Report 11

Lisa Denney, Rachel Gordon, Aminata Kamara and Precious Lebby | May 2016

Full summary:

Concerns about significant increases in Sierra Leone’s already high rates of teenage pregnancy during the Ebola crisis have led to redoubled efforts among policy-makers and development practitioners to address this problem. The startling health and education impacts on teenage girls -twice as many mothers aged 15-19 die in childbirth compared to those over 20 while teen pregnancy is one of the leading causes of school dropouts - underline the importance of these efforts. The central argument of this report is that common programming approaches focus overwhelming on girls, rather than the wider context which shapes girls’ actions. This approach ignores the different types of sex through which girls are getting pregnant, assumes knowledge promotion can lead to behaviour change and overlooks the justice and socio-economic components of the problem. If the Government of Sierra Leone’s renewed National Strategy for the Reduction of Teenage Pregnancy is to succeed, a more contextually tailored approach is needed. To that end, six recommendations are proposed.

The Migration Geo-Portal aspires to promote a better understanding of migratory trends towards Europe through in-depth data analysis and visualisation. Our work focuses specifically on migrant arrivals, and fatal incidences during the sea journeys, to Italy, Greece, and Spain. We update the Migration Geoportal monthly giving insight into the most recent developments in the Mediterranean diaspora.

The Famine Early Warning Systems Network (FEWS NET) monitors trends in staple food prices in countries vulnerable to food insecurity. For each FEWS NET country and region, the Price Bulletin provides a set of charts showing monthly prices in the current marketing year in selected urban centers and allowing users to compare current trends with both five-year average prices, indicative of seasonal trends, and prices in the previous year.

West Africa can be divided into three agro-ecological zones or three different trade basins (West Basin, Central Basin and East Basin). Both important for understanding market behavior and dynamics.

The three major agro-ecological zones are the Sahelian, the Sudanese and the Coastal zones where production and consumption can be easily classified. (1) In the Sahelian zone, millet is the principal cereal cultivated and consumed particularly in rural areas and increasingly, when accessible, in urban areas. Exceptions include Cape Verde where maize and rice are most important, Mauritania where sorghum and maize are staples, and Senegal with rice. The principal substitutes in the Sahel are sorghum, rice, and cassava flour (Gari), the latter two in times of shortage. (2) In the Sudanese zone (southern Chad, central Nigeria, Benin, Ghana, Togo, Côte d'Ivoire, southern Burkina Faso, Mali, Senegal, Guinea Bissau, Serra Leone, Liberia) maize and sorghum constitute the principal cereals consumed by the majority of the population. They are followed by rice and tubers, particularly cassava and yam. (3) In the Coastal zone, with two rainy seasons, yam and maize constitute the most important food products. They are supplemented by cowpea, which is a significant source of protein.

The three trade basins are known as the West, Central, and East basins. In addition to the north to south movement of particular commodities, certain cereals flow horizontally. (1) The West basin refers to Mauritania, Senegal, western Mali, Sierra Leone, Guinea, Liberia, and The Gambia where rice is most heavily traded. (2) The Central basin consists of Côte d'Ivoire, central and eastern Mali, Burkina Faso, Ghana, and Togo where maize is commonly traded. (3) The East basin refers to Niger, Nigeria, Chad, and Benin where millet is traded most frequently. These three trade basins are shown on the map above.

Key Messages

• Dans le nord-est du Nigeria durement affecté par le conflit de Boko-Haram, l’insécurité alimentaire de niveau Crise (Phase 3 de l’IPC) persiste dans plusieurs zones des Etats de Yobe, Borno et Adamawa avec des niveaux d’Urgence (Phase 4 de l’IPC) surtout dans l’Etat de Borno. Le risque de niveaux élevés de malnutrition aiguë et de surmortalité y est accru. Les zones moins accessibles, connaissent probablement des situations similaires ou pires et sont confrontées à un risque accru de famine (Phase 5 de l’IPC) en 2017.

• Bien que l’assistance humanitaire ait augmenté ces derniers mois dans le nord-est de Nigeria une grande partie de la population a encore besoin d'une aide alimentaire et d'autres services de base. Aussi, avec la dépréciation persistante du naira, les ménages vulnérables dans la région du lac Tchad seront les plus touchés, et les ménages pauvres dépendants du marché à travers le pays seront également confrontés à des contraintes d'accès à l'alimentation.

• La majorité de la région de l'Afrique de l'Ouest restera en situation Minimale (Phase 1 de l’IPC) jusqu’en septembre 2017 grâce au bon niveau des stocks ménages, des tendances de productions agricoles supérieures à la moyenne cette année, au fonctionnement normal des marchés et à la mise en œuvre des stratégies habituelles de moyens d’existence.

• Toutefois, des niveaux d’insécurité alimentaire Stress (Phase 2 de l’IPC) s’observent déjà dans l’ouest et l’est de la zone agropastorale en Mauritanie du fait des faibles productions agricoles et de la vente élevée de bétail. Ce niveau sera atteint entre mars et juillet 2017 dans la zone pastorale du Niger en raison des déficits de productions pastorales et la baisse générale de la demande de bétail, entre juin et septembre au Mali dans les zones de riz de submersion de Mopti, Tombouctou, Gao et dans le Sahel occidental et la zone des lacs de Goundam du fait des baisses importantes de production.

