HIGHLIGHTS

• GoL, USG support response activities linked to recent EVD cases in Liberia

• GoL monitors more than 160 contacts remaining under observation through December 11

• Guinea completes four consecutive weeks with no new EVD cases

• Sierra Leone plans transition of NERC functions to permanent GoSL institutions

West Africa - Ebola Outbreak, Fact Sheet #5, Fiscal Year (FY) 2015 (as of December 4, 2015)

Introduction

World Humanitarian Data and Trends presents global- and country-level data-and-trend analysis about humanitarian crises and assistance. Its purpose is to consolidate this information and present it in an accessible way, providing policymakers, researchers and humanitarian practitioners with an evidence base to support humanitarian policy decisions and provide context for operational decisions.

The information presented covers two main areas: humanitarian needs and assistance in 2014, and humanitarian trends, challenges and opportunities. This edition also features a new section on regional perspectives, which showcases region-specific trends identified by OCHA’s regional offices. The report intends to provide a comprehensive picture of the global humanitarian landscape, and to highlight major trends in the nature of humanitarian crises, their drivers, and the actors that participate in prevention, response and recovery. The 2015 edition builds on previous iterations of the report, providing an overview of 2014 as well as selected case studies that can be used for humanitarian advocacy.

There are many gaps in the available information due to the complexity of humanitarian crises. Even the concepts of humanitarian needs and assistance are flexible. There are also inherent biases in the information. For example, assistance provided by communities and by local and national Governments is less likely to be reported. The outcomes and impact of assistance are difficult to measure and rarely reported. Funding data is more available than other types of information. There are also limitations on the availability and quality of data. Further information on limitations is provided in the ‘User’s Guide’.

The data presented in this report is from a variety of source organizations with the mandate, resources and expertise to collect and compile relevant data, as well as OCHA-managed processes and tools, such as the inter-agency appeal process and the Financial Tracking Service (FTS). All the data presented in this report is publicly available through the source organizations and through the report’s own data set. Further information on data sources is provided in the ‘User’s Guide’.

World Humanitarian Data and Trends is an initiative of the Policy Analysis and Innovation Section of OCHA’s Policy Development and Studies Branch (PDSB). This report is just one part of OCHA’s efforts to improve data and analysis on humanitarian situations worldwide and build a humanitarian data community. This edition was developed with internal and external partners, whose contributions are listed in the ‘Sources and References’ section. OCHA extends its sincere gratitude to all those partners for their time, expertise and contributions.

Interpreting the visuals and data

The report uses many visual representations of humanitarian data and trends. There is also some limited narrative text and analysis, which provides basic orientation and helps to guide individual interpretation. However, there may be multiple ways to interpret the same information.

The ‘User’s Guide’ contains more detailed methodological information and specific technical notes for each figure. Readers are encouraged to refer to the technical notes for more detailed descriptions of decisions and assumptions made in presenting the data.

For the latest information on needs and funding requirements for current strategic response plans or inter-agency appeals, see fts.unocha.org.

Accessing the data

All the data presented in this report can be downloaded through the Humanitarian Data Exchange (https://data.hdx.rwlabs.org/). The report can be explored through its interactive companion microsite www.unocha.org/humanity360.

Highlights

• Three new Ebola cases were confirmed in Monrovia, Liberia. The first to be diagnosed, on 19 November, was a 15-year-old boy who subsequently died. His brother and father also tested positive. Investigations into the possible source of infection are ongoing.

• On 1 December, Liberia’s Ministry of Health announced that it had begun offering an experimental Ebola vaccine on a voluntary basis to people who may have been exposed to the virus in the outbreak that started on 19 November.

• As of 1 December, no new cases were reported in Guinea or Sierra Leone. Guinea has started the 42-day countdown towards declaring the end of human-to-human Ebola transmission.

• On 27 November in Conakry, Guinea, a three-day workshop on accelerated access to vaccines against viral haemorrhagic fevers and other emerging epidemics was organized by the Government, with the support of WHO and UNICEF.

• WHO is strengthening preparedness through a series of simulation exercises to test and improve Ebola Emergency Response Plans.

Epidemiological status

• Three new Ebola cases were confirmed in Monrovia. They are two brothers and their father. On 23 November, one of the boys died four days after testing positive. Investigations into the possible source of infection are ongoing.

• As of 29 November in Liberia, 165 contacts have been identified, including 13 health care workers at high risk.
  All contacts are being monitored. These are the first new Ebola cases in Liberia since the country was declared free from human-to-human Ebola virus disease (EVD) transmission on 3 September 2015. Approximately 40 health facilities in the area surrounding the cluster have been identified for targeted support as per the ring-IPC protocol. A field coordination team has been established by the Ministry of Health (MoH) and is being co-led by WHO.

• As of 1 December, no new cases have been reported in Guinea or Sierra Leone. Guinea has started the 42-day countdown towards declaring the end of human-to-human Ebola transmission. Sierra Leone has entered a 90-day period of enhanced surveillance, which is scheduled to conclude on 5 February 2016.

Alors que les trois pays les plus affectés par l’épidémie d’Ebola ont enregistré d’indéniables progrès, l’ONU reste vigilante et mobilisée pour éviter une rechute, restaurer la confiance et participer au redressement de l’économie et des systèmes de santé du Libéria, de la Sierra Leone et de la Guinée, selon l’Envoyé spécial du Secrétaire général pour Ebola, Dr. David Nabarro.

D’après les derniers chiffres de l’Organisation mondiale de la Santé (OMS), plus de 28.600 cas d’Ebola ont été enregistrés depuis le début de l’épidémie, causant la mort de plus de 11.300 personnes.

L’épidémie a fortement reflué mais les efforts ne peuvent pas se relâcher, a expliqué Dr. Nabarro dans un récent entretien avec le Centre d’actualités de l’ONU et la Radio des Nations Unies. Le Libéria, qui a été déclaré exempt de la transmission à deux reprises en mai et en septembre, a annoncé de nouveaux cas en novembre et la mort d’un adolescent.

« Il faut avoir une vigilance extraordinaire », a insisté Dr. Nabarro. Au Libéria, en Sierra Leone et en Guinée, un système de riposte a été mis en place qui permet de réagir en cas de soupçon de nouveau cas, afin de rassurer les gens.

Il s’agit de rassurer aussi les investisseurs « parce que l’on veut que l’investissement reparte pour la relance de l’économie », a souligné l’Envoyé spécial. « Et l’on veut aussi que les systèmes de santé soient plus forts qu’avant pour éviter d’autres problèmes comme Ebola ».

La Mission des Nations Unies pour l’action d’urgence contre Ebola (MINUAUCE) a été fermée le 1er août 2015 mais le système des Nations Unies reste mobilisé avec l’OMS qui a pris le relais.

« On a fermé cette riposte quand on était sûr que l’OMS était en position de prendre toutes les responsabilités », a souligné Dr Nabarro. « Maintenant l’OMS est au centre de la riposte des Nations Unies en partenariat avec les ministères de la santé et les cellules de coordination dans les pays ». D’autres agences des Nations Unies collaborent avec l’OMS dans la lutte contre Ebola. C’est le cas du Fonds des Nations Unies pour l’enfance (UNICEF), du Programme alimentaire mondial (PAM), du Bureau des Nations Unies pour la coordination des affaires humanitaires (OCHA) et du Programme des Nations Unies pour le développement (PNUD).

« Cette collaboration sera en place jusqu’à fin janvier. Après cela, il y aura l’OMS et le PNUD qui seront au centre de la riposte et aussi de la relance des systèmes de santé et de l’économie », a souligné l’Envoyé spécial.

Dr. Nabarro s’est félicité du travail de l’OMS qui compte plus d’un millier de spécialistes sur le terrain, dans les trois pays les plus affectés. Beaucoup de ces experts viennent d’autres pays africains. Ils vont dans les villages, sont en contact avec la population. « J’espère qu’avec cela ils vont pouvoir répondre vite s’il y a une rumeur d’un nouveau cas », a-t-il ajouté.

Ce système mis en place doit permettre de redonner confiance aux populations et aux gouvernements du Libéria, de la Sierra Leone et de la Guinée au sujet des capacités de surveillance, de détection et de réponse rapide. Il faut aussi redonner confiance aux pays voisins d’Afrique de l’Ouest.

