POVERTY: YEMEN: Women die as violence impedes antenatal care in Abyan

Photo: Lindsay Mackenzie/IRIN

In 2011, many Yemenis fled Abyan governorate for makeshift shelters, like this one, on the roof of a school in Aden

ABYAN, 24 August 2012 (IRIN) - In June, after spending 11 months in a makeshift camp for people displaced by violence, 19-year-old Dawlah Muslih, then seven months pregnant, returned to her home in an area of Yemen where safety was supposed to have improved. It was a move her family would come to regret. 

Two months ago, the government announced that the militant group Ansar al-Sharia had been routed from the southern Abyan Governorate by a large-scale military offensive. Hundreds of displaced families have since returned to their homes in Jaar and Zinjibar cities, according to Abdullah Al-Duhaimi, manager for a government-run office for internally displaced people and returnees based in Zinjibar city. 

But just two weeks after Muslih returned from a shelter in Aden, violence returned to Abyan. Suicide bombings have resumed, as have clashes between remaining Ansar al-Sharia fighters and armed tribesmen on the one hand, and criminal gangs on the other, Muslih’s brother, Mohammed, told IRIN. 

On 4 August, Muslih’s water broke and her family set out for the nearest hospital in Jaar City. 

“We were just two or three kilometers far from al-Razi hospital in Jaar, but couldn’t make it to the hospital after we heard a huge explosion in the main street leading to the hospital that had shaken the car we were in,” Muslih’s older sister, Habibah, told IRIN. 

Muslih was unable to deliver normally, and unable to reach a facility that could perform a caesarean section. On 7 August, she died at home, her baby still unborn. 

Insecurity obstructs healthcare 

Despite the government’s insistence that stability has improved since it regained territory taken by militants last year, insecurity remains a key problem in Abyan. 

“We stay home most of the time. We fear being killed if we go out,” Mohammed Muslih said. 

Nashwah Hassan, a local midwife in Jaar City, told IRIN that insecurity prevented too many pregnant women, who have returned from displacement over the past two months, from obtaining prenatal care. 

“To my knowledge, Dawlah is the fifth mother to die from dysfunctional labour over the past month. They couldn’t go to al-Razi Hospital for fear of suicide bombers and landmines,” Hassan said. “All these five mothers had to undergo a C-section because their CT-scans [taken while in displacement in Aden] show that the baby’s head wasn’t descendant enough to ease delivery.” 

While in displacement, many pregnant women had better access to antenatal healthcare services provided by the government and aid agencies. This was particularly true for those who sheltered in Aden. 

Antenatal healthcare services have historically been poor and limited in southern Yemen. 

In Abyan Governorate, nine public hospitals and 128 health centres serve an estimated 480,000 people. The hospitals lack specialized staff, equipment and funding, and the health centres are largely limited to providing primary healthcare services, according to Al-Khadher Mohammed al-Saeedi, head of the Ministry of Health’s regional office in Abyan. 

In 2010, the UN Population Fund estimated that 22 women die in Yemen every day due to pregnancy- and birth-related complications and that antenatal care coverage was 47 percent - the lowest in the Middle East. 

Months of clashes between the army and Ansar al-Sharia militants have only made the situation worse, al-Saeedi said. While he could not give an exact number of deaths resulting lack of healthcare access, “pregnant mothers are the most affected by such a dire security situation,” he said. 

Following their return, “recurrent sounds of landmine blasts and suicide bombings made women returnees traumatized. They fear going out to seek medical consultations,” al-Duhaimi told IRIN. 

Lethal violence 

More than two hundred people have been killed in the governorate and several dozen injured since mid-June, said Mohammed Fadhl Monasser, acting chief of Abyan’s security department. 

“No security has been restored yet. You could be killed by a suicide bombing or in a landmine explosion at any time,” he told IRIN. “Suicide bombings have become a daily scene since the military offensive ended in mid-June.” 

On 4 August, the day Dawlah couldn’t make it to hospital, at least 45 people were killed and another 50 injured when a suicide bomber attacked a funeral service taking place in Jaar. 

“Levels of violence have not decreased, but the nature of violence in Abyan has changed. In towns like Jaar, armed clashes have been replaced with indiscriminate violence from bombing attacks and accidents involving landmines,” said Anne Garella, project coordinator with Médecins Sans Frontières (MSF) in Aden. 

Local healthcare 

According to al-Saeedi, local health centres in the governorate are either understaffed or have no staff at all. He added that persistent insecurity in Abyan discouraged dozens of doctors and nurses from resuming work in public hospitals and health centres. Sometimes people venture out to their nearest health post, only to find that doctors are not on duty, MSF’s Garella said. 

Abyan Governor Jamal al-Aqel said popular committees of armed tribesmen - which backed the government in the fight against Ansar Al-Sharia militants - and some local NGOs have been collaborating with the government to protect public and private properties amid the very limited presence of security personnel. 