• L’insécurité alimentaire de niveau Crise (Phase 3 de l’IPC) pourraient s’observer dans la région de Diffa où la crise sécuritaire persiste et perturbe le fonctionnement normal des marchés et les principaux moyens d’existence, et dans les régions du Lac et de Borkou-Ennedi-Tibesti (BET), dans la Tandjilé, dans le Bahr El Gazal (BEG), et le Wadi Fira au Tchad du fait de la baisse importante des revenus.

• Les marchés sont bien approvisionnés en divers produits issus des nouvelles récoltes avec des prix stables voir en baisse, facilitant ainsi l’accès. Cependant, au nord du Mali et dans le bassin du Lac Tchad, l’insécurité civile continue de perturber le fonctionnement des marchés. Aussi, la dépréciation continue Naira continue de maintenir une tendance haussière des prix des denrées aux Nigeria de limiter les opportunités de vente de bétail et de produites de rentes des pays sahéliens vers le Nigeria.

ABOUT

• MHub is undertaking field surveys with migrants, refugees and asylum seekers along key migratory routes to build up a body of data over time and to map country and regional level mixed migration trends.

• This snapshot presents early survey findings of the profiles, intentions and experiences of those moving in mixed migration flows who have recently arrived in Italy in the last year.

• Though these findings cannot be considered statistically representative of the migration population, they do provide key insights into the migration process.

KEY FINDINGS

Findings are based on 381 surveys conducted with irregular migrants that transited through North Africa to Italy (23% female - 77% male) including respondents from Nigeria (28.1%), Eritrea (11.5%), Gambia (10.8%), Cote d’Ivoire (8.9), Mali (8.1%), Ghana (6.8%), Senegal (6.6%), Cameroon (3.1%), Bangladesh (2.6%), Ethiopia (2.1%), Guinea (2.1%), as well as (9.1% cumulative for the remainder) Togo, Pakistan, Central African Republic (CAR), Sudan, Somalia, Burkina Faso, Morocco, Sierra Leone, Democratic Republic of the Congo (DRC), Niger, Liberia, Libya and Afghanistan between 3 March 2016 and 25 January 2017 in Asti, Bologna, Castellammare del Golfo, Milan, Modena, Palermo, Rome, Trapani and Turin.

Le Réseau de systèmes d’alerte précoce contre la famine (FEWS NET) surveille les tendances des prix des aliments de base dans les pays vulnérables à l'insécurité alimentaire. Pour chaque pays et chaque région couvert par FEWS NET, le Bulletin des prix fournit un ensemble de graphiques indiquant les prix mensuels de l’année commerciale en cours pour certains centres urbains, et permettant à l’utilisateur de comparer les tendances actuelles à la fois aux moyennes quinquennales, qui indiquent les tendances saisonnières, et aux prix de l'année précédente.

L'Afrique de l’Ouest peut être divisée en trois zones agro-écologiques ou en trois bassins commerciaux (bassins de l’ouest, bassin du centre, bassin de l’est). Les deux sont importants pour l'interprétation du comportement et de la dynamique du marché.
Les trois principales zones agro-écologiques incluent la zone Sahélienne, la zone Soudanaise et la zone Côtière où la production et la consommation peuvent être facilement classifiées. (1) Dans la zone Sahélienne, le mil constitue le principal produit alimentaire cultivé et consommé en particulier dans les zones rurales et de plus en plus par certaines populations qui y ont accès en milieux urbains. Des exceptions sont faites pour le Cap Vert où le maïs et le riz sont les produits les plus importants, la Mauritanie où le blé et le sorgho et le Sénégal où le riz constituent des aliments de base. Les principaux produits de substitution dans le Sahel sont le sorgho, le riz, et la farine de manioc (Gari), avec les deux derniers en période de crise. (2)
Dans la zone Soudanienne (le sud du Tchad, le centre du Nigéria, du Bénin, du Ghana, du Togo, de la Côte d'Ivoire, le sud du Burkina Faso, du Mali, du Sénégal, la Guinée Bissau, la Sierra Leone, le Libéria) le maïs et le sorgho constituent les principales céréales consommées par la majorité de la population. Suivent après le riz et les tubercules particulièrement le manioc et l’igname. (3) Dans la zone côtière, avec deux saisons de pluie, l’igname et le maïs constituent les principaux produits alimentaires. Ils sont complétés par le niébé, qui est une source très significative de protéines.
Les trois bassins commerciaux sont simplement connus sous les noms de bassin Ouest, Centre, et Est. En plus du mouvement du sud vers le nord des produits, les flux de certaines céréales se font aussi horizontalement. (1) Le bassin Ouest comprend la Mauritanie, le Sénégal, l’ouest du Mali, la Sierra Leone, la Guinée, le Libéria, et la Gambie où le riz est le plus commercialisé.

(2) Le bassin central se compose de la Côte d'Ivoire, le centre et l’est du Mali, le Burkina Faso, le Ghana, et le Togo où le maïs est généralement commercialisé. (3) Le bassin Est se rapporte au Niger, Nigéria, Tchad, et Bénin où le millet est le plus fréquemment commercialisé. Ces trois bassins commerciaux sont distingués sur la carte ci-dessus.

