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How both sides in Ukraine’s war are losing the HIV battle

Thu, 15 Feb 2018 07:26:14 +0000

Every month or so, health project manager Yulia sets off on an arduous 24-hour, 100-kilometre journey across eastern Ukraine’s “contact line” from Severodonetsk to the rebel-held city of Luhansk. It is the front line not only of a conflict that has claimed more than 10,000 lives since early 2014 but also of one of Europe’s worst HIV epidemics.   Ukraine’s HIV problem is compounded by a twin tuberculosis epidemic, marked by a particularly high prevalence of the more lethal multi-drug-resistant form (MDR-TB). Tuberculosis remains the leading cause of death among people living with HIV, accounting for around one in three AIDS-related deaths globally.   Many problems face aid workers in east Ukraine: interrupted supplies of medication, shelling, military curfews. But the issue that forces Yulia to risk crossing battle lines is essentially bureaucratic.   Most international funding and supplies to fight HIV and TB go to NGOs in government-controlled Ukraine. So, to get funding for her needle exchange project, Yulia must be registered to do business with Kiev.   However, many of her potential patients are now on the separatist side. The two Russian-backed breakaway regions at war with the Ukrainian government – the “Luhansk People’s Republic” and the “Donetsk People’s Republic” – are not recognised by the international community. This means non-Russian aid can only reach them via Ukraine.   Yulia makes regular trips across the front line to try to get registration on the separatist side too, because this would allow her to work openly in rebel-held areas without getting into trouble with the de facto authorities there.    Aid agencies are forced to walk an impossible tightrope in Ukraine. Registered or not, health workers like Yulia risk being imprisoned by both sides, either for “collaborating with Kiev” or “aiding terrorist organisations”, depending on who is calling the shots.   It’s so hard to operate that some organisations have taken their work underground. All the while, more and more people are contracting HIV. “It’s a vicious circle,” Yulia, whose name has been changed for her own security, told IRIN. “Medical workers are really afraid, but it’s the patients who suffer most.”   Displacement   The eastern provinces of Donetsk and Luhansk – part of which now form separatist-controlled territory – have always been the hardest hit by HIV in Ukraine, accounting for a quarter of the more than 240,000 infections nationwide.   Widespread drug use, low living standards, and outdated or inaccessible medical services have long contributed to the crisis. But almost four years of war have made matters much worse.   Vital infrastructure has been damaged, while mass migration has increased, along with unsafe sex and sex work driven by high unemployment, rising prices, and the influx of a ready clientele – male fighters.   Exact numbers are hard to come by from areas not controlled by the government, but recent research based on data collected between 2012 and 2015 found that HIV rates had shot up in some parts of Ukraine due to displacement from the main rebel-held cities.   “In this study we found that virus migration has increased rapidly and follows a westward pattern,” lead author Tetyana Vasylyeva, a PhD candidate in Oxford University's Department of Zoology, told the University of Oxford. “Donetsk and Luhansk, two large cities in the east of Ukraine that have not been controlled by the Ukrainian government since 2014, are the main exporters of the virus.”   Funding   Fighting HIV and TB takes money, and in December 2014 Ukraine stopped sending supplies, funding, and salaries to state organisations no longer under its control – including hospitals and other treatment facilities.   The Global Fund to Fight AIDS, Tuberculosis and Malaria, which was already financing some treatment and prevention programmes in Ukraine, stepped in with emergency funding. Working through UNICEF and local partners, the Global Fund now provides anti-retrov[...]



