A. Situation analysis

Description of the disaster

Since early September 2015, the Bo, Bonthe, Freetown, Port Loko and Pujehun districts in the southern provinces of Sierra Leone experienced flooding due to torrential rains which led to widespread destruction. As of 5 October 2015, according to the Government of Sierra Leone through the Office of National Security (ONS) the total affected population in the five districts has reached 24,303, with the summary as follows: Bo (3,293), Bonthe (4,650) and Port Loko (1,510), Freetown (14,050) and Pujehun (800).

In Freetown, an estimated 14,050 people were displaced and staying in the Attouga Mini Football Stadium and National Football Stadium; however the conditions in both of these sites were not satisfactory – with limited access to safe drinking water, poor sanitary facilities, and the risk of epidemic outbreaks (Acute Watery Diarrhoea (AWD), cholera, Ebola Virus Disease (EVD) etc.). In the Bo, Bonthe, Port Loko and Pujehun districts, people have evacuated to nearby communities, seeking refuge with relatives or in public buildings (government buildings, mosques, schools etc.). In many of the more remote affected communities, assistance had not reached the affected population, leaving them exposed to the continuing rains. On 14 September 2015, the GoS appealed to humanitarian organisations to help in assisting the affected population.

On 18 September 2015, the International Federation of Red Cross and Red Crescent Societies (IFRC) released CHF 88,050 from the Disaster Relief Emergency Fund (DREF) to support the Sierra Leone Red Cross respond to the needs of 2,630 people (567 families), affected by flooding in Bo and Pujehun districts for a period of three months, specifically in the areas of health and care, shelter and settlements, water, sanitation hygiene promotion.

On 12 October 2015, Operation update no 1 was issued and additional allocation of CHF 196,950 was approved bringing a total allocation of CHF 285,000 for the DREF Sierra Leone floods operation to enable the Emergency Plan of Action (EPoA) to expand its activities to meet the needs of families in the city of Freetown (East End and West End), and the chiefdoms of Bonthe and Port Loko, which were also experiencing extensive flooding. In total, 24,303 beneficiaries/people i.e. (4,051 households) were reached through this DREF operation.

Operations update no 2 was issued on 18 December 2015 to extend the timeframe of the DREF operation by six weeks and to enable the completion of an operational review exercise.

The major donors and partners of the DREF include the Red Cross Societies and governments of Australia, Austria, Belgium, Canada, Denmark, Ireland, Italy, Japan, Luxembourg, Monaco, the Netherlands, Norway, Spain, Sweden and the USA, as well as DG ECHO, the UK Department for International Development (DFID) the Medtronic, Zurich and Coca Cola Foundations and other corporate and private donors. The IFRC, on behalf of the Sierra Leone Red Cross Society would like to extend many thanks to all partners for their generous contributions.

Financial situation:

• “Shelter-Relief” was underspent by CHF 20,999, which equates to 62 per cent as at the time of release of the report, items procured through the GLS and stock items released from the pre-positioned items at the regional office had not been booked.

• “Clothing and textiles” was underspent CHF 24,294, which equates to 59 per cent items procured through the GLS and stock items released from the pre-positioned items at the regional office had not been booked.

• “Distribution & Monitoring” was overspent by CHF 7,324, which equates to 7,324 per cent; and was due that the budget was captured under “logistics services” and budgeted for CHF 7,900

• “Workshops & Trainings” was overspent by CHF 15,593, which equates to 152 per cent; and was due to additional induction sessions for volunteers.

• “Travel” was overspent by CHF 18,354, which equates to 305 per cent; as additional travel was incurred by operation review team and additional costs were also incurred by regional team that delivered the items from Dakar who had to spend additional days on the road.

• “Information and Public Relations” was Overspent by 4,723 and was due to the fact that the activities were budgeted under ‘communication’ and also there was need for additional publicity activities aimed to sensitize the public, national and international media and donors on the situation, needs on the ground and the humanitarian response. A balance of CHF 148,813 will be returned to the DREF.

News

• Between April 22 and 29 2016, through its sub-office in N’Zerekore, IOM organized a series of field visits to meet with administrative and military authorities of Koyama, Kpaou, Zénié, Baala, Wolono. That aim of the visit was to inform the authorities about the set-up of health screening points at different border points of entry and introduce the health screening agents to be deployed at these border entry points.
• On April 29, IOM distributed hand washing materials to the committee in charge of resource mobilization for the pilgrimage that was organized by Catholics of Christians in the prefecture of Boffa.
• From 19 to 23 April, the IM unit supported IOM Sierra Leone staff in implementing their Public health risks and Mobility mapping activities. The main objective of this cooperation is to create a harmonized data base to facilitate the data exchange and comparison of results between both countries. The activities of Public health risks and Mobility mapping have begun in Kambia, near the Guinean border.

Epidemiological situation of the forest region after the end of the micro-quarantine of Koropara

After twenty one days of quarantine, the Government of Guinea on April 16, declared Koropara “Ebola Free”.

Following the request of the Government of Guinea, IOM reactivated health screening points (HSPs) along the borders of the Forest Region of Guinea and neighboring countries, mostly Liberia, in order to reinforce the vigilance and prevent any resurgence of the disease. A total of 13 HSPs have been reactivated.

In the prefecture of Macenta, 7 death cases have been notified between April 21 and May 4. The cases were investigated, but none revealed the Ebola virus. 210 cases of febrile sicknesses have been notified, including 3 cases which were identified at the border with Liberia. All the cases were investigated and were negative to the Ebola virus test.