The Desert Locust situation improved during March and became calm in all countries. Low numbers of locusts were present in a few countries and limited ground control operations were carried out in Morocco. Small-scale breeding is expected to occur during the spring in the interior of Saudi Arabia, Yemen and southeast Iran where good rains fell in March. Although this will cause locust numbers to increase slightly, they should remain below threatening levels. Spring breeding will also occur in Northwest Africa if more rain falls along the southern side of the Atlas Mountains. Regular surveys should be conducted throughout the spring to monitor the situation and prepare for the summer breeding period.

Western Region. The situation remained calm in the region during March. Limited control operations (20 ha) were carried out against high densities of adults, some of which were copulating, in the northern portion of the Western Sahara in southern Morocco. Low numbers of adults continued to mature in the central Western Sahara, and in northwest and northern Mauritania. Isolated adults were present near irrigated farms in the central Sahara of Algeria. If more rains fall, limited breeding may occur in the aforementioned areas as well as along the southern side of the Atlas Mountains in Morocco and Algeria. A few small groups could form in northern Western Sahara as vegetation dries out. No locusts were reported elsewhere in the region.

Central Region. The locust situation improved in Saudi Arabia as a result of previous control operations, and no locusts were seen in March during intensive surveys. Similarly, locust numbers declined in Sudan and Yemen where only scattered adults remained in a few places along the Red Sea coast, and scattered adults were present in southeast Egypt. Ecological conditions are expected to improve in the interior of Saudi Arabia and Yemen where widespread, good rains fell after mid-March. Consequently, one generation of breeding could occur, causing locust numbers to increase slightly in both countries. Smaller-scale breeding may also occur in coastal and interior areas of northern Oman.

Eastern Region. No locusts were reported and the situation remained calm in the region during March.
However, good rains fell in coastal and interior areas of southeast Iran that are likely to allow one generation of small-scale breeding to occur during the forecast period, causing locust numbers to increase slightly.

By Harriet Mason

Sierra Leone has one of the highest rates of maternal mortality in the world. Because of limited health facilities in the country, many women living in remote areas don't have access to the care they need for a safe delivery.

With funding from the European Union, UNICEF is working with the Government to rehabilitate existing hospitals and build new ones, so all new mothers can receive proper medical attention.

KONSHO, Sierra Leone, 5 April 2017 – Bakey Kamara is eight months pregnant with her third child and has just walked two miles under a hot sun for one of her last antenatal check-ups. Nonetheless, she’s visibly excited on arrival at Konsho Community Health Post, a centre that’s just had an upgrade, including a new maternity facility. “I’m glad for this new building and everything in it. It really looks different and nicer than what we had before,” says the 25-year-old.

Sierra Leone has one of the highest maternal mortality rates in the world with 1,360 mothers dying per 100,000 live births. 1 in 17 mothers in Sierra Leone have a lifetime risk of death associated to childbirth, according to estimates from 2015.

Dr. Brima Osaio Kamara, District Medical Officer of Bombali district, says limited health facilities in remote parts of the country are a major contributing factor. “The distance from most communities to available health facilities is long. So people, especially pregnant women, find it difficult to access crucial health services when they need them,” he says.

A key concern

Tackling maternal mortality in Sierra Leone, and meeting the global target of reducing the ratio to fewer than 70 per 100,000 live births by 2030, remains a key concern for the Government of Sierra Leone. UNICEF and the European Union are working in partnership with the Government to address the issue.

As part of this effort, UNICEF, with funding from the EU, has supported the Government of Sierra Leone with a nationwide construction and rehabilitation project in 23 district hospitals, peripheral health units and medical stores, worth $4.7 million. The work focuses on rehabilitating and expanding maternity and pediatric wards, as well as constructing and rehabilitating staff quarters and medical stores, fitting all of them with water, sanitation and hygiene facilities, and equipping them with solar power.

“We remain committed to working hard to reduce the alarming number of women and their newborns dying due to child birth complications,” says Dr. Nuzhat Rafique, Health Manager at UNICEF Sierra Leone. “This recent investment in construction work will directly help improve health service delivery for mothers and babies and ensure better conditions for health workers.”

“We know that buildings and equipment alone don’t save lives, which is why this is part of a wider investment in the health sector by the European Union, through UNICEF, worth around $25 million dollars. Since 2013, the money has been invested in training for health workers and health governance, and supported the President’s Free Health Care initiative,” she says.

The upgraded facilities were officially opened by the President of Sierra Leone, H.E. Dr Ernest Bai Koroma, on 4 February 2017 at a ceremony in Kenema, a major town in the south of the country.

Providing much needed basic services

When the Konsho community health post was established in 2012, there was no running water and limited space and equipment to attend to patients and clients, according to nurse Zainab Tity Sawaneh, who has been working from the beginning. “We had just one delivery bed so women had to deliver on mats or cloth on the floor, when we had more than one delivery. That was very uncomfortable for us and the women, and made infection prevention and control difficult,” she says.

Now the nurses, patients and even relatives who accompany them have access to the basic but needed facilities, including running water and electricity. In the past, the only way to light night time deliveries was by mobile phone. “There will be no reason now to drop my phone in fluids when conducting deliveries because I won’t need it since we now have solar power!” she says.

