Friday, 30 March 2012

POVERTY: MALI: Holy wars and hostages – AQIM in the Maghreb

DAKAR, 29 March 2012 (IRIN)

 Photo: US Army Africa
The cycle of violence between north and south has been going on for decades (file photo)This is part of a series of reports on the crisis in northern Mali exploring the MNLA rebellion, and the impact of AQIM

Mopti in central Mali had a thriving tourism industry a few years ago, but Issa Ballo, a private tour operator, says the city built at the confluence of two rivers and often described as the ‘Gateway to the North’ still has everything in terms of “adventure, discovery and culture”.
The cliff-dwelling Dogon people with their distinctive culture are a few hours’ drive away; Timbuktu, a centuries-old centre of Islamic learning, was receiving a steady stream of visitors. “Now, you can count the tourists on the fingers of one hand”, Ballo complained. “It is only… the really courageous who come here.”
He blames the embassies in Bamako, the capital, for issuing security alerts and declaring “no go zones” for their nationals. He accuses the media of exaggerating the problems in the north, “making out there is a gun pointed at your head everywhere you go.” But his strongest contempt is for Al-Qaeda in the Islamic Maghreb (AQIM, known as AQMI in French), the radical Muslim group that appears to have a stranglehold over parts of northern Mali and beyond, despite its modest numbers and murky agenda.
“They are bandits, thieves, criminals… murderers”, Ballo says. “Ninety-five percent of people in Mali are Muslims… and we have never read in the Koran that you should take someone’s life to gain money. Al-Qaeda, AQIM, I don’t consider these people to be Muslims - they are just a kind of mafia with very long arms.”

Threat or fake?
AQIM’s military and commercial activities, religious orientation, size, composition and leadership have been the subject of many research papers, newspaper articles and conspiracy theories. Direct media access to AQIM, except for a few interviews with leaders, has been limited, with journalists often dependent on the testimony of released hostages and security sources, occasional amateur footage posted on YouTube by defectors, or leaked police interviews with terror suspects.
Sceptics say the threat has been gravely overplayed by the United States and France for their own strategic reasons, and by countries like Algeria and Mauritania, whose military and political elites are keen to be identified as front-line fighters against international terrorism. One academic observed, AQIM can be seen as a “small shop with a very big sign”, using its Al-Qaeda ‘franchise’ in the Sahara and Sahel to generate headlines and huge cash injections through deftly organized kidnappings, but with limited reach.
Opinions are often sharply divided. The International Crisis Group (ICG) in its March 2005 report, Islamist Terrorism in the Sahel: Fact or Fiction? commented that “Fundamentalist Islam has been present in the Sahel for over 60 years without being linked to anti-Western violence.” The authors warned that “a misconceived and heavy-handed approach could tip the scale the wrong way”.
Others say the presence of an expanding transnational terrorist force could turn parts of the Sahel into a Somalia or even an Afghanistan. They point to a movement that has transcended its Algerian roots, recruiting in the Sahel and further afield, with the possibility of stronger ties in the future with organizations like Boko Haram in Nigeria and the emerging Jamaat Tawhid wa’l-Jihad fi Garbi Afriqqiya (Movement for Oneness and Jihad in West Africa - MOJWA).
The UN mission sent to the Sahel in late 2011 to assess “the impact of the Libyan crisis on the Sahel region” hinted at AQIM’s ability to find an accommodation with local communities in the poorest parts of the Sahel, noting reports “that in some areas, the humanitarian vacuum is being filled by AQIM and/or criminal elements who are reportedly providing services and humanitarian assistance in remote areas where State presence is reduced or non-existent”.
The mission warned that AQIM could use this situation “to develop recruitment and local support networks for gathering information, supplying arms and ammunition, and other logistics”. It noted that AQIM, like Tuareg combatants leaving Gaddafi’s Islamic Legion in Libya, may also have stocked up weaponry, including Semtex explosives, anti-aircraft artillery, and rocket-propelled grenades.

Out of Algeria
AQMI’s origins are usually traced back to the crisis in Algeria in 1992. As the military authorities annulled elections, depriving the radical Islamic Salvation Front (FIS) of probable victory, a bloody domestic conflict took hold. The future leaders of AQIM first found a niche in the Islamic Armed Group (GIA), but left it to found the Salafist Group for Call/Preaching and Combat (GSPC). The Salafists hold to a conservative traditional view of Islam.
The Algerian conflict in the 1990s saw atrocities committed by all sides. Human rights activists, academics and others repeatedly questioned the role of Algeria’s intelligence service, the Département du Renseignement de la Sécurité (DRS), and accused it of not only infiltrating armed movements, but controlling key terrorist operatives.
In September 2006, the GSPC announced its formal affiliation to Al-Qaeda and in January 2007 changed its name to AQIM. Much of AQIM’s activity still centres on Algeria. In April 2007, AQIM used car bombs against the prime minister’s office and a police precinct in Algiers, the capital, killing 33 people. A subsequent attack in December 2007 on the Algerian Constitutional Council and the United Nations office in Algiers killed 63 people. There have been repeated attacks on military bases in the north and south of the country.
AQIM’s leadership is overwhelmingly Algerian. The man named in the UN Al-Qaeda Sanctions List in 2007 as the ‘Emir’ of AQIM is Abdelmalek Droukdel, 41, an engineer thought to have combat experience in Afghanistan. Interviewed by The New York Times in July 2008, Droukdel took responsibility for several bombing campaigns and pledged to “liberate the Islamic Maghreb from the sons of France and Spain… and protect it from foreign greed and the Crusaders’ hegemony.”

The ‘Marlboro Man’
In a recent interview with the website Al Wissâl, one of AQIM’s senior brigade commanders, Mokhtar Belmokhtar, aka Khaled Abou Al-Abass, reminded Muslims that “selling or trafficking drugs, even in infidel countries, is outlawed by the laws of Allah, and that is clear and beyond discussion”. AQIM has well-established links with a burgeoning trans-Saharan trade in arms, migrants, narcotics and cigarettes, and Belmokhtar’s interest in the latter earned him the nickname “Marlboro Man”.
Like Droukdel, both Belmokhtar and Abud al-Hamid Abu Zeid have long been identified as the key figures in AQIM south of Algeria and have been given heavy sentences in absentia by Algerian courts. Both reportedly head significant commercial empires, and both have taken Tuareg wives, seen as an obvious way of securing favours from Tuareg communities.
Abud Zeid’s brigade, or katiba, is reportedly operating in Mali and Niger, while Belmokhtar’s is found in the west of the Maghreb. Mauritania appears to be more of a priority target than Mali. Belmokthar reviles Mali for hosting an Israeli embassy, its close ties with US intelligence services and its tough stance on Islamic militants.

Kidnappings and killings
AQIM’s notoriety, particularly in the Western media, is derived mainly from its involvement in kidnappings. The forerunner GSPC abducted 32 tourists from Algeria in 2003, releasing the 31 survivors several months later. AQIM has targeted smaller groups. The most high-profile abductees were Canadian UN diplomats Robert Fowler and Louis Guay, taken from Niger in December 2008, moved to Mali and released after four months in captivity in April 2009.
Among other abductees have been seven employees of the French company, AREVA, aid workers and tourists. Those executed or who died in captivity include British citizen Edwin Dwyer, one of a group of tourists kidnapped in 2009, and French humanitarian worker Michel Germaneu.
The governments of abductees have given out few details, particularly on the size of ransoms, or AQIM’s precise demands, but have included the withdrawal of French troops from Afghanistan and the release of senior Al-Qaeda prisoners.
Ransoms in millions of dollars and payment have been a source of division among the governments whose nationals have been taken (France, Britain and Italy, for example), and the African governments involved in negotiations. Algeria and Mauritania have been highly critical of Mali for releasing known AQIM operatives in return for hostages.

Mali – the weakest link
Recently ousted President Amadou Toumani Touré had repeatedly rejected accusations that Mali’s public commitment to fighting terrorism was not matched by actions. Touré, a keen defender of US-backed anti-terrorism initiatives, noted the vastness of the country’s 1.24 million square kilometres, and constantly appealed for stronger regional military cooperation.
Mauritanian President Mohamed Ould Abdel Aziz recently warned: “The north of Mali is a region left open for terrorism,” and said AQIM combatants were stocking up at will on food and fuel in places like Gao and Timbuktu, using easily identifiable vehicles. AQIM has attacked embassies in the Mauritanian capital, Nouakchott, targeted garrisons and killed tourists. The Mauritanian army has conducted hot pursuit operations inside Mali, and joint Mauritanian-Malian operations have occasionally been conducted.
A senior French official, quoted in the French weekly, L’Express, in November 2011, confirmed: “We are very angry with the Malians. Whether with regard to AQIM cells… their links with the Tuareg, or the trade in Latin American cocaine on its way to Europe, it’s no longer passiveness, but complicity. We have irrefutable proof.”

Tuaregs and terrorists – allies or adversaries?
Defenders of Mali’s failure to engage AQIM say the security vacuum in the north is the result of successive peace accords between the government and Tuareg rebel movements, which have forced a scaling-down of bases and troop numbers.