Moreover, 23 contacts in Mahakoita, in the prefecture of Macenta, were released after the 21 day follow-up period.

This new FAO publication brings an innovative contribution to the existing research work on Ebola. At its height, the outbreak led to border closures, quarantines and other restriction measures which seriously disrupted the marketing of goods including of agricultural commodities.

This study provides an analysis of the impact of the Ebola Virus Disease outbreak on agricultural market chains. Seven market chains were selected based on their importance to regional food security, the risks associated with Ebola and the extent of disruptions caused by the outbreak. This includes rice, cassava, potatoes, cocoa, palm oil animal products, bushmeat and cocoa in Guinea, Sierra Leone and Liberia. Recommendations to ensure the smooth functioning of trade flows and markets when facing a crisis, while minimizing the risk of disease spread, are also included.

At a critical time when the epidemic is in recession, this study lays the foundations for integrated recovery frameworks at the local, regional and international levels. ‘Improved preparedness and response to epidemics implies an in-depth understanding of the factors leading to public health emergencies of this magnitude.’ said Vincent Martin, FAO Representative in Senegal and Head of FAO’s sub-regional Resilience Team for West Africa.

Using a multidisciplinary approach, this report builds on consultations with experts in food security, disaster risk reduction, animal and public health, epidemiology, anthropology as well as actors chains agricultural value of the affected countries. It will also guide future studies aimed to design concrete measures to maintain the functioning of food systems when transboundary risks occur, and to better understand the underlying causes of emerging infectious diseases such as Ebola. Download: Impact of the Ebola virus disease outbreak on market chains and trade of agricultural products in West AfricaImpact of the Ebola virus disease out

Abstract

Background

It is estimated that more than two-thirds of the population in sub-Saharan Africa (SSA) must leave their home to collect water, putting them at risk for a variety of negative health outcomes. There is little research, however, quantifying who is most affected by long water collection times.

Objectives

This study aims to a) describe gender differences in water collection labor among both adults and children (< 15 years of age) in the households (HHs) that report spending more than 30 minutes collecting water, disaggregated by urban and rural residence; and b) estimate the absolute number of adults and children affected by water collection times greater than 30 minutes in 24 SSA countries.

Methods

We analyzed data from the Demographic Health Survey (DHS) and the Multiple Indicator Cluster Survey (MICS) (2005 – 2012) to describe water collection labor in 24 SSA countries.

Results

Among households spending more than 30 minutes collecting water, adult females were the primary collectors of water across all 24 countries, ranging from 46% in Liberia (17,412 HHs) to 90% in Cote d’Ivoire (224,808 HHs). Across all countries, female children were more likely to be responsible for water collection than male children (62% vs. 38%, respectively). Six countries had more than 100,000 households (HHs) where children were reported to be responsible for water collection (greater than 30 minutes): Burundi (181,702 HHs), Cameroon (154,453 HHs), Ethiopia (1,321,424 HHs), Mozambique (129,544 HHs), Niger (171,305 HHs), and Nigeria (1,045,647 HHs).

Conclusion

In the 24 SSA countries studied, an estimated 3.36 million children and 13.54 million adult females were responsible for water collection in households with collection times greater than 30 minutes. We suggest that accessibility to water, water collection by children, and gender ratios for water collection, especially when collection times are great, should be considered as key indicators for measuring progress in the water, sanitation and hygiene sector.

MESSAGE FROM THE EXECUTIVE DIRECTOR

At IRT, our mission and focus is to alleviate human suffering by aiding victims of disasters and building healthy communities. In times of disasters, we rely on partnerships with other international organizations to achieve maximum impact with your donations. In this way, we establish clear and appropriate roles, avoid duplication of efforts, and maximize the efficiency and effectiveness of our response.

To build healthy communities, we strive to partner with local organizations who better understand the political and cultural landscape of a country or region, and the complexities of the local humanitarian sector. These partners include non-governmental organizations (NGOs), professional medical societies, health ministries, and local health facilities—all of whom are invested and motivated to improve the health and well-being of their communities.

This year, as I think about all that we have accomplished together—more than $33 million in food, medicines, and relief supplies delivered (the most in our 27 year history), and hundreds of volunteers mobilized—I am overwhelmed by the generosity and compassion of our partners and supporters.

I am particularly proud of our “Healthy Baby” program in Vietnam, in which skilled volunteers train physicians in the skills they need to save the lives of newborn babies who have trouble breathing.
Vietnam has seen a significant decrease in newborn deaths over the last decade, and I believe IRT has contributed to that progress. I am also very proud of our Better Vision – Brighter Future program, which provided more than 1,700 eyeglasses to children so that they could learn in school, and to adults so that they could maintain their livelihoods and provide for their families.

Since 1988, we have helped millions of people in crisis in 68 countries, and for the last twelve years we have been ranked a four-star charity (the highest rating) by Charity Navigator, the largest independent evaluator of U.S. charities.

Looking ahead, we will continue to assist low-income and elderly victims of Superstorm Sandy in New Jersey, helping them get back into their homes; expand our “Health Baby” medical training program in Vietnam; and deepen our efforts to reach children and adults living in remote regions without access to vision care. Here in San Diego, we will seek new ways to meet the needs of vulnerable women and children.

As you read this report, I hope you will be inspired and motivated to participate in our ongoing efforts, whether as a donor or volunteer, and that you will appreciate the significant role you have in making this work possible.

Thank you for your continued support as together we help make the world a better, more equitable place.