The health post currently serves about 3,000 people from 13 villages, but has now been put on a better footing to provide improved health services to a larger population.

The feeling of gratitude for the support is also shared by the men. “We can’t thank EU and UNICEF enough for what they have done for us,” says Musa Koroma, a middle-aged man in Konsho. “Now we, especially the women and children, feel more convinced to come to the facility whenever there is need.”

In a country with such high maternal and child mortality, making health services accessible and appealing to people can go a long way in addressing maternal mortality. For women like Bakey, the added comfort the health facility now offers is worth the journey from their villages and will help take away the temptation to deliver babies or treat sick children at home.

“Now I don’t have any excuse not to access the health centre. I feel even more confident to come here when I need to,” she says. “I am really excited about giving birth to this baby here,” she adds, smiling and pointing at her tummy.

EXECUTIVE SUMMARY

This report presents research that looked at the integrity of the response to the Ebola crisis provided in Guinea and, for comparative analysis Sierra Leone, as part of the CREATE project (Collective Commitment to Enhance Accountability and Transparency in Emergencies) led by Transparency International (TI) in partnership with Humanitarian Outcomes (HO) and Groupe URD. The objectives fo the research were: to highlight the risks on integrity which humanitarian actors face in the response to the Ebola epidemic; to highlight the preventive/mitigation measures, tools and good practices implemented by humanitarian actors to ensure integrity in their operations; and to make actionable recommendations to humanitarian actors to enhance the integrity of the response in future similar crises.

A qualitative research approach was used for this study, including interviews with key stakeholders and community consultations as well as the inputs of a national stakeholder group comprised of both national institutions and international stakeholders, the research team visited the areas in Guinea that were affected by the Ebola crisis, and made a short visit to Sierra Leone to allow comparisons to be made.

The Ebola epidemic was a very specific crisis in a fragile context. When the haemorrhagic fever epidemic linked to the Ebola virus struck Guinea, Sierra Leone and Liberia, the countries were emerging from years of difficult conflict, refugee camps and major political crises, with repeated phases of acute tension. The health crisis led to a high level of mortality, particularly when the response was slow, with a high risk of contamination. The specific way that this crisis developed had as much to do with the recent opening up of forest areas (roads, markets, and rural exodus), which promoted exchanges with cities and non-forest regions, as it had to do with the shortcomings of the health systems.

The forest areas of the Mano River region have specific socio-cultural characteristics. As a result, a specific effort was required to explain and communicate about the disease and its epidemiological parameters (such as the management of bodies and interaction with traditional medicine).

Unfortunately, this did not take place at the beginning of the crisis, which put front line workers in greater danger. During responses like the Ebola response (complex crises in complicated environments), the added value of social scientists is often recognized only late and can be a hindrance to the early mobilization of resources.

The absence of a vaccine or specific drugs meant that the response was limited to treating symptoms and supporting the capacity of individuals, through nutrition, hydration and combatting related diseases, and this is most effective when the patient is taken into care rapidly.

However, the response to Ebola had to deal with challenges on various levels:

• At the community level, with the rejection of healthcare providers, and the stigmatization of victims and their families;
  
• At the level of neighbouring countries, with the embargo and the blocking of borders which significantly hampered the response;
  
• At the level of the international community who only began to react fully when the first cases were observed on other continents.

Summary

• The 2014–16 West African Ebola epidemic was unprecedented in both scale and duration.
By March 2016, when the World Health Organization (WHO) announced an end to the Public Health Emergency of International Concern declared in August 2014, some 28,616 confirmed, probable and suspected cases, with 11,310 deaths, had been reported in Guinea, Liberia and Sierra Leone – the three worst-affected countries.

• The exceptional magnitude and duration of the emergency meant that the response was honed over time, presenting a rare opportunity to study the management of the response as it matured. This paper focuses on Sierra Leone, which experienced the highest number of cases, with 14,124 infections, including 3,956 deaths, reported to WHO, and where the operational architecture of the Ebola response went through three main iterations over a 22-month period.

• The initial response to the outbreak was characterized by confusion, chaos and denial. While a country can be overwhelmed by a serious outbreak, a situation in which WHO fails to mobilize the assistance needed to help a national government take control of an epidemic is unusual. The rest of the international community was, meanwhile, slow to rally. The window of opportunity to contain the outbreak through conventional control approaches closed, and the outbreak became a humanitarian crisis.

• A number of international actors poured resources and expertise into the response, including through a specially created UN Mission for Ebola Emergency Response (UNMEER).
The UK, through a joint civilian–military operation, took a leading role among Sierra Leone’s international partners, including in overwhelmingly funding and supporting the National Ebola Response Centre (NERC) and a network of District Ebola Response Centres (DERCs).

• The paper draws on a set of interviews with key Sierra Leonean and international responders who were embedded in the various command-and-control structures during the emergency.
These shed light on the challenges that, to varying degrees and at various times, affected the response. Among issues highlighted were political manoeuvring and probity, inadequate financial agility, lack of coordination, partner ambivalence towards response structures, and tensions in the key relationships.

The NERC, chaired by Sierra Leone’s president and under the operational control of the defence minister, was judged a qualified success, considering the varied agendas, operational cultures and complexity of the problems encountered. Decentralization of the response appeared to be important for the level of agility and tailoring necessary. As in most humanitarian operations, personalities and personal relationships appeared to be key to the functioning of the response.