L’Envoyé spécial a rappelé que l’épidémie a été une « catastrophe énorme » dans la région et la confiance se conquiert peu à peu. « A Monrovia (la capitale du Libéria), en ce moment, les enfants vont à l’école, les hôpitaux commencent à rouvrir, les bateaux viennent dans les ports … C’est un pays qui se retrouve lui-même », a-t-il souligné. Selon lui, la confiance revient aussi peu à peu en Sierra Leone et en Guinée.

Parmi les pays voisins, certains ont montré qu’ils avaient pu contrôler la maladie, comme le Sénégal, le Mali, et le Nigéria et ont une certaine confiance dans leurs capacités. « Les autres pays ont encore un peu peur », a noté l’Envoyé spécial, qui a toutefois estimé que les choses allaient dans le bon sens.

by State House Communication Unit

President Dr. Ernest Bai Koroma Monday 7 December 2015 launched the “Week of Education” at the Miatta Conference Centre in Freetown.

“Education Week” is being observed by government through the Ministry of Education, Science and Technology, in collaboration with the Sierra Leone Teachers Union, with a symposium on the way forward for education.

Speaking at the opening ceremony, President Koroma said the issue before government and partners is to discuss how to further improve on education in the country by ensuring that quality education is offered, saying that everybody has a responsibility in improving the educational system.

“I think all of us in this hall collectively have a responsibility. We have a role to play. And I have to commend the minister for providing the platform to take a hard look at the sector. We really don’t need a prepared note to address the issues,” he emphasized.

The president observed that the problems in the educational sector are glaring everywhere saying; “You go to the schools you will see the problems, to the universities you will see the problems, you visit the homes you will see the problems,” and called on communities, parents and teachers, students as well as pupils to play their various roles in reforming the sector.

He said owing to the need to improving the sector, government prioritized education and has maintained that priority in both the Agenda for Change and now the Agenda for Prosperity as well as in the post-Ebola recovery programme.

President Koroma informed that government has increased the financial allocation to the educational sector, to further enhance capacity building in the sector, while fervently praying for ghost teachers to stay in their graves rather than continuing to resurface on the payroll.

Announcing a line of action that has been agreed upon, President Koroma declared that there should be minimum standards set for all learning institutions, provide incentives for institutions that do well through performance based financing institutions. He told heads of institutions and schools to pursue the task of improving the quality of teachers in the system thereby appointing an experienced and competent educationist to head the Teaching Service Commission as a first step in the process.

He also recommended fast tracking of the process of recruiting trained and qualified teachers into the teacher payroll and provide capacity building opportunities for the unqualified through an intensive in-service teacher improvement programme.

He also called for the provision of teaching and learning materials in all government and government-assisted schools, and the construction and furnishing of additional classrooms to address overcrowding in schools. President Koroma called for exploration of innovations by ensuring that textbooks and reference materials are easily accessed by teachers and students as well as placing premium on quality researches to improve the quality of education in Sierra Leone.

Minister of Education, Science and Technology, Dr. Minkailu Bah said the symposium was organized to discuss the way forward in education. He therefore encouraged heads of schools and tertiary institutions to embrace their various responsibilities. Dr. Bah said it was because of the conviction that education must go on amid disease and pestilence, which is a testimony of government’s resilience in promoting education in Sierra Leone.

He added that the educational landscape is improving and transforming rapidly from the 6334 to 6344, coupled with the revised method of recruitment. The Education Minister went on to note that the educational sector is now doing things that will have lasting impact on the country, citing the nationwide media education programme on radio and TV stations as a huge improvement.

CAMEROUN

LIBÉRATION ANNONCÉE DE 900 OTAGES

Le 2 décembre, le ministre de la Défense du Cameroun a annoncé que l'armée avait libéré 900 otages suite à une opération menée les 26 - 28 novembre contre Boko Haram dans laquelle 100 membres du groupe ont également été tués. Les otages ont depuis été transférés à Maroua, la capitale de la région de l'Extrême-Nord.

SEPT TUÉS DANS UN ATTENTAT-SUICIDE

Trois kamikazes ont attaqué le 1er décembre la localité de Waza dans la région de l'Extrême-Nord du pays, tuant sept personnes. Depuis juillet, la région a été secouée par de nombreux attentats-suicides soupçonnés d’avoir été perpétrés par Boko Haram.

REPUBLIQUE CENTRAFRICAINE (RCA)

ATTAQUES SUR UN SITE DE DÉPLACÉS

Une bande armée a attaqué le 3 décembre un site d'hébergement de personnes déplacées dans la localité de Ngakobo dans la préfecture centrale de Bambari, tuant huit personnes et en blessant plusieurs autres. Le Coordonnateur humanitaire des Nations Unies Aurélien Agbénonci a condamné "l'acte horrible qui a coûté la vie à huit personnes innocentes (…) en violation flagrante du droit international humanitaire».

TCHAD

30 TUÉS DANS UN TRIPLE ATTENTAT-SUICIDE

Trois attentats-suicides perpétrés par des membres présumés de Boko Haram ont frappé le 5 décembre Koulfoua, l'une des plus grandes îles du Lac Tchad, tuant environ 30 personnes et en blessant 80 autres. Deux kamikazes se sont fait exploser dans un marché aux poissons et un troisième dans une ruelle, profitant de mouvements de panique. En raison des difficultés d'accès, des hélicoptères ont été envoyé pour évacuer les blessés vers les hôpitaux de la région et la capitale N'Djamena.

NIGERIA

TROIS MORTS DANS DES ATTENTATS-SUICIDES

Au moins trois personnes ont été tuées et six autres blessées le 4 décembre dans des attaques-suicides dans l'Etat de Borno. Des hommes armés de Boko Haram sont soupçonnés d'être à l’origine des attentats. Deux kamikazes se sont fait exploser à un poste de contrôle de sécurité dans le sud de la capitale de l'Etat de Maiduguri, tuant deux personnes et blessant quatre autres. Séparément, un autre kamikaze à moto a activé sa charge explosive dans un village, tuant une personne et en blessant deux autres.

MVE REGIONAL

LES DEUX DERNIERS PATIENTS EBOLA GUÉRIS

Les deux derniers patients ayant été atteints d’Ebola au Libéria sont sortis de l’hôpital le 3 décembre après avoir guéri du virus qui avait refait surface dans le pays le 19 novembre, tuant une personne. Aucun nouveau cas n’a depuis été enregistré. Quelque 165 contacts sont sous surveillance, dont 13 considérées comme à haut risque. Aucun nouveau cas n’a été signalé en Guinée et en Sierra Leone dans la semaine se terminant le 6 décembre.

SUMMARY

 No confirmed cases of Ebola virus disease (EVD) were reported in the week to 6 December. Investigations are continuing into the origin of infection of the cluster of 3 confirmed cases of EVD reported from Liberia in the week to 22 November, with a working assumption that the cluster arose as a result of a rare re-emergence of persistent virus from a survivor. The first-reported case in that cluster was a 15-year-old boy who tested positive for EVD after admission to a health facility in the Greater Monrovia area on 19 November. He was then transferred to an Ebola treatment centre along with the 5 other members of his family. Two other members of the family – the boy’s 8-year old brother and his 40-year-old father – subsequently tested positive for EVD whilst in isolation. Both tested negative twice for Ebola virus on 3 December. The 15-year-old boy died on 23 November. In addition to the family of the first-reported case, 165 contacts have been identified, including 15 high-risk contacts. Contacts are now in the third week of their 21-day follow-up period.
 On 7 November WHO declared that Sierra Leone had achieved objective 1 of the phase 3 framework, and the country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016. As of 6 December it had been 20 days since the last EVD patient in Guinea received a second consecutive EVD- negative blood test. The last case in Guinea was reported on 29 October 2015.
 The recent cases in Liberia underscore the importance of robust surveillance measures to ensure the rapid detection of any reintroduction or re-emergence of EVD in currently unaffected areas. In order to achieve objective 2 of the phase 3 response framework – to manage and respond to the consequences of residual Ebola risks – Guinea, Liberia, and Sierra Leone have each put surveillance systems in place to enable health workers and members of the public to report any case of illness or death that they suspect may be related to EVD to the relevant authorities. In the week to 6 December, 19 864 such alerts were reported in Guinea, with alerts reported from all of the country’s 34 prefectures. Equivalent data are not currently available for Liberia. In Sierra Leone, 1420 alerts were reported from all 14 districts in the week ending 15 November (the most recent week for which data are available).
 As part of each country’s EVD surveillance strategy, blood samples or oral swabs should be collected from any live or deceased individuals who have or had clinical symptoms compatible with EVD. In the week to 6 December 8 operational laboratories in Guinea tested a total of 582 new and repeat samples from 12 of the country’s 34 prefectures. 84% of all samples tested in Guinea were swabs collected from dead bodies. By contrast, 82% of the 1020 new and repeat samples tested in Liberia over the same period were blood samples collected from live patients. In addition, all 15 counties in Liberia submitted samples for testing by the country’s 5 operational laboratories. 1363 new samples were collected from all 14 districts in Sierra Leone and tested by 8 operational laboratories. 95% of samples in Sierra Leone were swabs collected from dead bodies.
 964 deaths in the community were reported from Guinea in the week to 6 December through the country’s alert system. This represents approximately 43% of the 2248 community deaths expected based on estimates of the population and a crude mortality rate of 11 deaths per 1000 people per year. Equivalent data are not yet available for Liberia. In Sierra Leone, 1282 reports of community deaths were received through the alert system during the week ending 15 November (the most recent week for which data are available), representing approximately 62% of the 2075 deaths expected each week based on estimates of the population and a crude mortality rate of 17 deaths per 1000 people per year.