With deep gratitude,

Barry La Forgia
Executive Director

• L’urgence de santé publique de portée internationale liée à Ebola en Afrique de l’Ouest a été déclarée terminée le 29 mars 2016. Au total, 28 616 cas confirmés, probables et suspects ont été notifiés en Guinée, au Libéria et en Sierra Leone, dont 11 310 décès.

• Dans le dernier foyer en date, sept cas confirmés et trois cas probables de maladie à virus Ebola ont été notifiés entre le 17 mars et le 6 avril par les préfectures de N’Zérékoré (neuf cas) et Macenta (un cas) dans le sud-est de la Guinée. Entre le 1er et le 5 avril, trois cas confirmés ont également été notifiés à Monrovia (Libéria) ; il s’agit de la femme et des deux enfants du cas de Macenta, qui se sont rendus à Monrovia.

• Le cas indicateur de ce foyer (une femme âgée de 37 ans provenant de Koropara, une souspréfecture de N’Zérékoré) a vu ses symptômes apparaître aux environs du 15 février et est décédé le 27 février sans diagnostic confirmé. La source de son infection est probablement due à une exposition à des liquides biologiques infectés d’un survivant d’Ebola.

• En Guinée, le dernier cas enregistré a obtenu un deuxième résultat négatif au test de dépistage d’Ebola le 19 avril. Au Libéria, le dernier cas a obtenu un deuxième résultat négatif le 28 avril.

• Un délai de 42 jours (deux fois la période d’incubation) doit s’écouler avant de pouvoir déclarer la fin de la flambée épidémique en Guinée et au Libéria. En Guinée, ce délai se sera écoulé le 31 mai et au Libéria, le 9 juin.

• La Sierra Leone a contenu la dernière flambée d’Ebola en mars 2016 ; elle maintient une surveillance soutenue en réalisant des écouvillonnages et des tests sur toutes les personnes dont le décès a été signalé, et en procédant sans délai à l’investigation et au dépistage de tous les cas suspects. La politique d’écouvillonnage sera revue le 30 juin.

Ongoing conflicts and droughts exacerbate food needs

Food insecurity spreads as El Niño casts its shadow over Pacific and Caribbean states

2 June 2016, Rome - Drought linked to El Niño and civil conflict have pushed the number of countries currently in need of external food assistance up to 37 from 34 in March, according to a new FAO report.

The new edition of the Crop Prospects and Food Situation report, released today, adds Papua New Guinea, Haiti and Nigeria to the list of countries requiring outside help to feed their own populations or communities of refugees they are hosting.

In Haiti, output of cereals and starchy roots in 2015 dropped to its lowest level in 12 years. Around 3.6 million people, more than one-third of the population, are food insecure, almost half of them "severely", while at least 200 000 are in an extreme food emergency situation, according to the report.

Haiti's woes are largely due to El Niño, which has also exacerbated the worst drought in decades in Central America's dry corridor.

In Southern Africa, El Niño impacts have significantly worsened food security and the 2016 cereal harvest currently underway is expected to drop by 26 percent from the already reduced level of the previous year, triggering a "substantial rise" in maize prices and import requirements in the coming marketing year.

Prolonged drought in Papua New Guinea last year has been followed by heavy rains and localized flooding in early 2016, affecting around 2.7 million people. Cereal output in the country's Highland region is expected to suffer a severe shortfall, while the harvest in neighboring Timor-Leste is expected to be reduced for the second year in a row.

While El Niño is now over, the World Meteorological Organization forecasts a 65 percent chance it will be followed by a La Niña episode, which typically triggers the opposite precipitation patterns -- potentially a boon for parched land but also posing the risk of flooding.

Conflicts are taking an increasing toll

Civil conflicts and their displacement of populations have worsened the food security situation in 12 of the 28 countries on the watch list.

About 13.5 million people in Syria are in need of humanitarian assistance, with caseloads increasing. This year' s harvest is forecast to drop by around 9 percent, due to irregular rainfall in parts of the country, combined with a lack of agricultural inputs and damage to farm infrastructure, according to FAO.

The new report adds Nigeria, home to Africa's largest economy and population, to the list of countries needing external help, due to large-scale internal displacement of people stemming from ongoing conflict in northern districts, which also led to increased number of refugees and food insecurity in neighboring Cameroun, Chad and Niger. About 3.4 million people, mostly in the states of Borno and Yobe, are estimated to be in need of food assistance.

In Yemen, where over14.4 million people are estimated to be food insecure - half of them severely so - there is a high risk that desert locust swarms will increase in hard-to-reach interior regions from early June onwards.

Global cereal output on the rise

FAO raised its forecast for global cereal production in 2016 to 2 539 million tonnes, up 17.3 million tonnes from its previous May projection and up 0.6 percent from last year's harvest.

Aggregate cereal production in Low-Income Food-Deficit Countries (LIFDCs) is also forecast to increase to 420 million tonnes in 2016, led by a recovery in rice and wheat production in India after last year reduction due to El Niño-related drought. That would be a 2.5 percent increase from last year's "sharply reduced" level.

In spite of the improved world production prospects in 2016, output would still fall slightly short of the projected demand in 2016/17, meaning global stocks would need to be drawn down from their near-record level.

The 37 countries currently in need of external food assistance are Afghanistan, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Democratic People's Republic of Korea, Democratic Republic of the Congo, Djibouti, Eritrea, Ethiopia, Guinea, Haiti, Iraq, Kenya , Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Myanmar, Nepal, Niger, Nigeria, Papua New Guinea, Sierra Leone, Somalia, South Sudan, Sudan, Swaziland, Syria, Uganda, Yemen and Zimbabwe.