• The establishment of a civilian-led, military-supported operation appeared to work well.
However, what took shape in Sierra Leone in response to the Ebola outbreak reflected a rare convergence of factors that is unlikely to be replicated, and care should be taken not to generalize the applicability of the approach taken in this instance to future health crises.

See more at: Chatham House

Nina DeVries

FREETOWN, SIERRA LEONE — With the recent Ebola crisis, officials in Sierra Leone have seen a rise in mental health concerns. Mustapha Kallon's problems are typical. He survived Ebola but lost many family members during the epidemic.

"Whenever I think of my parents, I feel depressed," he said.

Kallon said he turned to alcohol to cope with his grief. He was still receiving care in the Ebola treatment unit when his parents died from the virus. He didn't get to say goodbye and doesn't even know where they are buried.

Sometimes Kallon goes with fellow Ebola survivors when they visit the graves of their loved ones.

'I always cry'

"I feel like dying ... I always cry when I am there," he said. "I always feel pity, because I can't find their graves."

The corpses of people infected with Ebola can be very contagious. During the epidemic, burying the dead quickly and safely was so important to stopping transmission that proper records were not kept and some graves were left unmarked.

From 2014 to 2016, the regional Ebola epidemic killed just over 11,000 people. Nearly all of them were in West Africa, with about 4,000 in Sierra Leone.

Those who survived the virus have faced stigma. Kallon was shunned by his community. It was only through support from the Sierra Leone Association of Ebola Survivors that he started to heal.

"When I am among my colleague survivors, we explain to ourselves what we go through, and that helps us to forget about the past and face the future," he said.

Many of the Ebola survivors in Sierra Leone are going through similar struggles, said Dr. Stephen Sevalie, one of the country's only psychiatrists.

"Our data has not been analyzed yet, but I can tell you that mental health symptoms are quite high among Ebola survivors," he said.

Scientists are studying a host of symptoms now known collectively as post-Ebola syndrome. Symptoms include loss of eyesight, joint pain and fatigue, as well as mental health issues like depression and anxiety.

Mental health, however, is a much wider problem in Sierra Leone. An estimated 240,000 people in the country suffer from depression.

Help within communities

Florence Baingana, who heads the mental health team with the World Health Organization in Sierra Leone, said that as a result of the Ebola epidemic, the Ministry of Health, with the support of the WHO, has trained 60 community health officers.

"So we are trying to get services down to as many people as possible," she said. "We are training health workers in psychological first aid so they can recognize and do some listening and helping."

Baingana added that it's not just Ebola survivors who have been suffering since the epidemic. Health care workers, burial workers and others involved in response efforts have also reported mental health concerns.

Nadia Nana Yilla, who volunteered in communities to help raise awareness about Ebola, said hearing people's painful stories took a toll at times.

"I cried endlessly," she said. "For me, that's my way of dealing with depression. I just isolate and seclude and cry it out … so sometimes if you cry, it really helps. If you can't cry it out, you have to find someone to talk to."

And that is the message on this World Health Day, April 7: People need to talk to someone if they are feeling depressed.

Kallon said that had he not reached out to others, he might not have been able to get through his depression. And although it's still hard at times, having that support around him helps, he said.

The Desert Locust situation improved during March and became calm in all countries. Low numbers of locusts were present in a few countries and limited ground control operations were carried out in Morocco. Small-scale breeding is expected to occur during the spring in the interior of Saudi Arabia, Yemen and southeast Iran where good rains fell in March. Although this will cause locust numbers to increase slightly, they should remain below threatening levels. Spring breeding will also occur in Northwest Africa if more rain falls along the southern side of the Atlas Mountains. Regular surveys should be conducted throughout the spring to monitor the situation and prepare for the summer breeding period.

Western Region. The situation remained calm in the region during March. Limited control operations (20 ha) were carried out against high densities of adults, some of which were copulating, in the northern portion of the Western Sahara in southern Morocco. Low numbers of adults continued to mature in the central Western Sahara, and in northwest and northern Mauritania. Isolated adults were present near irrigated farms in the central Sahara of Algeria. If more rains fall, limited breeding may occur in the aforementioned areas as well as along the southern side of the Atlas Mountains in Morocco and Algeria. A few small groups could form in northern Western Sahara as vegetation dries out. No locusts were reported elsewhere in the region.

Central Region. The locust situation improved in Saudi Arabia as a result of previous control operations, and no locusts were seen in March during intensive surveys. Similarly, locust numbers declined in Sudan and Yemen where only scattered adults remained in a few places along the Red Sea coast, and scattered adults were present in southeast Egypt. Ecological conditions are expected to improve in the interior of Saudi Arabia and Yemen where widespread, good rains fell after mid-March. Consequently, one generation of breeding could occur, causing locust numbers to increase slightly in both countries. Smaller-scale breeding may also occur in coastal and interior areas of northern Oman.

Eastern Region. No locusts were reported and the situation remained calm in the region during March.
However, good rains fell in coastal and interior areas of southeast Iran that are likely to allow one generation of small-scale breeding to occur during the forecast period, causing locust numbers to increase slightly.