Africa’s all too preventable cholera crisis

Thu, 14 Dec 2017 17:18:59 +0000

Southern and East African countries are facing a severe cholera outbreak that is exposing the failure in public sanitation and the impact of government neglect. Last year, there were more than 109,442 cholera cases resulting in 1,708 deaths in 12 countries in the Eastern and Southern Africa Region (ESAR), according to the UN children’s agency, UNICEF. Since the beginning of 2018, there have been more than 2,009 cases and a further 22 deaths in seven countries – Angola, Kenya, Malawi, Mozambique, Somalia, Tanzania, and Zambia. Zambia has been among the hardest hit, with the waterborne disease killing more than 74 people since October last year. Cases have been centred on the capital, Lusaka. To contain the outbreak, the government banned street food vending and public gatherings, which triggered violent protests by traders. The World Health Organization says that while sporadic cases of cholera are regular occurrences in Zambia during the five-month rainy season, 2017 exceeded the average annual caseload. The government and the WHO blame poor waste management and inadequate personal hygiene for the contamination of water and food in the townships, which has driven the epidemic. The government’s response has been to call in the army to help enforce control measures, clean markets, and unblock drains. It also launched an oral vaccine programme with a target of immunising one million people, and the number of cases is now beginning to fall. Failing record Zambia, as a lower middle-income economy, lies in the middle of a range of countries caught in the surge of cases in the region, from struggling Mozambique to relatively prosperous Kenya. “In the last four weeks of 2017 alone, Zambia reported 217 new cases of cholera including 11 deaths, Tanzania 216 new cases including eight deaths, Mozambique 155 new cases, and Kenya 44 new cases,” UNICEF’s regional WASH (Water, sanitation and hygiene) advisor for Eastern and Southern Africa, Suzanne Coates, told IRIN. But by far the worst-affected countries have been war-debilitated Somalia and South Sudan, with 72 percent and 16 percent respectively of the total cholera caseload. Beyond the ESAR region, the Democratic Republic of Congo is experiencing the worst cholera outbreak since 1994, with 55,000 cases and 1,190 deaths reported in 24 out of 26 provinces last year, according to Médecins Sans Frontières. allowtransparency="true" frameborder="0" height="429" id="datawrapper-chart-lvooQ" scrolling="no" src="//datawrapper.dwcdn.net/lvooQ/1/" style="width: 0; min-width: 100% !important;">   Aid agencies do appear to have back-up plans ready for a Hodeidah battle, which could, in the worst-case scenario, see the port destroyed.   The most recent published contingency plan, put together when a battle was predicted in March, says that if Hodeidah becomes completely inaccessible, the WFP-run logistics cluster (which facilitates humanitarian transport for various aid agencies) will reroute some cargo to Aden.   The plan notes that if all sea cargo is rerouted to Aden “there is a concrete risk of congestion, resulting in considerable delays”.   Overland transport via convoys from Oman or Saudi Arabia – both have borders that are open to commercial trade – are also on the table if access to Red Sea ports is limited and it is no longer feasible to transport cargo from Aden to northern (mostly Houthi-controlled) areas (already a difficult trip).   While the logistics of massive aid convoys would require some serious doing, not to mention a likely increase in security costs and the time it takes to deliver aid, it’s not seen as an impossible ask.   The ICRC told IRIN last month that it is “already using all available alternative land routes to bring supplies into the country” since the start of 2017, namely the Saudi Arabian and Omani land crossings.   Commercial traders – the main suppliers of Yemen’s fuel and food – may be able to adapt more quickly if Hodeidah becomes unusable, although the cost of security (not to me[...]