Key Messages

• In West Africa, market availability was good in April with supplies from above-average 2015/16 regional harvests, and international rice and wheat imports. Markets remained disrupted throughout the Lake Chad Basin and in parts of Central and Northern Mali. The recent depreciation of the Naira has led to price increases across Nigeria.

• In East Africa, maize prices followed seasonal trends in surplus-producing Uganda and Tanzania. Harvests are estimated to be well below average in Ethiopia, but prices have remained stable with the availability of food through humanitarian assistance programs underway. The South Sudanese Pound was allowed to float in December, leading to a persistent depreciation of the local currency and reducing purchasing power. Markets remain disrupted by insecurity in South Sudan and Yemen.

• In Southern Africa, although maize supplies remained well below-average, the start of the harvest improved availability and generally eased pressure on prices, except in southern Mozambique where maize prices continued to increase. Maize prices are well above-average levels across the region.

• In Central America, bean supplies improved with supplies from the Apante harvests while imports sustained stable levels of maize supplies. Maize prices were generally stable while beans prices were mixed. Locally-produced bean and maize availability remained below-average in Haiti, while imported commodity prices and availability remained stable.

• In Central Asia, wheat availability remained adequate region-wide. Prices are below their respective 2015 levels in surplus-producing areas.

• International staple food markets remain well supplied. Maize, wheat, rice, and soybean prices were stable in April and below or similar to their respective 2015 levels. Crude oil prices increased but remained well below-average.

By Lin Taylor (Thomson Reuters Foundation)

At least 17 million women and girls in Africa collect water every day, which increases their risk of sexual abuse, disease and dropping out of school, a study published yesterday has found.

It is one of the first studies to calculate how many women and children were responsible for water collection in Africa, the researchers said.

Using datasets from the World Bank, the United Nations children's agency UNICEF, and the United States Agency for International Development (USAID), researchers found that around three million children and 14 million women collect water in sub-Saharan Africa.

"The absolute number of adult females affected by this practice was a shock to me," Jay Graham, lead author of the study, told the Thomson Reuters Foundation.

"I knew it would be large... but I didn't realise it would be that high," added Graham, who is professor at the Milken Institute School of Public Health at The George Washington University.

The daily practice causes musculoskeletal damage, soft tissue damage and can lead to early arthritis, Graham said.

People also have to contend with water-borne diseases like schistosomiasis, an infection caused by parasitic worms living in fresh water, he said.

Across all 24 countries examined, including Sierra Leone, Malawi and Niger, more girls were tasked with water collection than boys. Women were also the primary water collector in all countries.

Children are pulled out of school for the daily task and many women cannot earn an income because of the time and energy it takes to collect water, Graham said.

Since they often need to walk long distances to find water, women and children are also at a higher risk of sexual abuse, he added.

In a statement issued last month, the Human Rights Commission of Sierra Leone said drought was putting even more pressure on children to find water.

"Children, particularly girls, are out in the street very late at night or as early as 4am in search of water," the statement read.

"This heightens their vulnerability and contributes to increase in teenage pregnancy, child labour, high rates of school dropouts and poor school performance," it said.

Demand for water is expected to increase by 2050 as the world's population is forecast to grow by one-third to more than nine billion, according to the UN.

As climate change strengthens, drought is becoming more frequent and severe in southern Africa, and that - combined with this year's El Nino phenomenon - is taking a heavy toll on rural lives and economies.

"With climate change, it's going to be more of an uphill battle," said Graham. "If there's focused attention on it and resources, we can improve upon the situation but I do think it's going to become more difficult."

But it also crucial to address gender inequality and to recognise the unpaid labour that women do across the globe, he said, which he believes is the underlying issue.

"There is a need to address cultural values and really shifting the belief that women and men are equal too."

Les premières prévisions de la FAO concernant la production mondiale de blé de 2016 font entrevoir une petite diminution, de moindres volumes étant attendus en Europe et aux États-Unis d’Amérique.

PAYS AYANT BESOIN D’UNE ASSISTANCE EXTÉRIEURE: selon les estimations de la FAO, 34 pays de par le monde, dont 27 en Afrique, ont besoin d’une aide alimentaire extérieure. Les troubles civils ont continué d’avoir des effets très négatifs sur la sécurité alimentaire d’un certain nombre de pays, tandis que les mauvaises conditions météorologiques, parfois liées au phénomène El Niño, ont réduit la production dans d’autres, limitant l’accès à la nourriture et faisant augmenter les prix à la consommation.

AFRIQUE: les mauvaises conditions météorologiques ont réduit la production céréalière de 2015, ce qui a provoqué une augmentation considérable du nombre de personnes en situation d’insécurité alimentaire dans plusieurs pays, tandis que les conflits ont aussi eu des effets néfastes sur la sécurité alimentaire et le secteur agricole en certains endroits. Les semis de 2016 ont commencé en Afrique centrale, en Afrique de l’Est et en Afrique de l’Ouest, tandis qu’en Afrique australe, où la récolte débutera en avril, le temps sec associé à El Niño a considérablement assombri les perspectives de production, ce qui a des implications très négatives pour la sécurité alimentaire de la sous-région. En ce qui concerne l’Afrique du Nord, la production de 2016 s’annonce mitigée, la sécheresse constatée actuellement au Maroc et en Algérie ayant conduit à abaisser les prévisions.

