by Dr. Fiona Shanahan and Reiseal Ni Cheilleachair

18 November 2015

Introduction

The Ebola crisis seriously impacted the psychosocial wellbeing of the population of Sierra Leone. Findings from participatory research + show that those directly affected experience multiple barriers to social integration, including relational difficulties, complex grief and stress. The research also documents how people affected by Ebola adapted in the face of adversity through a wide range of culturally embedded coping strategies. In order to effectively support people affected by Ebola in their recoveries, it is essential that we pay close attention to – and avoid undermining – existing patterns of resilience in communities.

Generally speaking, mental health and psychosocial support for those affected by humanitarian emergencies should focus on resources and strengths, build on local existing capacities and be delivered through existing structures and services. From the onset of an emergency, linked, multi-level supports should be made available, as illustrated in the intervention pyramid (see Figure 1). The first layer, basic security and services, represents the emergency response required to protect the psychosocial health of the entire population.

A smaller subset of the population affected by crises will be able to maintain their psychosocial wellbeing if they receive help in accessing community and family supports, the pyramid’s second layer, which are often disrupted by crises or emergencies. These supports might include family tracing and reunification, memorials, parenting groups and the activation of social networks, such as women’s groups and youth clubs.

Focused, non-specialized supports, such as Psychosocial First Aid (PFA) and basic mental health care by primary health workers, comprise the pyramid’s third layer and are necessary for the still smaller number of people who require additional and more focused individual, family or group interventions by trained and supervised workers. For example, survivors of gender-based violence might need a mixture of emotional and livelihood support from community workers.

Global expert guidance indicates that 10% – 15% of affected people will require specialized services, the pyramid’s final layer, such as professional psychological or psychiatric support.

Recent analysis + found that although the vast majority of mental health and psychosocial support programming in humanitarian settings focuses on strengthening family and community based supports (the lower levels of the pyramid+ ), existing research focuses almost exclusively on the top layer of specialized clinical mental health services. The risk of causing harm by continuing to implement untested interventions is significant. The lack of a solid evidence base is one factor in the continued implementation of ineffective programming, for example psychological debriefing, which has been found to exacerbate symptoms of distress.+

Why is psychosocial support needed in a post-Ebola context?

As of November 7, 2015, there are a total of 4,051 Ebola survivors in Sierra Leone + . 3,589 people have died leaving bereaved families, many of whom experienced multiple bereavements. Epidemiological calculations estimate that in Sierra Leone there are 3,300 orphans as a result of Ebola, with over 100 orphans having lost both parents+ .

Significant efforts have led to the eradication of the disease in Sierra Leone. However, the impacts of Ebola will continue to be felt and psychosocial support has a crucial role to play mitigating them, as we move past the end of the outbreak. The long-term health needs of those who have been impacted by Ebola, including distress, anxiety, loss, grief, shame and suffering, must be addressed.

The Ebola outbreak has resulted in a wide range of psychosocial protection concerns experienced at the individual, family, community and societal levels. Over the course of the outbreak, normally protective supports such as school, work, basic preventative health, community groups and daily routines were disrupted while pre-existing problems of social injustice and inequality were amplified.

The research was conducted from March to June 2015 in Kambia, Port Loko, Bombali and Western Area Rural District. In each district, two-person teams made up of staff trained in psychosocial first aid (who acted as a facilitator) and a local researcher (who recorded, translated and transcribed the material) engaged in participatory research with women, men, girls and boys directly affected by Ebola.

Interviews and group sessions were conducted in Temne, Limba or Krio and later transcribed into English. Children participated in at least three small group sessions over a period of six weeks and these groups were composed of similarly aged children of the same sex. Three participatory methods – storytelling, timelines and social mapping – were used to help participants discuss their experience of social integration and how they coped with difficulties after their bereavement or returning to the community from the treatment centre. Grounded Theory Analysis was the analytic method used, this method involves line-by-line coding of data to generate a category system to account for the data+ .

There were 42 adult participants:

• 60% women, 40% men

• 88% bereaved (51% women, 49% men)

• 40% survivors (53% women, 47% men)

• 33% guardians for children orphaned by Ebola (79 % women, 21% men )

There were an additional 12 key informants: 50% women, 50% men.

There were 69 child participants (under 18)

• Average age: 11 years, 7 months

• 52% girls (average age: 10 years, 11 months), 48% boys (10 years, 9 months).

Child participants were affected by Ebola in the following ways:

• 60% orphaned (17% of the total lost one parent, 43% lost two parents)
  
• 20% survivors
  
• 30% quarantined

Facilitators invited participants from their psychosocial support case load in affected communities and so had existing relationships with participants and were in a position to provide ongoing support and referral where necessary. Written informed consent was obtained from all participants and in addition parents or guardians of child participants also gave their consent. Voluntariness, the right to withdraw at any time, data protection, risks of participation, confidentiality and the limits of confidentiality were discussed with participants and any questions or concerns were addressed. Psychosocial referral pathways were in place and used.

As would be expected in any emergency, participants and key informants reported a range of psychosocial difficulties associated with, or amplified by, the emergency and the response.

Many of the people interviewed reported experiences of complex grief associated with multiple losses. The specific context of Ebola and the problems that come with it (such as the fear of infection, being unable to care for loved ones, the shock caused by transportation to treatment centres and witnessing deaths and culturally inappropriate burial practices) complicated and, in some cases, heightened people’s experiences of bereavement and loss.

Stigma and discrimination affecting adult survivors and bereaved family members are both complex phenomena. Interpersonal conflicts tended to be rooted in distrust and blame associated with specific events during the emergency rather than a person’s general status as a ‘survivor.’ In a number of cases, a person or family may blame a friend or neighbour for bringing Ebola to the community, infecting a loved one or calling 117 to report a suspected Ebola case. This breakdown in relationships is more complex than the concept of ‘stigma’ would suggest and requires a different kind of response. Rather than community-level sensitization on Ebola, more focused approaches are needed based on conflict resolution and mediation methods so that trust and relationships can be rebuilt.

While adults tended to report that children did not experience discrimination, children confirmed that they did. A considerable proportion of children who survived Ebola or lost parents reported that they felt isolated in their peer groups and tended to socialize with other children who had been affected by Ebola. In a number of communities, children reported deterioration in their relationships once school started, which highlights the need for continued interventions in schools and peer group settings.

Orphaned children and their guardians also reported challenges in adapting to new family structures. As many of the interviewed people came from Ebola hotspot communities, many had faced multiple bereavements. Guardians, 79% of whom were women, had often lost a number of family members to Ebola and were caring for between one and ten additional children. Some children and their guardians reported shortages of food, bedding and funds for school fees. Some orphaned children felt they were treated differently compared to biological children (for example, by receiving excessive house and farm work or not being allowed to return to school). Guardians expressed difficulties in providing for children economically and emotionally, particularly as children were grieving and in some cases were distressed, withdrawn or exhibiting mood or emotional difficulties. Ongoing family-focused support, with special focus on guardians and orphans, is required to support the development of health-sustaining relationships and improved psychosocial wellbeing.

Psychosocial difficulties associated with humanitarian aid and the Ebola response:

Health and social workers noted that explicitly targeting survivors for support causes resentment and can hinder reintegration. Global evidence (see for example, IASC, 2007) supports service provision on the basis of identified needs rather than crude categories such as “Ebola survivors” or “Ebola orphans”. Specialized support should also be provided for workers, who can experience distress as a result of aiding people affected by Ebola.

Severe distress has been experienced by families who remain unaware of the status or whereabouts of their loved ones. In a number of cases (over twenty in the Northern Region alone) parents have not received information regarding the whereabouts of their children who were taken by ambulance for treatment. Many of these cases originate in October, November and December 2014. Parents have in some cases received conflicting information from different service providers and do not know whether their children are still alive or have died.

Spiritual distress and harm was caused by burial practices, particularly during the first six months of the outbreak. Children reported witnessing disrespectful or innapprpriate burial practices and in some cases these experiences continued to cause them severe distress.

The participatory research sessions focused primarily on documenting the practical ways that girls, boys, women and men responded to these difficulties and brought about processes of resilience.

Resources and strategies people use to build resilience

The project documents how people attempt to respond to adversity in a very practical sense, examining daily activity at family and community level. Girls, boys, women and men reported using resources to bring about a sense of safety, calming, self-efficacy, community efficacy, connectedness and hope (Hobfoll et al., 2007) in response to these difficulties.

Child and adult participants attempted to bring about a sense of safety during the outbreak by taking control of infection control, by practising recommended infection control measures (hand-washing, avoiding body contact etc.) and also by engaging in religious, spiritual or cultural activities that they believed reduced the risk of infection. Cultural narratives of risk are central to health and it is vitally important that they be taken seriously by those attempting to control the spread of communicable diseases.

Several children and their guardians reported using medications (sleeping tablets, Paracetamol or benzodiazepines) to calm themselves when they became overwhelmed due to their loss. Although medication use to respond to shocks is not unusual in Sierra Leone, both children and adults reported unprescribed medication use several months after their bereavement which would be unusual in this context. This indicates an unmet need for support with calming, relaxation and sleep. Future programming may need to incorporate relaxation techniques (breathing exercises, traditional dance, music), sleep hygiene, practical skills and stress management for dealing with acute anxiety and stress. More targeted approaches such as grief and bereavement counselling or economic support will also be necessary in some cases.