 Photo: Emilio Labrador/IRIN
Tourists used to flock to experience the unique architecture, landscape and culture of northern Mali (file photo)

Bamako accuses the Tuaregs of lending support to AQIM by sharing their desert expertise and navigational skills, acting as auxiliaries, opening up their trade networks. It would be impossible for AQIM to operate in northern Mali without some sort of acceptance by the Tuaregs, say Sahel researchers.
There may be little spiritual affinity between AQIM’s Salafists and nomads in the north, but former hostages like Robert Fowler say AQIM’s fighters are respectful of local needs and customs. They also offer important fringe benefits. A Bamako-based peace activist with extensive research in the Kidal region, explained. “What are the alternatives for young [Tuareg] people? It’s not difficult to put yourself in their place, to see the temptations of getting involved in drugs trafficking or some other kind of adventure.”
Tuareg leaders, not least from the MNLA (Mouvement National pour la liberation de l’Azawad, or National Movement for the Liberation of Azawad), which is fighting to carve out an independent state in the north, have consistently called for the expulsion of AQIM from Malian territory, and accuse the authorities of giving free rein to criminal elements.
Alliances have shifted constantly in the north over the past 20 years, but a recurring figure is veteran Tuareg leader Iyad Ag Ghali, founder of the MPLA (Mouvement Populaire pour la Libération de l'Azawad, or Popular Movement for the Liberation of Azawad) in 1988. He has been used by the government as a mediator and could win over hardliners.
Sent as a diplomat to Saudi Arabia, Iyad famously converted to the Pakistan-based Tablighi Jam’at faith while in Jeddah. He now heads the Ansar dine movement, which has a nominally pacifist orientation. Iyad is thought to have been involved in hostage releases in the past, giving him a wide range of contacts and the opportunity to interact with key individuals in AQMI. In recent statements, MNLA has distanced itself from Iyad, suggesting that Ansar dine is more of an irritant than an ally.

Arguments over Aguelhoc
The government’s contention that there is an MNLA-AQIM link grew stronger after a Commission of Enquiry confirmed reports of a massacre of over 70 government soldiers at Aguelhoc (in Kidal) when it was overrun by rebels in late January, and said this was the work of “Salafist extremists” in cahoots with the MNLA.
The MNLA accused Malian intelligence services of staging an elaborately fake by rearranging the corpses to make it look as if they had been slaughtered using AQIM methods. An MNLA communiqué warned: “There is no relationship between us and any kind of Islamic movement. Our mission is clear and we don’t intend to be distracted.”

Thursday, 29 March 2012

POVERTY: SOMALIA: Border town in a fix over water

HARGEISA, 27 March 2012 (IRIN)

 Photo: Mohamed Amin Jibril/IRIN
Water is getting costlier in parts of Somaliland

Water scarcity in Tog-Wajale, a town straddling the border between northwest Somalia's self-declared republic of Somaliland and Ethiopia, is threatening the health and livelihoods of locals who cannot afford to buy it.
"One barrel of water [200 litres] was only 20 [Ethiopian] birr [US$1], but the price has now reached about 50 Ethiopian birr [$2.5]," said Ahmed Jama Weirah, a father of seven in Tog-Wajale. "We can't provide for our families... because our earnings are not enough to provide food and water."
The Somaliland side of Tog-Wajale has had no official water supply since 1995, following the closure of the town's only well, which had fallen into disrepair. The town's main water sources are a seasonal river that acts as the border between Somaliland and Ethiopia, and expensive pumped water from Ethiopia.
"Now the [river] water is over and we can't afford to buy imported water," said Weirah.
"While livestock have been moved further north where they can find water, townsfolk face water scarcity," said Abdillahi Omar, a resident. "Some families use less than 20 litres per day to cook meals, and they don't take a bath for several days."
Local officials told IRIN they hoped the rains would start soon, but were focusing on long-term solutions.
The dysfunctional well used to supply less than 2,000 litres of water a day, so repairing it would not provide sufficient water for the town’s estimated 40,000 people (up from 10,000 in 1995), said Hashi Mohamed Abdi, the mayor of Tog-Wajale.
Currently about 20,000 litres are pumped from Ethiopia every day, “which is not enough", he said, adding that water was also trucked in from Kalabiat and Gabiley to the northeast of Tog-Wajale.
However, the future looks brighter as the European Union (EU) has agreed to fund a water project in the town.
The EU is funding water projects in several Somaliland towns, including Hargeisa, Burao, Erigavo and Tog-Wajale; the Tog-Wajale water project is due for completion in 2015.

POVERTY: PAKISTAN: Anti-polio drive moves to tribal agencies

PESHAWAR, 29 March 2012 (IRIN)

 Photo: Kamila Hyat/IRIN
Some 14 cases of polio have been reported across Pakistan so far this year

Pakistan, which has reported 14 cases of polio this year, is focusing its anti-polio drive on tribal agencies along the Afghanistan border where militant violence has affected eradication efforts, say officials.
Last year, 198 cases were confirmed - the highest for any country in the world, despite the government’s launch of a National Emergency Plan against polio in 2011 and the setting up of a task force to combat the disease.
“Frankly speaking, this is very embarrassing for us as a nation. India’s success is pointed out at every meeting,” a health department official in Islamabad, who asked not to be named, told IRIN.
India has remained free of new cases for a year, and been removed from the list of polio endemic countries by the World Health Organization (WHO). Pakistan remains on the list alongside Nigeria and Afghanistan.
One area where attention is being focused is Bara `tehsil’ (administrative unit) in the troubled Khyber Agency, one of seven tribal agencies along the Pakistan-Afghan border. Here, militant violence has consistently impeded vaccination drives.
At a meeting in Islamabad in March, experts warned that displaced persons moving out of the Khyber Agency and into camps such as Jalozai, could trigger a crisis by spreading the disease.
The first anti-polio drive in nearly three years began in Khyber and Bara `tehsils’ on 25 March, according to Mazhar Zeb, the officer in charge of administration in Khyber Agency. Vaccination began at Jalozai Camp, near Peshawar, the next day.
“Since September 2009, most of Bara tehsil had not been vaccinated against polio,” Sona Bari, a spokesperson for the Global Polio Eradication Initiative (GPEI), told IRIN. "Vaccination points are being set up wherever people are moving so that children can be reached.”

Children up to 15 being vaccinated
Bari also said the age of vaccination had been raised to cover a wider population, and “locally suitable” methods were being used to raise awareness.
Children up to 15 are being vaccinated, rather than those aged up to five, as is the usual practice. Some 38 cases of polio have been confirmed in Bara since 2010. But as movement continues out of the Agency, there is concern also about reaching people moving to camps.
“The campaign in IDP [internally displaced persons] camps is very important,” Elias Durry, a WHO spokesperson, told IRIN in Peshawar.
Duniya Aslam Khan, a spokesperson for the UN Refugee Agency (UNHCR), told IRIN that “as of 17 March, a total of 126,605 IDPs have arrived from Bara. Of the total displaced, 82 percent of IDPs do not reside at camps.”
Despite the vaccination points set up by WHO and government health teams to reach people on the move, it is uncertain if all the people moving to different places, usually to live with relatives, are being reached.
“The situation here is quite chaotic. Members of the anti-polio teams are fearful, and people trust no one. This makes the work of reaching everyone in Bara very hard,” Zarina Bibi, a member of one of the over 70 teams working in the area, told IRIN. She also said it was unclear where people were going - with some even moving to places as far off as Karachi.
Recent US drone attacks and a sense that people are more concerned about saving themselves from violence in their home areas than having their children vaccinated, have added to the difficulties.
Others know what they want: “I want my three children, aged four, six and nine to be vaccinated. No team has come here yet, but I hope it will happen soon,” said Arif Khan, 35, from his village in Bara. “I have seen the effects of polio, and want my children saved. It is not their fault there has been no campaign here for so many years.”

Sunday, 25 March 2012

MALARIA: In the Andes

A recent epidemic of malaria in the highlands of Bolivia and establishment of multiple Anopheles species mosquitoes in the highlands of Ecuador highlights the reemergence of malaria in the Andes Mountains in South America. Because malaria was endemic to many highland valleys at the beginning of the 20th century, this review outlines the 20th century history of malaria in the highlands of Ecuador, and focuses on its incidence (e.g., geographic distribution) and elimination from the northern highland valleys of Pichincha and Imbabura and the role of the Guayaquil to Quito railway in creating highland larval habitat and inadvertently promoting transportation of the vector and parasite. Involvement of control organizations in combating malaria in Ecuador is also outlined in a historical context.

MALARIA: parasites in faeces

Comparison of diagnostic methods for Plasmodium spp. in humans from Uganda and the Central African Republic showed that parasites can be efficiently detected by PCR in fecal samples. These results, which rely solely on PCR-based examination of feces, validate numerous estimates of the prevalence of malaria in great apes.

POVERTY: The Global Polio Eradication Initiative

The Global Polio Eradication Initiative (GPEI) was launched in 1988 and, as of March 2012, indigenous wild poliovirus (WPV) transmission has been interrupted in all countries except Afghanistan, Pakistan and Nigeria. However, outbreaks resulting from importation of WPV occurred during 2003–2011 in 29 previously polio-free African countries. Most of these outbreaks were contained, but WPV transmission became re-established (i.e. lasted >12 months) in Angola, Chad, the Democratic Republic of the Congo (DRC), and in Sudan. Sudan reported the last confirmed case in 2009.4 This report summarizes progress towards polio eradication in Africa during 2011.

POVERTY: USA: When Poverty Was White

NELL IRVIN PAINTER: March 24, 2012

Arthur Estabrook Papers, Special Collections & Archives, University at Albany, SUNY.
Carrie Buck with her mother, Emma, perhaps for the first time since her childhood, on the day before the trial that led to her sterilization.