ASIE: les perspectives concernant la récolte des cultures d’hiver de 2016 sont en général bonnes, les premières prévisions laissant entrevoir des volumes de blé abondants dans la plupart des pays. En ce qui concerne le Proche-Orient, toutefois, la persistance des conflits en Iraq, en République arabe syrienne et au Yémen a continué d’éroder la capacité du secteur agricole, nuisant aux perspectives de production de 2016 et accentuant encore la crise humanitaire. Selon les estimations, la production céréalière de 2015 de la région est supérieure à celle de l’année précédente, essentiellement du fait des récoltes plus abondantes rentrées en Chine et en Turquie, qui ont largement compensé les moindres volumes enregistrés dans plusieurs pays de l’Extrême-Orient, en particulier en Inde.

AMÉRIQUE LATINE ET CARAÏBES: en au début 2016, la production céréalière s’annonce globalement bonne, les volumes récoltés devant rester importants, principalement du fait des meilleurs résultats attendus au Mexique et en Amérique du Sud. En ce qui concerne l’Amérique centrale et les Caraïbes, alors que le Mexique devrait enregistrer une augmentation de sa production, la persistance par ailleurs d’un temps sec lié à El Niño pourrait maintenir la production à un bas niveau en 2016. En Amérique du Sud, la production céréalière de 2016 devrait être en léger recul par rapport au niveau record de l’année précédente, ce qui tient pour l’essentiel à une contraction des semis, mais elle devrait rester bien supérieure à la moyenne

• The Public Health Emergency of International Concern (PHEIC) related to Ebola in West Africa was lifted on 29 March 2016. A total of 28 616 confirmed, probable and suspected cases have been reported in Guinea, Liberia and Sierra Leone, with 11 310 deaths.

• In the latest cluster, seven confirmed and three probable cases of Ebola virus disease (EVD) were reported between 17 March and 6 April from the prefectures of N’Zerekore (nine cases) and Macenta (one case) in south-eastern Guinea. In addition, three confirmed cases were reported between 1 and 5 April from Monrovia in Liberia; these cases, the wife and two children of the Macenta case, travelled from Macenta to Monrovia.

• The index case of this cluster (a 37-year-old female from Koropara sub-prefecture in N’Zerekore) had symptom onset on or around 15 February and died on 27 February without a confirmed diagnosis. The source of her infection is likely to have been due to exposure to infected body fluid from an Ebola survivor.

• In Guinea, the last case tested negative for Ebola virus for the second time on 19 April. In Liberia, the last case tested negative for the second time on 28 April.

• The 42-day (two incubation periods) countdown must elapse before the outbreak can be declared over in Liberia which is due to end on 9 June. Guinea declared an end to Ebola virus transmission on 1 June.

• Having contained the last Ebola virus outbreak in March 2016, Sierra Leone has maintained heightened surveillance with testing of all reported deaths and prompt investigation and testing of all suspected cases. The testing policy will be reviewed on the 30 June.

Risk assessment:

Guinea declared an end to Ebola virus transmission on 1 June and the 42-day count down will elapse on 9 June in Liberia. The performance indicators suggest that Guinea, Liberia and Sierra Leone still have variable capacity to prevent, detect and respond to new outbreaks (Table 1). The risk of additional outbreaks originating from exposure to infected survivor body fluids remains and requires sustained mitigation through counselling on safe sex practices and testing of body fluids.

Polio this week as of 1 June 2016

• Last week, health ministers from around the world met in Geneva for the annual World Health Assembly (WHA). Among other public health topics, delegates reviewed and discussed the latest global polio epidemiology and reaffirmed commitment to ending transmission in the remaining polio reservoirs. Read more

• At the 42nd G7 Summit on 26-27 May 2016 in Ise-Shima, Japan, G7 Leaders reaffirmed their continued commitment to polio eradication in the Ise-Shima leaders’ statement. Read more

• The report of the Strategic Advisory Group of Experts on immunization from their meeting in April 2016 has been published, including a discussion on progress made towards polio eradication.

​The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats.

This issue covers the period 29 May - 4 June 2016 and includes updates on Zika virus, an outbreak of enterovirus and yellow fever.

The outbreak of the Ebola virus disease in West Africa from 2014 to 2015 underscored the fragility of public health services in countries emerging from protracted conflict, as well as the link between governance and health. In both Sierra Leone and Liberia, war had seriously undermined the health sector. Ebola arrived as the large-scale postwar international presence was downsizing and the responsibility for healthcare was shifting to the governments. Both governments had developed comprehensive health policies and plans, including devolution of health service delivery, but these were not fully implemented in practice. As a result, they were unprepared to address the Ebola crisis.

In this report, authors Edward Mulbah and Charles Silver explore the response to the Ebola crisis in Sierra Leone and Liberia, respectively. They both begin by examining the state of healthcare governance prior to the outbreak, then look into how health service providers, policymakers, communities, and volunteers grappled with the challenges the outbreak posed. Based on their analysis, the authors identify a number of lessons emerging from the response to the crisis in both countries:

Local engagement is critical: In both countries, the involvement of local actors who understood the local context and were trusted by their communities was crucial to eventually containing the outbreak.

Emergency measures can be effective but can also have negative consequences: The bold containment measures that both governments adopted helped contain Ebola but could have been better implemented.

Top-down approaches are insufficient, and inclusivity is necessary: The shift from a top-down approach to greater involvement of state and non-state actors, including civil society groups and traditional leaders, facilitated prevention, control, and containment.

Highlights

• WFP is providing technical assistance to the disaster management authorities to develop national capabilities to prepare for and respond to future emergencies. This includes working in direct partnership with communities to enhance preparedness to flooding and other environmental shocks.

