibor County was experiencing chronic levels of food insecurity and predicted that 39,000 people would be severely food insecure in early 2013, with food insecurity potentially reaching emergency thresholds by July-August,” said a statement by InterAction, an alliance of US-based NGOs.

“These people need food now and cannot wait for much longer after hiding in the bush for weeks”

According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), in 2012, “pre-harvest malnutrition rates between January and July were already approaching emergency thresholds”, while as of March 2013, 12 percent of Jonglei’s population was severely food insecure and 24 percent moderately food insecure.

Access to populations in need

On 14 July, after protracted negotiations with state and non-state armed groups, charities were allowed access to around 25,000 people in parts of the state.

Vincent Lelei, head of OCHA in South Sudan, said aid agencies had only accessed “a very, very small part [of Pibor county] both for logistical and security reasons,” although thousands had been suffering for six months.

“Going forward into the lean season, it is very likely that they will get into difficulty,” he said, adding that flying in food would be more difficult than flying in other commodities such as plastic sheeting, water purification tablets and medicines, as limited air assets meant the UN had “very limited weight to carry”.

Lelei said some of the populations they had accessed showed signs of serious illness, while Lanzer noted that “some children show signs of measles, a fatal disease in such conditions”.

Some of those affected do not want to come in to towns to seek help. “They are afraid to seek medical care in towns, so it is essential for us to intervene where they are so that all those in need can access treatment,” said John Tzanos, head of the Médecins Sans Frontières (MSF) team in Pibor.

MSF is running the only healthcare facility in the village of Gumuruk after its hospital in Pibor was destroyed during clashes in May.

hm/kr/rz source

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The crisis in the CAR has persisted for years

Posted by African Press International on July 9, 2013


NAIROBI,  – The precarious security situation in the Central African Republic (CAR) is worsening seasonal food insecurity and increasing the burden of disease, especially among children, warns a humanitarian official.

“In our projects, we do see increasing numbers of children with severe acute malnutrition (marasmus and kwashiorkor) [but] the increases seen in MSF projects are so far in line with seasonal experience. However, the instability has aggravated pre-existing food security problems: a poor harvest, poor food supplies and volatile food prices and, as a result, the country could also be at risk of a rise in malnutrition cases,” Ellen Van Der Velden, the head of mission of Médecins Sans Frontières (MSF) in CAR, told IRIN in an e-mail.

Kwashiorkor is a health condition caused by severe acute malnutrition (SAM) and is characterized by oedema. (See: IRIN’s Food and nutrition jargon buster).

Marasmus is the most common form of acute malnutrition in nutritional emergencies and, if untreated in its severe form, can very quickly lead to death, according to the UN Children’s Fund (UNICEF). UNICEF notes the disease “is characterized by severe wasting of fat and muscle, which the body breaks down to make energy.”

Diseases on the rise

According to Van Der Velden, MSF’s recent exploratory mission in southwest CAR, in the areas of Nola, Boda, Berberati, Gamboula and Gadzi, revealed an increase in levels of global acute malnutrition (GAM), which ranged from 6 percent to 10.3 percent. SAM levels ranged from 1.3 to 5 percent. (GAM refers to the total rate of acute malnutrition in a given population, while SAM is a sub-category of GAM.)

“This situation, together with the malaria peak, increases the vulnerability of children in CAR,” she said.

Between January and March, MSF-supported health facilities in CAR treated 74,729 patients for malaria, a dramatic increase over the same period in 2012, when 50,442 patients were treated for the disease.

Children under age five are among the worst affected; 23,910 children sought treatment for malaria during this period in 2012, while 44,469 have sought treatment so far this year.

Photo: DFID
The crisis in the CAR has persisted for years

In the area of Boguila, in western CAR, for example, malaria accounted for 61 percent of outpatient consultations for under-fives in the first quarter of 2013, compared to 41 percent over the same period in 2012.

Disrupted healthcare

The spike in diseases comes as health services are severely disrupted. Health infrastructure were looted and staff fled amid the general insecurity following the 24 March Séléka rebel ouster of the government.

Access to healthcare and medical supplies is also a problem.

“In a country which already had the second-lowest life expectancy in the world, at just 48 years, the people are now even more at risk,” said Van Der Velden. “The impact of the recent crisis has been tremendous. Fear of movement has further reduced access to healthcare, loss of income has made it even more difficult to pay medical fees, and unreliable drug supply systems have been completely collapsed. Mortality rates are only likely to worsen in the coming months.”