HIGHLIGHTS

• GoL, USG support response activities linked to recent EVD cases in Liberia

• GoL monitors more than 160 contacts remaining under observation through December 11

• Guinea completes four consecutive weeks with no new EVD cases

• Sierra Leone plans transition of NERC functions to permanent GoSL institutions

KEY DEVELOPMENTS

• The Government of Liberia (GoL), the USG Disaster Assistance Response Team (DART), and relief organizations continue to support response activities linked to the three recently confirmed cases of Ebola Virus Disease (EVD) in Liberia’s Montserrado County. The GoL is monitoring more than 160 contacts of the cases, including at least 10 health care workers and 13 community members classified as high-risk contacts. EVD response actors are providing food, water, and emergency relief supplies to high-risk contacts under precautionary observation in designated sites, as well as contacts monitored at home.

• The Government of Sierra Leone (GoSL) is finalizing the organizational structure of the emergency public health entities expected to succeed the National Ebola Response Center (NERC) and District Ebola Response Center (DERCs) by late December.

Highlights

• In October, coping improved in Liberia and less broadly in Guinea and Sierra Leone.

• A few commodity price changes were detected this month, including a decrease in the price of local rice and an increase in palm oil. This corresponds with respondents’ reports of food availability during the current harvest.

National coping levels The Reduced Coping Strategies Index (rCSI) measures the frequency and severity of the mechanisms households employ when faced with food shortages such as skipping meals or reducing the size of portions. A higher score indicates households are resorting to more frequent and/or severe negative coping strategies. Detailed information on the rCSI can be found here.

In September, average national rCSI levels did not improve in all three countries. In October, the rCSI improved an average of 1.3 points for repeat respondents (those who report in the current and previous survey round, n=775) in Liberia.*** 1 In Guinea and Sierra Leone, while the change in the average national rCSI was not statistically significant, some wealth groups saw improvements in their rCSI as well as the average duration of coping.

Context: Bombali district is located in the northern province of Sierra Leone. Bombali is the second largest district in Sierra Leone and its capital and largest city is Makeni, which is the largest city in the north. It compromises thirteen chiefdoms. The population of Bombali district is ethnically diverse, although the Temne and Limba form the largest ethnic groups. Bombali is a political stronghold of the All Peoples’ Congress (APC), the current ruling party in Sierra Leone; and one of the two major political parties in the country. During the war (1991-2002), Bombali was a principal former rebel stronghold and experienced considerable displacement, destruction, and trauma as a result of the conflict. While progress has been made since the conflict, particularly in restoration of state authority, the level of social services and economic recovery remains unsatisfactory throughout the district. The provincial importance of Makeni is in contrast with its lack of basic services, such as water and power supply. The poor road network and large distances in the district have meant that limited intervention has been made in chiefdoms outside of the Makeni area, particularly in the far north. Savannah woodland is mostly found in Bombali. Approximately 90% of the cattle in the country are found in the Northern Province, predominantly in Koinadugu and Bombali districts. Range or pasture management is limited; bush fires continue to affect about 200 000 hectares of savannah woodlands annually.

Education: In Sierra Leone, it is legally required for all children for six years at primary school level and three years in junior secondary school. A shortage of schools and teachers has made implementation impossible, although the number of children in primary education has greatly increased since the end of the civil war in 2002. Currently, Bombali has 679 schools (42 pre-primary, 510 primaries, 102 Junior Secondary Schools and 22 Senior Secondary Schools.). The outbreak of Ebola led to the closure of schools for a prolonged time period from July 14 to April 2015. 16 A 2010/11 School Census from Ministry of Education reports that 55 percent -in the country are in need of repairs. Twentyfive percent of schools typically collect water from a stream, while 38 percent of schools have a non-functional toilet1. Sierra Leone has a low level of literacy among adults with only 42.0% of adults literate in 2010.

Food Security: This zone is characterized by open-bush and grasslands. Rice, cassava and sweet potatoes are the staple food crops while groundnuts, peppers and tobacco comprise the main cash/non-staple crops. While the land is suitable for livestock rearing, theft during the civil war has hindered the continuation of this livelihood. In 2014-2015 in the communities directly affected by the Ebola outbreak, food consumption was slightly worse than in those non-affected, farmers decrease rice production due to the reduction of the farm workforce caused by containment measures. The total number of people food insecure in Bombali is 132,322 and the percentage of household food insecure (severe and moderate) is 25.5%.

Health: Medical services are provided by a mix of government, private and non-governmental organizations (NGOs). The Ministry of Health and Sanitation (MOHS) shifted to a decentralized health system structure after the end of the civil in war in 2002, in an effort to increase coverage. Bombali has 16 community health centers (CHC), 18 community health posts (CHP), 48 maternal child health posts (MCHP), 1 government hospital, 1 military hospital, 1 community hospital, 3 mission Clinics, 3 mission hospitals and 3 private clinics. Traditional medicine forms part of the primary health care system in Sierra Leone. Endemic diseases are Yellow Fever and Malaria across Sierra Leone. Ebola Emergency: Bombali experienced its last Ebola case on 13th of September, following the last positive case in the district, WHO activated ring vaccination for contacts and contacts of contacts in Robuya village, Makari Benti chiefdom. A total of 101 participants were identified and received the vaccine. In Sierra Leone, at least four trials are underway to prove the efficacy needed for licensing.

Water and Sanitation: Access to water and sanitation remains poor, despite considerable activities since the war. The Ministry of Energy and Water Resources (MoEWR) and its partners conducted a comprehensive mapping exercise in the first half of 2012. The findings confirmed there were 2,429 water points in Bombali. Of these, 1,434 were partially damaged or broken (41%), and 126 were under construction. The person per water point average is 337. Water points require repairs, and new points need to be built in areas where there is a lack of adequate safe water supply.

Context: The district is located predominantly around the peninsula in the Western Area of Sierra Leone. The Freetown peninsula consists of three roughly parallel ranges of highlands that are narrow, but extend about 30 km south of Freetown. The hills and mountains in the highlands rise from 200 m to 1 000 m above the low-lying narrow coastal area. As the rest of the country has a tropical climate with two pronounced seasons: a wet season from May to October, and a dry season from November to April. Rainfall in this area is 3,000 to 4,000 mm per year. The Rural District capital is located in the city of Waterloo. The agricultural sector comprising food crops, fisheries, livestock, and forestry sub-sectors are the backbone of Sierra Leone’s economy. Nearly two-thirds of the population depends on the agriculture sector for their livelihoods. Major protected areas are forest reserve, with a large cross section of biodiversity resources.

Education: Education in Sierra Leone is legally required for all children; six years at primary school level; and three years in junior secondary school. A shortage of schools and teachers has made implementation impossible, although the number of children in primary education has greatly increased since the end of the civil war in 2002. Recently, the outbreak of Ebola led to the closure of schools for a prolonged period from July 2014 to April 2015. By October, 2015, 540 schools were open in Western Rural district. Sierra Leone has a low level of literacy among adults with only 37.1% of adults literate in 2006.