• In coordination with the Ministry of Education, Science, and Technology, WFP is preparing to restart food for education activities by providing a take home ration for children in food insecure areas.

• Food and cash transfers to Ebola Virus Disease (EVD) orphans and survivors are ongoing nationwide, supporting 18,800 orphans and their caregivers, and 2,703 Ebola survivors.

WFP Assistance

In Sierra Leone, WFP is implementing activities to support recovery from the negative impacts of the EVD outbreak on food security and nutrition among vulnerable populations. Activities include support to primary education of boys and girls through school feeding; (ii) nutritional support to people living with HIV (PLHIV) undergoing anti-retroviral therapy and to TB clients (ART/TB) and treatment of moderate acute malnutrition (MAM) among children aged 6-59 months and pregnant and nursing women (PLW); and (iii) livelihood support through community asset creation and rehabilitation.

In support of the National Ebola Recovery Strategy, WFP plans to start a new Protracted Relief and Recovery Operation in May 2016 to (i) strengthen livelihoods of vulnerable communities; (ii) improve the nutritional status of malnourished children, pregnant and nursing women and people living with HIV and TB; and (iii) develop national capabilities to prepare and respond to future emergencies.

To maintain a robust readiness capability to respond to any EVD flare ups, WFP’s Special Operation (SO 200773) provides logistics and supply chain support, engineering services, emergency ICT and telecommunications provision, and humanitarian air services. Under the SO WFP is also providing practical training and technical assistance to support the development of logistics preparedness and response capabilities for national institutions.

Six Month Net Funding Requirements: A budget revision for the Country Programme (CP) has been approved extending the CP to 31st December 2016.

WFP's CP, which contributes to Sustainable Development Goals (SDGs) 2, 3 and 4 was designed to empower vulnerable households and individuals with the highest rates of food insecurity, malnutrition and illiteracy in meeting their food and nutrition needs in a sustainable way. The CP is also designed to support the government to realise its priorities set forth in the Agenda for Prosperity, particularly advancements in the education sector (SDG4) and improvements in mother and child health, as well as safeguarding the welfare of people living with HIV (SDG3). The livelihood component seeks to build productive assets and to improve food consumption in targeted households facing food insecurity through food/cash for asset creation activities (SDG2).

Given the important role that smallholder farmers have to play in strengthening the country's economy and reducing poverty, the Purchase for Progress (P4P) initiative is tailored to strengthen the capacity of smallholder farmers to access reliable markets. This enables smallholders to sell their surplus crops at competitive prices, thus bolstering their income and reducing their poverty. Food procured through P4P is used to support other activities under the CP such as school feeding, nutrition and asset creation.

What is mVAM?

The World Food Programme’s mobile Vulnerability Analysis and Mapping (mVAM) project collects food security data through short mobile phone surveys, using SMS, live telephone interviews and an Interactive Voice Response (IVR) system. The project also includes an automated two-way communication system to give people access to real-time information for free.

What are the objectives of the project?

The mVAM project aims to:

• Provide high frequency, real-time data on food security to support decision making processes.

• Develop and share a sound methodology to run mobile surveys.

The mVAM story

The mVAM project started in 2013 at WFP offices in Goma, the Democratic Republic of Congo (DRC) and Galkayo, Somalia, with a grant from the Humanitarian Innovation Fund. WFP’s first country-wide SMS and IVR-based food security monitoring system was launched in September 2014, when mVAM was deployed in Guinea, Liberia and Sierra Leone to support the Ebola emergency response. The system has provided WFP with operational information in emergencies, overcoming obstacles related to restricted access and staff safety. In 2015, WFP also deployed the mVAM approach to monitor the food security situation in Iraq and in Yemen. Other countries employing the mVAM approach are Chad, Malawi, Niger, and Sudan.

Increased rainfall to alleviate dryness in areas of West Africa and Central America

Africa Weather Hazards

1. Despite increased rainfall over some areas of the Gulf of Guinea over the past fews weeks, low and erratic rainfall in April and May has led to growing moisture deficits over Liberia and parts of Sierra Leone.

2. Low and infrequent rainfall since late March has resulted in drought across parts of southeastern Kenya and northeastern Tanzania. The potential for recovery remains unlikely as below-average rain is forecast during the next week for coastal regions, and areas inland are now climatologically dry.

Below-normal rain in most regions

Rainfall was below average throughout the region during the past 7 days.
Many areas recorded rainfall deficits between 10-50mm, while some areas received less than 10mm of total rainfall (Figure 1). A few local areas received heavier, and even above-average, amounts of rain, including parts of Sierra Leone, western Guinea, central Mali, and southern Nigeria. Already-dry portions of far western Africa such as Liberia and parts of Sierra Leone remained abnormally dry, with the exception of northern Sierra Leone.
This past week’s limited rain has begun to broaden the region of significant moisture deficits.

An analysis of the cumulative rainfall during the last 90 days indicates a favorable rainfall performance across much of central Gulf of Guinea, with higher rainfall percentile rankings (> 70%) over portions of Burkina Faso, Mali, Niger, Ghana, Togo, and Benin (Figure 2). This was due to a surge in on-shore, southerly flow, bringing moisture and inducing weather disturbances within the region. In contrast, very low percentile rankings (< 10%), indicating that the past month has been among the driest in record, are observed across Liberia, portions of Sierra Leone, and localized areas of Guinea, and southern Togo. Southern portions of Nigeria register similar percentile rankings. The drier than average conditions over areas of Liberia and Sierra Leone are attributed to an extremely poor and erratic start to the rainfall season since mid-April.