CARRIE BUCK, or rather her last name, appears just once in the books of Charles Murray, the conservative sociologist and author of the recent work “Coming Apart: The State of White America, 1960-2010,” his portrait of the decline of poor white Americans. To find it, you have to look through the endnotes for the introduction to his most famous book, “The Bell Curve,” in which he cites Buck v. Bell, the 1927 Supreme Court case that approved Ms. Buck’s involuntary sterilization.
 It’s a striking omission, because her case highlights the historical blindness of Mr. Murray’s narrow focus on the cultural and policy changes of the 1960s as the root of white America’s decline. The story of white poverty, as Ms. Buck’s story illustrates, is much longer and more complex than he and his admirers realize or want to admit.
In 1924 Virginia ordered Ms. Buck, 18 years old, unmarried and pregnant, to be forcibly sterilized. Her legal guardian appealed, and the case made it to the Supreme Court. The winning argument blamed her pregnancy on hereditary weaknesses — in particular, her presumed feeblemindedness. Justice Oliver Wendell Holmes Jr.’s majority opinion entered history: “Three generations of imbeciles are enough.”
Involuntary sterilization was the early 20th century’s remedy for what Mr. Murray blames on changes in the 1960s. But it was precisely the changes of that era — for black civil rights, women’s rights, poor people’s rights — and socially committed Catholicism that ended this inhumane practice.
Along the way, though, something got lost. Ms. Buck, sterilization, white poverty — this older history disappeared in the mid-20th century, when prosperity isolated the stigmata of poverty in black Americans. In 1965 Daniel Patrick Moynihan’s “The Negro Family: The Case for National Action” laid blame on a black “tangle of pathology” of ghetto culture. Mr. Moynihan voiced a logic widespread at the time, translating the disarray associated with poverty into a racial trait.
And so when Mr. Murray faults poor whites’ morals today, he unwittingly joins an earlier tradition of blaming the poor for their condition, whether they be black in the 1960s or white at the turn of the 20th century.
The roots of the movement for the involuntary sterilization of poor whites — the policy that Ms. Buck embodied — reach back into 19th-century social-betterment circles and an abundant social science literature on poor families.
The movement’s pioneer was Richard L. Dugdale, corresponding secretary of the Prison Association of New York and secretary of the National Prison Association. He took up the scientific study of crime after the economic panic of 1873, which he blamed on unmarried sex, drunkenness and crime.
After visiting county and state jails, Mr. Dugdale published a report destined for greatness: “The Jukes: A Study in Crime, Pauperism, Disease and Heredity, Also Further Studies of Criminals.” By Mr. Dugdale’s calculation, the “fornication,” “crime,” “prostitution,” “bastardy,” “intemperance” and “disease” of generations of the pseudonymous Jukes family had cost New York State a staggering $1.3 million.
“The Jukes” found favor among penologists, social workers and social gospellers, who combined a humanitarian commitment to the poor with a scientific approach to charity. One admirer was the Rev. Oscar Carleton McCulloch of the Plymouth Congregational Church in Indianapolis. Inspired by Mr. Dugdale, Mr. McCulloch sought to make his own philanthropy scientific through research on Indiana’s poor, some of whom came through his church doors.
One result was “The Tribe of Ishmael: A Study in Social Degradation,” which appeared in 1888. In it, Mr. McCulloch answered a gigantic question in the burgeoning field of heredity at a time when the concept of “race” divided not just white and black, but white people themselves: How could Americans of supposedly the finest racial stocks — English, Saxon and Anglo-Saxon — engender a long history of pauperism and crime?
The answer, Mr. McCulloch said, still lay in blood, but in blood of the wrong kind. He wasn’t being original when describing the English ancestors of the Ishmaelites as the “old convict stock which England threw into this country in the 17th century,” but he was among the first to put it into a social-scientific context.
That logic was largely superseded in the 1910s by a seemingly more advanced approach to the persistence of white poverty: I. Q. testing. Such techniques to quantify intelligence aligned perfectly with an interventionist approach to social betterment, thanks to Charles Benedict Davenport, head of the Eugenics Record Office. Mr. Davenport stood at the hard end of a continuum of eugenic thinking, beside so-called negative eugenicists like Madison Grant, who proposed the literal elimination of people he thought inferior.
Though genes were not yet fully understood, Mr. Davenport had something like them in mind when he argued that intelligence was passed on as a single “unit trait.” That unit trait could be quantified, in the words of an enthusiastic tester, as “the value of a man.” (Mr. Murray made a similar argument in “The Bell Curve,” though he has since moved away from I. Q. hereditarianism.)
Mr. Davenport urged Henry H. Goddard, head of research at the Training School for Backward and Feeble-Minded Girls and Boys in Vineland, N.J., to test his charges. Mr. Goddard found the perfect resident, a 22-year-old he called Deborah Kallikak. His results, published in 1912 in the best seller “The Kallikak Family,” invented the name Kallikak by joining the Greek “kalos” (goodness) and “kakos” (badness).
HER forebear, he deduced, had engendered two families: one upstanding, from a legitimate union, and Deborah’s degenerate one, from sex with a feebleminded barmaid. Rating Deborah a “moron,” Mr. Goddard concluded that she would lack moral judgment and blamed her mental handicap on her ancestry. According to Mr. Goddard, Deborah’s degenerate branch counted 36 illegitimate children, 33 sexually immoral persons (mainly prostitutes), 3 epileptics (epilepsy was considered solely hereditary), 82 dead babies, 3 criminals and 8 brothel keepers. How to block the propagation of hereditary social ills? Sterilization.
States had started sterilizing in 1907 to prevent crime, idiocy and imbecility, in the parlance of the day. But some governors vetoed sterilization laws; in other states, courts invalidated the laws as cruel and inhumane, for lack of due process and for lack of equal protection.
Were sterilization to prevail, expert guidance was needed, and Mr. Davenport’s Eugenics Record Office supplied it in the form of a model sterilization law devised to withstand court challenge. Virginia passed the first such act in 1924.
The first person slated for sterilization under Virginia’s new law was Carrie Buck, the daughter of an unmarried mother living in the State Colony for Epileptics and Feeble-Minded. Since both mother and daughter had been designated as feebleminded, her sterilization was deemed necessary to halt the propagation of “the shiftless, ignorant and worthless class of anti-social whites of the South.” After her sterilization, she lived an otherwise normal adult life.
Along with Ms. Buck, some 65,000 Americans were sterilized before 1968. Virginia repealed its sterilization law in 1974, and in 2002 the state placed a commemorative marker to Buck v. Bell in Ms. Buck’s hometown of Charlottesville. The governor issued a formal apology.
Involuntary sterilization is no longer legal, and intelligence is recognized as a complex interplay between biology and environment. Indeed, the 1960s, the era that Mr. Murray blames for the moral failings that have driven poor and middle-class white America apart, was the very same era that stemmed the human rights abuse of involuntary sterilization. (Not coincidentally, it was the same era that began addressing the discrimination that entrenched black poverty as well.)
The stigmatization of poor white families more than a century ago should provide a warning: behaviors that seem to have begun in the 1960s belong to a much longer and more complex history than ideologically driven writers like Mr. Murray would have us believe.

Nell Irvin Painter is the author of “The History of White People.”

MALARIA: How Hidden Can Malaria Be in Pregnant Women?

How Hidden Can Malaria Be in Pregnant Women? Diagnosis by Microscopy, Placental Histology, Polymerase Chain Reaction and Detection of Histidine-Rich Protein 2 in Plasma
Alfredo Mayor et al.
Correspondence: Alfredo Mayor, PhD, Barcelona Centre for International Health Research, Hospital Clínic, Universitat de Barcelona, Rosselló 132, 08036 Barcelona, Spain (

Background. Accurate diagnosis of malaria infection during pregnancy remains challenging because of low parasite densities and placental sequestration of Plasmodium falciparum. The performance of different methods to detect P. falciparum in pregnancy and the clinical relevance of undetected infections were evaluated.

Methods. P. falciparum infections were assessed in 272 Mozambican women at delivery by microscopy, placental histology, quantitative polymerase chain reaction (qPCR) and detection of histidine-rich protein 2 (HRP2) in plasma by enzyme-linked immunosorbent assay (ELISA) and a rapid diagnostic test (RDT). Association between infection and delivery outcomes was determined.

Results. Among the 122 women qPCR-positive for P. falciparum in peripheral and/or placental blood samples, 87 (71.3%) did not receive a positive diagnosis by peripheral microscopy, 75 (61.5%) by HRP2 ELISA, and 74 (60.7%) by HRP2 RDT in plasma. Fifty-seven of the 98 qPCR-positive placental infections (58.2%) were not detected by histology. Women who were qPCR-positive but negative in their peripheral blood by microscopy or HRP2 RDT in plasma (n = 62) were at increased risk of anemia, compared with negative women (n = 141; odds ratio, 2.03; 95% confidence interval, 1.07–3.83; P = .029).

Conclusions. Microscopy, placental histology and HRP2-based plasma diagnostic methods fail to identify the majority of the P. falciparum infections detected by qPCR in peripheral and placental blood. Undetected infections were associated with maternal anemia, highlighting the urgent need for more accurate malaria diagnostic tools for pregnant women to avoid the negative clinical impact that hidden infections can have during pregnancy.

Friday, 23 March 2012

TUBERCULOSIS: A new global strategy for TB vaccines

Michael Regnier
Saturday 24 March, it will be exactly 130 years since Robert Koch identified the cause of tuberculosis (TB) and while there is a vaccine used widely around the world (Bacille Calmette-Guérin, or BCG), it has not proved effective enough to stop this disease killing one and a half million people every year.
Earlier this week, a new Strategic Blueprint for TB vaccines was published in the journal Tuberculosis. Its purpose is to once again draw attention to the need for new TB vaccines to complement or replace BCG, which was first used in humans in 1921. The drive for new tools to prevent, diagnose and treat TB is particularly important in the context of rising reports of drug-resistant TB around the world.
BCG works very well at protecting newborn children against severe forms of TB early in their lives but it is not sufficiently effective against pulmonary TB, which affects adolescents and adults and is now the most common form of the disease. The Blueprint’s authors call for researchers, clinicians, advocates, vaccine manufacturers and governments around the world to work together on creative approaches to vaccine development.
The Blueprint was edited by Dr Jelle Thole, director of the Tuberculosis Vaccine Initiatve (TBVI) and Dr Michael Brennan, senior adviser for scientific and global affairs at Aeras, a non-profit working to develop new TB vaccines. They acknowledge progress in the last decade, which has seen 15 TB vaccine candidates enter clinical trials. The most advanced of those candidates is MVA85A, which has been developed by Dr Helen McShane, a Wellcome Trust Senior Clinical Research Fellow, with funding from Aeras, the Wellcome Trust and other agencies. MVA85A is currently in phase IIb clinical trials, the results from which will determine its safety and effectiveness as a vaccine.
However, we cannot take it for granted that any of the 15 candidate vaccines in the pipeline will prove successful enough to stop TB. Research funded by the Wellcome Trust and many others continues into the basic biology of the mycobacteria that cause TB and possible new ways to fight the infection.