Food Security: As a result of poor yields, even in rural areas, three quarters of the population rely on markets for access to food. Poverty and the exposure to international food price volatility are the underlying causes of vulnerability in Sierra Leone. The Ebola Virus Disease (EVD) outbreak has further eroded the livelihoods of both affected and non-affected communities. The total number of people who are food insecure in Western Rural Area is estimated at 53,116 and the percentage of households who are food insecure (severe and moderate) is 22.0%. The prevalence of food insecurity remains below the national average.

Health: The District Health Management Team (DHMT) has a total of 317 registered staff medical and non-medical staff working in health facilities in Western Area. The facilities available in Western Rural Area are: 12 Community Health Centers (CHC), 20 Community Health Posts (CHP), 21 Maternal Child Health Post s (MCHP) and 1 hospital. Traditional medicine forms part of the primary health care system in Sierra Leone.

Ebola Emergency: Western Rural reported the last two Ebola cases on 20 April 2015. Prior to this Ebola transmission was intense and the area was considered the “hotspot” of the West African outbreak. The cumulative number of confirmed cases is 1,164 for the area.

Water and Sanitation: Access to safe drinking water in the rural areas has remained considerably low over the last two decades, fluctuating between 26% and 35% during 1990-2008, before rising to 48% over the next two years to 2010. The sanitation situation remains poor, with rural access to improved sanitation at 9% over the last two decades. The depletion of economic and social infrastructure, combined with the deterioration in levels, access, and quality of social services during this time placed Sierra Leone in a very fragile position. In 2010, almost a fifth of rural water points were reported as broken. The Water Point Mapping in 2012 reported that 18% of existing water points across the country was broken, while another 14% are partly damaged and currently dysfunctional. Many communities, especially the rural poor, depend on streams and swamps to gather their water; many of these dry up during periods of severe drought. During the rainy season, floods can overwhelm existing systems, contaminating drinking water, and creating sewerage overflows.

Context: The district comprises eleven chiefdoms, with Magburaka as the capital, and Mile 91, the commercial center. The population of the district are predominantly Muslim, with a Christian minority. Tonkolili is strategically located in the center of Sierra Leone, and is crossed by many rivers including the Pampana River and Sierra Leone's longest river, the Rokel. The district has both highlands and lowlands. The highlands rise up to 700 feet, and are the highest in Sambaia Bendugu chiefdom. It is from these hills that the major rivers in the district have their sources. The rest of the district is lowland which occupies a greater part of the district and is appropriate for rice production. In the past, the district was covered with thick forests, but due to increased farming activities, and the use of slash and burn methods of cultivation, the forests have gradually given way to grass lands. Tonkolili has two major industries: The Magbass sugar complex, which produces sugar and ethanol, and the Gari factory at Robinke, which processes cassava. There are other small-scale industries such as tailoring, carpentry, weaving, blacksmithing, gara tie-dye and soap making. Roads in this region are particularly poor, as is access to markets.

Education: In Sierra Leone, it is legally required for all children from six years old to attend primary school level, and spend three years in junior secondary school. A shortage of schools and teachers has made implementation impossible, although the number of children in primary education has greatly increased since the end of the civil war in 200214. Currently, Tonkolili has 637 schools (20 pre-primary, 525 primaries, 74 junior secondary schools and 18 senior secondary schools.) The outbreak of Ebola led to the closure of schools for a prolonged time period from July 2014 to April 2015. A 2010/11 School Census from the Ministry of Education reported that 55% of the schools in the country were in need of repairs. Twenty-five percent of schools typically collected water from a stream, while 38 percent of schools had nonfunctional toilets. Sierra Leone has a low level of literacy among adults, with only 42.0% of adults literate in 2010. Tonkolili suffered significant losses during the civil war in terms of educational facilities, with 66% of schools in the district completely destroyed during this period.

Food Security: Poverty and the exposure to international food price volatility are the underlying causes of vulnerability in Sierra Leone. Tonkolili is significantly affected by food insecurity. The total number of people who are food insecure is 291,211 and the percentage of households food insecure (severe and moderate) is 74.1%.Tonkolili has a high prevalence of acute malnutrition in women (4.6%). The EVD outbreak further eroded livelihoods of communities. Farmers in Tonkolili experienced a drop in rice production, due to a reduction in the farming workforce caused by the Ebola containment measures. As a result of unmet food needs, and a high economic vulnerability, the food security situation remains very poor.

Health: All medical care is generally provided by a mixture of government, private and non-governmental organizations (NGOs). The Ministry of Health and Sanitation (MOHS) is responsible for health care. After the civil war in 2002, the Ministry moved to a decentralised structure of health provision to increase its coverage. In Tonkolili, the medical facilities are 8 community health centers (CHC), 9 community health posts (CHP), 52 maternal child health posts (MCHP) and 1 government hospital, 2 mission clinics, 1 mission hospital, 1 NGO clinic, and 1 private clinic. Traditional medicine forms part of the primary health care system in Sierra Leone. In Sierre Leone, endemic diseases are Yellow Fever and Malaria.

Ebola Emergency: Tonkolili experienced its last Ebola case on 24 July 201525 and has not reported any human-to-human transmission since. During the Ebola outbreak, transmission in this part of the country was intense. The cumulative number of confirmed cases in Tonkolili is 456.

Water and Sanitation: Access to safe water and sanitation has not improved significantly since the end of the Sierra Leone Civil War in 2002. The Ministry of Energy and Water Resources (MoEWR) and its partners conducted a comprehensive mapping exercise in the first half of 2012. They found 1,742 water points. Of these, 896 were partially damage or broken down, 155 were under construction and 692 were functional. Population per water point was 237. In percentages, 60 % of the water points were not functional.

Context: Kenema district is in the Eastern Province of Sierra Leone, the capital and the largest city is Kenema, which is the third largest city in Sierra Leone. The city is located on the railway line, in a valley of the Kambui Hills. The district is ethnically diverse, and the Mende people make up the largest ethnic group. Kenema city is the centre of the Alluvial Diamond Mining Scheme Area and the site of the Government Diamond Office. Kenema is an important agricultural market town and the centre of the timber industry in Sierra Leone. The area’s production of cocoa, coffee, palm oil and kernels, furniture, and wood carvings is transported mainly by road to Freetown for sale and export . Politically, Kenema is a stronghold of the Sierra Leone People's Party (SLPP), the main opposition party in Sierra Leone. Rainfall is 2,001 to 3,000 mm per year.

Education: In Sierra Leone, it is legally required for all children from six years to attend primary school and three years in junior secondary school. A shortage of schools and teachers has made implementation of this policy impossible. The number of children in primary education has greatly increased since the end of the civil war in 2002 . Currently, Kenema has 739 schools (42 pre-primary, 605 primaries, 73 junior secondary schools and 19 senior secondary schools.) The outbreak of Ebola led to the closure of schools for a prolonged period from July 2014 to April 2015. A 2010/11 School Census by the Ministry of Education found that 55% of the schools in the country were in need of repairs. Twenty-five percent of schools typically collect water from a stream, while 38 percent of schools have non-functioning toilets. Sierra Leone has a low level of literacy among adults, with only 42.0% of adults found to be literate in 2010.

Food Security: Kenema is one of the most food insecure districts in the country. The State of Food Security and Nutrition in Sierra Leone (2010) report confirmed the percentage of household as food insecure was 33.8%.The district exceeded the 40% critical threshold of chronic malnutrition set by WHO. In March 2014, the Ebola outbreak began in Guinea and the epidemic crossed the border into Sierra Leone, with the highest concentration initially in Kailahun and Kenema districts. By 2014, the district had alarming levels of food insecurity, where more than half of the households were food insecure. The EVD outbreak further eroded the livelihoods, especially Kenema as a cash-crop production area. Labourers were affected by restrictions and quarantines with production and trading being significantly impacted.

Health: Healthcare is provided by Government, private and non-governmental organizations (NGOs). The Ministry of Health and Sanitation (MoHS) is responsible for health care. Following the civil in war in 2002, the Ministry moved to a decentralised structure of health provision to increase coverage. 18 In Kenema, the medical facilities are 21 community health Centers (CHC), 17 community health posts (CHP), 44 maternal child health posts (MCHP) and 1 government hospital, 1 government clinic, 2 mission clinics, 1 mission hospital, 1 NGO clinic, and 3 private clinics. Traditional medicine forms part of the primary health care system in Sierra Leone. Endemic diseases are Yellow Fever and Malaria in Sierra Leone.