“Interior Minister Abdulqader Qahtan pledged to provide us with more security personnel and required equipment such as vehicles and radars. We are waiting for this pledge to be fulfilled,” al-Aqel said. “This could take several weeks, if not months.” 

MALARIA: Updates by William Brieger

[malaria] drug resistant malaria in Cambodia vs Philippines to be malaria free
From:	William Brieger
To:	Malaria Update
Date:	Sat, Aug 25, 2012 7:32 am

Drug-Resistant Malaria Vexes Health Workers in Cambodia Voice of America Fri, 24 Aug 2012 13:10 PM PDT PHNOM PENH â A little-known battle being fought in Cambodia could have global ramifications. The fight is against drug-resistant malaria. The problem is more severe in Cambodia than anywhere else in the world, says Steven Bjorge, the World Health Organization's malaria team leader in Cambodia. About 17 percent of all cases in the Cambodian-Thai border area of Pailin were drug-resistant in 2011 ... Philippines to be malaria-free by 2020: DOH Sun Star Fri, 24 Aug 2012 09:40 AM PDT THE Philippines could be malaria-free by 2020 as the number of cases declined by 80 percent in the recent years, the Department of Health (DOH) said on Friday. Health Secretary Enrique Ona said the government has recorded 9,642 malaria cases in 2011 as compared to 43,441 in 2003. PH malaria-free by 2020? Rappler.com Fri, 24 Aug 2012 04:49 AM PDT MANILA, Philippines - The health department says malaria cases in the Philippines had gone down by 80 % from 2003 to 2011, raising the hopes that the country will be free of the disease by year 2020. âThis decrease is the lowest malaria level on record for the country ... PH malaria-free by 2020 possible: DOH ABS-CBNNEWS.com Fri, 24 Aug 2012 03:28 AM PDT The Philippines may reach its target of being Malaria-free by 2020, as records show a decline in the number of cases of the parasitic disease. Health Secretary Enrique Ona said the Philippines recorded 9,642malaria cases in 2011, significantly lower than the cases recorded in 2003 with 43,441. PH malaria-free in less than a decade, says DOH Yahoo! Philippines News Fri, 24 Aug 2012 02:08 AM PDT In 2020, PH could be malaria-free. Philippines on way to being malaria-free by 2020, says DOH InterAksyon Fri, 24 Aug 2012 01:32 AM PDT A malaria-free Philippines is possible by 2020, Department of Health (DOH) Secretary Enrique Ona said on Friday. Malaria-free Philippines possible by 2020, health secretary says InterAksyon Fri, 24 Aug 2012 00:47 AM PDT A malaria-free Philippines is possible by 2020, Department of Health (DOH) Secretary Enrique Ona said on Friday. Philippines to be malaria-free by 2020: health official Sin Chew Jit Poh Fri, 24 Aug 2012 00:27 AM PDT MANILA, Aug. 24 (Xinhua) -- The Philippines could become malaria-free by 2020 as cases of the disease dropped significantly in recent years, a senior government official said Friday. DOH: Malaria cases reach record low Office of the President - Philippines Thu, 23 Aug 2012 20:09 PM PDT An August 24, 2012, press release from the Department of Health: Secretary of Health Enrique Ona today revealed the possibility of the Philippines being malaria-free by 2020 as he cited the data that showed an 80 percent decrease in malaria cases in 2011 as compared to 2003

MALNUTRITION: Water in Africa

FOOD: A quiet water revolution

Photo: Pierre Holtz/IRIN

Most farmers in developing countries rely on buckets and watering cans

JOHANNESBURG, 24 August 2012 (IRIN) - Quietly, a revolution to develop cheap ways to draw water for irrigation is unfolding in small villages and rural regions in sub-Saharan Africa and South Asia, a new three-year study has found. This movement has the ability to turn agriculture around in the developing world. 

The study - by the Sri Lanka-based International Water Management Institute (IWMI), a nonprofit research centre - found that small farmers, tired of waiting for governments to deliver aid, have found ways to access motor pumps, build reservoirs or ponds to harvest rain water to improve their crop yields. And it is paying off. 

"We were amazed at the scale of what is going on,” said IWMI’s Meredith Giordano, who coordinated the initiative. “Despite constraints, such as high upfront costs and poorly developed supply chains, small-scale farmers across Africa and Asia have moved ahead using their own resources to finance and install irrigation technologies. It’s clear that farmers themselves are driving this trend.” 

Surveys carried out in Ghana, Ethiopia and Zambia found that more than 80 percent of all owners of small-scale irrigation equipment had used their own or their family’s savings to buy it. Banks or microcredit organisations rarely lent money to buy the equipment, and help from NGOs or donors was uncommon. 

Buckets and watering cans used by most farmers in sub-Saharan Africa are handy for watering small plots and are rather cheap, with negligible operating costs. A treadle pump can cost up to US $100, with families helping out, and the cost of operating it is also zero. Prices for motorized pumps can reach up to $250, but Giordano told IRIN that many farmers had found a way to manage this cost. For instance, in parts of India, a farmer will buy a pump and then rent it out to other farmers when not using it. There are also pump-on-a-bike hire schemes, where cycling entrepreneurs tour rural areas, renting out pumps strapped to their bicycles. 