During the upcoming week, model forecasts suggest that rains will increase for the eastern part of the Gulf of Guinea region. Rainfall amounts could exceed 100mm in parts of Nigeria. More seasonable, but still substantial rainfall totals are to be expected in far western portions of the region, which could favorably impact areas of abnormal dryness.

Editorial

This rather large issue of Field Exchange has a typically wide range of material from field practitioners and researchers. Some examples of innovative practice include an article by the International Rescue Committee (IRC) that has developed and is field testing approaches for treatment of uncomplicated severe acute malnutrition (SAM) by low-literacy community health workers, as part of community case management in South Sudan. We also have a summary of research conducted in Sierra Leone on an integrated moderate acute malnutrition (MAM) and SAM treatment programme. It is good to see adolescent care featuring, a huge gap area when it comes to nutrition programming; International Medical Corps (IMC) share experiences of adolescent targeted programming in Nigeria and Zimbabwe. The low profile of and access to SAM treatment in emergency-prone East Asia and the Pacific, despite the high burden of wasting, and actions to address this are the subjects of a thoughtful article by the UNICEF regional team. It complements nicely an article on the progress made in the Philippines on this front, which has partly come about through the capacity gaps identified and addressed with external humanitarian support. As ever, the pros and cons of mid upper arm circumference (MUAC) and weight-forheight measures in determining access to acute malnutrition treatment programmes remain a hot topic amongst some of the nutrition fraternity; we feature a cross-section of research that no doubt will fuel discussions that will feature in future issues of Field Exchange.

This editorial would like to focus on two sets of material in particular; namely the new Lancet series on breastfeeding and related articles, and a series of case studies on Global Nutrition Cluster (GNC) experiences in six recent emergencies (Ukraine, Somalia, South Sudan, Yemen, Philippines and Bangladesh).

The first paper in a recent Lancet breastfeeding series reinforces that where infectious diseases are prevalent, exclusive breastfeeding (EBF) is critical to infants under 6 months of age in terms of mortality and infectious disease, and remains significant for children aged 6-24m in reducing mortality and infectious disease morbidity. It’s a worry that in resource poor settings, EBF rates remain stubbornly low. The Lancet paper calls for the need to tailor breastfeeding support strategies to specific patterns recorded in each country. Research from the Democratic Republic of the Congo (DRC), summarised in this issue, reflects such an approach, where a short-cut version of the Ten Steps to Successful Breastfeeding programme made a difference to EBF rates in the target group. Interestingly, adding in community support groups to the clinic-based programme probably made things worse – misinterpretations and mixed messages by the wider interested community were, in all likelihood, behind this finding.

Behaviour change communication (BCC) on feeding practices is a common thread to socalled ‘nutrition sensitive’ programming. It would be interesting to examine – through literature review and likely research - the impact of such BCC, since many factors influence infant feeding decisions. A selection of these are reflected in an article on the social impact of the Kenyan government’s Baby Friendly Community Initiative. Whilst some expected and unexpected social returns were positive (e.g. having healthier children, more paternal support of mothers), some significant negative outcomes of improving maternal and infant and young child feeding (IYCF) were also identified. Mothers reported they were now more worried knowing how they should be feeding their children but in reality, not being able to do so in their circumstance. Key informants reported less income due to job loss as a result of following optimal feeding practices, increased household expenditure on food and health care, increased workload of healthcare providers, financial strain on, and increased stress of, community health volunteers.

The investment case for breastfeeding is the focus of the second Lancet paper. e costs of not breastfeeding in terms of lost Gross Domestic Product (GDP) is used to support the case for breastfeeding investment. However the costing - based on economic calculations around cognitive development consequences of not breastfeeding and increased health costs of sicker non-breastfed children – does not capture the significant opportunity cost to mothers of feeding options, in terms of lost income and time. Such costs need to be monetised and captured in economic calculations or explicitly stated as absent; breastfeeding is not free. This paper reflects a lack of data that is critical to moving forward (or to halt us fighting a losing battle) on the feeding front. Six actions are proposed related to advocacy, societal attitudes, political will, breastmilk substitute (BMS) industry regulation, scale-up of interventions, and removal of structural and societal barriers. But reliable estimates of the costs and benefits of the actions needed to support optimal breastfeeding, including maternity entitlements, are missing. Just one available study estimates that it will cost $17.5 billion globally for a large range of interventions, much of which is maternity entitlements for poor women. Asia and Africa account for 80% of the millions of women with no or inadequate maternity protection; the economic implications and feasibility for governments of recommendations, and how accessible changes would be for the poorest women, is poorly understood. How fair is it to engage in BCC with individual mothers in these challenging contexts, in the absence of the societal and community support to enable change, and how much has it cost us trying and largely failing to do so? It would have been valuable if the Lancet economic analysis could have gone further and scrutinised what investments have been made to date and for what gains; it was not possible to ascertain national or overseas aid budgets for the protection or support of breastfeeding.