Ebola Emergency: Kenema suffered significantly during the Ebola outbreak. The total cumulative number of confirmed cases is 50321 . On 2 April 2015, the district reached 42 days without any new EVD cases, and has remained transmission free since then.

Water and Sanitation: Despite efforts, access has not improved since the end of the Sierra Leone Civil War in 2002. The Ministry of Energy and Water Resources (MoEWR) and its partners conducted a comprehensive mapping exercise in the first half of 2012 and reported 3659 water points in Kenema. Of these, 772 were partially damaged or broken; 151 were under construction (25% non-functional). The population per water point was 160. Points require repairs and many new points need to be built to provide the community with adequate safe water supplies.

Opinion piece by Mr Tadateru Konoé, President of the International Federation of Red Cross and Red Crescent Societies

The scale of humanitarian need around the world is expanding exponentially, emerging from environments that are so dangerous and highly complex that few organizations can act within them. This reflects a broader pattern: 80 per cent of humanitarian aid is being spent in countries where there is some sort of conflict.[1] Natural disasters such as severe tropical storms, droughts, floods and wildfires are increasing in frequency and severity; oftentimes occurring in situations of conflict or chronic violence. These and other large-scale emergencies such as outbreaks of deadly diseases require mass mobilization of local volunteers within risky environments.

Today, around the world, more than one million Red Cross and Red Crescent volunteers are providing humanitarian services in countries where there are situations of conflict. Local volunteers in these contexts bring considerable advantages, they understand the complexity of the situations and know how to manoeuvre and get things done. They can also operate on a scale that is unmatched. In Syria for example, more than 9 million people were helped by volunteers from the Syrian Arab Red Crescent in just three months (July, August and September) in 2014. In West Africa, 3.2 million people were reached in Ebola-affected countries by Red Cross volunteers.

The work of these volunteers however comes with considerable risk. Over the past two years, nearly 50 of our local aid workers, including volunteers, have died in the line of duty. In previous years (1994-2014), 20 per cent of Red Cross and Red Crescent aid workers were killed by conflict or violence-related injuries and 60 per cent or our fatalities were as a result of natural disasters. Statistics from recent years show that the trend has completely shifted, with 80 per cent of our aid workers were killed by conflict related injuries and 10 per cent as a result of natural disasters. In addition to fatalities, many more have been injured or put under such extreme psychological stress that they require significant and advanced support for many years.

The stories that volunteers in these challenging situations tell offer an excellent example of local resilience and solidarity in the face of conflict and crisis, of mobilizing in the face of great risks and of taking up the reins within their own communities when most others cannot, or will not. Greater attention must be paid to the critical roles they play, and the short and long-term risks they face.

Some of these risks include facing stigma and the potential of attack from the communities they are operating within, lacking access to all of the equipment and training they need, managing challenges in community acceptance, accessing affected populations, psychological distress and inadequate insurance and other ‘safety-nets’.

While there has been considerable research and writings about conflict settings, major emergency responses and other complex environments, little attention has been given to the needs, experiences, lessons and practices of volunteering in these situations. The motivation, dignity and commitment of each individual volunteer despite the manifold challenges and risks they face, continue to profoundly impress and move me. Time and again they talk of helping their communities, of saving lives, of the fact that no one else is there to do it and how they must stand up for the vulnerable. They also strive to work according to the Fundamental principles of the Red Cross and Red Crescent Movement, maintaining Impartiality and Neutrality, attempting to win or maintain the confidence of all sides of conflicts, so that they can service the needs of everyone affected by the conflict.

It is critical for humanitarian organizations to take precautions here. The commitment of humanitarian volunteers to the cause and to their communities coupled with their effectiveness and scale, can also make them vulnerable within highly dangerous settings where international aid workers cannot operate anyway. Care must be taken to ensure that the large cohorts of local volunteers are consulted and included in design and decision-making and not relegated solely to execution of tasks.

Humanitarian need is likely to continue to outstrip the global capacity (or will) to fund the required response. Investment in volunteering is therefore one of the most pragmatic ways, or sometimes only available option, for responding to this need. It can simultaneously contribute to strengthening local communities, building organizational capacities and increasing the capability for rapid and innovative humanitarian responses.

Greater efforts also need to be made to ensure that the role of volunteers is understood by all, making certain that they are allowed safer access to reach those in need. Just as there are local imperatives for ensuring people understand and respect the work of local volunteers, it is also significant internationally. Greater research and dissemination is needed to ensure that global actors understand and provide appropriate support for local volunteers, including engaging them in decision-making processes and providing protection and support that match the protection and support received by paid staff or international aid workers.

This is not just a practical programmatic imperative but a great moral and humanitarian obligation we owe to these brave local volunteers.

On the 5th of December, International Volunteer Day, the International Federation of Red Cross and Red Crescent Societies (IFRC) will be releasing their Global Review on Volunteering, which is the largest study ever conducted with Red Cross and Red Crescent volunteers. Almost 600 volunteers and staff members were interviewed or surveyed in 158 countries. The report is available on the IFRC website ifrc.org/volunteers

[1] Valerie Amos (2015)

Remarks
Steven Feldstein Deputy Assistant Secretary, Bureau of Democracy, Human Rights, and Labor
New York City Bar Association
New York City
December 7, 2015

I’m pleased to be here, I’d like to thank Elizabeth Barad and the New York Bar for inviting me to deliver remarks and answer some of your questions.

I’m here tonight to talk about human rights and democracy trends in Africa. What I can say with certainty is that in the 20 months I have been on the job, no day has been the same, and every week has been unpredictable. Consider the following:

Early in the year in Burkina Faso, we saw a popular uprising in response to a longstanding leader – Blaise Compaore – who felt that 27 years as head of state wasn’t sufficient. He sought to change the constitution so that he could run for president yet again. In this instance, Burkinabes of all ages, professions and affiliations stood up in defense of their country’s democratic institutions and said enough. A year later, they had to thwart a subsequent coup by Compaore loyalists who couldn’t stomach that the old days were truly over. Finally, two weeks ago, Burkina Faso held peaceful, free and fair elections, with a clear winner accepted by the other candidates.

In Burundi, the opposite story has taken hold. President Nkuruziza also made a bid to alter his country’s constitution for personal gain. After failing, he pressured Burundi’s high court to falsely declare his third term candidacy constitutional, a clear violation of the Arusha peace agreement, which has guided Burundi since the end of its bloody civil war. Nkurunziza’s power grab has split the country and brought significant violence and bloodshed. In response, on November 23, President Obama signed an Executive Order sanctioning individuals that have contributed to the turmoil. We hope that peace will one day soon return to Burundi.

Meanwhile, the heads of state of Rwanda, the Republic of the Congo – or Congo-Brazzaville, and the Democratic Republic of the Congo, are closely watching how these events unfold, with an eye towards extending their own respective presidencies, despite term limit prohibitions.

In Congo-Brazzaville, President Sassou-Nguesso, whose own reign extends 31 years, has already orchestrated a constitutional referendum to extend term limits, which the opposition has deemed a “constitutional coup.” Amidst a climate of fear and intimidation, we expect Sassou to call general elections in early 2016, and try yet again to extend his rule.

President Kagame in Rwanda is also maneuvering to change the constitution and run for a third term. The Rwandan parliament just approved amendments that would make an exception for Kagame, and allow him to potentially serve up to 17 more years. Rwandans will likely vote to affirm these amendments before the end of the year. Opposition to Kagame’s machinations has been more muted as all credible dissenting voices have been effectively exiled, imprisoned or suppressed.

In the DRC, President Kabila’s attempts to modify the constitution for additional terms have so far been forestalled. But his strategy is still devious. Using an approach known as “glissement,” he is attempting to gum up the works of an incredibly complicated national election scheduled for next year, so that it will be postponed for an indefinite period of time, enabling him to stay in power.