Introduction

It is a fact that natural hazards disproportionately affect lower-income countries and those who benefit least from wealth creation owing to economic globalization. In Africa, in particular, various forms of vulnerability have the potential to amplify minor hazard events into major disasters. Since 1970, Africa has experienced more than 2,000 disasters, with just under half taking place in the last decade. The most common disasters in Africa consist of floods and droughts; however, other hazards such as cyclones, earthquakes, landslides, volcanoes and epidemics have serious implications in sustainable water supply, health, food security, agricultural productivity, livelihoods and fiscal risk management. These disrupt the normal functioning of states, economies and development efforts at large, seriously undermining their prospects of achieving the Sustainable Development Goals.

African governments and Regional Economic Communities (RECs), under the aegis of the African Union Commission (AUC), adopted the Extended Programme of Action for the Implementation of the Africa Regional Strategy for Disaster Risk Reduction (PoA) in line with the Hyogo Framework for Action (HFA). The PoA sets out strategic areas of intervention, offers policy guidance at regional level, as well as key activities, expected results, measurable indicators and mechanisms for coordination and support. Coordination of this framework is ensured by the AUC and RECs through the African Working Group on Disaster Risk Reduction (AWG DRR). Moreover, four of these RECs have established Disaster Risk Reduction (DRR) policies and/or strategies based on the priorities for action of both the HFA and the PoA: Economic Community of West African States (ECOWAS), Intergovernmental Authority on Development (IGAD), Economic Community for Central African States (ECCAS) and Southern African Development Community (SADC). The RECs perform a twin role in supporting disaster and climate risk management. Several of them house the sub-regional institutions and capacity for early warning, emergency response and data sharing. They also serve as the coordinating entities for member states’ individual efforts at disaster and climate risk management, which allows regional integration and economies of scale.

Despite this engagement at all levels, the prevention, mitigation of and preparedness to natural hazards is still an emerging issue in the policy agenda of many African governments. As disasters have flow-on effects to entire countries and sub-regions, a fully integrated, allsector approach, is needed to secure development gains in Africa based on accurate risk information and improved decision support systems. Development assistance must deliver the greatest direct benefits for cost and prevention as well as disaster management also enhance competitiveness and strengthen resilience to increasing global risks and shocks, in particular in times of economic crisis. Therefore, the Building Disaster Resilience to Natural Hazards in Sub-Saharan African Regions, Countries and Communities Program (in short “Building Disaster Resilience in Sub-Saharan Africa Program”) proposes a complete cycle of disaster risk management (DRM) measures and capacity building through risk identification and assessment, risk reduction and preparedness, risk financing and resilient recovery and reconstruction. The purpose is to provide the analytical basis and accelerate the effective implementation of a comprehensive DRR framework for the African continent.

Recognizing that Africa is particularly vulnerable to the impacts of climate change, the World Meteorological Organization has launched the Training Programme on Climate Change Adaptation and Disaster Risk Reduction in Agriculture to improve the capacity of national technical services in West African countries. The programme seeks to reduce the impacts of natural disasters and climate change on the agricultural sector and to support sustainable development.

“Climate change is threatening food security in many parts of the world,” said WMO Secretary-General Petteri Taalas. “This new training program will make a significant contribution to strengthening the capacity of the technical services of West African countries to address the impacts and risks of climate change on agriculture through early warning systems and climate prediction.”

The partners for the project are two WMO Regional Training Centers: the Institute of Biometeorology of the Italian National Research Council (CNRIBIMET), represented at the inaugural ceremony at WMO by the Italian Ambassador, His Excellency Ambassador Maurizio Serra and by IBIMET Director Mr Antonio Raschiand, and the AGRHYMET Regional Center, represented by Mr Etienne Saar.

The project will be implemented in the 15 member states of ECOWAS (Benin, Burkina Faso, Cape Verde, Ivory Coast, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo) plus in Mauritania and Chad. With a budget of some €820 000, the 12-month project will focus on training experts from national agriculture, agro-meteorological, hydrological and early warning services.

The project will organize training courses for technicians and experts of national services in order to develop effective climate services for climate change adaptation and disaster risk reduction. The main objective of the training is to enhance the participants' ability to plan and adopt strategies to mitigate the effects of these phenomena and to harmonize the methods of analysis, thereby strengthening cooperation at regional level.

The project will also consolidate a network among scientific and technical institutions in order to work on shared methodologies and to create an objective and harmonized base of information. The aim is to transfer and share the know-how, to expand cooperation in sensitive areas to the national and regional level and to promote exchanges and collaboration.

Africa is one of the most vulnerable regions to climate change impacts in the world because of its widespread poverty and its limited adaptation ability. Since the 1990s, the issue of natural disasters has gained international visibility. In addition, because much of West Africa’s growing population relies on rain-fed agriculture, the region is vulnerable to crises that can turn into humanitarian disasters, such as the one that hit East Africa in 2011 when a long period of extreme drought threatened the survival of millions of people.

Highlights

• Food distributions to orphans in foster families nationwide is ongoing, targeting the most vulnerable orphans.

• The Nutrition unit held a stakeholders meeting on stunting prevention and incentives for immunization in Moyamba district which identified synergies and common platforms for joint programming.

• WFP completed food deliveries to health centres for tuberculosis clients on directly observed treatment, short course and distributions are expected to end in April.