When asked what they did to feel better when things were difficult, many participants reported activities that involved supporting others, for example one boy who had survived Ebola and lost his parents to the disease talked about the sense of wellbeing and purpose he derived from volunteering to assist elders in his community. It is essential that future programming is developed in a highly participatory way to avoid undermining these important processes of self-efficacy and community efficacy.

Using social mapping, children and adults mapped their relationships and how they had changed during the outbreak. Those boys and girls who were isolated by their peers reported their attempts to repair and restore their friendships, though these efforts were not always successful. Women and men who had guardians of children reported their attempts to create a safe, secure family context, in the context of real difficulty in providing emotional support when their own resources were depleted by multiple losses.

Survivors and bereaved people reported turning to their close family members and neighbours to give them a sense of hope in the context of great difficulty. Teenage boys in one research group that met over a number of months began to sing traditional songs and pray together in their sessions, bringing about a sense of coherence and optimism.

What is needed for the development of successful psychosocial interventions?

Long-term and appropriately resourced psychosocial service provision is required to respond to locally identified needs. Training, supervision and resourcing of national community-based staff is needed. Short-term project-based funding is not sufficient to meet the psychosocial needs identified. Without adequate support, actions to lessen the impact of the crisis on people’s lives, livelihoods and long-term wellbeing will be compromised. Appropriate, community-based programming will prevent problems escalating and straining clinical settings.

Psychosocial interventions should draw on existing familial, social and cultural systems in facilitating psychosocial recovery. Effective interventions will mimic naturally occurring supports and utilize local resources and strategies that foster wellbeing and bring about resilience at family and community levels. This can involve linking to existing family and community support, focused, non-specialized supports and specialized services. Strong referral mechanisms within and between intervention layers are essential. Furthermore, this approach should be intersectoral, making sure healthcare workers, teachers and child protection workers are trained in psychosocial practices.

Following the research, an inter-agency working group was established to implement the recommendations. The working group is currently engaged in a process of developing socio-culturally adapted, gender sensitive, participatory community based programs which can be integrated into existing structures and services in Sierra Leone. This working group is comprised of Trócaire, International Medical Corps, Plan International, Save the Children, Medicos del Mundo, CAPS Sierra Leone, International Organization for Migration, Mental Health Coalition, Enabling Access and UNICEF. It was established in June 2015 under the Child Protection and Psychosocial Support Pillar of the National Ebola Response Centre. The aim of this long-term project is to more effectively support families and communities in Sierra Leone to mobilize processes of resilience in order to respond adaptively to future crises and shocks.

Dr. Fiona Shanahan is a psychologist who specialises in psychosocial interventions and transitional justice processes in post conflict and humanitarian settings. Réiseal Ni Chéilleachair is Trócaire’s Humanitarian Policy Adviser, based in Ireland.

This article was written in collaboration with:

Florie de Jager Meezenbroek, Country Director of Trócaire Sierra Leone.

Sabrina Brett, an independent consultant based in Ireland and was Programme Manager with Trócaire Sierra Leone at the time of the research.

Ella MacFoy, Gender Equality Officer with Trócaire Sierra Leone.

Rebecca Grogan, Humanitarian Response Officer with Trócaire Sierra Leone.

Michael Solis, Programme Manager with Trócaire Sierra Leone.

SUMMARY

• No confirmed cases of Ebola virus disease (EVD) were reported in the week to 3 January. On 29 December, WHO declared that human-to-human transmission of Ebola virus has ended in Guinea, after the completion of 42 days with zero cases since the last person confirmed to have EVD received a second consecutive negative blood test for Ebola virus RNA. Guinea has now entered a 90-day period of heightened surveillance. Guinea, Liberia, and Sierra Leone have all now succeeded in interrupting human-to-human transmission linked to the original outbreak in West Africa.

• Human-to-human transmission linked to the most recent cluster of cases in Liberia will be declared to have ended on 14 January 2016, 42 days after the 2 most-recent cases received a second consecutive negative test for Ebola virus, if no further cases are reported. In Sierra Leone, human-to-human transmission linked to the primary outbreak was declared to have ended on 7 November 2015. The country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016.

• The most recent cluster of cases in Liberia was the result of the re-emergence of Ebola virus that had persisted in a previously infected individual. Although the probability of such re-emergence events is low, the risk of further transmission following a re-emergence underscores the importance of implementing a comprehensive package of services for survivors that includes the testing of appropriate bodily fluids for the presence of Ebola virus RNA. The governments of Liberia and Sierra Leone, with support from partners including WHO and the US Centres for Disease Control and Prevention, have implemented voluntary semen screening and counselling programmes for male survivors in order to help affected individuals understand their risk and take necessary precautions to protect close contacts. 405 male survivors had accessed semen screening services up to 3 January 2016 in Liberia and Sierra Leone. A network of clinical services for survivors is also being expanded in Liberia and Sierra Leone, with plans for comprehensive national policies for the care of EVD survivors due to be completed in January 2016. To date approximately 3000 survivors have accessed basic care services.

• In order to effectively 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 3 January, 645 alerts were reported in Guinea from 33 of the country’s 34 prefectures, with the vast majority of alerts (639) being reports of community deaths. Over the same period 9 operational laboratories in Guinea tested a total of 282 new and repeat samples (18 samples from live patients and 264 from community deaths) from only 16 of the country’s 34 prefectures. In Liberia, 633 alerts were received from all of the country’s 15 counties, the vast majority of which (529) were for live patients. The country’s 5 operational laboratories tested 588 new and repeat samples (420 from live patients and 168 from community deaths) for Ebola virus over the same period. In Sierra Leone 952 alerts were reported in the week to 3 January from all of the country’s 14 districts. The vast majority of alerts (878) were for community deaths. 976 new and repeat samples (8 from live patients and 968 from community deaths) were tested for Ebola virus by the country’s 8 operational laboratories over the same period.

• The deployment of rapid-response teams following the detection of a new confirmed case continues to be a cornerstone of the national response strategy in Guinea, Liberia, and Sierra Leone. Each country has at least 1 national rapid-response team, with strengthening of national and subnational rapid-response capacity and validation of incident-response plans continuing throughout January.

FAITS SAILLANTS

• Les partenaires humanitaires cherchent deux milliards de dollars US pour financer l’aide au Sahel en 2016.

• 4,5 millions de personnes déplacées au Sahel, un nombre qui a triplé en deux ans.

• Environ 4,4 millions de personnes vivant dans le bassin du lac Tchad ont besoin d’une aide alimentaire d’urgence.

• Près de 50 000 personnes ont été déplacées à la suite des violences survenues en RCA où les violations des droits de l’homme persistent.

• Le virus Ebola réapparaît au Libéria. Un mort et deux personnes guéries

CHIFFRES CLÉS

Personnes vivant en situation d’insécurité alimentaire au Sahel en 2016 : 23,5 millions

Nombre de cas d’Ebola en Guinée, au Libéria et en Sierra Leone depuis le 20 novembre : 0

Personnes à risque épidémique au Sahel, ciblées pour une assistance : 6,8 millions

Enfants courant un risque de malnutrition en 2016 : 5,9 millions

FINANCEMENT DE LA STRATÉGIE AU SAHEL

1,976 milliard de dollars US requis en 2015

820 millions de dollars américains reçus (pour le SRP)

Les partenaires humanitaires cherchent deux milliards de dollars US pour financer l’aide au Sahel

Le 9 décembre à Dakar, les agences des Nations Unies et les autres partenaires humanitaires ont lancé un appel humanitaire en faveur du Sahel représentant 1,98 milliard de dollars US destinés à apporter une aide critique à des millions de personnes frappées par les crises dans neuf pays de la région du Sahel. Ce chiffre représente un dixième de la réponse humanitaire mondiale pour 2016.

« Au Sahel, les effets combinés des changements climatiques, de la pauvreté extrême, de l’accroissement rapide de la population et de l’augmentation très inquiétante de la violence et de l’insécurité, menacent dangereusement les vies, les possessions et les perspectives d’avenir de certaines des communautés les plus vulnérables au monde », a déploré lors du lancement Toby Lanzer, Sous-secrétaire général des Nations Unies et Coordonnateur humanitaire régional pour le Sahel.

L’année 2015 a brillamment illustré la force de la nature humaine. Nos activités de développement regorgent d’exemples de personnes qui relèvent les défis liés aux changements climatiques, aux conflits, aux catastrophes et aux inégalités.

LUTTE CONTRE L’ÉPIDÉMIE D’EBOLA

En 2015, les pays touchés sont parvenus à éradiquer la transmission du virus Ebola à l’homme. Avec l’aide du PNUD, les gouvernements concernés ont pu rémunérer en temps et en heure près de 20 000 agents chargés de la riposte face à l’Ebola, contribuant ainsi à l’efficacité de la lutte contre l’épidémie en Guinée, au Libéria et en Sierra Leone. Le PNUD poursuit ses activités de relèvement dans ces trois pays ainsi que leurs voisins.