In a 28 June situation report, the UN Office for the Coordination of Humanitarian Affairs (OCHA) noted that malnutrition treatment services at therapeutic feeding centres and units in Berberati, Mambéré- Kadéï Province (South) had stopped due to a lack of nutritional supplies.

The population in Berberati is susceptible to malnutrition, and the lack of money to buy food has forced households there to reduce the number of meals they eat per day from two to one, according to OCHA.

“The impact of the recent crisis has been tremendous. Fear of movement has further reduced access to healthcare, loss of income has made it even more difficult to pay medical fees, and unreliable drug supply systems have been completely collapsed. Mortality rates are only likely to worsen in the coming months.”

According to Van Der Velden, “Some medical nutritional supplies are available in the country, but [it] is beyond anyone’s capacity to bring them to all health facilities in the country and assure their correct use.”

Ongoing insecurity

Insecurity in CAR has also disrupted access to basic commodities and exacerbated human rights abuses.

According to OCHA, in the areas of Damara and Sibut, “the population continues to live in their farms or in the forest and come to town only during the day to obtain essential items and return by 3:00pm”.

Seleka forces have installed their own local administrative and judicial authorities in Damara and Sibut, negatively impacting humanitarian access to affected populations there, notes OCHA.

In a 5 July CAR briefing, the UN Refugee Agency (UNHCR) noted, “Overall, there remains a serious absence of security, and lawlessness is widespread.”

UNHCR staff have received reports of “arbitrary arrest and illegal detention, torture, extortion, armed robbery, physical violence including sexual violence, rape and attempted rape, abduction, restriction of movement, targeted lootings and attacks on civilians”, the briefing said.

Human Rights Watch (HRW), in a 27 June report, called on the UN Security Council to sanction those involved in rights violations. “Séléka fighters are killing civilians and burning villages to the ground while some villagers are dying in the bush for lack of assistance,” stated Daniel Bekele, HRW’s Africa director.

The Séléka movement is also grappling with internal problems, the latest being the arrest of a minister from one of its constituent groups, the Convention Patriotique pour le Salut Wa Kodro, who is accused of recruiting mercenaries. Clashes between Séléka members and armed civilians on 28 June caused several deaths in the capital, Bangui.

aw/rz source

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Containing diseases in a refugee camp

Posted by African Press International on July 7, 2013

Drinking safe, walking tall

DOMIZ CAMP, – On a hot June afternoon, 27-year-old Gharib Mohammed stands outside his tent at this camp for Syrian refugees in Iraq, shovel in hand.

Sewage and garbage have blocked the small stream that runs the length of his dusty avenue and the smell has entered his tent.

“There are some other streams but I can’t clean them all. I just clean the one in front of my home. If everybody did the same thing, the camp would be clean, but not everybody does it.”

The water running past Mohammed’s house is what is technically known as “grey” water – cooking and washing water that is not contaminated with sewage. Or at least it is not supposed to be.

Mohammed points to the septic tank behind his tent, which he says is shared by 25 families.

“In two days, it gets full [then] it overflows and mixes with the other water.”

In the three months he has been living there, government contractors have emptied the tank three times, he said. He once had to resort to paying the truck driver 5,000 Iraqi dinars (US$4.30) to empty it.

Aid agencies say overcrowded living conditions in Domiz (Duhok Province) – built for 25,000 refugees but now accommodating almost twice that number – have put refugees’ health at risk.

“Water, sanitation and hygiene facilities on the site are far from adequate, increasing the risk the camp could become fertile ground for the spread of disease,” Mahendra Sheth, regional health adviser for the UN Children’s Fund (UNICEF), which is responsible for water and sanitation activities, said at the start of summer.

In April, a number of measles cases were reported in the camp, and between mid-March and mid-May, the number of diarrhoea cases tripled, the medical charity Médecins Sans Frontières (MSF) said.

An assessment conducted by MSF in April showed “clear inequalities” in water distributions, it said in a 15 May press release. Some areas of the camp receive only four litres per person per day, MSF said, far less than the minimum 15-20 litres per person recommended in humanitarian emergencies.

“In some instances, people simply do not have access to water or sanitation,” MSF emergency coordinator Stéphane Reynier wrote. “This is simply not acceptable.”