But there are positive democratic trends that deserve recognition as well. Perhaps the most significant achievement this year was historic elections in Nigeria – Africa’s most populous country and its largest economy. For the first time, an opposition party won the Presidency in generally clean and transparent elections. Widespread violence did not break out, as was feared. Where there were instances of electoral violence or allegations of fraud, we expect Nigerian authorities to continue investigations and take appropriate measures. A strong election observation effort provided real-time verification of results and ensured election authorities would be more accountable than in the past. The electoral commission’s efforts to increase transparency and curb irregularities through live announcements of voting results on radio, television and social media, prevented wide-scale fraud and disenfranchisement. And when the commission declared Muhammadu Buhari the winner of the presidential election, rather than fight the result, the incumbent President Goodluck Jonathan gracefully congratulated his opponent and bowed out.

One of the benefits to covering such a wide portfolio – overseeing human rights and democracy issues for the 49 countries comprising the African sub-continent – is the tremendous diversity of policy matters that arise. Everyday we grapple with issues that range from how to preserve civil society space in Kenya, to speaking out against criminalization of LGBTI members in Uganda, or fighting repressive restrictions in Ethiopia and Sudan against opposition parties and human rights activists. I am convinced that U.S.diplomatic engagements on these issues have contributed to positive change.

For example, in February I became the first senior U.S. human rights official to visit Sudan in four years. I approached the trip with some trepidation. We have a very challenging relationship with the government, including comprehensive sanctions due to gross human rights violations committed in Darfur and the Two Areas. But it was precisely because we have such significant concerns that I felt traveling to Sudan and talking directly with Sudanese government officials was the right thing to do. The trip represented an opportunity to initiate a frank conversation with the government on a range of human rights concerns – aerial bombardments of civilians, lack of humanitarian access, restrictions on civil society and religious freedom, and ongoing detention and harassment of opposition members. It also provided a chance to emphasize to my Sudanese counterparts that any improvement in U.S.-Sudan relations must be premised on real and substantive improvements on key human rights issues. And just as importantly, I was also able to schedule an extensive set of meetings with those fighting for change in the country – independent NGOs, opposition members, student activists, and religious and women leaders.

So after multiple trips to the continent, countless policy meetings, public statements, panel events, op-eds, tweets, and roundtables, I’d like to present a few thoughts about trends and developments shaping human rights and democracy in Africa.

To begin, many are questioning whether democracy and human rights are on the retreat in favor of authoritarians and dictators. The latest analysis from organizations like Freedom House reveals a stark picture -- nine straight years of global decline in measures of freedom. But I believe the situation is more nuanced. It is not that Africa has suddenly turned undemocratic. Instead, many countries have yet to fully resolve the transition from post-liberation movements and leaders, to genuine multi-party democracies. A phrase I often hear in meetings with government counterparts is that “we’re still a young country.” Sometimes this is used to explain why institutions remain weak, why corruption is endemic, and why the government cannot provide access to basic services. Other times, it is applied in a more sinister fashion – to justify rampant detentions of political opponents or mass imprisonments of civil society activists – under the guise of protecting stability and preserving public order for a “young nation.” And often, the pretext that the country is still young is used to justify why the current head of state – who may have already served 25 or 30 years – needs to stay in power just a little longer. Until the population can be trusted to freely elect their own leader.

This practice undercuts meaningful political competition, and allows heads of states like Uganda’s Yoweri Museveni, Zimbabwe’s Robert Mugabe, or Cameroon’s Paul Biya, to perpetuate their rule year after year. Yet polling data suggests African citizens reject the notion that their countries are “too young” for democracy. Afrobarometer polling across a wide swath of African countries suggests that 75% of people support a two-term limit on the presidency. Paradoxically, the percentage is even higher in African countries that lack term limit provisions.

There is a lot of discussion about why political institutions in Africa remain weak and under-capacity despite substantial effort and investment. Much of this weakness is deliberate. Strong political institutions do not serve the self-interest of dictators and autocrats. Independent judiciaries and courts, vigorous legislatures, and vibrant media outlets enable political competition and serve as key points of accountability. They diminish the impunity, power and discretion of the strongman’s inner circle. When rulers successfully muzzle and suppress these institutions, they create an alternate set of perverse incentives. Where access to lucrative contracts, secure jobs, gated mansions and luxury cars is wholly contingent on loyalty to the president and ruling party. The correlation between weak institutions, token political competition and meager oversight – and systemic corruption – is all too obvious.

And this explains why genuinely tackling corruption is such a tough proposition. While it is easy for outside actors to condemn bribe-taking and graft, these practices are often a necessary means of survival. As such, they are completely interwoven into the fabric of political systems that govern African countries. Fighting corruption is not just a matter of prosecuting a few offenders at the top. Really making a dent in corruption requires a fundamental overhaul of how politics is pursued, and how power and resources are allocated and distributed. Every flawed election, every politicized firing of an honest administrator, every jailing of a civil society advocate or an investigative journalist asking too many uncomfortable questions, every military abuse that continues unchecked, they all contribute to a system of corruption that is deeply entrenched and dreadfully difficult to root out.

In spite of these challenges, I do believe the tide can turn. For example, enhanced political competition and citizen engagement have brought increased transparency in countries such as Nigeria, Senegal, and Sierra Leone, which have respectively instituted freedom of information laws and greater budget transparency.

Another issue that I often encounter is the uneasy balance between human rights and national sovereignty. Too often, one country’s leader will propagate human rights atrocities, and regional leaders will turn a blind eye. Calling out fellow African leaders for committing human rights abuses is extremely uncomfortable and goes against the well-worn tradition of “non-interference.” Recently, we have started to see more willingness to publicly condemn and respond to the worst violations. The African Union in particular has rallied its membership in several instances – including most recently the Burundi crisis – to call for accountability and an end to politically orchestrated assassinations. This is a welcome start, but much more is needed. Public statements must be linked to concrete actions. And stronger political will is needed to get bad actors to the negotiating table – and ultimately out of power.

I have found that one of the biggest obstacles to advancing human rights in Africa is the underlying sentiment that human rights principles are western constructs that do not fully relate to the African experience. I have received significant pushback – from regular citizens as well as government officials - when I have called for the release of jailed dissidents or advocated for the fair treatment of minority groups. Sometimes they will argue that X country in Africa is not the United States, and that I have to appreciate their special circumstances. Other times, the message will be even blunter - that the U.S. is imposing unrealistic human rights standards, while tolerating significant abuse at home. The events of Ferguson and our sharp domestic debates about race and the police have not gone unnoticed. My answer is consistent from conversation to conversation: human rights principles are universal principles enshrined in the Universal Declaration of Human Rights and the International Covenant on Civil and Political Rights. As such, all countries have an obligation to uphold these principles. And this certainly includes the United States.

Increasingly, my human rights conversations include discussion of LGBTI issues. Even if I receive pushback when I raise concerns about torture or intolerable prison conditions, there usually is some shared understanding that these actions are not appropriate. But when I raise issues of equality and fairness for members of the LGBTI community, the response can be quite negative and extremely tense, with even stronger accusations that I lack an understanding of the particular values of that country. It is a conversation that harkens back several decades to our own polarizing arguments about sexual orientation – a long and agonizing process that only recently has led to more widespread tolerance.

A final issue I’d like to highlight is the complicated relationship between providing security and protecting human rights. Our policy on engaging with foreign militaries is guided by the Leahy Law, which stipulates that any military credibly found to have engaged in gross violations of human rights is ineligible for U.S. military assistance until the host government takes effective steps to bring those responsible to justice. My bureau – the Democracy, Human Rights and Labor Bureau – is directly responsible for implementing this law. It will come as no surprise to this audience that the history of military conduct in Africa is riddled with abuses and violations.

But an unexpected trend has started to take root – militaries are increasingly recognizing that committing gross human rights violations is not a smart way to win a war, and not a great way to build support among civilian populations and affected communities. If communities don’t trust the military, then they will refuse to cooperate. They won’t provide vital information about the enemy, and they may offer safe haven and resources to insurgents. This ultimately makes restoring peace and stability impossible.

The Boko Haram threat is a good example. Boko Haram started out as a small, localized outfit with a particular set of grievances. But the Nigerian security force’s heavy-handed tactics and abuses of civilians did little to bolster public support. As a result, government actions contributed to the mutation of Boko Haram into an insurgency that threatens peace and stability throughout northeastern Nigeria, as well as in Cameroon, Chad, and Niger. The Nigerian government now recognizes that it will not defeat Boko Haram as long as civilians feel threatened by security forces. It has started to institute real reforms to ensure the military adheres to international human right standards and builds trust with civilian populations. But this is a long process that will not bring results overnight.