ADOPTION D’UN ACCORD HISTORIQUE À PARIS

En décembre, les dirigeants du monde ont entériné un accord historique lors du Sommet des Nations Unies sur le climat à Paris. Si chaque pays a la responsabilité de traduire ses engagements en actes concrets à partir de 2016, le PNUD a collaboré avec différents gouvernements sur l’identification de leurs objectifs et des moyens les plus efficaces pour y parvenir. Le PNUD dispose d’un portefeuille de projets de lutte contre les changements climatiques dans plus de 140 pays.

PRÉVENIR DES CRISES ET RECONSTRUIRE DES VIES

Selon le HCR, le nombre de réfugiés, de demandeurs d’asile et de personnes déplacées à l’intérieur de leur propre pays dépasse 60 millions de personnes à travers le monde. Impliqué depuis longtemps dans les questions liées aux migrations et aux déplacements de populations, le PNUD œuvre à trouver des solutions de long terme aux niveaux local et national, conformément aux nouveaux objectifs de développement.

CRÉATION D’EMPLOIS EN SYRIE

Le conflit prolongé a contraint plus de 4,3 millions de Syriens à l’exil. Fin 2015, tandis que les négociations internationales de paix se poursuivaient, des réfugiés continuaient d’entreprendre un voyage périlleux vers les pays voisins et l’Europe.

Depuis le début des hostilités, le PNUD intervient sur place ainsi qu’en Iraq, au Liban, en Jordanie et en Turquie pour venir en aide aux réfugiés et aux déplacés ainsi qu’aux communautés d’accueil. Dans le pays, on recense 7,6 millions de déplacés en proie à des conditions de vie extrêmement difficiles. Le PNUD a créé des emplois d’urgence pour fournir des sources de revenus aux déplacés et aux communautés d’accueil, leur permettant de subvenir aux besoins de leurs familles et de se procurer des produits ou des services de première nécessité.

FAIRE RENAÎTRE L’ESPOIR AU YÉMEN

Selon l’UNOCHA, plus de 84 % de la population du pays (soit 21,1 millions de personnes sur un total de 25 millions) nécessite une aide humanitaire et peine à faire respecter ses droits fondamentaux ainsi qu’à accéder à des produits et des services de première nécessité tels que la nourriture, l’eau, les soins médicaux et des abris. Les services publics du pays se sont effondrés, tandis que le prix des denrées alimentaires, des carburants et du gaz de cuisine a explosé.

Dans le cadre de son Programme de résilience pour le Yémen, le PNUD intervient pour rétablir les moyens de subsistance, la cohésion sociale et la sécurité tout en ouvrant la voie à la stabilisation et au relèvement dans une perspective de développement humain. À l’heure actuelle, ses programmes « Argent contre travail » sont axés sur la sécurité alimentaire, l’accès à l’eau potable, la reconstruction des logements et des infrastructures et le rétablissement des capacités des services publics essentiels. Le programme de soins obstétricaux du PNUD, qui forme et déploie des sages-femmes dans le pays, a ainsi contribué à garantir le bon déroulement des grossesses et des accouchements, et à protéger la santé des mères pendant les conflits.

RÊVE DE PAIX AU SUD-SOUDAN

« La guerre a de graves conséquences : la maladie, la mort et la pauvreté sont partout. Les combats doivent cesser » - Mary, a fui son domicile, accompagnés de son mari et de leurs huit enfants, avec pour tout bagage les vêtements qu’ils portaient. Elle et sa famille ont trouvé refuge pendant plusieurs jours dans la brousse avant de prendre la direction du camp de Magateen, à Djouba, au Sud-Soudan.

Depuis que la guerre civile a éclaté en décembre 2013, le PNUD a fait de la consolidation de la paix et de la cohésion sociale ses priorités, en rétablissant l’état de droit, la sécurité ainsi que les moyens de subsistance, et en renforçant les capacités des services publics.

DÉMOCRATIE À L’ŒUVRE EN RÉPUBLIQUE CENTRAFRICAINE

En trois ans, l’explosion de la violence sectaire en République centrafricaine a entraîné le déplacement de près d’un million de personnes. Plus de la moitié de la population du pays, soit l’équivalent de près de 2,5 millions de personnes, a cruellement besoin d’une aide humanitaire, tandis que près de 60 % des Centrafricains vivent toujours dans l’extrême pauvreté.

Le 30 décembre, 1,8 million d’électeurs inscrits se sont rendus aux urnes pour les élections présidentielle et législative, organisées après l’adoption par référendum d’une nouvelle Constitution les 13 et 14 décembre derniers, un événement qui a fait naître l’espoir d’une paix durable.

RECONSTRUIRE APRÈS LE CYCLONE PAM

Le 13 mars 2015, le cyclone Pam, de catégorie 5, a balayé le Vanuatu ainsi que l’archipel des Tuvalu. Plus de 95 % du secteur agricole du Vanuatu ont été détruits, paralysant les moyens de subsistance et la sécurité alimentaire dans le pays.

Moins d’une semaine après le passage du cyclone, une équipe d’intervention d’urgence composée d’experts du PNUD a été dépêchée pour participer aux opérations de relèvement. En collaboration avec les autorités locales, le PNUD a lancé son programme « Argent contre travail » à Port Vila, la capitale du Vanuatu. Les populations touchées ont été rémunérées pour le déblaiement des décombres laissés par le cyclone ainsi que la récupération et le recyclage des déchets.

NÉPAL : L’ESPOIR SOUS LES DÉCOMBRES

Le 25 avril 2015, un séisme de magnitude 7,9 a frappé le Népal et le nord de l’Inde, suivi en l’espace de 24 heures d’une quinzaine de violentes répliques. C’est la pire catastrophe qu’ait connue le Népal depuis le tremblement de terre de 1934.

Grâce à ses équipes déjà présentes sur place au moment du séisme, le PNUD a pu lancer un programme de relèvement rapide. En août, les habitants ont pu commencer à reprendre une vie normale.

LUTTE CONTRE LES CHANGEMENTS CLIMATIQUES

Outre ces catastrophes, l’année 2015 a été marquée par la lutte contre les changements climatiques au niveau local.

En Ouganda, Catherine, institutrice et présidente du collectif des femmes de Sangaasana, dirige une initiative communautaire visant à combattre la déforestation. Avec l’appui du PNUD, le collectif a développé une méthode écologique de production de briques reposant sur la compression plutôt que sur la chaleur, supprimant ainsi le recours au bois de chauffage.

Au Turkménistan, pays qui ne compte que 20 % de terres arables, les communautés agricoles luttent contre l’ensablement pour survivre.

Les îles du Pacifique sont en première ligne dans le combat contre les changements climatiques, car elles sont les premières à en subir les conséquences dévastatrices. Aux Maldives, où le point le plus bas ne se situe qu’à un mètre au-dessus du niveau de la mer, agir est une question de survie.

Dans le district de Miraflores, niché dans les montagnes péruviennes, les communautés agricoles s’adaptent aux changements climatiques afin de préserver des traditions telles que l’élevage en troupeaux.

Nichée au cœur de l’Himalaya, la population du Bhoutan voit sa santé menacée par la fonte des glaciers, la multiplication des crues soudaines et des étendues d’eau stagnante qui créent des conditions propices à la propagation de maladies jamais auparavant détectées au Bhoutan telle que la dengue.

ÉGALITÉ ET PROTECTION POUR TOUS

Une femme sur 3 dans le monde subira des violences domestiques au cours de sa vie. Avec la multiplication des violences armées et des conflits, et la montée de l’extrémisme, le viol est de plus en plus utilisé comme une arme de guerre. Le PNUD collabore avec les communautés pour permettre aux femmes de mieux exercer leurs droits et lutter contre la violence sexiste.

En Inde, Basi behen, 65 ans, a saisi un tribunal et récupéré ses terres. Lorsque son époux est décédé, son beau-frère l’a accusée d’être une sorcière et a confisqué les terres dont elle aurait dû hériter. Avec l’aide du PNUD, elle s’est familiarisée avec le système juridique et a pu faire valoir ses droits.

En Afghanistan, seulement 16 % des femmes ont une activité professionnelle. Pour la première fois dans le pays, des femmes ont été recrutées en tant que guides-rangers à Band-e-Amir, premier parc national afghan, situé à Bamiyan.

Monica, militante pour les droits des personnes lesbiennes, homosexuelles, bisexuelles, transgenres et intersexuées (LGBTI), est devenue la première femme transgenre népalaise titulaire d’un passeport reconnaissant un troisième sexe.

Pour la première fois dans l’histoire, 2 000 athlètes issus de 40 peuples autochtones à travers le monde ont participé au Brésil aux premiers Jeux mondiaux des peuples autochtones, une reconnaissance de leur patrimoine et de leurs traditions.

NOUVEAU PROGRAMME DE DÉVELOPPEMENT DURABLE

L’année 2015 marque la fin des objectifs du Millénaire pour le développement (OMD), huit objectifs de lutte contre la pauvreté que les pays du monde entier s’étaient engagés à atteindre d’ici 2015.

Les nouveaux objectifs de développement durable (ODD) s’attaquent aux causes profondes de la pauvreté ainsi qu’à l’impératif universel d’un développement au service de tous. La survie des humains dépend de leur capacité à changer leur rapport aux autres et à la planète. L’année 2016 sera celle des initiatives entreprises au niveau local en vue d’atteindre les nouveaux objectifs de développement durable.