In many African countries, private irrigation by farmers is already much more significant than the public irrigation sector

"The proliferation of small-scale private irrigation is an established trend in South Asia that is now gaining ground in sub-Saharan Africa," said the study." In many African countries, private irrigation by farmers is already much more significant than the public irrigation sector," said Giordano. For example, in Ghana, private irrigation by smallholder farmers employs 45 times more individuals and covers 25 times more land than public irrigation schemes. 

Paying off 

The results are becoming apparent. In the Indian state of Madhya Pradesh, farmers who have constructed ponds to irrigate crops have seen their incomes rise by 70 percent. A similar initiative in Gursum, an area in Ethiopia's Oromia region, has been so "successful that it is now known as the ‘No-pond-No-wife’ sub-district,” said the study. Rainwater harvesting was introduced by the Oromia government in 2002, with ponds being built with plastic sheets. Farmers, however scaled-up the initiative by improving the water-holding capacity of the ponds by joining two plastic sheets, ultimately improving crop yields - so much so that "farmers without ponds are said to have difficulty finding a wife, hence the area’s nickname." 

The study also found that in Tanzania, half of the dry-season incomes of smallholders come from growing irrigated vegetables. In Zambia, the 20 percent of smallholders who cultivate vegetables in the dry season earn 35 percent more than those who do not. 

Enormous impact 

Read more

NIGER-CHAD: Is sustainable agriculture possible in the Sahel?

GLOBAL: Joined-up thinking on water, energy and food

IRAQ: Call to adopt modern irrigation techniques

Analysis: Agriculture in a changing environment

VIETNAM: From rice to shrimps and ginger - adapting to saltwater intrusion

Climate change in-depth

Food crisis in-depth

FILM: Harvesting Rain

The researchers also examined how each of these technologies - use of motorized pumps, small reservoirs, community-managed river diversions - could reduce poverty. They found the growth and impact of these technologies would be enormous. Motorized pumps, for instance, could be provided to at least 185 million people in sub-Saharan Africa, generating a revenue of $22 billion annually. The study took variables such as access to markets, investment costs and availability of natural water sources to calculate benefits. 

The findings are not surprising considering only three percent of sub-Saharan Africa's water is drawn for irrigation, according to the UN's Food and Agriculture Organization, and only four percent of its arable land is irrigated. The IWMI study found that more than 80 percent of the farmers use water cans and buckets to draw water for their food crops. Small farmers across the ocean in South Asia have similarly relied on low-tech forms of irrigation, such as depending on monsoon rains to water their crops. 

Yet the study warns that there are also risks to unchecked expansion of smallholder water management. "The poorest farmers, especially women, still struggle to find the resources needed to access new technologies, which may lead to greater inequities. And if farmers engage in a water free-for-all, supplies in some areas could dwindle past sustainable levels." 

The study recommends that governments and local authorities engage with what is happening on the ground and support it with policies that increase access to loans and improve agricultural extension services i.e., teaching improved farming methods. 

POVERTY: PAKISTAN: Afghan refugees weigh their dwindling options

From:	IRIN
Date:	Fri, Aug 24, 2012 10:46 am

PAKISTAN: Afghan refugees weigh their dwindling options

ISLAMABAD, 24 August 2012 (IRIN) - At 70 years old, Mohammad Issa is already 
struggling to survive in Pakistan's capital Islamabad, where he sought refuge 
from war in Afghanistan years ago. Suffering from a heart condition, he has 
trouble leaving the house and depends on his children, who collect cardboard for 
a living. 

Yet with the legal status of Afghan refugees in jeopardy, Issa may be soon faced 
with the prospect of starting over back home.

"I have lived a very tough life. I am tired now. I don't want to bother anyone. 
I just want to be left alone so I can live out the rest of my years," Issa told 
IRIN.

He is among the 1.7 million registered Afghan refugees in Pakistan whose 
registration documents are set to expire at the end of this year. The 
governments of Pakistan and Afghanistan and the UN Refugee Agency (UNHCR) have 
not decided on an arrangement for the refugees beyond that date.

Decades of displacement

The first Afghan refugees came to Pakistan when the war in Afghanistan started 
in the late 1970s. Many fled Afghanistan in the decades that followed, escaping 
the civil war of the early 1990s and Taliban rule later in the decade. Over the 
years, they have set up businesses, constructed homes and settled into 
professions. The governments in Islamabad and Kabul, with UNHCR assistance, have 
provided identification cards to refugees to protect them from forcible 
deportation. 

But Pakistan's Afghan refugees are now in limbo. Some choose not to think about 
the deadline; others are scrambling to find options. Few can even afford to 
travel to the border if they are forced out.