POVERTY: SUDAN: Food crisis looms as bombs drive farmers from their fields

DAR, 22 March 2012 (IRIN)

 Photo: Peter Moszynski/IRIN
Tall pillars of smoke rise in the distance after an air raid as seen from these burnt houses in Dar, South Kordofan

Driving north across the border from South Sudan into the warring Sudanese state of South Kordofan, the landscape abruptly changes from the swamps and seasonal grasslands into the fertile foothills of the Nuba Mountains, rising gently from the plains. Each hill is topped by a village, with acorn-shaped clusters of huts perched on rocky outcrops.
In the picturesque village of Dar, women in brightly-coloured `taubs’ gather around the communal pump chatting and exchanging gossip in a scene typical across rural Africa. But on closer inspection, none of the houses have roofs: most of the village has been burned to the ground. The area is littered with spent cartridge cases, unexploded ordnance, and several wrecked tanks.
Since fighting between the Sudan Armed Forces and the rebel Sudan People’s Liberation Army - North (SPLM-N) broke out in June 2011, spreading later to neighbouring Blue Nile State, more than 400,000 people have been displaced.
Women in Dar said they had taken advantage of the lull in fighting that followed SPLM-N’s recent capture of Dar, descending from the caves where they had sought shelter to fetch water and try to salvage their belongings from their wrecked homes.
During this reporter’s visit, the sense of security was shattered by the growing roar of an approaching Antonov plane, sending residents fleeing. The aircraft passes by this time, dropping its rudimentary bombs elsewhere, leaving tall pillars of smoke rising in the distance.
“This is why people are going hungry,” says Mubarak Ahmed, from the Nuba Youth Association. “You can see how everyone is terrified by the bombing, so nobody is able to plant or tend their crops.”
Over a million people now live in rebel-controlled areas, cut off from the outside world, as was the case in the 1983-2005 civil war, when many in South Kordofan sided with southern rebels.

Time running out
With the rainy season due to start in a few weeks, humanitarian agencies are warning that time is running out to bring in life-saving supplies.
Local officials say the conflict has severely affected agricultural production, and estimate that the next harvest will be only 20 percent of normal, leaving most of the population dependent on outside aid. They warn that unless supplies are brought in within the next few weeks, the onset of the rains will make it virtually impossible to distribute the relief, just when the annual pre-harvest hungry season reaches its peak.

Photo: Peter Moszynski/IRIN
Nursing mothers queue to register for supplementary feeding at the Yida camp, which is home to over 20,000 Nuba refugees

A small proportion of the war-affected population has managed to cross the new border into South Sudan. Even here the refugees find little safety. Close to the border, Yida refugee camp is home to over 20,000 Nuba refugees. The camp is pitted with foxholes, rough shelters scraped out of the red earth by frantic civilians to provide protection against cross border air raids.
One nine-year-old girl had broken her collar bone whilst diving for cover in one of the many air raid shelters, incongruously placed all around the supposedly safe refugee camps.
A disabled old woman, struggling to care for five visibly traumatized grandchildren, described how they had to flee their village in the Nuba Mountains after the children's parents had been killed in a bombing raid.
Another old woman had broken ribs, and said she had been beaten by soldiers after being arrested on suspicion of attempting to flee to rebel-held areas.
International aid agencies are attempting to relocate the refugees from Yida, which was bombed in November, to a new site some 70km further south.
Although war returned to the Nuba Mountains in June 2011, the UN Mission in Sudan (UNMIS) wound up its operations when South Sudan gained independence the following month, and its successor mission only operates in the new state, not in Sudan.

Abandoned by the UN?
Everywhere people complain they have been abandoned by the UN whilst being attacked by their own government. They ask: “Why has the international community left us in the hands of an indicted war criminal?”
Ahmed Mohammed Haroun, who was declared the winner of disputed gubernatorial elections in May 2011, is wanted by the International Criminal Court for war crimes he allegedly committed in Darfur.
In February, the UN, the African Union and the Arab League drew up a plan to deliver humanitarian aid to the region, but Khartoum has yet to endorse it.
President Omar al Bashir is expected to visit South Sudan in the coming weeks to finalize this and other outstanding matters, including the issue of oil revenues and a new framework agreement on citizenship and border issues.
Mukesh Kapila, who headed UN operations in Sudan in 2003 and 2004 and now works for the Aegis Trust, a group which campaigns against genocide and war crimes, recently visited South Kordofan.
While with the UN in Sudan “I saw what genocidal violence was doing in Darfur. When I asked the world to heed my warnings, it looked away until it was too late,” he said.
“From what I have seen in the Nuba Mountains, I fear that much the same scenario is unfolding there. Will the world listen this time around?”

POVERTY: MALI: Rebellion claims a president

BAMAKO, 22 March 2012 (IRIN)

 Photo: Eskinder Debebe/UN Photo
Just-ousted President of Mali, Amadou Toumani Touré

Former Malian President Amadou Toumani Touré, overthrown this morning by mutinous soldiers, said recently that tackling recalcitrant Tuareg rebels in the north is going to be an ongoing task for future governments.
“The problems of the north have been with us for 50 years now… Our elders dealt with them; we are tackling them, and the younger generation will continue to do the same. This is not going to be over tomorrow,” he told Radio France Internationale.
Touré’s successor government, the Comité national pour le redressement de la démocratie et la restauration de la démocratie et la restauration de l’état (CNRDRE), led by army captain Amadou Sango, has dissolved state institutions, suspended the constitution, reportedly arrested several ministers, taken over the state broadcaster, and announced a curfew.
CNRDRE says it has brought an end to “an incompetent regime” and singled out Touré’s “incapacity to manage the crisis in the north of the country… and to fight terrorism”.
There have been persistent complaints from soldiers of inadequate supplies and military hardware, poor direction and strategic planning and a sense of abandonment for those on the frontline, fighting a war that could and should have been prevented.
Touré, 63, having first taken power aged 42, had planned to retire gracefully, leaving after a second-five year term, as stipulated in the constitution. Until recently, he had been adamant that presidential elections scheduled for the end of April would take place, that there was no question of the military situation forcing an emergency transitional government, and that he was looking forward to retirement and more time with his family.
The current situation has an ironic symmetry. Touré’s first period in office after overthrowing military ruler Moussa Traoré in March 1991 began against a background of revolt in the north and ended in June 1992 just after a Pacte Nationale was signed by the government and representatives of Tuareg resistance movements fighting for a separate territory.
Twenty years later, the long-term solutions put forward in that agreement - decentralization, reconciliation and bringing resources and development to some of the country’s most isolated regions - have not taken hold.
Many Malians from different communities believe Touré responsible for the current crisis, alleging that the promises did not turn into concrete developments, too many projects were left on the drawing board, and too much of the funding was never accounted for.

Arsenal from Libya
Having dealt messily with an earlier insurgency, signing an inconclusive peace agreement in February 2009, Touré’s beleaguered army found itself up against a much better organized rebel movement, flush with an arsenal taken from Libya.
The new, largely Tuareg force, the Mouvement National pour la liberation de l’Azawad (MNLA), initiated hostilities with an attack on Ménaka in the far east of the country on 17 January, following this up with a series of strikes on small towns spread across a vast expanse of the north: Léré, Niafunké, Aguel-hoc, Tessalit.
While Touré reorganized his senior command, and military communiqués pointed to a rapid recovery of lost territory, there has been little evidence in recent weeks of the national army gaining ground.
There was a serious warning for the government when widows of soldiers killed in the north demonstrated in the garrison town of Kati, 15km outside the capital, on 1 February, marching with the clear support of sections of the military.
Civil society activists have talked of the need for Malians to come together and draw on a long history of peaceful coexistence, but have warned the situation is much more complex than before, not least because parts of the north now dominated by a flourishing illicit economy that appears strongly linked to Islamist “terrorist” networks, notably Al-Qaeda in the Islamic Maghreb (AQIM).
“This only confirms what I have believed all along”, said Mohamed Ag Ossade, reacting to the overnight coup in Mali. “All Mali’s children have to come and sit down together. We need to talk to each other now more than ever.” For three years, Ag Ossade has run TAMUST, the Tuareg Cultural Centre in Bamako, the capital.
TAMUST plays host to curious visitors, but has also been a successful concert venue and the site is dominated by a vast tent housing Tuareg cultural artefacts, swords and jewellery.

Ag Ossade is proud of his Tamsheq heritage, but also a firm champion of the concept of `brassage’ (mixing), pointing out that Mali’s ethnic groups have lived together and intermarried for centuries, and that one of the country’s abiding strengths is its diversity. “No culture can thrive in isolation,” Mohamed told IRIN. “People have to know each other.”
He says he has found the events of the past few months distressing and frustrating. “I have friends and family fighting on both sides. They should put an end to this wretched piece of cinema now.”
One of the major fears since even before the conflict began is that revived tensions in the north would lead to inter-ethnic violence in the south. Both Tuareg and Arab communities in the capital have expanded significantly in recent years, partly because of the prevailing poverty and lack of opportunities in the north. Many have fled, Mohamed acknowledged, but stressed that: “nobody has been killed as far as I know and people should be wary of rumours and exaggeration”.