Summary

As recent media reports have highlighted, all three of the seriously affected countries – Guinea Conakry, Sierra Leone and Liberia – have all now been declared free of Ebola. The IFRC is therefore now revising its Regional Emergency Appeal for Ebola Global Coordination and Preparedness.

This revised Emergency Appeal i s seeking CHF14,058,887 (revised down from CHF 15.8m) to enable the IFRC to continue its support to the Guinea Red Cross, Liberia Red Cross and the Sierra Leone Red Cross Societies to assist them in their w o r k delivering assistance and support to over 34 million people at risk in West Africa. In extending and re-targeting this regional appeal, it will also enable the IFRC to continue providing regional coordination and cross-country support to other countries in the region and beyond, to provide opportunities for the development of those National Societies in their role as auxiliary to their governments in the area of health emergencies and epidemic response and preparedness. In addition, the revised appeal will seek to broaden communication and lesson learning and to enhance such preparedness in the broader African and global contexts.

The current West Africa Ebola Virus Disease (EVD) outbreak was declared in Guinea in March 2014, with the index case dating back to December 2014. The outbreak quickly spread to neighbouring Sierra Leone and Liberia. As of December 2015, there have been approximately more than 28,600 cumulative (suspected, probable, and confirmed Ebola) cases. This outbreak has recorded more cases than all past Ebola epidemics combined, with more than 11,300 deaths reported. The most recent cases were from Guinea on 29 October and in Liberia in the week of 22 November (WHO, 20/11/2015).

Liberia’s last two Ebola patients recovered and left hospital on 3 December. Sierra Leone was declared Ebola-free on 7 November 2015 and on 29 December, Guinea was declared Ebola-free, marking the first time all three countries have stopped the original chain of transmission.

This achievement owes much to Red Cross National Society staff and volunteers who worked tirelessly towards halting the spread of the disease. The National Societies in Guinea, Liberia and Sierra Leone have played a critical role in community engagement, without which the Ebola response and prevention would have been impossible. As a result of National Society activities aimed at reducing the spread of the disease, case prevalence began to decline. However, the introduction of an EVD case remains a risk as long as cases exist in any country. Good preparedness and timely and effective response, can, however, still enable the National Societies in the three most affected countries, and in other countries, to halt the spread of the disease.

Working in partnership with the National Societies in Guinea, Liberia and Sierra Leone, this revised Appeal elaborates on the Red Cross Red Crescent’s vital role and responsibilities in efforts to keep Ebola at zero cases in the respective countries. The appeal reflects the evolving epidemiological situation in West Africa, where EVD operations in Guinea, Liberia and Sierra Leone are scaling down their response activities and transitioning to early recovery programming. The EVD operation will continue to integrate progressively into the existing IFRC Africa Region programmes and structure, while maintaining coordination and preparedness functions for future outbreaks and enhancing the documentation, evaluation and research of the Red Cross Red Crescent Movement into EVD response. This will be done in collaboration with external partners (Centre for Disease Control (CDC), the World Health Organisation (WHO), Medecins Sans Frontieres (MSF), etc).

This revision updates the multi-country Ebola Coordination and Preparedness Appeal and seeks to:

• Enhance Community Event Based Surveillance (CEBS) in order to detect early EVD potential re- emergence and keep appropriate operational response capacity for early response.

• Facilitate the smooth transition and management of the EVD operation management following the closure of the Ebola Management Unit (EMU) in Accra.

• Ensure that the revised Ebola Strategic Framework and ongoing operation recovery plans in Guinea, Liberia and Sierra Leone align with regional institutional policies and frameworks, including but not limited to t h o s e of ECOWAS, the Manu River Union, and Comité Inter-Etat pour la Lutte contre la Sécheresse au Sahel (CILLS).

• Contribute to EVD-specific regional coordination mechanisms, advocating for harmonised efforts to address immediate and longer-term community needs in the response and recovery phases.

• Conduct in-depth research and evaluative activities to build the EVD evidence-base, and facilitate institutional learning from successes and failures in the West Africa EVD preparedness and response operations, including lessons learned and recommended actions for the future.

• Utilise knowledge generated through research and evaluative activities to develop and revise tools and training, Standard Operating Procedures (SOPs) and other guidelines and to enable National Societies to provide greater support to volunteers working in health emergencies.

• Contribute to a review of IFRC/Movement emergency health programming, tools and mechanisms, in collaboration with partners and other stakeholders.

• Strengthen epidemic preparedness and response capacities in West Africa through a preparedness project that enhances community engagement and social mobilization, using a beneficiary communications approach and drawing from findings and recommendations of the lesson learned workshop on strengthening community engagement.

This revised plan has re-targeted the budget to provide ongoing support to an increased number of beneficiaries, through an extended timeframe and the engagement of more volunteers to deliver a greater number of activities related to recovery from the effects of the Ebola outbreak in the three most affected countries and an increased number of volunteers.

PROJECTED FOOD ASSISTANCE NEEDS FOR JUNE 2016

This brief summarizes FEWS NET’s most forward-looking analysis of projected emergency food assistance needs in FEWS NET coverage countries. The projected size of each country’s acutely food insecure population (IPC Phase 3 and higher) is compared to last year and the recent five-year average and categorized as Higher , Similar , or Lower. Countries where external emergency food assistance needs are anticipated are identified. Projected lean season months highlighted in red indicate either an early start or an extension to the typical lean season. Additional information is provided for countries with large food insecure populations, an expectation of high severity, or where other key issues warrant additional discussion. Analytical confidence is lower in remote monitoring countries, denoted by “RM”. Visit www.fews.net for detailed country reports.

FREETOWN, SIERRA LEONE— Sierra Leone has been Ebola-free for two months. While the situation has improved in some ways, many Ebola survivors say they are not getting enough help to rebuild their lives.

Ebola survivors discussed their frustrations recently at a meeting of the Sierra Leone Association of Ebola Survivors in Freetown, the country’s capital.

Each survivor was entitled to a discharge package after recovery. This was to include a bag of rice, a foam mattress and some cash, equal to about $70.

However, some said they were still waiting for that package. Others said it came very late.

Massah Stevens, a nurse who caught Ebola from a patient while working in a treatment center, said she did not get her discharge package until 10 months after her release. She said she managed because her husband could help out, but not all survivors have that luxury.

“They have lost their parents. They have lost their mother, father,” she said.

The Ministry of Social Welfare and Gender and Children Affairs is responsible for the packages. Tina Davies, who directs Ebola survivor activities within the ministry, admitted that some discharge packages had been delayed. This was because Ebola treatment units did not inform the ministry fast enough that survivors had been discharged, she said.

Davies said most survivors had received their packages by now.

Too little, some say

Still, survivors like Yusif Koroma said the supplies weren't nearly enough compensation for what he had gone through.

“The family is vulnerable. I won’t eat that bag of rice alone; I have to share,” Koroma said.

More help is needed, survivors said — and fast.

Davies said more help would be coming through a specific program for Ebola survivors. Now that the country is Ebola-free, she said, the ministry can focus more on issues of survivors.

The government is looking at a long-term program for survivors that gives them scholarships, skills training and startup kits for businesses.

Davies added that survivors can go to health clinics for continued treatment of medical issues.

Survivors have received psychological counseling as well as their discharge packages, so "it’s not like nothing is happening," she said. "I think it’s that cultural aspect, that people want cash in their hands, but we’re trying to provide services that are sustainable for survivors. You get livelihood skills [and] support them through education, to empower them.”

Davies said she could understand the frustration that arises when things are not moving as quickly as survivors would like, but she insisted that Ebola survivors were a priority for Sierra Leone and that they would not be forgotten.

1. Background

The Ebola outbreak in 2014 and 2015 in West Africa and the repercussions it had at international level have substantially changed our perception and understanding of global health security. In this context, DG SANTE, together with the Luxembourg Presidency, organised a conference on "lessons learned for public health from the Ebola outbreak in West Africa – how to improve preparedness and response in the EU for future outbreaks”.

The event took place in Mondorf-les-Bains (Luxembourg) from Monday 12 October to Wednesday 14 October 2015.

The aim of this conference was to identify learning points arising from the Ebola epidemic which will be crucial to strengthen health security in the European Union, better prepare us for similar crises and put us in the position to respond rapidly, flexibly and effectively to emergencies and disease outbreaks in the future.

The outcomes of the conference will inform Council conclusions to be adopted by the Health Ministers in December 2015. The results will also be incorporated in the report on the lessons learned from Ebola that EU Ebola coordinator and Commissioner, Mr Christos Stylianides, will present to the European Council.

An award ceremony of the 2015 European Health Prize for NGOs followed the opening session. Subsequently four workshops - run in parallel sessions – analysed:

1. the Ebola outbreak as a complex crisis: the EU response and inter-sectorial cooperation,

2. best practices for treatment and prevention including protection of health care workers, medical evacuation, diagnostic methods and vaccines,

3. communication activities and strategies addressed to the public and health professionals, and

4. the Ebola epidemic from a local challenge to a global health security issue.

Over 350 participants attended, including health authorities and experts from EU Member States, EU bodies, international and non-governmental organisations and projects working in risk and crisis management and communication who have been involved in the response in West Africa as well as in preparedness and response in the EU.

The following report will provide the reader with the main messages of the key speakers as well the recommendations based on the discussions in the four parallel workshops.