Operational Updates

• Food distributions to orphans in foster families nationwide is ongoing. The current food assistance is for three months (February to April 2017) and targets the most vulnerable orphans. A monthly household food ration is provided to cater to the food needs of foster families.

• The Nutrition unit held a meeting of stakeholders on stunting prevention and incentives for immunization in Moyamba district. The meeting brought together amongst others, the District Health Management Team representatives, World Health Organization, World Vision, Cause Canada, Action Against Hunger, Health Coalition Sierra Leone and the Moyamba district council. The meeting identified synergies and common platforms for joint implementation with other nutrition specific projects in the district.

• WFP completed food deliveries to health centres for tuberculosis (TB) clients on directly observed treatment, short course (DOTS) and distributions are expected to end in April. WFP supports the integration of nutritional rehabilitation as a standard component of TB comprehensive treatment packages which includes nutrition assessment and counselling for all clients and the provision of nutritious food for those clients who are malnourished based on anthropometric criteria.

UNITED NATIONS, Apr 11 2017 (IPS) - The Group of 77 has pointed out that the Ebola crisis of 2014-2015 proved that “no country is immune from a disease outbreak, no matter where it emerges”

The Group has argued that the world is now a big village, where the borders between countries are crossed by millions every day for different reasons– a better life for some, a migration for others, all due to different factors, including climate change and the outbreak of fast-spreading diseases.

Speaking on behalf of the Group of 77, joined by China, Lourdes Pereira of the Ecuadorean Mission to the UN told the Fifth Committee that since the 2014 Ebola outbreak, it became quickly evident that one country alone, with limited capacities and resources, could not face singlehandedly a threat of that dimension spreading across the borders – particularly, if it was not contained with global efforts.

But it also became evident, she pointed out, that regional and international organizations in charge of health, in particular the World Health Organization (WHO), did not have the relevant mechanisms and resources in place for a rapid response to stem the tide of the crisis.

“Uncertainty, fear and a lack of capacity and preparedness contributed to an ineffective and delayed response.”

She expressed the Group’s appreciation for the establishment of the United Nations Mission for Ebola Emergency Response (UNMEER), the first-ever UN emergency health mission.

Despite serious challenges, the presence of UNMEER played a catalytic role in mobilizing the necessary financial and human resources to scale up the response to fight a disease which mostly affected West Africa.

The UN Mission contributed in bolstering national operational response capacity of the three Ebola affected countries, namely, Liberia, Guinea and Sierra Leone where more than 11,000 died.

The Group underlines that, the availability of immediate funds in an emergency intervention, flexible enough to meet identified critical gaps, is every important and helps build synergies of the global response.

To this end, the Group commended the Office of the Special Envoy on Ebola for its role in mobilizing extra-budgetary resources to the Ebola Multi-Partner Trust Fund, the international institutions, in particular WHO, OCHA, the bilateral and multilateral partners, the African Union and sub-regional organizations, the civil society, and many others for their fundamental contributions during the Ebola outbreak.

She said the reports under consideration by the Fifth Committee highlighted the numerous challenges encountered in the fight against the Ebola virus disease.

These challenges included, but not limited to the lack of coordination, initial confusion on responsibility sharing; trained and experienced personnel; inefficiencies in the use of new mechanisms which led to the loss of time; ineffective community engagement; proper logistic coordination; information on the financial performance of the Mission and on the liquidation and disposal of assets.

In order to avoid future problems in such crisis situations, the Group underlined the importance of building on existing institutional and coordination mechanisms, working with entities already on the ground such as the WHO and the United Nations Country team and the African Union, so as to reduce confusion, especially in the midst of health crises such as the recent Ebola outbreak.

Situation Générale en mars 2017

Prévision jusqu'à’mi-mai 2017

La situation relative au Criquet pèlerin s’est améliorée en mars et est devenue calme dans tous les pays. Des criquets en faibles effectifs étaient présents dans quelques pays et des opérations de lutte terrestre limitées ont été réalisées au Maroc. On s’attend à ce qu’une reproduction à petite échelle ait lieu au printemps dans l’intérieur de l’Arabie Saoudite, au Yémen, ainsi que dans le sud-est de l’Iran où de bonnes pluies sont tombées en mars. En conséquence, les effectifs acridiens augmenteront légèrement mais ils devraient rester en-deçà de seuils menaçants. Une reproduction printanière aura également lieu en Afrique du nord-ouest en cas de nouvelles pluies le long du versant méridional des monts Atlas. Des prospections régulières devraient être réalisées durant tout le printemps afin de suivre la situation et de se préparer à la période de reproduction estivale.

Région occidentale. La situation est restée calme dans la Région en mars. Des opérations de lutte limitées (20 ha) ont été réalisées dans la partie nord du Sahara occidental, dans le sud du Maroc, contre des adultes en forte intensité, dont certains en accouplement. Des ailés en faibles effectifs ont continué leur maturation dans le centre du Sahara occidental, ainsi que dans le nord-ouest et le nord de la Mauritanie. Des ailés isolés étaient présents à proximité de fermes irriguées dans le Sahara central d’Algérie. En cas de nouvelles pluies, une reproduction limitée pourrait avoir lieu dans les régions susmentionnées ainsi que le long du versant méridional des monts Atlas, au Maroc et en Algérie. Quelques petits groupes pourraient se former dans le nord du Sahara occidental avec le dessèchement de la végétation. Aucun criquet n’a été signalé ailleurs dans la Région.