Diphtheria in Bangladesh Rohingya camps expected to double every few days

Tue, 12 Dec 2017 15:34:10 +0000

Diphtheria continues to rapidly spread in Bangladesh’s swelling Rohingya refugee camps, with aid groups predicting the number of suspected cases – reported at more than 700 as of this week – could multiply every few days, testing already strained resources in the densely packed settlements. The World Health Organization says there have been at least 722 “probable diphtheria cases” and nine deaths over the last month. Conditions in the crowded refugee camps are ripe for the spread of disease, and aid groups fear the reported cases may well be the “tip of the iceberg”. “The extremely congested conditions in the camps, low immunisation coverage of the refugees, the lack of clean water and proper sanitation facilities are conducive to a rapid spread of the epidemic, with the number of cases expected to double every three to five days,” the European Union’s humanitarian aid arm, ECHO, reported this week. In response, authorities in Bangladesh announced a mass immunisation campaign beginning 12 December to tackle the latest health crisis in the camps. It comes after a mass cholera vaccination campaign in October – billed as the second-largest oral vaccination campaign ever — reached more than 700,000 people. Some 350,000 people have also received measles vaccinations. UNICEF says diphtheria is now “the top health priority” in the camps, which have seen more than 646,000 Rohingya refugees surge into Bangladesh since late August, fleeing a military crackdown that has purged entire villages from Myanmar’s Rakhine State. Preventable The latest outbreak has put a spotlight on a highly contagious but preventable disease. Diphtheria is a respiratory illness that can trigger blockages to a person’s airways. It is a potentially deadly disease, with a fatality rate between five and 10 percent — but death rates can be as high as 20 percent for children younger than five years old. In Bangladesh, diphtheria had all but been eliminated, thanks to robust immunisation coverage. There were only two reported cases of diphtheria in 2016, part of a steady drop over the preceding two decades, according to figures from Bangladesh’s government and the WHO. frameborder="0" height="450" scrolling="no" src="https://datawrapper.dwcdn.net/qkjUQ/1/" width="100%">  Local organisations warn that the strained health system in Cox’s Bazar, where most of the new Rohingya refugees fled, is ill prepared for the outbreak of a highly infectious disease. This could have far-reaching impacts on local residents, who have hosted the Rohingya but generally see little of the aid resources that reach the refugees. “Physicians and health workers on the ground are unfamiliar with the nature of this disease,” BRAC, a Dhaka-based aid group, said in a report this week, calling for training and resources to help local health workers combat the outbreak. But treating the disease has been difficult even in the camps, which stretch over vast distances through rough terrain and limited or often non-existent roads. In early November, health workers treated a 30-year-old woman suspected of having diphtheria — she had a “thick grey-white slough over the back of the pharynx”. But two days later, the woman left the clinic where she was receiving treatment, and WHO officials were unable to track her down. Health officials say early treatment of diphtheria is critical for survival, but the antitoxins used to treat the disease were unavailable in Cox’s Bazar. Early warning Compounding the problem are the squalid conditions and extreme density in the Rohingya refugee camps, which have mushroomed in size but lack basic infrastructure. Almost three quarters of people living in the giant refugee camp, pieced together to accommodate the new influx, live in areas with population densities of less than 15 square metres per person — far below even the bare minimum international guidelines for refugee camps: 30 to 45 square metres per person. ISCG [...]



Congo UN attack, Rohingya camp fears, and ethical aid ads: The Cheat Sheat

Fri, 08 Dec 2017 16:33:56 +0000

Every week, IRIN’s team of specialist editors scans the humanitarian horizon to curate a reading list on important and unfolding trends and events around the globe:   Attack app in the Democratic Republic of Congo   This item was supposed to focus on Human Rights Watch and the New York University-based Congo Research Group launching a new Kivu Security Tracker to plot the trouble wreaked by non-state actors and the Congolese armed forces. But as we went to press, news broke that an armed group in North Kivu on Thursday committed one of the deadliest attacks ever on UN peacekeepers – killing at least 14 and wounding more than 50 others – a grim way to underline that there is so much violence in eastern Congo that you now need an app to keep up. According to the tracker, there are more than 120 armed groups operating in the region. From June to November this year, at least 526 civilians were killed and 1,087 abducted or kidnapped for ransom. There were also at least 11 incidents of mass rape. And these are just the documented incidents. One consequence of the violence is mass displacement. About a million new people were made homeless in the first half of this year, on top of 922,000 in 2016. The Norwegian Refugee Council has described it as a “mega crisis”. The World Food Programme is stretched to the limit with cash running out to support those in need. “We’re letting down those who need us most,” said Claude Jibidar, WFP’s country head. “Without immediate donor support, many – particularly women and children – will die.” Cumulatively, an estimated 3.2 million people are desperately short of food. In addition to an imminent story on the latest attack in North Kivu, which also killed five Congolese soldiers and dozens of Islamist rebel fighters, look out for IRIN’s upcoming investigative report on the army’s brutal campaign of rape in South Kivu.   A war child’s view of War Child ad   Battle-weary aid workers and policy wonks alike admit to wiping back the tears watching a recent Batman-themed promo video from War Child Holland. The short film won top place in a search for this year's most effective – and ethical – aid agency adverts. Other videos made for the UK's fundraising coalition Disasters Emergency Committee and telethon charity Comic Relief however got slammed: an ad about Yemen was "devoid of dignity" and an excursion by Ed Sheeran indulged in "poverty tourism". The agencies criticised said they may review their production values. The Rusty Radiator awards, run from Norway, spun out from a 2012 viral satirical video about the "white saviour complex" in aid. Humanitarian analyst Ben Ramalingam, in a heartfelt personal blog, said the video had triggered memories of his own wartime childhood in Sri Lanka, and that it – rare among NGO ads – highlighted "shared common humanity" rather than "short-term charity'.   New health fears in teeming Rohingya camps   Diphtheria is “rapidly spreading” in Bangladesh’s densely packed Rohingya refugee camps, the World Health Organization is warning. Health workers have diagnosed at least 110 suspected cases – and six deaths – attributed to diphtheria, an infection that can block a person’s airways and lead to paralysis or death. The WHO says 1,000 doses of a lifesaving antitoxin are on their way, while health officials are also planning a vaccination campaign. However, they warn that these initial cases could be “the tip of the iceberg” and that even a small disease outbreak could devastate the camps, which are now teeming with more than 646,000 new refugees from Myanmar since late August. In the giant makeshift camp hastily pieced together as the influx began, the majority of refugees have less than 15 square metres of space per person – far below the aid sector’s minimum guidelines. Read IRIN’s earlier reporting on the wider health fears for the giant camp.   Africa’s worsening displacement crisis   It’s one t[...]