Massoud Barzani, president of the Kurdistan Regional Government (KRG), recently accused the international community of “abandoning” the Syrian refugees in Kurdistan and asked foreign officials to bring the situation to the attention of their governments.


Aid agencies have vaccinated people and are trying to increase water and sanitation services in the camp, but the problem, explains Jaya Murthy, head of communications for UNICEF, is that the camp is overstretched.

“Services were only planned for [25,000] people, so when you [nearly] double that number, of course those services are stretching, which means less for everybody.”

Many irregular settlements and transit areas have emerged, he said, and some of the people on the fringes may not even have access to some of those regular services.

The differences between the original areas and the irregular and transit areas of the camp are stark. Approved tents in the first three phases of construction of the camp each have their own latrine and share one septic tank for every four tents.

In Phases 1-3, Swedish NGO Qandil contracts a waste removal company to empty tanks when families report them full. “The trucks stand by 24 hours a day,” says Salar Rasheed, Iraq programme coordinator, “so the truck is available even at night.”

But residents in unapproved tents and in some of the transit areas share one latrine between 29 to 189 people, according to a Norwegian Refugee Council (NRC) report based on February data from the UN Refugee Agency (UNHCR). In one case documented by NRC, residents had to keep using a communal latrine that was overflowing for lack of an alternative.

To address the overcrowding, the UN is working with the Kurdish authorities to allocate more land for new camps. KRG has approved the construction of two new refugee camps in the region – one in Erbil Province, scheduled to open this month, which will house 2,000 families; and one in Sulaymaniyah, designed to hold 1,500 families.

Although there were initial hopes to install proper sewage systems in both camps, the cost of doing so – around $5 million dollars each – was prohibitive given the region’s limited budget.

“It can be done,” says Qandil’s Rasheed, “but it costs a lot of money.”

A neglected crisis?

In June, the UN issued the largest appeal for funding in history to address humanitarian needs related to the Syrian crisis. Included is a request for $37 million for water, sanitation and hygiene services in Iraq, including ensuring safe water and sanitation throughout Domiz.

Gharib Mohammed unblocks the stream outside his tent. Open gray water channels in Domiz Camp are often contaminated with garbage and sewage

But aid workers say the international community has neglected the Syrian crisis in Iraqi Kurdistan, focusing instead on Jordan and Lebanon, where donors perceive the needs to be higher. Aid agencies in Iraq have received just 14 percent of the funding requested for their humanitarian response to Syrian refugees in 2013. As a percentage, and also by raw figures, this makes Iraq the least-funded of the four countries in the Regional Response Plan that border Syria.

“The Syrian refugees have the same right to vital assistance, wherever they flee to seek protection. However, it has – unfortunately due to various political and economic reasons – been very difficult to attract funding to the projects in Iraq, and the refugees are the ones paying the price,” said Toril Brekke, acting secretary-general of the Norwegian Refugee Council, which just published a report on how the international community is “failing” Syrian refugees in the Kurdish region of Iraq.

Rising disease risk

In the meantime, government authorities and aid agencies are trying to prevent a disaster with the little funds they do have. With temperatures rising (in July, they often surpass 40 degrees), the risk of water-borne diseases is increasing.

“Over several weeks [the number of reported cases of diarrhoea] went down but it can come up at any time so ensuring access to sanitation and safe water is absolutely critical,” said UNICEF’s Murthy. “So as new people keep coming and settling in these irregular areas, we have to be really on top of it to ensure that [the water supply] is properly maintained and those services are delivered to everybody. Otherwise contagious diseases like diarrhoea and other water-borne diseases can catch very quickly.”

The Duhok Province authorities provide a water network to the original settlements and, for the time being, water trucks take care of the rest of the camp.

Thanks to a grant of $4.5 million from the Japanese government, UNICEF is currently planning to lay a pipe network in one of the newest areas of the camp, Phase 7.

UNICEF and NRC are about to start a water monitoring project, checking that the levels of chlorine are adequate.

As well as putting together a cholera prevention plan, UNICEF and MSF have started to send health and hygiene promoters around the camp, tent to tent, to teach families how to minimize the risk of disease and infection. It is particularly important to help residents used to living in modern urban environments to adjust to their new conditions, Murthy said.

“Hygiene promotion is one area that we really need to critically scale up. It’s really, really our priority area.” There are 64 hygiene promoters working in Domiz, “but we need to double or triple that.”

hg/ha/cb source


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