At the Dhok Choorah settlement that houses about a hundred Afghan families in 
Islamabad, there is a mix of defiance, uncertainty and resignation.

"I have no plan, no money, if they force us out. I don't even have the money for 
a bus to the border. We will have to walk," said Najibullah Khan, 75, who 
scrapes together a living collecting paper and glass from the streets to sell to 
scrap yards. He makes the equivalent of US$2 a day, barely enough to feed his 
five children, four of whom have learning disabilities.

Many younger Afghans, born and raised in Pakistan, do not see return to the 
country of their parents' origin - which is still wracked with violence and 
lacks opportunity - as an option.

"There is no way I'm going back to Afghanistan, no way anyone is forcing me go 
to back," said Khan Mohammad, 23, who works as a labourer at one of Islamabad's 
busiest markets. "I'd rather die than allow my children and my wife to go to 
Afghanistan. There is nothing but bloodshed and misery there. 

"I'm trying to find a way to move to another country, but I have no money so it 
is difficult. But I'll keep trying. If I fail, I'd rather stay here."

Mohammad shares a house with his elder brother Sultan Mohammad, 35. To stay in 
Pakistan after the deadline, they intend to keep a low profile.

"We'll keep our heads down, keep working hard and not get in to trouble," Sultan 
said.  
In a small living room decorated with rugs and cushions, the family gathers to 
hear news from Afghanistan. The brothers say it offers little comfort.

"It is clear what is happening in Afghanistan. How can I ask my children to go 
and live in a place like that?" asked Sultan, who came to Pakistan in the 
mid-1980s with his parents.

"Once the NATO forces leave, Afghanistan will collapse into civil war again. 
Never mind that, there are enemies of our family who will kill us if we set foot 
in our village again." 

Situation unclear

Pakistani officials have been quoted [ http://www.irinnews.org/Report/95937/AFGHANISTAN-PAKISTAN-Pressure-mounts-on-Afghan-refugees 
] as saying registration cards for Afghan refugees will not be renewed, and that 
they will be asked to leave the country. 

But Pakistan's government is rife with internal power struggles, and others 
insist no decision has yet been taken.

The situation remains unclear, said a senior government official at the 
Commissionerate Afghan Refugees, run by the government of the Khyber Pakhtunkhwa 
Province, who requested anonymity because he was not authorized to speak to the 
media.

"Several discussions have taken place. We agree that the proof of registration 
cards will expire at the end of the year, but we have still not made a decision 
on what arrangement will be put in place after that."

UN officials have also said that no such decision has been made, and that 
various bodies are in discussions over an arrangement. 

Mohammad Hussain, 24, a law student who works as an office manager at a law firm 
in Islamabad, is holding out hope.

"No one is sure about our status after December 31, but I've talked to many 
people about this, especially human rights lawyers. I don't think they will 
force us out. They can't. It would be a major international issue and the United 
Nations will not allow that," he said.

UNHCR says Afghans in Pakistan will maintain their refugee status [ 
http://www.irinnews.org/Report/95640/PAKISTAN-Uncertain-future-for-Afghan-refugees-as-deadline-looms 
] regardless of the government of Pakistan's decision.

"People have built their entire lives here. This is their home," Hussain said. 
"The government can't just say, 'Leave everything and go.' I am expecting them 
to figure out a solution soon."
Sitting outside her two-room mud house, Bibi, 55, who goes by just one name, 
wants the confusion to end. 

"No officials have come to us to explain what is going on, what my options are," 
Bibi said. Her husband and son, both disabled, provide the family's only income 
by selling plastic bags in Islamabad's markets.

"If they are going to throw us out, they should let us know instead of keeping 
us in suspense."

For more, see IRIN's recent in-depth on Afghan refugees in Pakistan. [ 
http://www.irinnews.org/report/94954/AFGHANISTAN-PAKISTAN-From-pillar-to-post-the-plight-of-Afghans-abroad 
]

POVERTY: How to measure urban poverty

	humanitarian news and analysis a service of the UN Office for the Coordination of Humanitarian Affairs