Amref Health Africa asks the Government of Sierra Leone to protect girls from injury and death caused by the harmful practice

On February 6, 2016, the world will be marking the International Day of Zero Tolerance to Female Genital Mutilation. This day has been set aside by the United Nations as a reminder to all that the international community has taken a stand on complete eradication of female genital mutilation (FGM).

Amref Health Africa is concerned that contrary to this international position, Sierra Leonean Social Welfare and Gender Minister Mr Moijua Kaikai recently announced that female genital mutilation was a cultural practice supported by the government and would therefore not be outlawed. Sierra Leone is one of the few remaining countries in Africa that have not made FGM illegal.

It is widely acknowledged that FGM, also known as female genital cutting (FGC) includes procedures that intentionally cause injury to and alter the female genital organs for non-medical reasons. Today more than 25 million girls and women from 29 countries in Africa and the Middle East are living with mutilated genitals. Most of the victims underwent mutilation between infancy and the age of 15 years.

FGM has acute and chronic complications. Acute complications include pain, bleeding and infection, and sometimes death. As the wound heals, chronic complications with serious consequences on maternal health set in. These include fistula, infertility and inability to deliver vaginally causing obstetric complications and newborn deaths. Women who have undergone the cut cannot have normal sexual relations and pain during sex is common.

It is for this reason that in 1993 FGM was classified as a form of violence against women under the International Human Rights Law. In 2012 the UN General Assembly passed a resolution on elimination of FGM. Progress has been made and today 24 of the 29 countries where FGM is concentrated have enacted legislation against the practice.

Amref Health Africa, the largest health development organisation on the continent, stands for the rights of women in Africa. We believe that sustainable development cannot be achieved unless the rights of women are upheld and until women have equal opportunity in the community to fully engage in development.

“Female Genital Mutilation is illegal. It is a form of violence against women. It is against natural justice and the rights of women,” says Dr Githinji Gitahi, Group CEO, Amref Health Africa.

In the course of our work with communities, Amref Health Africa has noted that FGM not only leads to medical problems but disadvantages women, leading to school dropouts, early marriage and relegation to a lower status in the community as far as human development is concerned. From our experience working with African Communities, Amref Health Africa has also learnt the importance of cultural practices that act as a bridge between adolescence and adulthood. It is for this reason that we support communities to abandon FGM and replace it with practices that uphold the wellbeing of women.

In Kenya and Tanzania, Amref Health Africa has been working with Maasai community elders to develop an Alternative Rite of Passage for teenage girls in order to eliminate the practice of FGM. The Alternative Rite of Passage has been put into practice since 2012 and enables girls to transition to womanhood without going through the cut. In Kenya alone, over 8,000 girls have graduated from the Alternative Rite of Passage, thus escaping death, injury and early marriage.

In Ethiopia we have been working with multi-sectoral government structures to address FGM. The ‘United for Body Rights’ project funded by the Dutch Government has been running in the Afar Region for the last five years and has led a significant decline in the practice. In South Omo, a project funded by the Canadian Government addresses harmful traditional practices, including FGM, by seeking to influence behaviour change and enhancing women’s decision-making power on maternal and child health issues.

Amref Health Africa implores the Government of Sierra Leone and stakeholders working to uphold the rights of women in Africa to stand with Sierra Leonean women and condem FGM. Amref Health Africa is available to provide the Government of Sierra Leone with technical support to develop and implement policies and strategies for the elimination of this harmful practice.

Ends

Note to Editors

About Amref Health Africa

Amref Health Africa is an international African organisation founded and headquartered in Kenya. Amref Health Africa works with the most vulnerable African communities through its country programmes in Ethiopia, Kenya, South Sudan, Tanzania and Uganda, and its Southern Africa and West Africa regional hubs based in South Africa and Senegal respectively. Through its laboratory, clinical outreach and training programmes, Amref Health Africa reaches an additional 30 plus countries in Africa. With over half a century of experience in delivering health care and building health systems in Africa, Amref Health Africa supports those at the heart of the communities, particularly women and children, to bring about lasting health improvement.

For more information contact Betty Muriuki, Ag Communications Manager – Corporate and Kenya; Tel: +254 731002450; email betty.muriuki@amref.org

Freetown, Sierra Leone | AFP | mercredi 13/01/2016 - 09:56 GMT

par Rod MAC JONHSON

L'orpailleur sierra-léonais Dauda Kamanda n'a jamais été riche mais jusqu'à l'épidémie d'Ebola, il pouvait vivre de la vente de ses pépites à des marchands qui les exportaient à travers l'Afrique et le Moyen-Orient.

Puis, un par un, ses clients libanais et sénégalais de la province de Koinadugu, dans le nord de la Sierra Leone, ont fui la propagation du virus en 2014 et ses revenus mensuels de 500 dollars (460 euros) - de quoi subvenir aux besoins de sa famille de quatre enfants - se sont évaporés.

"Après le départ des acheteurs, j'ai dû trouver un emploi de transporteur de bagages dans une gare routière pour les gens allant dans la capitale" Freetown, raconte-t-il.

A la veille de l'annonce officielle, attendue jeudi, de la fin de la pire épidémie de l'histoire d'Ebola (plus de 11.300 morts), les trois pays d'Afrique de l'Ouest les plus touchés mesurent l'étendue des dégâts subis par leur économie.

La Banque mondiale évalue le montant des pertes en produit intérieur brut (PIB) pour ces trois pays à 2,2 milliards de dollars (1,4 milliard pour la Sierra Leone, 535 millions en Guinée et 240 millions au Liberia).

Ils ont reçu en 2015 des promesses d'aide de plus de 5 milliards de dollars, qui ne seront pas de trop pour redresser des économies sinistrées, en particulier en Sierra Leone, frappée par une récession de plus de 20 % de son PIB.

"Les secteurs qui tirent habituellement la croissance - agriculture, mines, etc - ont été gravement perturbés", a déclaré à l'AFP le ministre sierra-léonais de l'Economie et des Finances Kaifala Marah.

L'impact économique a été aggravé par une forte baisse des prix mondiaux du minerai de fer, premier article d'exportation du pays, et l'effondrement du secteur minier, les investisseurs étrangers ayant fui la Sierra Leone.

La fermeture de deux mines, exploitées respectivement par African Minerals et London Mining, s'est soldée par la perte de 7.500 emplois.

Le nombre d'emplois est néanmoins revenu à son niveau antérieur à la crise, mais avec des durées et des salaires inférieurs, selon un rapport de la Banque mondiale publié en juin.

• 'Repartir à zéro' -

En Guinée voisine, où l'impact s'est également fait sentir sur les investissements miniers, l'arrêt de nombreuses liaisons terrestres et aériennes a également asphyxié le commerce, souvent dominé par le secteur informel.

Avant la crise Ebola, "j'étais souvent à Dubaï et à Bangkok pour acheter des chaînes en or, ma boutique était toujours bien achalandée, j'avais beaucoup de clients, notamment parmi les détaillants", indique une négociante, Fatou Baldé.

L'import-export de produits de base, tels que le riz, le lait, la farine et le sucre, a lui aussi souffert.

"En temps normal je fais entre 35.000 et 40.000 tonnes par mois", estime Elhadj Diallo, qui importe essentiellement du riz. "Mais pendant cette période d'Ebola j'importais seulement entre 10.000 et 15.000 tonnes parce que les fournisseurs avaient souvent peur d'envoyer leurs bateaux à Conakry", explique-t-il, confiant avoir dû faire convoyer ses marchandises via "le Sénégal ou la Gambie pour ne pas décourager les fournisseurs puisque la Guinée était devenue un problème".

De l'autre côté de la frontière, au Liberia, Amadou Diallo, qui importe des marchandises de Guinée, affirme avoir dû "repartir de zéro" à cause d'Ebola. "C'était vraiment l'enfer. Nous ne pouvions plus sortir du pays pour nous approvisionner et devions survivre avec l'argent que nous avions".

Dans le pays, 12% des entreprises suivies par l'International Growth Centre (IGC), basé à Londres lors du pic de l'épidémie, à l'été 2014, ont fait faillite.

Mais population et gouvernants des trois pays affichent leur optimisme quant à leurs capacités de rebond après le choc de l'épidémie, à l'image de la présidente libérienne Ellen Johnson Sirleaf.

"Nous pouvons et nous devons revenir aux progrès qui prévalaient avant le traumatisme d'Ebola", a-t-elle déclaré en juillet lors d'une réunion aux Nations unies avec ses homologues guinéen Alpha Condé et sierra-léonais Ernest Bai Koroma.

Une confiance confortée selon Dianna Games, du cabinet-conseil sud-africain Africa At Work, par les perspectives de croissance encourageantes de l'Afrique de l'Ouest, estimées à 7 % en 2016, alors que "les trois pays les plus touchés représentent moins de 3 % du PIB" de la région".

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© 1994-2016 Agence France-Presse

Freetown, Sierra Leone | AFP | Wednesday 1/13/2016 - 10:08 GMT

by Rod Mac Johnson

Gold miner Dauda Kamanda has never been rich, but before Ebola hit Sierra Leone he was getting by selling the nuggets he unearthed to traders who exported them across Africa and the Middle East.

Then, one by one, his Lebanese and Senegalese clients in the northern district of Koinadugu fled as the deadly outbreak gripped the country in 2014, and Dauda's $500 (460-euro) monthly income disappeared.