One of the challenges for humanitarian programming is how to appraise relative risk in mixed feeding contexts and minimise risks for all infants. The Syria and Ukraine crises pose particularly challenging contexts given the lowrates of EBF and increasing tendency prior to the crises to use BMS (the Lancet series calculates that global infant formula sales in 2014 were US$44.8 billion, most of the 50% growth by 2019 projected in the Middle East, Africa and Asia-Pacific regions). Middle income countries inhabit a grey area between high income and low income settings with declining breastfeeding rates (improved rates more likely amongst the better off women), yet still carrying some of the infectious disease burden that fuels morbidity and mortality risk. There are also inconsistencies been global perceptions of best practice and field experiences. Increases in infant mortality have not been demonstrated amongst the refugees in Jordan, Lebanon and Turkey amongst refugees nor reported in the Europe migrant crisis, despite widespread infant formula use in risky environments.
Children may well be sicker and undernourished (we just haven’t measured it) but it may also reflect that mothers engage their own risk minimisation strategies and adapt more effectively than we give them credit for. An article by Save the Children on their IYCF response in Croatia reflects the challenges of meeting the needs of both breastfed and formula dependent infants in a rapidly transiting population and the necessary compromises in terms of assessment and support offered. These and many more experiences will be reflected in in an update of the Operational Guidance on IYCF in emergencies currently underway (see news piece in this edition).

Our second editorial focus relates to findings from recent and ongoing GNC coordination experiences summarised in this issue. Three themes and challenges from the GNC case studies are worth mentioning here. The first relates to the default response in emergencies (first reported on extensively in the Field Exchange special issue (49) on the response to the Syria crisis) to focus on treatment of acute malnutrition in young children and IYCF to the exclusion of other groups and nutrition challenges. There are many questions for us to ponder. For example, do we have sufficient capacity and understanding to address the needs of the elderly in emergencies (including non-communicable diseases (NCDs)) and do we know how to address high levels of stunting. Emergency contexts are rapidly changing and yet our protocols and institutional capacity seems to be lagging behind these changes.

A second challenge appears to be how to effect inter-sector planning and coordination so that nutrition objectives can become part of so called ‘nutrition sensitive’ planning in emergencies.
Again, the response to the Syria crisis first highlighted the lack of influence of nutrition actors on widespread social protection planning. The GNC case studies in this issue again demonstrate lack of coordination between the nutrition sector and other sectors to enhance the nutrition sensitivity of programming in water, sanitation and hygiene (WASH), food security, health and social protection. A key question is whether the overall cluster mechanism does enough to support the potential for inter-sector collaboration and planning and what role the nutrition cluster can have in realising this potential.

Finally, the case studies show a highly variable engagement in preparedness and longer-term coordination mechanisms – especially where a formal inter-agency standing committee (IASC) activation of the cluster is not needed or wanted. Engagement of the cluster with Scaling Up Nutrition (SUN) actors and mechanisms may provide an excellent opportunity to strengthen links between humanitarian and development planning. The new ENN programme of work to support the SUN Movement’s knowledge management work in fragile and conflict affected states should ensure that ENN is able to fully capture this type of collaboration in the future. e new thematic areas on SUN opened on ennet should also, we hope, help cross-fertilise experiences between cluster/SUN mechanisms (for example, see www.en-net.org/question/ 2485.aspx) and develop connections between humanitarian and development practitioners.

A final word on Field Exchange itself. As you’ll have noticed, the size of our print edition has grown over the last couple of years (issue 24 was just 28 pages!). This reflects, no doubt, the appetite to share and learn from each other and the breadth of programming and research now relevant to nutrition. However, we do need to consider what is manageable to sustain (in terms of resources) and digest (for our readership).

So over the coming months, we’ll be looking to innovate a little on how we deliver Field Exchange content to you, such as selected content for print, online editions, changes in format, etc.
We’ll contact those of you who have shared your email addresses for feedback and welcome unsolicited suggestions anytime; make sure your contacts are up to date (or add them) at: www.ennonline. net/subscribe/fex

Jeremy Shoham & Marie McGrath Field Exchange Co-editors

• L’urgence de santé publique de portée internationale liée à Ebola en Afrique de l’Ouest a été déclarée terminée le 29 mars 2016. Au total, 28 616 cas confirmés, probables et suspects ont été notifiés en Guinée, au Libéria et en Sierra Leone, dont 11 310 décès.

• Dans le dernier foyer de cas, sept cas confirmés et trois cas probables de maladie à virus Ebola ont été notifiés entre le 17 mars et le 6 avril par les préfectures de N’Zérékoré (neuf cas) et Macenta (un cas) dans le sud-est de la Guinée. Entre le 1er et le 5 avril, trois cas confirmés ont également été notifiés à Monrovia (Libéria) ; il s’agit de la femme et des deux enfants du cas de Macenta, qui se sont rendus à Monrovia.

• Le cas indicateur de ce foyer (une femme âgée de 37 ans de Koropara, une souspréfecture de N’Zérékoré) a vu ses symptômes apparaître aux environs du 15 février et est décédé le 27 février sans diagnostic confirmé. La source de son infection est probablement due à une exposition à des liquides biologiques infectés d’un survivant d’Ebola.

• En Guinée, le dernier cas a obtenu un deuxième résultat négatif au test de dépistage d’Ebola le 19 avril. Au Libéria, le dernier cas a obtenu un deuxième résultat négatif le 28 avril.

• Le délai de 42 jours (deux fois la période d’incubation) qui doit s’écouler avant de pouvoir déclarer la fin de la flambée épidémique au Libéria prendra fin le 9 juin. La Guinée a déclaré la fin de la transmission du virus Ebola le 1er juin.

• La Sierra Leone a contenu la dernière flambée d’Ebola en mars 2016 ; elle maintient une surveillance soutenue en réalisant des écouvillonnages et des tests sur toutes les personnes dont le décès a été signalé, et en procédant sans délai à l’investigation et au dépistage de tous les cas suspects. La politique d’écouvillonnage sera revue le 30 juin.