Last year, I had an illuminating conversation with a high-ranking Kenyan police official on security sector reform. He pointed out that the Kenyan police were a British creation, created to help colonial administrators efficiently extract resources from the indigenous population, and to guard against local challenges to their rule. The police never had a mandate to protect civilians or local communities. Consequently, even after the British departed, the original idea that security forces should protect and serve whomever is in power – as opposed to safeguarding local communities – has not changed. It is not surprising that Kenyan police forces today, as in many other African countries, continue to grapple with rampant corruption, ineffectiveness in protecting communities from ordinary crime, and human rights violations. It will take dramatic shifts in philosophy, policy and tactics, and of course, better connections to the communities they serve, before real reform happens.

So much of the contemporary human rights struggle in Africa revolves around competition for power. As the strongman’s power begins to diffuse, the authority of the state is directly challenged and threatened. This is why dictators around the continent view civil society as such threats, and why these organizations are the first targets for repression in authoritarian states. It is precisely because they give voice to different ideas, different ways of doing things, and different methods of governing, that they are harassed, detained, intimidated and often killed. And this is precisely why it is so vital and critical for us to support their efforts. Civil society represents the frontlines of human rights and change, and the hopes of a new generation that seeks better, freer, more productive and more prosperous lives. These groups and their movements represent the future of Africa, and they must be supported with all the power, energy and resources we can muster.

Thank you and I would be happy to take your questions.

10 December 2015 – In August 2014, amid a rapidly growing outbreak of Ebola, Dr. David Nabarro was tasked with providing strategic guidance for an enhanced international response, and galvanizing essential support for affected communities and countries. As the Secretary-General’s Special Envoy on Ebola, Dr. Nabarro played a key role in responding to the outbreak, which mainly affected Guinea, Liberia and Sierra Leone, and claimed more than 11,300 lives to date.

While the Ebola outbreak in West Africa has declined significantly in recent months, it is not completely over, making it all the more vital for everyone involved in the response to remain vigilant and focused on stopping the outbreak, staying at zero cases and preventing re-emergence. The Office of the Special Envoy will end its mandate on 31 December 2015, but the UN system will continue to remain fully engaged with the affected countries.

Dr. Nabarro, a national of the United Kingdom with over three decades of experience in public health, nutrition and development work, spoke with the UN News Centre about the achievements of 2015, the priorities ahead for next year, as well as the lessons learned from the outbreak and the international response that followed. He also explains how the experience gave him an opportunity to see the human spirit at its best, such as he had never seen it before.

It’s really important that we continue to have a high degree of vigilance right through 2016 until we can be sure that transmission is completely ended

UN News Centre: Can you give us an overview of the current situation regarding the Ebola outbreak?

David Nabarro: The Ebola outbreak in West Africa, the largest that we’ve ever seen, was intense in September and October last year and then started to decline significantly in early 2015. Throughout this year, it has continued to decline with a slightly bumpy road at the end with occasional flare-ups. But in Sierra Leone, transmission of Ebola has finished and we’re in a period of enhanced surveillance. In Guinea, we expect transmission to finish before the end of this year. Liberia, which had reported an end to Ebola some months ago, had a flare-up recently in Monrovia and is dealing with that situation now, and we anticipate that in Liberia transmission will end early next year.

But I want to stress that this has proved to be a very difficult outbreak to end and therefore, it’s really important that we continue to have a high degree of vigilance right through 2016 until we can be sure that transmission is completely ended.

UN News Centre: What has been achieved in 2015? Are we past the worst of it, or is there concern that the infection could resurface?

David Nabarro: In 2015, we have seen a gradual decrease in the number of people with Ebola in West Africa. At the beginning of the year, the number of cases reported each week was of the order of 150. That’s 150 people infected, of whom a significant proportion will not survive. Throughout the year, the number has declined, bit by bit, and often we had periods when we wondered how we were going to see an end to the outbreak. But it has steadily declined with the number of cases reaching zero most quickly in Liberia, followed by Sierra Leone and then Guinea. But it’s not been easy. And that’s because the virus survives despite the fact that people are cured of the disease. And it stays in body fluids, particularly in semen but also in other parts of the body, including the eye of certain people. And that means that it is possible for people to continue to transmit the virus even when they have been cured and that leads to the possibility of flare-ups. That’s why the end of the outbreak has been so difficult but it’s proved possible to reach this point through the steady and continuous involvement of thousands of people involved in the response.

UN News Centre: What do you see as the main priorities for the Ebola response as we enter 2016

David Nabarro: As we enter 2016, we must be aware that the virus is still present in the bodies of many of those who have survived the disease. We reckon there are about 15,000 people who were sick and were cured. And of these, a proportion – we don’t know how many – are still carrying the virus in their bodies. And it’s particularly the case for men, who continue to have the virus in their seminal fluid, and that means that they may unwittingly pass the virus onto others. So our first priority is to help ensure that those who’ve survived the disease can access good quality care and support so that they themselves are kept healthy and also to reduce the risk that they’ll pass the virus to other people.

Our second priority is to be sure that if there is a small flare-up, the countries and indeed the rest of the world are ready. And we’ve already seen on a number of occasions during this year, 2015, that this rapid response capacity is there.

Our third priority, and perhaps I think we’d say the most important of all, is to make sure that services, particularly health care, for the millions of people in these countries return to normal, and are in fact made better, as quickly as possible. And that recovery and rebuilding is the primary focus for so many of us at this time.

UN News Centre: Given the closure of the Office of the Special Envoy at the end of 2015, will the UN system still be involved next year?

David Nabarro: The United Nations has had a very strong involvement in this Ebola outbreak, really since it started because we’ve had teams in the countries who have worked with the national offices in order to do their best to get on top of it. It has been difficult because the outbreak did catch us by surprise and was much more ferocious than anything we’ve ever seen before in terms of the number of people affected and the speed of spread. During August last year, the number of people with Ebola was doubling every three weeks. The United Nations, under the leadership of our Secretary-General and with the full involvement of the World Health Organization and all other entities in the UN system, came in with the strongest possible response that built up, so that by the end of 2014 we had of the order of 3,500 staff working in support of the countries. Gradually, our numbers of staff have reduced as the outbreak has subsided. But even now, there are several thousand UN staff in the countries and in the vicinity who are working in support of the response, and they’re going to stay there. We will continue to back the countries with personnel, both for responding to the outbreak and to the threats of recurrence and for the recovery.

My office, the Office of the Special Envoy, ends its time on December 31st 2015. But I will personally stay continuously engaged in the issue, working with the World Health Organization, working with governments, working with partners to try to keep a close eye on what is happening and to ensure that the whole UN system continues to fully engaged with the affected countries.

UN News Centre: You mentioned there are some 15,000 survivors. What is life like for them, their families and communities? And what kind of support do they need?

David Nabarro: The people who have experienced Ebola are really extraordinary. They’ve been close to death and they have come back. They’ve clung onto life and they have recovered. But it is a terrible disease. It makes people extremely ill when they get it because they lose fluid, they bleed, they have terrible fevers, awful headaches and their joints, in fact the whole of their bodies, ache. It hurts. But they, when they pull through, are truly the heroes.

First of all, they get continued headaches and sometimes also mental discomfort leading to severe depression. They get eye problems that can continue even after the Ebola has been treated and the patient is cured. The eyesight deterioration may even lead to blindness, certainly some visual impairment in at least 10 per cent of affected people. Then they get joint discomfort and they hurt even when sitting, but certainly when walking and they are unable to move around which means that if they’re working in fields, they can’t deliver the agricultural production that they would really like to. And perhaps most seriously, they experience terrible stigma from the rest of society, and it’s not helped by the fact that there’s an increasing recognition that some of them may still carrying the virus in their bodies. So these hero survivors are also people who suffer in health terms and in socio-economic terms. So they need help.

What we in the United Nations system is doing is trying to make sure that every person who survives Ebola has access to the care that they need from anybody who can provide that care, whether it’s from government or a non-governmental organization. And it’s trying to ensure this universal access to survivor care that is our priority right now and we’re working on it really very intensively, trying to identify resources so that the care can be available and then try to make sure that every survivor has a mentor who is with them to help them get the care that they need.