How to: Measure urban poverty BANGKOK, 27 August 2012 (IRIN) - In a world where more than half of the population lives in cities, poverty is increasingly an urban phenomenon. As researchers and aid agencies struggle to distinguish between chronic poverty and acute vulnerability, IRIN reviewed efforts to measure city dwellers ’ poverty and vulnerability in life-threatening scenarios. More than two-thirds of the world’s urban population lives in low- and middle-income countries where nearly one billion are living in slums, mostly in sub-Saharan Africa and South Asia, according to the World Bank. As more people pour into cities often ill-equipped to handle the influx, experts are trying to find ways of defining and measuring urban poverty. Their findings influence humanitarian policy and programmes as well as basic services, including health, water and sanitation and education. “Conceptualization and definition could be very much context-specific,” said Geetha Mayadunne, a senior researcher at the Centre for Poverty Analysis (CEPA) in Colombo, Sri Lanka. The UN International Poverty Centre, based in Brazil, defines poverty as “a complex set of deprivations in many dimensions that cannot be determined on a basis of low level of income”.  “What [poverty] is taken to mean depends on who asks the question, how it is understood, and who responds,” said Robert Chambers, a researcher at the Institute of Development Studies in Sussex. Historically, measurements have looked at a person’s income (“consumption” poverty), or what a person can get in return for their cash and assets; the fulfilment of basic needs, including food, health, water and sanitation, education and shelter; capabilities - a concept the Indian Nobel laureate and economist, Amartya Sen, developed throughout the 1990s - which measure basic needs fulfilment as well as what individuals are able to accomplish, and a “multidimensional” index, which is a recent effort to make poverty measurement more holistic. Income measurements  The World Bank has fixed poverty measures, based largely on an international poverty line set at 2005 international prices, or close to US$1.25 a day in low-income countries, and $2 for middle-income countries. This international poverty standard has been applied to household survey findings to determine who falls below these two levels. At the $1.25-a-day measure of global poverty, there were between 336 and 472 million people in chronic poverty in 2005. However, the poverty standard has not been updated since then, while the cost of living has significantly increased, and experts warn that using this index grossly underestimates the current number of people trapped in chronic poverty. Chronic poverty is multi-year and often inter-generational, as opposed to a shock or temporary loss, which often occurs post-disaster and may lead to “extreme” or “severe” poverty. Regardless of the type of poverty, experts say income is an incomplete measure. “It is difficult to compare urban and rural poverty with income measures,” said Jose Manuel Roche, researcher at the Oxford Poverty and Human Development Initiative (OPHI). “With income measurements, rural poverty would appear too high compared to urban poverty… there are aspects of well-being, such as employment or violence, that are not captured and not included in the household surveys.” Income measurements often underestimate urban poverty because they do not factor in the higher cost of food in cities, which must generally be transported farther, and housing. Multidimensional measures  The reasons people are poor are as varied as the numbers who are poor, notes the UK-based Chronic Poverty Research Centre (CPRC). People are trapped in poverty by combinations of insecurity, poor work opportunities, location, limited citizenship rights and discrimination.  In Bangladesh the number of people living on less than $1.25 per day in cities dropped from 20 percent in 2000 to 15 percent in 2005. However, the capital, Dhaka, was recently rated the least liveable city among 140 surveyed by the UK-based Economist Intelligence Unit, based on 30 factors that included stability, healthcare, culture, environment, education and infrastructure. A 2011 study of the Sri Lankan national poverty line concluded the standard did not capture multidimensional poverty, where the “non-poor” in cities have unmet basic needs. Half of the population in the capital, Colombo, live in informal settlements, according to the UK-based NGO, Homeless International.  In 2010, OPHI attempted to develop a more holistic assessment of poverty with its Multidimensional Poverty Index(MPI) to capture simultaneous deprivations in health, education and living standards.  The MPI estimates the intensity of poverty and replaced the human poverty index (HPI), used until then in UN annual human development reports.  The MPI uses the three HPI measurements of living standards, health and education, as well as an additional 10 indicators that reflect some of the Millennium Development Goals. Whereas the HPI used country averages to reflect overall deprivation, it did not identify vulnerable groups, communities, households or individuals, which the MPI is designed to identify. Determining who is poor is an exercise undergoing constant analysis and refinement. “A household, which is not in poverty in terms of food consumption, could be in poverty in some other dimension,” said Mayadunne from CEPA. “Those different estimates arising from different definitions should be explored further in the future.” Urban emergencies  Photo: Jason Gutierrez/IRIN Hauling scrap metal to rebuild destroyed slum housing post-typhoon in Manila, Philippines Urban poor tend to face a number of common deprivations: limited access to income and employment; inadequate and insecure living conditions, and poor infrastructure. Slum-dwellers have been among the most affected in recenturban deluges, while undocumented residents - whether migrants, refugees or families fleeing violence - are cut off from state services year-round.  Counting the poor is one thing, but identifying who needs help is another, as aid agencies increasingly find in responding to man-made and natural disasters in cities. Citing increased threats faced by cities, the UN Development Programme (UNDP) recently pledged to double its overall support for disaster reduction over the next five years, while a recent Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP) meeting was devoted to “adapting humanitarian efforts to an urban world”.  The Inter-Agency Standing Committee (IASC), composed of humanitarian assistance groups, set up a task forcein 2009 to meet humanitarian challenges in urban areas, which has compiled dozens of tools to identify city-dwellers in need of urgent assistance. The very people most in need of help often seek urban refuges for their anonymity, obscuring efforts to count, identify and help them, said François Grünewald, executive director of the research, training and evaluation group, Urgence, Réhabilitation et Développement, located in France. “People come to cities to disappear, so you cannot cut and paste tools used in other places [to target them]. There needs to be a different way of doing things in cities.” fm/pt/he