 Photo: Nancy Palus/IRIN
A Tuareg clinic in Kati, outside Bamako, that was recently ransacked. Turmoil erupted 21 March in Mali when Defence Minister Sadio Gassama visited a military camp in Kati

There were ugly demonstrations in early February, particularly in Kati, as anger over government troop casualties spilled over into attacks on prominent Tuaregs. Malians have bitter memories of rebellions in the 1960s and 1990s, and of how easily armed attacks in one location could bring on a cycle of reprisals and counter-reprisals in another.
People watch out for echoes of the mid-1990s when Ganda Koye (“masters of the land”), a self-defence militia drawn mainly from the Songhai community, took up arms, targeting Tuaregs and Arabs. The latest rebellion has not, so far, triggered that kind of confrontation, although there have been hints of an anti-Tuareg backlash in areas like Gao with a past history of inter-ethnic tension.
Politicians from Touré down spoke out against `les amalgams’, or half-truths that can be used by troublemakers to stir up hate campaigns, using the rebellion as a pretext for ethnic pogroms.
Presidential candidate Ibrahim Boubacar Keita, known to Malians as IBK, made sure that his condemnations of the rebellion were combined with appeals for moderation, pointing out that “the overwhelming majority of communities in the north live in peace and want to contribute to the development of the nation”. IBK called for a special conference on the north, a proposal which has been endorsed by other politicians, religious leaders and civil society organizations.
The faith in dialogue is shared by some outsiders. Prior to the events of 21 March, a Western diplomat confidently observed that: “sorting things out, finding a consensus, that’s in Mali’s DNA”.
But there were concerns too about the potential for breakdown.”People often say: “enough is enough, no more peace conferences, we must see this thing through until the end”, said Jean de Dieu Dakouo, Director-General of the Centre Djoliba, in Bamako, which specializes in conflict resolution. “But they don’t think through what they are saying”.
With a curfew in place and the capital in shutdown mode, it is difficult to gauge the impact of the coup. “Our main priority for now is working out what is going on”, a Bamako-based diplomat acknowledged.

Displacement and food insecurity
Watching with particular concern are aid agencies. The coup comes at a critical time in terms of food assistance. The north, west and several other parts of the country are experiencing severe food insecurity due to erratic rains and a poor harvest in 2011.
As the conflict goes into a third month, relief organizations like the UN Refugee Agency (UNHCR), the International Committee of the Red Cross (ICRC) and Médécins Sans Frontières (MSF) have consistently highlighted the need for food, shelter, water and medical care for the 100,000 who have fled across the borders, while stressing the pressure placed on the regions taking in the influx. Northern Burkina Faso, southern Mauritania, western Niger and parts of Senegal are all grappling with serious food insecurity and malnutrition that are likely to escalate in the coming months.
But there has also been massive internal displacement inside Mali, with 93,500 making it to provincial centres, like Gao, Tomboctou and Kidal, while others remain on the fringes of conflict areas, like Aguel-hoc and Tessalit, according to UNHCR.
Germain Mwehu of the ICRC, speaking to IRIN from Niamey, capital of Niger, Mali’s southern neighbour, cited the example of Ménaka, in eastern Mali, the first target of a rebel attack on 17 January and now held by the MNLA.
“Many people made for the border with Niger,” Mwehu told IRIN. “Many of those who stayed are living on the periphery of the town. Food and shelter are our priorities and this in an area very vulnerable to drought.” The ICRC has serious concerns about access to people in the more isolated areas and for the security of its staff. Mwehu also talked of the psychological burdens facing the target population.
“People in Ménaka are very stressed about not knowing what to do. Should they try to leave for Niger? Should they stay put? Will the conflict resume? Will the government look to stage an offensive?”

Aid agencies
Even before the rebellion, international and national NGOs operating in the north faced security scares and access issues, sometimes being forced into a temporary suspension of activities or the withdrawal of expatriate staff.
Médecins du Monde (MDM) was forced to scale down its activities in response to worsening security in February 2012, but was able to resume in early March.
François Fille, MDM’s Security Focal Point, says his organisation, like other NGOs in Mal, is still taking stock of the coup.
“At the moment, our teams in displacement camps in the north are working”, File emphasized. “There has been no harassment. They are able to access our beneficiaries. That is the situation as of now”. But he said nothing could be taken as guaranteed. "We are very concerned about the situation and what could happen now with the coup in Bamako."
MDM has been able to run its nutritional and medical activities unimpeded, gaining access to populations in both MNLA and government-held areas. "Until now, we haven't noticed extra controls from both sides and hope it won't change in the future".
NGOs often have to prioritize humanitarian operations ahead of development work, and there are longer-term concerns too: how will the costs of military campaigns affect government budgets in a year of huge food security problems? “There are going to be three million people affected by the food security problems in Mali come April [2012],” warned Abdoulaye Samoura, advocacy officer with Oxfam in Bamako. “There is a danger that the government will put all its political, financial and decision-making capacity into sorting out the crisis in the north.”
Numerous small-scale development projects, covering everything from irrigation to governance, operate in isolated, war-affected zones like Kidal. “If there is no security in the north, how can the projects they need there be made to work?” asked Mohamed Ag Ossade. “Resorting to arms will never help a country to develop.”

POVERTY: INDONESIA: Facing the stigma of leprosy

JAKARTA, 22 March 2012 (IRIN)

 Photo: Mark Wilson/IRIN
Leprosy patients, shunned in the community, retreat to a compound village

In Indonesia, a diagnosis of leprosy can cut patients off from family, employment, public services, even marriage and places of worship, say health officials.
According to a 2011 World Health Organization (WHO) report, Indonesia ranked third globally in 2010 with 19,785 registered leprosy patients, behind Brazil with 29,761 and India with 83,041. By the end of 2011 there were 22,726 recorded cases in Indonesia, with approximately 1,900 under the age of 15.

More than a health risk
Leprosy is caused by a bacillus transmitted by air through droplets from the nose and mouth during frequent contact with untreated persons. Without treatment, the disease can lead to permanent nerve damage and muscle paralysis, according to the WHO.
People with leprosy often face social ostracism, especially when they lose limbs, which can be eaten away by infections that go unnoticed or treated due to lack of sensation in the fingers and toes, and also by facial deformities caused by damaged nerve tissue.
H M Subuh, a senior Health Ministry official for infectious diseases, told IRIN that there is widespread stigma associated with the disease and the people who suffer from it.
"They are rejected by public services, experience difficulties in finding new spouses after divorce from their previous partners due to their diagnosis, and they have also been rejected in religious places.”
According to Intan Setiadi, coordinator of a leprosy patient group in the city of Tangerang in West Java Province, even children are not spared. “If children have been disabled by the disease, if they have lost fingers or toes, then they too can become stigmatized.”

Sitanala Hospital in West Java is one of three state hospitals in Indonesia with a unit specifically for leprosy patients (the others are in the provinces of South Sumatra and South Sulawesi).
The local government covers the cost of care, along with the WHO, which provides medication.
Once patients have been treated for the disease there is no risk of passing it on to others, but some 60 post-treatment patients are still quarantined in West Java’s Sitanala District Hospital.
“Other patients would not want to come to this hospital if they thought that leprosy patients were mixed in with other patients,” said Ruli, a doctor working at the hospital. “Due to the stigma, and to ensure that we can attract other patients, we must have a separate leprosy facility.”
Ruli says that what she calls “leprophobia” is common. “The disease can be considered a curse. People are scared when they hear the name but they don’t really understand the disease.”
“We all have something in common here”
Like many Indonesians, Marcus goes by one name. He used to work for a logging company in Kalimantan, an Indonesian island some 1,000 km northeast of the capital, Jakarta. In the 1980s he contracted leprosy and lost toes and fingers. Eventually he came to Sitanala District for medical help.
“Once my family knew what I had, they were scared of what the rest of the community would think,” said the 72-year-old. “I didn’t want my family to be shunned by the community, so I left and came to a place where I would be more accepted.”
He never returned to work after contracting the disease, opting instead to live in a village in the hospital compound with hundreds of others who have had leprosy. The hospital provides older leprosy patients in the village with free accommodation and three meals daily.
“I have many friends here,” Marcus said. “We all have something in common because we’re all leprosy sufferers.”
His contact with the world is limited to attending the local church. His fellow residents, Enny, 40, and Yuniati, 38, both admitted their embarrassment about venturing outside the compound because they have lost legs to the disease.

 Photo: Mark Wilson/IRIN
“They are all scared of me, and if I go back to my home in Bandung [capital of West Java], they won’t accept me because they know I’ve had leprosy. I’ve forgotten my address, it’s been that long.”

Sumiyati, 70, a neighbour, says she has had leprosy since 1985. Unlike Marcus, she was diagnosed early and has only a slight deformity to her nose. She has three children and seven grandchildren, but has not seen any member of her family since the week after she was admitted to the hospital in 1985.
“They are all scared of me, and if I go back to my home in Bandung [capital of West Java], they won’t accept me because they know I’ve had leprosy. I’ve forgotten my address, it’s been that long.” Sumiyati has helped at the district hospital since she was cured.
Unable to return home and resume their previous jobs - and lives - some patients garden or clean nearby, while others can be seen begging, selling food or operating rickshaws.
Despite the hospital’s efforts to get patients into the community through paid work, nearby residents keep their distance.
Nurhadi, 43, a local taxi driver, says he never eats from street vendors in the vicinity of the village because he worries that they may have leprosy.
“I feel pity for them because of their suffering,” he says. “But at the same time I prefer to keep my distance from them because I don’t want to catch anything. A lot of people here think that way.”