"After the buyers fled, I had to take a part-time job carrying luggage at the lorry park for people going to the capital," he told AFP.

As the world awaits the announcement on Thursday that the worst-ever Ebola epidemic has been beaten in west Africa, the three most affected countries of Liberia, Guinea and Sierra Leone are taking grim stock of the devastation wrought on their economies.

The epidemic has devastated the mining, agriculture and tourism industries in the region -- already fragile after years of civil war, dictatorship and coups -- where more than 11,000 people died from Ebola.

Strong recent expansion has been curtailed in Guinea and while Liberia has resumed growth, Sierra Leone is in a severe recession, according to the World Bank.

The bank estimates the regional economic damage to have been $2.2 billion over 2014-15 and has mobilised around $1.6 billion for Ebola response and recovery efforts.

• Mine closures -Fuelled by foreign investment in its mineral wealth, Sierra Leone had made considerable progress in recovering from a brutal 11-year civil war and its economy grew by 11.3 percent in 2013.

But Ebola slashed growth to four percent in 2014 and the economy contracted by a massive 21.5 percent in 2015, according to Finance and Economic Planning Minister Kaifala Marah.

"The traditional growth-driving sectors -- agriculture, mining, et cetera -- were severely disrupted," he told AFP, adding that the damage had been exacerbated by a slump in iron ore prices, the main international export.

Around 7,500 jobs were lost by the closure of two mines run by African Minerals and London Mining, which both went into administration.

A World Bank report released last June said employment had returned to pre-crisis levels, although employees were working fewer hours and earning smaller wages.

In Guinea, where small enterprises and the informal economy are heavily reliant on imports, the closing of air borders that accompanied the crisis were crippling.

"I often went to Dubai and Bangkok to buy gold chains and my shop was always well stocked," businessman Fatou Balde told AFP in Conakry.

"I had a lot of customers, especially among retailers, but now the shelves are empty."

Growth of 2.3 percent in 2013 slowed to 0.6 percent in 2014, although financial institutions expect the Guinean economy to expand by 4.3 percent in 2016.

In Liberia, 12 percent of businesses surveyed during the peak of the crisis have since closed down, according to the London-based International Growth Centre (IGC).

Like numerous entrepreneurs interviewed by AFP, 45-year-old Amadou Diallo, who imports goods from Guinea to Liberia, said the closing of borders at the height of the crisis and an exodus of foreign investment had put him out of business.

"After the first outbreak we had to start over. It was hell really. We could no longer go for goods out of the country, we had to survive on the money we had," he said.

• Reason for hope -The US Agency for International Development funded a mobile phone survey of 30,000 people across Liberia and Sierra Leone in the first six months of 2015 to find out the impact of Ebola on their finances.

In Sierra Leone 70 percent said their household incomes had dropped since June 2014 while the figure was 60 percent in Liberia.

Yet respondents were confident about job markets recovering, in a note of optimism echoed by ministers in Sierra Leone, who expect the economy to stabilise this year and recover strongly to 19.6 percent growth in 2017.

A further reason for hope, says Dianna Games of South African business consultancy Africa At Work, is the relative good health of the regional economy.

She noted in a recent commentary for the Johannesburg-based newspaper Business Day that growth for the broader Economic Community of West African States is forecast at seven percent for 2016.

"Ebola's effect has been minimal because the three worst-affected countries comprise less than two percent of regional gross domestic product," she said.

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CENTRAL AFRICAN REPUBLIC
FIRE DESTROYS IDP CAMP

On 10 January, fire destroyed hundreds of huts in a camp for internally displaced persons in Bambari, Ouaka Province. One person was killed and 21 others injured. The injured are being treated at Bambari provincial hospital. Humanitarian partners are working to provide emergency assistance to the affected families. On 22 December 2015, fire also destroyed more than 200 huts in the same camp.

NIGERIA
LASSA FEVER KILLS 35

An outbreak of Lassa fever has spread across eight Nigerian states, infecting 76 people and killing 35 others (case fatality rate of 46 per cent). The first case was reported in Bauchi state in the north-east in November and spread to Kano, Edo, Nasarawa, Niger, Oyo, Rivers and Taraba states. According to WHO, Lassa fever is endemic in parts of the country, with an overall fatality rate of one per cent. The health minister has confirmed the outbreak. The Government is managing the response with support from WHO.

SEVEN DIE IN VILLAGE RAID
Suspected Boko Haram gunmen attacked a village in the north-eastern Borno state on 5 January, killing seven people. The attack was the first since President Muhammadu Buhari declared on 24 December that the group had been defeated “technically”.

DEMOCRATIC REPUBLIC OF CONGO

Intense flooding over the recent months has killed 74 people and affected around 385,000 in 10 of the country’s 26 provinces. The floods are the worst in recent years and are linked to the impact of El Niño. Food, shelter, health, education and nutrition are the priority needs. A crisis cell has been set up within the Prime Minister’s office and the government has provided assistance to some communities.

EBOLA VIRUS DISEASE
NO NEW CASES REPORTED No new cases were reported in the week leading up to 10 January. Guinea launched epidemiological surveillance activities in Forécariah prefecture on 7 January. In Sierra Leone, the National Ebola Response Centre has closed down and its responsibilities transferred to the Ministry of Health and Sanitation, the Ministry of Social Welfare, Gender and Child Affairs, and the Office of National Security. Meanwhile, CDC has recommended the vaccination of Ebola survivors’ partners in Sierra Leone.

RÉPUBLIQUE CENTRAFRICAINE
UN INCENDIE DÉTRUIT UN CAMP DE DÉPLACÉS

Le 10 janvier des centaines de huttes ont été détruites dans un incendie dans un camp de personnes déplacées internes à Bambari, dans la province de la Ouaka. Une personne a été tuée et 21 autres blessées, qui sont en train d’être traitées à l'hôpital de Bambari. Les partenaires humanitaires se mobilisent pour fournir une assistance humanitaire aux familles touchées. Le 22 décembre 2015, plus de 200 abris du même camp ont été entièrement détruits par le feu.

NIGERIA
LA FIÈVRE DE LASSA TUE 35 PERSONNES

Une épidémie de fièvre de Lassa s’est répandue à travers huit états nigérians, infectant 76 personnes et en tuant 35 autres (taux de létalité de 46%). Le premier cas a été signalé dans l'État de Bauchi, au nord-est en novembre, et la maladie s’est ensuite propagée dans les États de Kano, d’Edo, de Nasarawa, du Niger, d’Oyo, de Rivers et de Taraba. Selon l'OMS, la fièvre de Lassa est endémique dans certaines régions du pays, avec un taux de létalité global de 1%. Le ministre de la Santé a confirmé l'épidémie. Le gouvernement gère actuellement la réponse avec le soutien de l'OMS.

SEPT MORTS DANS LE RAID D’UN VILLAGE
Des hommes armés soupçonnés d’appartenir à Boko Haram ont attaqué un village de l'État de Borno, au nord-est du pays, le 5 janvier, tuant sept personnes. L'attaque était la première depuis que le président Muhammadu Buhari a déclaré le 24 décembre que le groupe avait été vaincu "techniquement".

RÉPUBLIQUE DEMOCRATIQUE DU CONGO
LES INONDATIONS AFFECTENT 385 000 PERSONNES

D’importantes inondations au cours des derniers mois ont tué 74 personnes et en a touché environ 385 000 dans 10 des 26 provinces du pays. Les inondations sont les pires de ces dernières années et sont liées à l’impact d’El Niño. Les vivres, le logement, la santé, l’éducation et la nutrition sont les besoins prioritaires. Une cellule de crise a été mise en place au sein du bureau du Premier ministre et le gouvernement a fourni une assistance à certaines communautés.

MALADIE À VIRUS EBOLA
AUCUN NOUVEAU CAS SIGNALÉ

Aucun nouveau cas n’a été rapporté dans la semaine menant au 10 janvier. La Guinée a initié des activités de surveillance épidémiologique dans la préfecture de Forécariah le 7 janvier. En Sierra Leone, le Centre national d'intervention d'Ebola a fermé ses portes et ses responsabilités ont été transférées au ministère de la Santé et de l'Assainissement, le ministère de la Protection sociale, de l'Egalité et des Affaires de l'enfant, et le Bureau de la sécurité nationale. Entre temps, le Centre américain pour le contrôle et la prévention des maladies (CDC) a recommandé la vaccination des partenaires de survivants Ebola en Sierra Leone.

Monrovia, Liberia | AFP | jeudi 14/01/2016 - 03:00 GMT

par Zoom DOSSO

L'Organisation mondiale de la santé (OMS) doit annoncer jeudi la fin de la transmission d'Ebola au Liberia, et du même coup celle de l'épidémie ayant ravagé l'Afrique de l'Ouest, la plus grave depuis l'identification du virus il y a 40 ans.

Prudent, le secrétaire général de l'ONU Ban Ki-moon a prévenu mercredi que "nous pouvons nous attendre à de nouvelles flambées d'Ebola dans l'année à venir", même si leur ampleur et leur fréquence "devraient décroître avec le temps".

Partie en décembre 2013 de Guinée, l'épidémie, qui a fait plus de 11.000 morts, s'est propagée au Liberia et en Sierra Leone voisins, ces trois pays concentrant la quasi-totalité des cas, puis au Nigeria et au Mali.