CAMBODIA: unknown pyrexic illness

Disputes Arise Over Cambodia’s Killer Illness

By Mary Kozlovski Reprint |      

PHNOM PENH, Aug 17 2012 (IPS) - The deaths of dozens of Cambodian children in recent months from an initially undiagnosed disease has highlighted the difficult balancing act between informing the public and potentially provoking panic.
On Jul. 4 the country’s Ministry of Health and the World Health Organization jointly announced that they were investigating an “unknown disease” that had killed 61 out of 62 children infected since April.
“The unknown disease starts with high fever, followed by respiratory and/or neurologic symptoms with rapid deterioration of respiratory functions,” the statement said.
Just over a week later, the MOH and WHO said that the cause in most of the cases was a severe form of hand, foot and mouth disease (HFMD). A majority of 31 samples obtained tested positive for enterovirus 71 (EV-71), which causes HFMD.
The controversy came after Swiss paediatrician Dr Beat Richner, founder of the respected Kantha Bopha children’s hospitals, criticised the WHO on Jul. 8, accusing it of causing panic “for nothing”.
Richner, who had first alerted the government to the disease that was killing children admitted to his hospitals, was concerned about comments the WHO had given the news agency Reuters that he felt were “neither professional nor necessary.”
Richner wrote that the WHO had told the world there was a “new mystery killer disease in Cambodia.” He said he had flagged the possibility with health authorities that an enterovirus was the cause. In an additional message later posted on Facebook, Richner said the WHO in Cambodia should be closed.
Maria Concepcion Roces, an epidemiologist with WHO in Phnom Penh, told IPS that the agency generally preferred to have a diagnosis before releasing information, but in this case the media had approached the agency with enquiries.
“We then decided with the Ministry of Health (that) we must say something, so that people would not speculate,” she said, adding that the ministry had requested WHO’s assistance with the investigation after informing it of the illness on Jul. 1. “If we don’t say anything and people hear rumours, then I think that is what may cause panic.”
Dr Richner also pointed out that of more than 75,000 patients treated at Kantha Bopha outpatient stations in June, only 34 were hospitalised because of the illness in question, stating that on a public health level it was “not an alarming issue”. He cited dengue fever cases as a particular concern.
Richner could not be reached for further comment.
Duane Gubler, professor in the Emerging Infectious Diseases programme at Duke-NUS Graduate Medical School in Singapore, told IPS by email that the response to the EV-71 outbreak was a “higher priority” because the illness was initially undiagnosed.
“The MOH (Ministry of Health) and WHO were working blind at the time; the etiology of the outbreak was not known and there were fatalities,” he said. “Once the virus was identified, then the MOH can return to a normal public health response.”
Gubler said health agencies often communicated confidentially before making public announcements to ensure that accurate information was disseminated without sparking panic or overreaction.
He said the media often exacerbated such issues through “irresponsible reporting”.
“In such events, for the good of the public, the press should be provided accurate and up-to-date information so they can help public health officials inform the public and prevent panic,” Gubler said.
Possible outbreaks of infectious disease are a matter of concern in the region, which in the last decade has been hit with cases of severe acute respiratory syndrome (SARS) and A(H5N1), commonly known as avian influenza or bird flu. According to WHO figures, 21 people are known to have been infected with avian influenza in Cambodia since 2003, resulting in 19 deaths.
HFMD is a common infectious illness that often affects children, but there is no specific treatment for it. The WHO says symptoms can include fever, mouth sores and a rash with blisters on hands, feet and buttocks, and patients usually recover within a week. However, in some cases EV-71 can cause more serious, and potentially life-threatening, symptoms.
Sok Touch, director of the MOH’s communicable disease control department, told IPS it was “inevitable” that people would be concerned when details about such an illness were released, but insisted that keeping the public and other health authorities informed was crucial.
Shortly after the results of the investigation were announced last month, local media reported that Cambodian authorities had closed schools and kindergartens ahead of the mid-year vacation because of concerns about EV-71.
Sok Touch declined to comment on the decision to close the schools. The WHO’s Maria Concepcion Roces said that the agency did not make recommendations regarding school closures, and left such decisions up to individual states.
In a Jul. 27 update, the Ministry of Health and WHO said that 56 children of the original 61 investigated have died, and said the authorities had identified nine additional cases of severe EV-71 infection, resulting in three deaths, among 533 HFMD cases reported.
Duane Gubler agreed that there was particular sensitivity to potential outbreaks of infectious disease in the region because today’s “unprecedented urbanisation and globalisation” increases the likelihood that exotic pathogens will spread from rural to urban areas.
“This is why WHO is much more proactive about outbreaks such as the one in Cambodia that wasn’t immediately identified,” he said. “Rapidly spreading epidemics such as SARS can threaten global economic security.”

MALARIA: on Mars?

UK MPs livid over aid money for India being used for Mars mission | 67607

http://www.newkerala.com/news/newsplus/w...