POVERTY: Myanmar to immunize 6.4 million against measles

YANGON, 22 March 2012 (IRIN)

 Photo: Courtesy of UNICEF Myanmar
Millions targeted in measles campaign

The Burmese Ministry of Health, in collaboration with the UN Children’s Fund (UNICEF) and the World Health Organization, have launched a measles vaccination campaign to reach 6.4 million under-five children nationwide.
“Such campaigns play a significant role in reducing global and national mortality and morbidity due to measles,” Marinus Gotink, UNICEF’s chief of health in Myanmar, told IRIN on 22 March, the first day of the campaign. “It’s important to continuously emphasize high levels of routine immunization coverage.”
The 10-day campaign involves 9,500 immunization teams of health workers and volunteers in all seven states, with 75-100 children under-five per ward in urban areas and 50-75 children per village in rural areas to be vaccinated daily.
Measles outbreaks are reported every four to five years in Myanmar. The last nationwide campaign was in 2007. In 2010 there were 190 registered cases. The following year, 1,774 cases were reported, although health experts believe more infections went undetected or unreported.

TUBERCULOSIS: Childhood tuberculosis a “hidden epidemic”

NAIROBI/NAROK, 22 March 2012 (PlusNews)

 Photo: Kenneth Odiwuor/IRIN
Childhood TB has been dangerously neglected

Globally, an estimated 200 children die from tuberculosis every day despite the availability of cheap drugs to prevent and treat this highly infectious condition, the UN World Health Organization (WHO) has said.
"We have made progress on TB: death rates are down 40 percent overall compared to 1990 and millions of lives have been saved. But unfortunately, to a large extent, children have been left behind, and childhood TB remains a hidden epidemic in most countries. It is time to act and address it everywhere," Dr Mario Raviglione, Director of the WHO Stop TB Department said in a statement.
Every year at least 500,000 babies and children become infected with TB worldwide, and according to WHO an estimated 70,000 die of it. The organization noted that most developing countries still use a diagnosis method developed 130 years ago - the patient coughs up a sample of sputum, which young children are generally unable to produce - and even if a child with active TB succeeds in providing a sample, it often contains no detectable bacteria.
Infants and young children are as much at risk of developing drug-resistant TB as adults, and are at particularly risk of developing "severe, often fatal forms of TB, such as TB-meningitis, which can leave them blind, deaf, paralysed or mentally disabled".
At a government clinic in Narok, a rural town west of the Kenyan capital, Nairobi, Lelempai Nkare waits to see the clinical officer in charge. Her one-year-old sits on her lap breastfeeding, occasionally interrupted by her mother's hacking cough.

Children ignored
Nkare, who is also HIV-positive, was diagnosed with tuberculosis three months ago and has made numerous visits to the clinic, always accompanied by her child. Despite the highly infectious nature of TB, the health workers have never suggested testing her daughter for the disease.
"I get my medicines here... When I see the doctor, he will tell me whether I am doing fine or not," Nkare told IRIN/PlusNews. "He didn't see my child and he just told me I should continue taking my medicine and I will get better."
The Kenya government has guidelines that require health workers to be vigilant and monitor children born to HIV-positive mothers, and for TB in TB-infected households, but lack of information and frequent drug shortages mean that health workers, particularly in rural areas, become discouraged from looking out for TB infection in children, putting them at risk of infection.
"We experience so many drug outages that at times the frustration stops us from even caring to look out at possible TB infection in children and infants," one Narok health worker who wished to remain anonymous told IRIN/PlusNews
According to WHO, when health programmes actively search for children infected with TB, they usually discover far more cases than expected; one study in Bangladesh found that after community members received special training in paediatric TB, the number of cases reported more than trebled.

Duncan Nkoitoi, TB programme coordinator for the Christian Missionary Fellowship, an NGO that runs community clinics in Narok, says many health workers are not informed that the Bacillus Calmette-Guérin (BCG) vaccine given to children soon after birth does not provide full protection against active forms of tuberculosis.
In fact, some research suggests that HIV-positive babies who receive the BCG are more likely to contract TB from the vaccine than was previously thought. More than 80 percent of Kenyan newborns are given BCG vaccination.
Before we can give prevention or treatment we have to find the children at risk of TB ... From now on let us agree: It is unconscionable to let a single child die of TB
"Many health workers fail to realize that BCG, even though provided widely to children, doesn't often protect them against active form of TB, which they can very easily acquire from adults. So this creates the feeling among health workers that these children might be safe, but it is normally a false sense of safety," Nkoitoi said.
"There is a thin line between pneumonia and TB symptoms, not just for parents, but even for health workers. Parents complicate it even further by preferring traditional treatment methods like herbs," he commented.
Children account for 11 percent of new TB infections in Kenya each year. According to government records, more than 10,000 children were diagnosed with TB nationally in 2011, and about 20 percent of children infected with TB are also HIV-positive.
Government officials say controlling TB in children is difficult as a result of inadequate diagnosis and treatment, but prevention among adults will have a knock-on effect on paediatric TB infections.

Improvements necessary
"Diagnosis of TB in children remains difficult because earlier developers of diagnostic tools have treated children like small adults, but when the society is able to contain TB among adults, which is relatively easier, then children benefit because adults with TB infection are the most dangerous to children," Joseph Sitienei, head of National Leprosy and TB Control Programme at the Ministry of Health told IRIN/PlusNews.
"The guidelines are very clear on how health workers need to deal with children from TB-infected households, or those born to HIV-positive mothers. Monitoring should be done every time a health worker gets into contact with a child who stands a high chance of contracting TB. Unless this is done, many children will die from TB."
Sitienei said the government was deploying paediatricians to high-prevalence areas to help control TB in children and streamline drug distribution to government clinics. Kenya is hosting one of the sites of a large TB vaccine trial, which, if successful could contribute significantly to ending TB in both children and adults.
WHO advises that health centres examine all children who have been exposed to TB by someone living in their household, and treating them for TB immediately if they are very ill or living with HIV, even if a definitive diagnosis unavailable. Health workers should provide preventive treatment with the drug Isoniazid to all children at risk for TB but not ill with the disease, and all health workers who care for pregnant women, babies and children should be trained to check patients for TB risk, signs and symptoms, and refer them for TB preventive therapy or TB treatment as needed.
"Before we can give prevention or treatment we have to find the children at risk of TB, and this will only happen if governments, civil society and the private sector work together,” said Dr Lucica Ditiu, executive secretary of the Stop TB Partnership. “From now on let us agree: It is unconscionable to let a single child die of TB."

MALARIA: Imported malaria and dengue fever in returned travelers in Japan from 2005 to 2010

Imported malaria and dengue fever in returned travelers in Japan from 2005 to 2010 ( Article in press )

Mizuno, Y.a ,Kato, Y.a,Kano, S.b,Takasaki,
Malaria and dengue are important problems in Japan particularly since international travel to developing countries has become increasingly popular. To describe the clinical features of malaria and dengue cases in Japan, a retrospective study was conducted on 50 malaria cases and 40 dengue cases presented to the National Centre for Global Health and Medicine of Japan between 2005 and 2010. The most frequent area of acquisition for cases of malaria was Africa (76.0%), and for dengue fever was Asia (90.0%). Although the immigrant population is very small in Japan, patients categorized as visiting friends and relatives were relatively high in proportion, which is similar to Western reports. Confirmed cases of malaria and dengue account for less than 10% of the all travelers returning with any health problems according to the National Centre for Global Health and Medicine. Careful observation of symptoms and signs helps the differential diagnosis of malaria and dengue.

POVERTY: UGANDA: Meningitis outbreak kills 16 in north

KAMPALA, 23 March 2012 (IRIN)

 Photo: Charles Akena/IRIN
Meningitis vaccination can significantly reduce mortality (file photo)

At least 16 people have died in a meningitis epidemic in two districts in northern Uganda over the past three weeks, say health officials.
Amuru District, where the epidemic is spreading fast, has recorded 33 cases with 14 deaths since 24 February, while Oyam District has reported 25 cases with two deaths.
The two districts are just recovering from two decades of Lord’s Resistance Army insurgency which displaced over 1.8 million people and left thousands dead.
“The deadly disease is spreading… The number could be higher as not all come to health facilities,” Charles Okwera, deputy district health officer in Amuru, told IRIN.
“We have stepped up surveillance and alertness following the outbreak. We are doing everything possible to contain the disease.”
The World Health Organization (WHO) in a 21 March statement said 18 suspected cases with three deaths were recorded in three parishes in Pabbo sub-county, Amuru District, while 25 cases including two deaths were recorded in Oyam.
“In Oyam the sample revealed that the causative organism was streptococcus pnuemonie which is a usual bacteria that causes meningitis of the sporadic nature,” said Emmanuel Tenywa, a WHO official in Gulu.
Meningitis is an inflammation of the meninges, the lining surrounding the brain and the spinal cord. It is caused by bacteria and transmitted through contact with respiratory or throat secretions. The most worrying type of meningitis is caused by a bacteria of the subtypes of meningococcal meningitides.

Dust helps meningitis spread
Medical experts say dust, which is common during the dry season, leads to an increase in respiratory infections and helps spread meningitis because the bacteria attach themselves to dust particles, but “the dry season is ending and there should not be much worry,” said Tenywa.
Rukia Nakamatte, a Ministry of Health spokesperson, said an Epidemic Response Team and health experts had been dispatched to the affected districts to contain the outbreak. “We have delivered the necessary drugs and supplies to contain the deadly disease,” Nakamate, told IRIN.
Uganda lies within the African meningitis belt, stretching from Senegal in the west to Ethiopia in the east, according to WHO. The region, experiences meningitis cycles whenever the dry season sets in. While vaccination can significantly reduce mortality, the exact strain of meningitis needs to be identified before vaccines are administered.
Typically, the disease has a mortality rate of 5 to 10 percent, with death occurring within 24 to 48 hours, while some survivors suffer brain damage, hearing loss or learning disabilities.