En deux ans, elle aura atteint 10 pays, dont l'Espagne et les Etats-Unis, provoquant officiellement 11.315 morts pour 28.637 cas recensés. Ce bilan, sous-évalué de l'aveu même de l'OMS, est supérieur à toutes les flambées d'Ebola cumulées depuis l'identification du virus en Afrique centrale en 1976.

Après la Sierra Leone le 7 novembre et la Guinée le 29 décembre, le Liberia a atteint jeudi son 42e jour - deux fois la durée maximale d'incubation - depuis le second test négatif sur le dernier patient.

Mais le risque persiste car le virus subsiste dans certains liquides corporels de survivants, notamment le sperme où il peut rester jusqu'à neuf mois, comme le Liberia en a fait l'amère expérience: déclaré débarrassé d'Ebola en mai puis septembre 2015, le pays a connu ensuite des résurgences localisées.

"Cette maladie ne peut plus nous détruire comme elle l'a fait", a assuré le responsable de la cellule nationale de crise anti-Ebola, Francis Karteh. "Nos médecins et soignants ne la connaissaient pas, c'est pourquoi beaucoup en sont morts" - 192 sur 378 contaminés.

Aux pires moments, les pays les plus touchés ont craint l'effondrement, notamment le Liberia, "menacé dans son existence même", selon l'expression du ministre de la Défense Brownie Samukai devant l'ONU, par une maladie qui "se propage comme un feu de forêt".

- 'Brûlez-les tous' -

"Il y avait des jours où nous ramassions plus de 40 ou 50 corps", se souvient Naomi Tegbeh, une survivante qui collectait les cadavres hautement contagieux. "C'était des expériences horribles dont nous espérons que le Liberia ne les revivra pas".

Ouvert en août 2014 avec 120 lits, le centre anti-Ebola de l'ONG Médecins sans Frontières (MSF) à Monrovia a dû plus que doubler sa capacité, devenant le plus grand jamais construit. Mais au paroxysme de l'épidémie, il a dû renvoyer des patients faute de place.

A la même époque, à Ballajah, près de la frontière sierra-léonaise, Fatu Sherrif, 12 ans, et sa mère, atteintes d'Ebola, étaient emmurées chez elles sur décision des autorités. Elles ont appelé à l'aide jusqu'à ce que leurs voix s'éteignent, d'abord celle de la mère, puis la fille, a constaté un journaliste de l'AFP: terrorisés, les habitants n'ont jamais osé approcher pour les aider.

En septembre 2014, près de Monrovia, une équipe de la Croix-Rouge, en combinaison de protection biologique, tançait les habitants qui avaient signalé, outre les morts à collecter, une vieille femme encore vivante. "Avant de nous appeler, assurez-vous que la personne est décédée. D'autres que nous s'occupent des malades", expliquait le chef d'équipe. "Oui, monsieur. Nous vous rappellerons quand ils seront morts", répondait avec déférence le chef de quartier.

"Cette épidémie tue notre tissu social", déplorait alors George Weah, star du football libérienne et fondateur d'une ONG de lutte contre Ebola.

Car la maladie a bouleversé le mode de vie des pays frappés, par la recommandation d'éviter tout contact physique entre vivants, mais aussi avec les morts - une interdiction mal acceptée, notamment à cause des rites funéraires impliquant le lavage des corps.

En octobre 2014, les autorités libériennes avaient même édicté une consigne unique pour les cadavres, peu importe la cause du décès: "Brûlez-les tous".

Dépassés, les Etats ouest-africains pauvres, aux services de santé sinistrés, ont multiplié les mesures d'exception, comme la mise en quarantaine de régions entières. La Sierra Leone a ainsi confiné ses habitants pendant trois jours, en septembre 2014 puis en mars 2015.

Face à des réglementations perçues comme autoritaires et des messages de prévention initiaux mal formulés, promettant une mort quasi inéluctable, les populations ont souvent regimbé.

C'est en Guinée que ces réactions se sont manifestées le plus brutalement: en septembre 2014, huit membres d'une équipe de sensibilisation à la maladie étaient massacrés à Womey, dans le Sud forestier, épicentre originel de l'épidémie.

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13 January 2016 – On the eve of West Africa being declared free of Ebola virus transmission, top United Nations officials today highlighted the “extraordinary” global cooperation mustered to tackle an epidemic that killed over 11,300 people, at the same time calling for vigilance against future flare-ups.

“Governments will need resources to help communities prevent infection, detect potential cases and respond rapidly and effectively,” Secretary-General Ban Ki-moon told a regular informal General Assembly meeting on Ebola recover and response, stressing that the international community must make good on the pledges made in 2015 to support the over 10,000 survivors in West Africa.

Remarks were also made by World Health Organization (WHO) Director-General Dr. Margaret Chan (via video link), Administrator of the UN Development Programme (UNDP), Helen Clark, Special Adviser on 2030 Agenda for Sustainable Development and former Special Envoy on Ebola Briefing Dr. David Nabarro, and the Deputy Health Minister of Liberia, His Excellency Tolbert Nyenswah (video link), among others, including Ebola survivors.

Sierra Leone declared the end of Ebola transmission on 7 November and Guinea, where the epidemic began two years ago, on 29 December, with both countries now observing a 90-day period of heightened vigilance. Liberia is slated to declare the end of the recent flare-up tomorrow.

“That means that tomorrow – January 14th – all known chains of transmission will have been stopped in West Africa,” Mr. Ban said. “These achievements could not have happened without the decisive leadership of the Presidents and other national authorities of the three affected countries, and the engagement of all communities.

“Of course, significant challenges remain. We can anticipate future flare-ups of Ebola in the coming year,” he added, noting that Liberia’s experience in combating two flare-ups shows the resilience and capacity of affected countries to reactivate emergency response mechanisms and contain the virus.

“But we also expect the potential and frequency of those flare-ups to decrease over time. Governments will need resources to help communities prevent infection, detect potential cases and respond rapidly and effectively.”

Apart from the original chain of transmission, there were 10 new small outbreaks between March and November this year, apparently due to the re-emergence of a persistent virus from survivors. One challenge is that after recovery and clearing the virus from the bloodstream, the virus may persist in the semen of some male survivors for as long as nine to 12 months.

Mr. Ban paid tribute to the “courageous health workers, burial teams, and others,” and called for a concerted effort to counter the distress, mistrust and stigma caused by Ebola.

In the face of “an active outbreak, a rising death toll, an exponential infection curve, and perhaps, above all, uncertainty and mounting fear […] our Organization faced a fundamental test of our collective strength and will – and we mobilized,” he emphasized.

“Governments and communities in the region stepped up in extraordinary ways. Dozens of countries provided life-saving contributions. We created the first-ever United Nations emergency health mission and coordinated a unified response, with key contributions from UN Country Teams,” he said.

“The end of Ebola transmission in West Africa is testament to what we can achieve when multilateralism works as it should, bringing the international community to work alongside national governments in caring for their people,” the Secretary-General said.

General Assembly President Mogens Lykketoft also praised the role of national authorities, local communities, health workers, ordinary citizens, civil society and the international community in combatting the epidemic, including the Assembly itself.

“Both by generating political engagement through six dedicated meetings and by establishing the UN Mission for Ebola Emergency Response (UNMEER), the Assembly demonstrated solidarity and an ability to take swift action in the face of an emergency,” he said, while warning that the crisis is far from over since both survivors and the three Governments continue to face considerable challenges.

“It is important therefore that the international community remain seized of this matter; that partners continue to provide support to affected communities; and that lessons are learned on how best to prevent and manage future global health crisis,” he said.

For her part, WHO chief Dr. Chan said tremendous strides had been made towards defeating the largest, longest and most complex Ebola outbreak in history. And with Liberia set to be removed tomorrow from the list of countries with ongoing Ebola virus transmission, marking the first time that all three most-affected countries had logged 42 days without a case of the disease – twice the incubation period of the virus – “this is a monumental achievement.”

Indeed, she explained, every chain of transmission had to be broken; tens of thousands of contacts had to be monitored. And while vigilance and response capacity must be maintained throughout 2016, WHO expected that “all survivors will have cleared the virus from their bodies by the end of the year.” Meanwhile, the countries would need international solidarity to ensure a safe transition, and the period of intense vigilance must continue as recovery proceeded.

“While the job is far from being finished, the situation will not return to what it was 15 months ago. The steps taken at national and international levels to defeat the disease were unprecedented [and] no one, no one, will let this virus take off and run away again,” underscored Dr. Chan.

Conakry, Guinea | AFP | Thursday 1/14/2016 - 03:00 GMT

by Abdoulaye BAH

Saa Mathias Lenoh, a high school student in the Guinean capital Conakry, says he's "learning to smile little by little," like thousands of other youngsters orphaned by Ebola in west Africa.

According to the United Nations, more than 22,000 children lost at least one parent to the deadliest Ebola outbreak in history whose epicentre lay in the west African countries of Guinea, Sierra Leone and Liberia.

"The children really suffered at the start. The moment one came to know of illness in the family, they were automatically stigmatised," said Yaya Diallo, an official with Plan International, a leading global NGO.

"The neighbours and even neighbourhood children who would play with them and went to school with them were forbidden by their parents to do so," he said.