Read Details About: UK MPs livid over aid money for India being used for Mars mission - British lawmakers are angry with the David Cameron-led Government despite it making it clear that their aid is not used to fund India's space programme, but is earmarked for specific purposes like tackling child …

MALARIA: Solomon Islands

THE Australian government will give more than $14 million to the Solomon Islands to help eradicate malaria in the tiny Pacific Islands nation.

Foreign Minister Bob Carr, speaking from a hospital in the Solomon Islands on Saturday, said the federal government would give $14.75 million to fund further anti-malaria measures and community education about the disease.

He said Australian assistance had already prevented 77,000 cases of malaria since 2003, and the government would work towards eliminating malaria in Solomon Islands communities.

"We're delivering practical measures to fight this preventable, yet potentially fatal disease," Senator Carr said in a statement.

The new funding "would cover treated mosquito nets for beds, spraying programs and community education, particularly for children and pregnant women", he said.

http://www.adelaidenow.com.au/news/breaking-news/aust-to-aid-solomon-islands-malaria-fight/story-e6frea7l-1226453313083?from=public_rss 

MALARIA: Emergence of artemisinin-resistant malaria on the western border of Thailand:

Aung Pyae Phyo MD a b, Standwell Nkhoma PhD c, Kasia Stepniewska PhD a d e, Elizabeth A Ashley MD a b d, Shalini Nair MSc c, Rose McGready MD a b d, Carit ler Moo b, Salma Al-Saai MSc c, Arjen M Dondorp MD a d, Khin Maung Lwin MD b, Pratap Singhasivanon MD a, Nicholas PJ Day FRCP a d, Nicholas J White FRS a d, Tim JC Anderson PhD c, Prof François Nosten MD a b d

Summary

Background

Artemisinin-resistant falciparum malaria has arisen in western Cambodia. A concerted international effort is underway to contain artemisinin-resistant Plasmodium falciparum, but containment strategies are dependent on whether resistance has emerged elsewhere. We aimed to establish whether artemisinin resistance has spread or emerged on the Thailand—Myanmar (Burma) border.

Methods

In malaria clinics located along the northwestern border of Thailand, we measured six hourly parasite counts in patients with uncomplicated hyperparasitaemic falciparum malaria (≥4% infected red blood cells) who had been given various oral artesunate-containing regimens since 2001. Parasite clearance half-lives were estimated and parasites were genotyped for 93 single nucleotide polymorphisms.

Findings

3202 patients were studied between 2001 and 2010. Parasite clearance half-lives lengthened from a geometric mean of 2·6 h (95% CI 2·5—2·7) in 2001, to 3·7 h (3·6—3·8) in 2010, compared with a mean of 5·5 h (5·2—5·9) in 119 patients in western Cambodia measured between 2007 and 2010. The proportion of slow-clearing infections (half-life ≥6·2 h) increased from 0·6% in 2001, to 20% in 2010, compared with 42% in western Cambodia between 2007 and 2010. Of 1583 infections genotyped, 148 multilocus parasite genotypes were identified, each of which infected between two and 13 patients. The proportion of variation in parasite clearance attributable to parasite genetics increased from 30% between 2001 and 2004, to 66% between 2007 and 2010.

Interpretation

Genetically determined artemisinin resistance in P falciparum emerged along the Thailand—Myanmar border at least 8 years ago and has since increased substantially. At this rate of increase, resistance will reach rates reported in western Cambodia in 2—6 years.

Funding

The Wellcome Trust and National Institutes of Health.

MALNUTRITION: HORN OF AFRICA: Greater food insecurity forecast

NAIROBI, 5 April 2012 (IRIN)