Région centrale. La situation acridienne s’est améliorée en Arabie Saoudite suite aux précédentes opérations de lutte et aucun criquet n’a été observé en mars lors de prospections intensives. De même, les effectifs acridiens ont décliné au Soudan et au Yémen, où seuls des ailés épars ont persisté sur quelques sites le long de la côte de la mer Rouge, et des ailés épars étaient présents dans le sud-est de l’Égypte. On s’attend à ce que les conditions écologiques s’améliorent dans l’intérieur del’Arabie Saoudite et au Yémen où de bonnes pluies généralisées sont tombées après la mi-mars. En conséquence, une reproduction pourrait avoir lieu, entraînant une légère augmentation des effectifs acridiens dans ces deux pays. Une reproduction à plus petite échelle pourra également avoir lieu dans les zones côtières et de l’intérieur du nord d’Oman.

Région orientale. Aucun criquet été signalé et la situation est restée calme en mars dans la Région. Cependant, de bonnes pluies sont tombées sur des zones de la côte et de l’intérieur du sud-est de l’Iran, ce qui permettra probablement une reproduction à petite échelle pendant la période de prévision, entraînant une légère augmentation des effectifs acridiens.

By Dr Margaret Chan, Director-General, WHO

13 APRIL 2017 - Today we begin the launch of “Ten years in public health 2007-2017” – a report that chronicles the evolution of global public health over the decade that I have served as Director-General at WHO.

This series of chapters, which will be published over the next 6 weeks, evaluates successes, setbacks, and enduring challenges during my administration. They show what needs to be done when progress stalls or new threats emerge. The chapters show how WHO technical leadership can get multiple partners working together in tandem under coherent strategies. The importance of country leadership and community engagement is stressed repeatedly throughout the chapters.

Together we have made tremendous progress. Health and life expectancy have improved nearly everywhere. Millions of lives have been saved. The number of people dying from malaria and HIV has been cut in half. WHO efforts to stop TB saved 49 million lives since the start of this century. In 2015, the number of child deaths dropped below 6 million for the first time, a 50% decrease in annual deaths since 1990. Every day 19000 fewer children die. We are able to count these numbers because of the culture of measurement and accountability instilled in WHO.

The challenges facing health in the 21st century are unprecedented in their complexity and universal in their impact. Under the pressures of demographic ageing, rapid urbanization, and the globalized marketing of unhealthy products, chronic noncommunicable diseases have overtaken infectious diseases as the leading killers worldwide. Increased political attention to combat heart attacks and stroke, cancer, diabetes, and chronic respiratory diseases is welcome as a powerful way to improve longevity and healthy life expectancy. However, no country in the world has managed to turn its obesity epidemic around in all age groups. I personally welcome is the political attention being given to women, their health needs, and their contributions to society. Investment in women and girls has a ripple effect. All of society wins in the end.

Lessons learned from the 2014 Ebola outbreak in West Africa catalysed the establishment of WHO’s new Health Emergencies Programme, enabling a faster, more effective response to outbreaks and emergencies. The R&D Blueprint, developed following the Ebola response, cuts the time needed to develop and manufacture new vaccines and other products from years to months, accelerating the development of countermeasures for diseases such as Zika virus. For example, in December 2016, WHO was able to announce that the Ebola vaccine conferred nearly 100% protection in clinical trials conducted in Guinea.

The chapters reveal another shared priority for WHO: fairness in access to care as an ethical imperative. No one should be denied access to life-saving or health-promoting interventions for unfair reasons, including those with economic or social causes. That principle is profoundly demonstrated in WHO’s work on universal health coverage, which in the past decade has expanded from a focus on primary health care to the inclusion of UHC as a core element of the 2030 Agenda for Sustainable Development. Health has a central place in the global goals. Importantly, countries have committed to this powerful social equalizer. Universal health coverage reflects the spirit of the SDGs and is the ultimate expression of fairness, ensuring no one is left behind.

These chapters tell a powerful story of global challenges and how they have been overcome. In a world facing considerable uncertainty, international health development is a unifying – and uplifting – force for the good of humanity. I have been proud to witness this impressive spirit of collaboration and global solidarity.

Dryness remains in the Greater Horn of Africa

Africa Weather Hazards

1. Below-average and erratic rainfall since December has resulted in strong moisture deficits and degraded ground conditions. However, above-average rainfall since March has helped to alleviate seasonal dryness.

2. Despite an increase in moisture following the passage of Tropical Cyclone Enawo during early March, long- term moisture deficits remain due to very poor rains earlier in the season throughout central and eastern Madagascar.

3. Inconsistent rainfall and dry spells since late December has led to strengthening moisture deficits and deteriorating ground conditions across many parts of western Angola.

4. Despite improvement in rainfall during late March and early April, below-average rainfall accumulations since late February have resulted in moderate to locally strong moisture deficits in many parts of southern South Sudan, Kenya, southern Ethiopia, southern Somalia, and northern Tanzania.

5. Above-average rainfall across northwestern Namibia and western Zambia since early March has increased the risk for flooding along the Cuvelai Iishanas river basin and the Zambezi floodplains over northern Namibia.