UN calls for ‘humanitarian pause’ in Yemen as conditions in capital deteriorate

Mon, 04 Dec 2017 16:11:54 +0000

Conditions for civilians in Yemen’s capital city of Sana’a are “deteriorating by the hour” after six days of violence, the International Committee for the Red Cross said Monday, as the United Nations called for a “humanitarian pause” in the fighting.   The heavy fighting came as the UN, along with other relief agencies, Friday launched a humanitarian funding appeal for Yemen, seeking $2.5 billion for 2018 to meet the needs of 10.8 million Yemenis. The document, drafted before the latest events, said violence against civilians was already causing “unspeakable suffering.”   Monday saw a dramatic change in the more than two year conflict as former President Ali Abdullah Saleh, who until several days ago had been allied with Houthi rebels, was reportedly killed, according to Houthi media. Unverified images and video circulated on social media of what appeared to be Saleh’s body with a severe head wound.   The increasingly uneasy Saleh-Houthi alliance has been fighting a Saudi Arabia-led coalition and forces loyal to internationally recognised (but deposed) President Abd Rabbu Mansour Hadi since March 2015, but Saleh appeared to have switched sides in recent days, offering in a speech to talk with his former enemies.   But days of clashes that began before Saleh’s offer, in addition to airstrikes Riyadh said were to aid the former president against the Houthis, have reportedly left civilians trapped in their homes, unable to seek help, move to safer locations or get out to buy food and water. Most aid workers in the city are trapped too and unable to venture out.     The ICRC said in a statement that 125 people had been killed and 238 wounded in the latest round of violence, adding that “the targeting of our main medical warehouse by the fighting is hampering our work.” The ICRC is supporting medical teams in Sana’a’s hospitals.   Jamie McGoldrick, the UN’s humanitarian coordinator in Yemen, called for a six hour “humanitarian pause” on Tuesday, 5 December, “to allow civilians to leave their homes and seek assistance and protection and to facilitate the movement of aid workers.”   “The wounded must be afforded safe access to medical care,” he said in a Monday statement.   A humanitarian pause is different from a ceasefire: the UN’s emergency aid coordination body defines it as “a temporary cessation of hostilities purely for humanitarian purposes. Requiring the agreement of all relevant parties, it is usually for a defined period and specific geographic area where the humanitarian activities are to be carried out.”   There have been multiple calls for humanitarian pauses in Yemen’s war, with varying degrees of success. Aid workers said a May 2015 break in the fighting allowed for the distribution of some supplies but was not enough to make a real difference.   More than two years later, with more than 5,350 civilians (and counting) killed in violence, 2,223 Yemenis dead of cholera since April, and warnings of famine, the situation is much worse. The UN says Yemen is the world’s largest humanitarian catastrophe and while a coalition blockade on aid (ostensibly to prevent arms smuggling) has been eased, the majority of commercial ships are still not being allowed into the country’s Red Sea ports.   Given the massive scale of Yemen's humanitarian crisis, however, all this does is slow the collapse towards a massive humanitarian tragedy costing millions of lives. It does not prevent it,” said leaders of several UN agencies on Saturday. “Without the urgent resumption of commercial imports, especially food, fuel and medicines, millions of children, women and men risk mass hunger, disease and death.”   One international aid worker in Sana’a contacted by IRIN was sheltering in a strong room and said “it’s terrible” and “the game is changing for the worse... the longer the fighting lasts, the more severe and tragic the consequences.”   (T[...]