 Photo: Wendy Stone/IRIN
Poor rains could further undermine food security

 Food insecurity in the eastern Horn of Africa is expected to worsen as a result of less rain than previously forecast falling in the key March-to-May season.
The US Agency for International Development’s Famine and Early Warning Systems Network (FEWS NET) warned that rainfall in this period would be 60-85 percent of the long-term average and that there was a 30 percent chance of the lower figure materializing.
“An expansion in the size of the food insecure population and an increase in the severity of food insecurity is likely,” FEWS NET said in an 3 April report.
The report warned of “significant impacts on crop production, pasture regeneration, and the replenishment of water resources” in a region that in 2011 suffered one of its worst drought-related food crises in decades.
March to May is the major rainfall season for pastoral and agricultural areas of northern Kenya and Ethiopia and parts of Somalia, and accounts for 50-60 percent of annual rainfall in the region.
In an effort to prevent future weather shocks translating into new humanitarian crises, the Intergovernmental Authority on Development (IGAD), a regional body, and international development partners, have launched an initiative to strengthen resilience in the region.
“We have mobilized funds [US$340 million] to support resilience programmes, and while the problems cannot be solved overnight, it is important to appreciate the need for long-term investments in such areas as education, water, and the need to identify problems early and deal with them in good time. People need to be helped to recover quickly from disasters,” Kristalina Georgieva, European commissioner for international cooperation, humanitarian aid and crisis response, told IRIN.
Political commitment from IGAD member countries, apart from development partners’ support, will play a crucial role in creating sustainable solutions to help people cope with the effects of the region’s recurrent droughts, according to Sileshi Getahun, Ethiopia’s minister of agriculture, in whose country some 3.2 million people are in need of humanitarian assistance.
Time to “stand up and be counted”
“We [regional governments] can’t talk about the same thing [drought] over and over and yet do nothing to help people. This is the time for regional governments to stand up and be counted,” Sileshi said.
Speaking to IRIN, the UK’s development minister, Stephen O’Brien, said: “Resilience programme support is an important part of humanitarian support and response and provides a more sustainable way to deal with disasters.”
Among things to be prioritized will be the provision of drought-resistant seeds, water, education, investing in weather forecasting technology, and scaling up nutrition programmes.
Solving the various conflicts in the Horn of Africa, which have seen thousands of people displaced and many more killed, will be crucial in improving the ability of people in the region to be resilient in the face of disasters, Mahboub Maalim, executive secretary of IGAD, told IRIN.
“In the face of disasters like drought and famine, people’s livelihoods are disrupted and efforts towards halting the various conflicts we see [in the Horn of Africa] cannot be ignored, because people can’t cope when conflicts persist,” he said.
http://www.irinnews.org/Report/95247/HORN-OF-AFRICA-Greater-food-insecurity-forecast

POVERTY: EGYPT: Fuel shortage threatens bread supplies

CAIRO, 2 April 2012 (IRIN)

 Photo: Amr Emam/IRIN
Customers buy subsidized bread at a Cairo bakery

It has been three months since a fuel shortage hit Egypt, and people’s patience is wearing thin amid fears the crisis could disrupt the production of subsidized bread.
“I move from one petrol station to another every day to find the fuel necessary for the work of the bakery,” Omar Muselhi, a bakery owner from Giza, told IRIN. “I cannot do this for long. If things get worse, I will close down.”
Most of Egypt’s subsidized bakeries need diesel to operate, and some have had to close, for example in the Nile Delta governorate of Monofiya (Arabic).
Outside Muselhi’s bakery, men, women and children form two long lines, and wait their turn.
“I buy 20 loaves of this bread for one pound, whereas the same number sells for four pounds at unsubsidized bakeries,” said Ayman Farahat, standing in line outside the bakery. “This shows how important these bakeries are for people like me.”
Observers say there is a 35 percent shortfall in fuel supplies. The government blames hoarding for the crisis. Thousands of cars queue outside petrol stations from early morning, while long queues form outside gas cylinder centres.
“We are doing our best to solve the problem, but what is happening is abnormal,” Petroleum Minister Abdallah Ghorab said on 24 March. “Some people take the subsidized fuel and sell it on the black market.”
The Petroleum Ministry has increased daily diesel supplies from 36,000 tons to 38,000 tons; petrol supplies from 16,000 to 18,000 tons; and gas cylinders from one million to 1.3 million.
But despite the move, there are numerous reports (Arabic) of fighting over fuel, reflecting citizens’ exasperation, and the need for further government intervention

Ambulance services are also at risk.
“The drivers go to petrol stations from early morning,” Naeem Rizk, the operations manager at Cairo’s main ambulance point, told IRIN. “Sometimes they spend the whole day waiting, but when their turn comes, they are told the fuel is over.”
When a policeman recently called Rizk to ask for help after he was wounded in a fight against armed men on the outskirts of Cairo, Rizk could not find an ambulance with enough fuel to take the policeman to hospital. The policeman’s colleagues had to call the Interior Ministry to borrow some.
Mohamed Abdullah, a 30-year-old ambulance driver, says his job has become even more stressful. “There are always long queues at petrol stations…This prevents me from reaching patients in time. The patients’ relatives always yell at me.”

Rethinking subsidies
Some economists believe the current crisis may force the government to rethink its fuel subsidies’ policy. Egypt spent the equivalent of US$83.3 billion subsidizing fuel over the past five years, according to the Petroleum Ministry.
“Around 60 percent of these subsidies go to people who do not deserve them,” said Rashad Abdo, a leading economist from Cairo University. “This makes it necessary for the government to rethink these subsidies.”
The government is currently reconsidering its support to major industrial institutions, which account for almost 70 percent of fuel subventions.
“If we can reduce petroleum subsidies by 10 percent, we can channel this money for the building of houses, hospitals, or schools,” said Petroleum Minister Ghorab. “We need to deliver subsidies to those who deserve them,” he was quoted as saying by al Masry Al Youm newspaper (Arabic) on 11 March.
Another government plan envisages the issuing of vouchers to poorer citizens to enable them to buy cooking gas for the equivalent of 83 US cents instead of US$5 for everyone else.
http://www.irinnews.org/Report/95222/EGYPT-Fuel-shortage-threatens-bread-supplies