"Their own parents in turn would virtually lock them up at home or send them to communities very far away so that they would not have to suffer," Diallo said.

The outbreak, which had its origins in Guinea, infected almost 29,000 people and claimed 11,315 lives, according to official data which most experts accept represents a significant underestimate.

The World Health Organization will on Thursday declare an official end to this outbreak.

It initially led to a knee-jerk reaction from locals, and children from affected families often bore the brunt of ignorance and prejudice.

In one particularly horrific case in neighbouring Liberia, 12-year-old Fatu Sherrif was locked into her home with her dead mother in the quarantined hamlet of Ballajah, 150 kilometres (90 miles) from the capital Monrovia, as panicked neighbours fled to the forest.

Her cries could be heard for several days by the few who had stayed in the abandoned village before she died alone, without food or water.

International organisations deplored the lack of traditional solidarity to those affected this time round in contrast to earlier times, such as when AIDS had ravaged the continent.

But since then, nearly all those children have been taken in by foster families or are in care, the UN childrens' agency UNICEF noted.

- 'Life has been difficult' -

"Today, no study shows that a child is on the streets because his parents have died of Ebola," Diallo said, adding that Plan International extended counselling for such children and helped host families by distributing food rations and hygiene kits.

But despite this, many children have suffered.

"Life has been difficult," said 18-year-old Lenoh, who lost a sister and both his parents to the disease.

"If it hadn't been for my elder brother, I don't know how I would have continued my studies," he said.

"Luckily nobody in my school knows that I'm an Ebola survivor except the principal who I took into confidence. He encourages me and comforts me often."

His elder brother Emmanuel was not so lucky.

"I was forced to stop going to university and start working," he said. "I lost both my parents in the span of a week," in October 2014.

Emmanuel Lenoh said his mother, a trader, contracted the virus during one of her regular trips to Sierra Leone, and then infected other members of the family.

"Today, I cannot finish my studies. Otherwise without my help, the rest of the family can't continue their studies."

Jean Pe Kolie, a doctor at Conakry's public university, lamented that there was no programme to rehabilitate Ebola orphans.

"There is no backing from the state and no funds to set up a project to reintegrate these children," he said.

"We are trying to provide school stationery. We have programmes with some partners," he said, citing UN agencies such as UNICEF and the World Food Programme.

"There is aid for survivors but not for orphans," he said.

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Freetown, Sierra Leone | AFP | Thursday 1/14/2016 - 02:59 GMT

by Rod Mac Johnson

They may have conquered Ebola but survivors of the fever and the heroic workers who saved them face a new struggle: acceptance by communities after the end of the deadly epidemic.

The worst outbreak of the tropical fever in history ravaged west Africa over two years, infecting -- by the most conservative estimates -- almost 29,000 people and killing more than a third.

It is due to be declared over as Liberia gets the all-clear Thursday, thanks to a brave army of doctors, nurses, grave diggers, contact tracers and others there and in neighbouring Sierra Leone and Guinea.

They are celebrated as heroes by their government and the international community, yet many face the harsh reality of stigmatisation rather than gratitude once back in their communities.

Helen Matturi signed up for the Red Cross disposal teams responsible for safely burying highly infectious victims as the outbreak began to tighten its grip on Sierra Leone's capital Freetown in 2014.

"At the onset of the Ebola outbreak, it was men that were handling the corpses of women, sometimes in an exposed fashion. I wanted to keep the dignity of women if they were dead," she said.

Soon after joining up, her fiance left for work one morning and never returned.

"When some friends tracked him down and asked the reason for abandoning the house where we were living together, his answer was: 'I don't want an Ebola family'."

The tropical pathogen, one of the deadliest known to humankind, is spread through contact with the bodily fluids of an infected person showing symptoms such as fever or vomiting, or the recently dead.

- 'Ebola Corpse Man' -

The fever, which can cause fatal haemorrhaging, organ failure and severe diarrhoea, spread to 881 health workers, killing more than 500.

As well as shattering health services, economic growth and family life, it has also sewn deep fissures in communities hit hardest by the contagion.

Ebola bred fear and suspicion, particularly in rural areas where many believe that foreigners are responsible for spreading the disease, including the very humanitarian groups who helped overcome it.

Victor Koroma, another member of a Freetown burial team, told AFP he was forced to move home six times as landlords or neighbours found out how he was earning a living.

"In some instances, I was openly called the Ebola Corpse Man and, since the nickname was persistent, I had to move," he said.

The hostility encountered by both west African and western aid workers and medical staff has manifested itself not just in low-level disapproval but in sporadic bloodshed.

Guinea and Sierra Leone saw numerous episodes of mobs attacking ambulances and burial teams as they imposed a state of emergency and began restricting movement of their populations.

The violence reached a grim nadir in 2014 when eight members of an outreach team in southern Guinea were slaughtered by protesters who denied the existence of Ebola and denounced a "white conspiracy".

The hostility has hit not just health workers but also survivors, made pariahs by the fear of contagion and because their very existence is a painful reminder for families who lost loved-ones.

- Stigma, shame, discrimination -

A UNICEF survey of 1,400 households across Sierra Leone in 2014 found that Ebola survivors suffered high levels of stigma, shame and discrimination.

In another survey by Sierra Leone's health ministry and the United States' Centers for Disease Control and Prevention, 96 percent of respondents reported discrimination toward people who had beaten Ebola.

An exacerbating factor has been the discovery that the virus can stay in semen for at least nine months after a patient has recovered, six months longer than previously thought.

Scientists are working to establish how long it can persist in other bodily fluids and tissues such as they spinal column and the eye, and for how long it could remain infectious.

Ebola passed on from survivors whose blood had been given the all-clear is thought to have been behind two small outbreaks in Liberia after it was initially declared Ebola-free.

Medical charity Doctors without Borders estimates around three-quarters of survivors are dealing with a variety of post-Ebola complications including headaches, fatigue and eye problems.

Momoh Sesay, a middle-aged farmer in Kambia, a major trading post in northwestern Sierra Leone, was already struggling with grief after losing his two wives and four children to the epidemic.

He survived his own infection, but encountered hostility rather than sympathy when he returned home.

"Everything was went well at first when I was discharged," he told AFP.

"But as soon as word went round that some male survivors sometimes have the virus in their semen, many of my best friends would wave to me from afar and then hurry on."

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GENEVA/14 January 2016 - Today the World Health Organization (WHO) declares the end of the most recent outbreak of Ebola virus disease in Liberia and says all known chains of transmission have been stopped in West Africa. But the Organization says the job is not over, more flare-ups are expected and that strong surveillance and response systems will be critical in the months to come.

Liberia was first declared free of Ebola transmission in May 2015, but the virus was re-introduced twice since then, with the latest flare-up in November. Today’s announcement comes 42 days (two 21-day incubation cycles of the virus) after the last confirmed patient in Liberia tested negative for the disease two times.

“WHO commends Liberia’s government and people on their effective response to this recent re-emergence of Ebola,” says Dr Alex Gasasira, WHO Representative in Liberia. “The rapid cessation of the flare-up is a concrete demonstration of the government’s strengthened capacity to manage disease outbreaks. WHO will continue to support Liberia in its effort to prevent, detect and respond to suspected cases.”

This date marks the first time since the start of the epidemic two years ago that all three of the hardest-hit countries—Guinea, Liberia and Sierra Leone—have reported zero cases for at least 42 days. Sierra Leone was declared free of Ebola transmission on 7 November 2015 and Guinea on 29 December.

“Detecting and breaking every chain of transmission has been a monumental achievement,” says Dr Margaret Chan, WHO Director-General. “So much was needed and so much was accomplished by national authorities, heroic health workers, civil society, local and international organizations and generous partners. But our work is not done and vigilance is necessary to prevent new outbreaks.”

The World Health Organization cautions that the three countries remain at high risk of additional small outbreaks of Ebola, like the most recent one in Liberia. To date, 10 such flare-ups have been identified that were not part of the original outbreak, and are likely the result of the virus persisting in survivors even after recovery. Evidence shows that the virus disappears relatively quickly from survivors, but can remain in the semen of a small number of male survivors for as long as one year, and in rare instances, be transmitted to intimate partners.

“We are now at a critical period in the Ebola epidemic as we move from managing cases and patients to managing the residual risk of new infections,” says Dr Bruce Aylward, WHO’s Special Representative for the Ebola Response. “The risk of re-introduction of infection is diminishing as the virus gradually clears from the survivor population, but we still anticipate more flare-ups and must be prepared for them. A massive effort is underway to ensure robust prevention, surveillance and response capacity across all three countries by the end of March.”

WHO and partners are working with the Governments of Guinea, Liberia and Sierra Leone to help ensure that survivors have access to medical and psychosocial care and screening for persistent virus, as well as counselling and education to help them reintegrate into family and community life, reduce stigma and minimize the risk of Ebola virus transmission.

The Ebola epidemic claimed the lives of more than11,300 people and infected over 28,500. The disease wrought devastation to families, communities and the health and economic systems of all three countries.

Media inquiries:

Gregory Härtl Media Coordinator, WHO Phone: +41 22 791 44 58 Mobile: +41 79 203 67 15 Email: hartlg@who.int

Tarik Jašarević Communications Officer, WHO Mobile: +41 793 676 214 Tel: +41 22 791 5099 Email: jasarevict@who.int