POVERTY: MADAGASCAR: Addressing toilet taboos to improve sanitation

TAMATAVE, 23 March 2012 (IRIN)

 Photo: Guy Oliver/IRIN
A lack of latrines has led to rivers being contaminated

In Madagascar's east coast city of Tamatave, a local taboo against having a toilet in your house or on your land has complicated the task of trying to improve the region's dire sanitation situation.
Nationwide, more than 10,000 people, of whom two thirds are children under five, die prematurely from diarrhoea annually, according to the World Health Organization, which attributes 88 percent of these cases to poor quality water and sanitation.
In the under-developed and flood-prone coastal regions of the country, sanitation is particularly poor and deteriorates even further following a cyclone, a regular event during the rainy season.
“Within three hours, water levels go up so much that everything gets contaminated. In some places, people use traditional pits instead of adequate latrines. When they fill up and overflow, they contaminate the whole environment, including the water wells,” said Edwin Joseph of the faith-based organization, Frère St Gabriel, which is working on sanitation projects in the region.
No one needs to convince Joseph of the importance of adequate sanitation. Shortly after his arrival in Madagascar in 2000, the Indian Ocean island was hit by three successive cyclones, and in the aftermath an outbreak of cholera claimed 3,000 lives and hospitalized over 20,000 people.
“The hospitals refused to take in new patients, as they were already too full," he recalled. "Even the verandas of the hospitals were filled with people. In some cases people burnt the dead with all their belongings, as they were afraid of the disease spreading. Our own neighbours - a family of five - died of cholera.”
According to the UN Children’s Fund (UNICEF), an estimated 7.4 million Malagasy who lack latrines defecate along beaches and rivers. “Sometimes people drink the water from the river," said Joseph. "During the rainy season, all the dirt washes into [that] water.”
Overcoming local taboos and convincing people that they need latrines has required some drastic measures. “Our trainers go to the villagers and offer them water with excrement in it to drink. When they refuse, they take them to the river and show them that this is what they drink every day,” said Joseph.
Our trainers go to the villagers and offer them water with excrement in it to drink. When they refuse they take them to the river and show them that this is what they drink every day
The NGO also recruits the help of local youth and women’s groups. “There was one stretch of beach in Tamatave which was used [for defecation] by 20,000 people. We worked with the youth groups to clean up the place and make it into a soccer field. This way, the young take care others won’t use their fields,” explained Joseph.
Once a village has decided to be part of the process of improving sanitation, aid workers start a programme called Community-Led Total Sanitation, which encourages households to find their own ways and means of constructing latrines, often by helping them obtain loans from micro-credit institutions.
With UNICEF leading the push for improved sanitation nationally and providing technical assistance, this approach has led to the construction of more than 7,500 latrines in 1,750 villages in Madagascar since 2008.

Campaign with ambitious goal
A nationwide Sandal (Sans Defication Air Libre) 2018 campaign was launched by UNICEF and the Ministry of Water in October 2011. The campaign aims to reduce the 32 percent of Madagascar's population who currently practice open defecation to less than 1 percent by 2018.
Evariste Kouassi-Komlan, water and sanitation manager at UNICEF, told IRIN that reaching this ambitious goal would require 440 villages a year in each of the country's 22 regions to be declared open-defecation free.
“This is a huge job and UNICEF is engaged to push this campaign further," he said.
Frère St Gabriel has already nearly achieved the 1 percent goal on the tiny tourist island of Ile St Marie, off the coast of Tamatave. “They shortly will be the first district in Madagascar to be completely Sandal,” said Joseph, adding that he had seen similar campaigns in other African countries achieve impressive results.
“When a government is enrolled, it becomes a mass movement and the whole country stays focused on it. In Madagascar, it’s the NGOs that are taking it up. We might not meet the deadline, but it will happen,” he said.

Thursday, 22 March 2012

Malaria: video

To kill a mosquito while singing in French!

POVERTY: AFRICA: Slum dweller representatives denounce forced evictions

NAIROBI, 22 March 2012 (IRIN)

 Photo: Manoocher Deghati/IRIN
More than a billion people live in slums

Slum dwellers from across Africa have urged their governments to stop forced evictions and work towards providing them with adequate shelter and basic services.
“Better housing is not a favour our governments should extend to us, but a right that we deserve to be given like everybody else,” said Alhassan Ibn Abdallah, a resident of Old Fadama, the largest informal settlement in Ghana’s capital Accra.
Abdallah was speaking at a meeting organized by Amnesty International (AI) in Nairobi, on the sidelines of a ministerial conference on housing and urban development.
“We urge our governments to stop the practice of forced evections, whether carried out by government itself or by private developers. You cannot have development by creating more homeless people,” he said.
In Old Fadama, AI estimates that 55,000-79,000 people live without security of tenure and under constant threat of forced eviction, while in Nigeria, at least 20,000 people may be rendered homeless should the government implement its plan to demolish waterfront settlements in Port Harcourt.
Activists from Chad, Kenya, Ghana, Nigeria, Egypt and Zimbabwe have been, since 20 of March, taking part in a week of action dubbed “People Live Here”, aimed at highlighting the plight of residents of informal settlements or slums and the need to provide essential services like health, water, education and security to them.
George Amaka from Nigeria said forced evictions normally disrupt the social networks and economic activities of those living in slums, saying the lack of security of tenure creates anxiety among many slum residents.
“We have to look for new schools for our children; we have to start creating new businesses, normally with no capital with which to do it. Every social safety net that slum people rely on to survive is disrupted. We are not criminals but people working hard to earn a living and provide for our families,” Amaka told IRIN.

Another activist from Kenya, Minicah Otieno, who coordinated the Rapid Response Team which mobilizes slum dwellers in Nairobi to stand up against forced evictions, told IRIN that slum upgrading programmes in Africa, normally meant to provide affordable housing to the poor, are affected by corruption.
“In Kenya, we have slum upgrading programmes that are meant to provide affordable and dignified housing to slum dwellers, but because of corruption, people do not benefit and instead, government officials allocate these houses to themselves and their cronies”, she said.
“It is because of corruption that land grabbers evict people from their settlements and the government assists them to do it,” she added.
Justus Nyang’aya, AI director in Kenya, said while evictions are at times necessary, they need to be carried out within the confines of both local laws and international statues on evictions, to which, he says, many African countries are voluntary signatories.
“People must be consulted, provided with alternative settlement before eviction and must be told exactly what the land they live on will be used for,” he added.
Speaking to IRIN on the sidelines of the conference, Kenya’s minster for housing, Soita Shitanda, admitted more work needs to be done: “We have to look afresh on our urban planning and accommodate this growing population, because poor planning also impedes provision of services.”

MALNUTRITION: NIGER: Drought does not mean death of pastoralism

DIFFA REGION, 22 March 2012 (IRIN)

 Photo: Jaspreet Kindra/IRIN
A man ferries a precious drum of water through a sandstorm. Failed rains could push the numbers of people in need to more than six million in the coming months

Having spent a fruitless day in search of pasture in the searing heat, about 20 worried and exhausted Fulani pastoralists from Niger near the southeastern edge of the Sahara lie under the stars and mull their future. The next rains and green pastures are still another four months away - or maybe not, mused one of them - “only Allah knows”.
“Do you remember any time it was harder than this?” asked Yousufa Bukar, directing his question to the two elders in the camp. “I managed to find temporary work to feed my family last year but I don’t know how long my savings are going to last.” He is down to a few chickens, a goat and a horse, assets that cannot keep his family of five fed until the next rains.
Not all the usual coping mechanisms seem to be working this time: “I have to leave to find work in town, but I hear there is not much work there. We could have gone across the border to Nigeria but it is difficult now with this Boko Haram threat,” said a young man, adding that it was still relatively easy to walk across, but you could get arrested on the Nigerian side. “They are catching newcomers suspecting them of being Boko Haram sympathizers.”
Salle Galgno, 60, was unequivocal: “We had difficult years before. Life has become harder now. But we have to keep our way of life by all means. We cannot be anything else. We will remain pastoralists till we die.”

But had Galgno travelled 30km south to Medelaram village to ask its chief, Malammamane Nur, how they were managing, he would have been told the solution was to “diversify”.
Nur, who leads a semi-settled pastoralist Toubou community (traditionally nomadic camel-herders), said he decided in about 1970 to allow some villagers to farm and others to trade to sustain their pastoralist way of life.
That time coincided with the beginning of the longest drought in West Africa, which lasted until the 1990s, according to several studies.
Diversifying their sources of income helped them survive some of the toughest years. “Some of us grow millet and we have our own grain and forage reserves.”
But even Nur is stumped this time round because of the border closure. “Our younger men would have taken our animals across to Nigeria. But they haven’t been able to and I am worried about our animals.”
Keeping animals mobile and healthy is key to survival in a drought. The Diffa Arabs, a nomadic community also known as Mahamid Arabs, realized that a long time ago. They have been largely unaffected by the current drought, except for a shortage of drinking water. “We have money to buy food and water, but it would be better if we had some more wells - the wells in our area are drying up,” said Mustafa Mohammed, leader of a settlement outside Diffa town and 2km from the Nigerian border.