UN News Centre: Ebola wreaked havoc not only on the lives of people but on the hard-won development gains in these countries. What will it take to get these countries on a solid path to recovery and development?

David Nabarro: I worked in Liberia shortly after the end of the war in the early 2002-2003 period, trying to see what could be done to help the country recover and get back onto the path to development. And I saw just how terribly badly it had been affected by war and how its systems were really damaged and battered, and the people’s confidence in government and what government could offer was very much shaken. But during the period after the Liberian war, there has been an extraordinary recovery and that recovery was looking really good, and then along came Ebola, setting the government and people back almost worse than the point that they were at immediately after the war. The same is the case in Sierra Leone, another war-torn country that had been painfully recovering with people regaining confidence in what government had to offer, and then again badly knocked back by Ebola. Guinea is a different country – it hadn’t had these terrible wars but still it had been affected by many difficulties… it’s an extremely poor country. And Guinea too has been badly affected by Ebola.

And it’s not just the effect of the disease on health services, which are after all the worst affected by an outbreak like Ebola, it’s also the impact on other aspects of life in the country – on transportation, on trade, particularly business, on the agriculture sector, and on the industrial sector – all affected by the outbreak, leading to a cutback in economic growth that was quite significant. And that was coupled with the effect of commodity prices falling on the world markets, which also impacted on the economic opportunities for the countries. And then added to that was another injustice, which was the quite dramatic cutback in links between these countries and the rest of the world – maritime links because ships were not docking in the ports, and air links because for various reasons a number of airlines decided to stop flying to this region and many of them have still stopped flying and have not restarted their flights.

So taken together, the direct effects on services, health, education and social support, the effects on commerce, on agriculture, and on transport in country, which affected internal economies very badly, and then the effects on international links, on sea and on air in particular, have had an overall negative impact on the economies. And it will take years… I suspect five years… for recovery to take place and that’s why the recovery conference that took place in New York on July 10th was so important in setting the stage for long-term support by the international community for these countries and for the great people who’ve done all the work and for their leaders who have led them so strongly through the outbreak.

UN News Centre: What were the main lessons learned from this outbreak and the response that followed?

David Nabarro: We’ve learnt many lessons from this outbreak and from the response. First of all, we’ve learnt that, as with all diseases, it’s really important that communities are fully engaged in both the identification of the disease and the response right from the start. After all, you get the disease through contact with somebody else who’s got it. And it’s got to be close contact. And so, if it’s human behaviour patterns that lead to risk of disease, it’s communities themselves that are going to be the first to find ways to reduce physical contact and reduce the risk of spread. And so communities that got involved and that owned the disease were the first to be able to shift from being in a situation where the disease instance was high to being in a situation where it dropped and they were able to prevent themselves from being sick. Community engagement is the key and it’s the centre.

The second thing that I learnt and that many of us now feel is really important is that this kind of outbreak can’t be handled by outsiders just simply on their own. It’s got to start from within the countries. It’s national leadership, from presidents, from ministers and from leaders in government, in civil society, in faith communities, coming to the centre and showing the way. Often parliamentarians play a key role and certainly in each of the countries, it was the local representatives, the traditional chiefs and others who were at the centre. And so it’s the countries themselves that have played the leadership role. And I give particular credit to health workers from Liberia, Sierra Leone and Guinea who have borne the risk and have done the heart of the work.

Third lesson that I’ve learnt is that when the outside world gets involved, and it did get involved in an extraordinary way in this situation, we need early support, we need coordinated support and we need that support to be put at the disposal of the countries.

My fourth and last lesson that I’d like to share is that we’ve also learnt that when you’ve got multiple groups involved in a response, it is necessary for there to be one identified location from which the whole operation is directed – what we sometimes refer to as command and control. Because if you don’t have that central direction, a strong and unequivocal central direction, it’s very difficult to get everybody working together. And that command and control is necessary at the local level, at the community level I mean, as well as at the national level and regionally. So taken together, community engagement and ownership, countries being at the centre of the response operation, the importance of a coordinated international support, and then command and control are all things I see as important. And I would add, try always to make certain that this support is available early on. If you get in early and act early, you can prevent the situation from deteriorating and that’s what in future I hope we will be able to do much better.

UN News Centre: As a life-long public health and international development official, what has this experience as Special Envoy on Ebola been like for you on a personal level?

David Nabarro: When I look at the outbreak and my involvement in the outbreak since August last year, and I link that other work that I have done in public health over the last three decades, I am consistently humbled by the power of individuals, communities and coordinated groups of people to transform the lives of others. In this outbreak, we have seen numerous examples of individual and collective courage, bravery, commitment, compassion, and continuous selfless giving. It’s hard to explain it without perhaps sounding a little bit idealistic. But I want to share it with you because it’s so important to me.

I can identify hundreds of people who have worked tirelessly on this outbreak since the very beginning and who have just said ‘I’m not going to stop.’ They’ve been offered periods of vacation and rest and recuperation, but they’ve stayed on the job, working 24 hours a day, seven days a week. I’ve seen people who have gone way beyond what their normal responsibilities are to try to bring relief and help to people who’ve been suffering. And I have seen continuous efforts by everybody to just work together and to get on well. There have been remarkably few tussles between organizations about who’s in charge, remarkably few episodes of name-calling and anger. Instead, everybody’s just pulled together to try to transform the situation so that the suffering is reduced.

Of course outsiders have kind of assessed what we’ve been doing and have made properly critical judgments and the lesson-learning effort must go on. But all I can say is this has been the most remarkable opportunity to see human generosity, human commitment and the human spirit in its best force that I have ever seen in my life. And I hope that we can remember this forever because what it shows is that if we pull together to respond to a desperately difficult situation of suffering for thousands of people, we can be transformative and we can make life better for all. And we can do it without fussing about who we work for or what our motives are. We can do it because we believe in the good of humanity. That has been my real lesson and that’s one that I will never forget.

Vienna, Austria, December 11, 2015. Over 24 partner countries stand to benefit from the latest round of financing approved at the 153rd Session of the Governing Board of the OPEC Fund for International Development (OFID).

Public sector approvals amount to nearly US$154m and comprise the following: See complete table

Grant funding totaling US$3.36m was also approved for the following projects/programs:

• ECOWAS Regional Center for Renewable Energy and Energy Efficiency (ECREEE). US$860,000. To provide communities, businesses, small enterprises and public buildings with access to modern energy services through the implementation of mini-grid schemes in Benin, Cape Verde, Senegal and Sierra Leone. Over 4,200 people are expected to directly benefit from the project.

• Foundation for the Social Promotion of Culture (FPSC). US$400,000. To improve the socioeconomic prospects of disadvantaged women in the Gran Asunción metropolitan area in Paraguay and indigenous women from small rural communities in Guatemala. This will include providing vocational training courses and coaching, as well as building a vocational training center in Paraguay.

• United Nations Children’s Fund (UNICEF). US$500,000. To support a project that will improve water and sanitation infrastructure and services, and carry out hygiene promotion campaigns in Haiti to reduce the incidence of cholera in high-risk areas.

• United Nations Office on Drugs and Crime (UNODC). US$500,000. To support the second phase of an HIV/AIDS prevention, treatment, care and support program in Afghanistan, Nepal and Pakistan for women who use drugs, are in prison settings or have spouses who are drug users.

• International Union for Conservation of Nature and Natural Resources (IUCN). US$500,000. To provide safe, reliable alternative (solar, biogas) energy solutions to around 3,000 people in seven rural and marginalized areas in Palestine to improve livelihoods and living standards.

• United Nations Development Program/Program of Assistance to the Palestinian People (UNDP/PAPP). US$600,000. To expand and upgrade the chemotherapy department at the Augusta Victoria Hospital and provide equipment and furniture to boost access to cancer treatment services in the occupied Palestinian territories, including Jerusalem.

Five financing facilities totalling US$87m were also approved under OFID’s private sector business activities. Two will support financial institutions in expanding their lending activities to micro-, small- and medium-sized enterprises in Bangladesh and Sri Lanka. Another will support a lending institution that extends loans to small and medium-sized agribusinesses in Latin America and the Caribbean. Financing will also be provided in support of an agricultural production facility in Mozambique and to help improve the generation and transmission of electricity in Zambia.

Under OFID’s trade finance facility, US$10m was approved to a financing facility that supports import and export related financial transactions for corporates in Georgia.