Aggressively pastoralist
The Mahamid Arabs are a lot more aggressive in maintaining their pastoralist lifestyle compared to other communities in the region. They have also diversified their sources of income, explained Mohammed, “but our younger men left with our herds for Nigeria [following the rains] before the border closed last year.” He said they would remain there until the rains begin again in Diffa in June.
Returning pastoralists will be unaffected by the border closure, say Nigerien officials. Recognizing mobility as a fundamental right of pastoralists, the government enacted changes in 2010 to its pastoral code - guaranteeing the right to travel across borders during the rainy season.
Policies and attitudes towards pastoralists are changing (in Niger and Mali in particular) and helping communities to maintain their cultural integrity and become resilient as rains become more erratic, said Peter Gubbles, who authored the multi-agency 2010 study Escaping the Hunger Cycle: Pathways to Resilience in the Sahel.
Changes to Niger’s pastoral code ensure animals can drink water from public reserves such as ponds which happen to be located in cropping areas. The code also earmarks certain times of the year when agricultural fields can be accessed by their animals. But some pastoralists said the code is not always adhered to at the local level.
Aid agencies are creating and maintaining water points along corridors used by pastoralists to move their animals. The government and aid agencies are also paying pastoralists to stem the desert with planting schemes, which also help restore the fragile ecosystem.
Experts support diversification. “To some extent, livelihood diversification among pastoralists is not a totally new phenomenon but it can strengthen resilience to shocks like drought,” said Peter Little, a leading expert on pastoralism and the director of Emory University’s (Atlanta, USA) development studies programme.
Many policymakers mistake diversification among pastoralists as a desire to exit pastoralism
“Those who are able to keep their animals mobile to adapt to climatic and vegetation variability but also have some family members pursue non-livestock activities are those who tend to be most resilient to drought."
So the communities are not strictly nomadic (where both people and animals are mobile) any more.
That does not mean giving up on a way of life. “Many policymakers mistake diversification among pastoralists as a desire to exit pastoralism, but in reality it actually allows them to remain in pastoralism and to reap benefits both from livestock production and non-livestock activities,” Little said.

Sedentary versus mobile herding
Studies from Niger show that sedentary forms of animal production are 20 percent less productive than mobile herding. "Nomadic herding generates six times more total revenue than agriculture practised in the same zones," noted Gubbles. With droughts becoming more frequent, the already vast expanses of dry land will continue to grow, and pastoralism will be the only sustainable way of life. But it needs support in the form of financial services, improved access to water, education and health care. Urban areas are not able to sustain the many pastoralists who may no longer be able to sustain their lifestyles, he said.
Bappa Dari, leader of aWoDaabe community, a nomadic sub-sect of the Fulanis, was forced to give up a nomadic way of life and take a temporary job as a security guard in Diffa town. Ten years on, he and his community still live in temporary shelters on the outskirts of town. He and the other men earn less than US$50 a month. The women make about a dollar a day braiding hair.
"This is no life - we can be removed from this land anytime," said Dari. "If we manage to make some money, I will buy some livestock and go back to our old way of life. This time I know how to do it properly - only some of us will move with the animals - the rest will stay doing other activities."

Wednesday, 21 March 2012

POVERTY: KENYA: Conflict fears as wildfires destroy pasture, cause displacement

ISIOLO, 20 March 2012 (IRIN)
 Photo: Elzbieta Sekowska/Shutterstock
Wildfires have destroyed large tracts of grassland in northern Kenya

Wildfires have destroyed large tracts of grassland in northern Kenya, giving rise to fears of conflict between pastoralist communities amid an already serious food security crisis.
“In the areas we have managed to visit, the loss of vegetation is large, at least 20,000 hectares,” said an officer with the Kenya Forest service in the town of Wajir, who asked not to be named because he was not authorized to speak publicly. He said an overall assessment to establish the total level of destruction had yet to be conducted.
According to Mohamed Wako, an elder, tension is rising along the Isiolo, Garissa and Wajir borders with residents accusing each other of causing the fire.
A Wajir resident, Ibrahim Mohamed, said the fire is suspected to have been started by a cartel of traders who are hoping to secure aid agencies’ and government contracts to supply fodder in the region. A fortnight ago, residents of the Habaswein area of Wajir barricaded a road to prevent trucks ferrying hay, accusing the truck owners of being behind the inferno.
The districts of Wajir North, South and West are the most affected with the fire spreading to parts of neighbouring Isiolo. "The wildfire which broke out last month but was stopped, started again two weeks ago and burnt more areas we have not visited… Extensive rangeland has been affected,” the forest officer said.
"We have lost a number of livestock, mainly calves, weak and sick animals that were not able to move quickly,” Adan Dualle, a Wajir resident told IRIN, adding: “Two people burnt by the fire are still at Wajir District Hospital.”
Some herders have been forced to migrate further north towards Moyale with some crossing the border into Ethiopia. “We are already faced with a shortage of pasture. While we had enough just last month, I am afraid the situation will be worse if it fails to rain,” said Dualle.
At least 500 families from the Biyamadow, Dadachabulla and Sarif areas have been displaced and forced to move to neighbouring districts, he added. A further 150 families had also been forced to flee from Berami Villlage to the Bute and Buna areas, according to a Wajir North District resident, Hussein Nurow.

Food insecurity
The fire (cause unknown) is fast spreading in Isiolo’s Merti and Garbatulla areas, according to officials.
"We are unable to control the fire,” said Diba Golicha, chairman of the Rangelands Users Association in Merti. “The government should give us helicopters or planes to fight this fire. It’s spreading fast and getting close to Marsabit [north of Isiolo]. We also want this matter be investigated.”
The cause of the fire is being investigated and more resources being mobilized to ensure that it does not spread further and damage infrastructure, according to the upper eastern regional commissioner, Isaiah Nakoru.
The March-May long rains are forecast to be below-average and poorly distributed, meaning that further improvements in pastoral food security are not expected, according to the Famine Early Warning Systems (FEWS NET). Food security in the area had improved after good October-December 2011 short rains regenerated pasture, increasing household milk availability and incomes.
“The majority of households will remain in either the Stressed [consumption is reduced but minimally adequate] or Crisis [significant food consumption gaps with high or above usual acute malnutrition] phase of food insecurity through June 2012,” said FEWS NET.

POVERTY: MALI: Unrest hinders fight against fistula

DAKAR, 20 March 2012 (IRIN)

 Photo: Phuong Tran/IRIN
This woman has undergone multiple fistula repair surgeries (file photo)

 The turmoil in northern Mali is thwarting efforts to treat and prevent obstetric fistula, say health experts and local NGO workers.
It is just one example of the fallout from the latest fighting between Tuareg rebels and the Malian army, triggered when rebels began attacking northern military posts in January. Since then, some 195,000 people are estimated to have been displaced by fighting, according to the UN Office for the Coordination of Humanitarian Affairs.
Obstetric fistula - a tear in the birth canal caused primarily by prolonged labour, resulting in chronic leakage of urine and/or faeces - is both preventable and treatable, and for years health workers in Mali have been working on both tracks.
The latest instability in the north has had both an immediate and a potential long-term impact on efforts to address fistulas, primarily in nomad communities: Many women in northern areas who were to have operations in early March did not, while prevention and training activities also took a hit.
One component of a project backed by the US Agency for International Development (USAID) in northern Mali is the quarterly “fistula care week”, in which women from northern districts are assisted in coming to the regional hospital in Gao, eastern Mali, for treatment. For the latest campaign running from 25 February to 3 March, about a third of the 30 women scheduled for operations did not show up and could not be reached, health workers said.
“We have lost contact with all the women we were following in Ménaka [one of the first areas attacked by rebels],” said Fatimata Touré, head of Gao-based NGO GREFFA whose work includes educating communities about prevention and treatment of fistula. She said fistula prevalence is highest in nomad communities and most of the women GREFFA assists are in Ménaka, a sub-region of Gao populated mostly by nomadic and pastoralist communities. “We don’t know where they are today - people from that area have fled in all directions.”
“Granted, we’re talking about communities who move regularly,” Touré said. “But when things are stable we know exactly where to find them during this or that period of the year.”
Ibrahim Oumar Touré, GREFFA’s coordinator for the prevention of early marriage and fistula, told IRIN NGO workers could not transport the women as they normally would because of the security situation.
“God alone knows how much these women with fistula suffer, and beyond that now we can’t get to many of them for treatment,” he said. “It pains me just to think about it…. It’s atrocious.”
Long-term impact
GREFFA, which receives support in reproductive health and other programmes from Norwegian Church Aid, has also lost contact with the local women who collaborated with the NGO in year-round outreach efforts, Mr Touré said.
Mali, with the support of several donors and NGOs, has made significant strides in incorporating fistula prevention and care into local and national health structures, and health workers say the conflict threatens to set back some of this progress in northern communities.
They noted a number of concerns, including the suspension of education and prevention efforts in some nomad areas, and the loss of contact with women who have had fistula treatment in the past and need close attention especially in childbirth.
Demba Traoré, coordinator of the fistula care project at NGO Intrahealth, said prevention is a major component of the work. “We know that early marriage [and thus childbirth] and excision are two major contributors to fistula,” he told IRIN. “We regularly talk with local authorities and traditional and religious leaders, who have a huge role to play in prevention. But with the current security situation we can’t continue this outreach in some areas.”
He said there is a concern that the incidence of fistula could rise because health services in some areas have been interrupted. “Even if under normal circumstances many of these women did not go to health centres, we had started to see an improvement there. Fistula is linked to a lack of obstetric care. Now we fear we could see a rise in new cases in these affected communities.”
A 2009 Malian Health Ministry strategy on fistulas says while the exact prevalence of the condition is unknown, it is estimated that 600 new cases occur per year. For years the aid agency Médecins du Monde has supported fistula care in Mali; it has a programme to support corrective surgery as well as post-operation psychological care in Mopti.
Obstetric fistula is a distinctly difficult condition to bear and to quantify, say experts. Women with fistulas are generally shunned by their families and communities. An indispensable component of any fistula care effort - including in Mali - is helping women post-operation to reintegrate into their communities and re-establish a livelihood.
Outreach in safer areas continues, as does fistula treatment at the Gao regional hospital, Touré of GREFFA said, though all the current patients are from Gao communities not affected by fighting. A principal aim of the fistula care project has been to make treatment available on a regular basis at the hospital, where three trained surgeons are based. “Even as we speak, women are receiving treatment,” he said.