Executive Summary

This paper explores the urban-specific challenges of the Ebola Virus Disease (EVD) epidemic in West Africa, focusing specifically on community engagement. In doing so, it identifies learning to take forward into future urban public health crises. Key points made in the paper are as follows:

• Communication and engagement are broad terms to describe a variety of ways in which crisis affected people can be involved in a response.

• All of the countries affected by EVD have complex social and power structures and diverse cultures and populations. These populations exhibit varying degrees of capacity to respond to an epidemic.

• Humanitarians struggled to respond to the scale of the challenge during the EVD response. In particular, the atomised nature of community and diversity among stakeholders made it difficult for responders to use traditional approaches to communication and engagement.

• The range of stakeholders in urban environments provides opportunities for communication and engagement as well as challenges. Unfortunately, many opportunities to effectively engage communities and bring stakeholders together were missed during the EVD outbreak.

• Humanitarians used a variety of communication and engagement approaches during the EVD response, including social media chat groups, community radio and door-to-door canvassing.
Communication was particularly challenging owing to restrictions on movement and public gatherings.

• Practical, relevant messaging is critical in urban public health crises. Many messages during the EVD response were clinical, negative and confusing.

• A history of mistrust between the population and authorities further complicated response and furthered new fears. It took time for humanitarians to understand these dynamics and to know how to respond to them.

• The nature of urban communities and lack of social cohesion made it harder to get people to work together within the response. Though there were examples of community self-mobilisation, often these efforts did not receive sufficient support.

Zero Ebola-related fatalities documented among the 59,000 sponsored children and family members supported by World Vision during the outbreak.

Summary

The unprecedented Ebola Virus Disease (EVD) outbreak in West Africa was first reported in Sierra Leone in March 2014 and rapidly spread as the response to the crisis failed, revealing the faults of the region’s chronically fractured and under-resourced healthcare system. However, a review of district level EVD records indicated that no Ebola-related deaths were documented among the 59,000 World Vision-supported sponsored children and their family members. World Vision, Inc. commissioned Johns Hopkins University Bloomberg School of Public Health to determine the effectiveness of specific strategies employed by World Vision in order to increase the evidence of what works in responding to similar disease outbreaks. The study also explored differences between households containing children sponsored by World Vision that had a documented case of Ebola and households without a case of Ebola.

EVD in Sierra Leone

Sierra Leone’s fragile healthcare system is a result of a civil war that ended in 2002, which severely damaged the health infrastructure and created a cohort of young adults with little or no education. Consequently, there was a severe shortage of healthcare workers as well as weak transportation infrastructure, making it difficult to transport samples to laboratories and patients to health centers. In August 2014, the World Health Organization (WHO) declared the EVD outbreak a “public health emergency of international concern.” Due to a lack of early warning systems, Ebola spread rapidly and the country’s health system lacked the capacity to address the overwhelming number of cases.
Studies demonstrated the critical role of isolation of Ebola patients and safe burials in controlling spread of the disease. But initially approaches, particularly quarantine and body collection, were designed with lack of bottom-up community engagement, and were therefore ineffective. Designed and implemented without buy-in and input from community leaders, they failed to address key infrastructure constraints and were culturally insensitive. This resulted in general distrust among community members, and, ultimately, underutilization, and underuse of these interventions. By March 2016, WHO had documented a total of 14,124 cases of Ebola, including 3,955 deaths, in Sierra Leone— more than any other country.

Today the Government of Sierra Leone and its partners launched a new five-year Strategy for Human Resources for Health (2017-2021). Through investments in the health workforce, the Strategy will support the country to improve the quality of its health services and ensure it is better placed to respond to current and emerging health needs.

While there has been progress in training and building up its health workforce, Sierra Leone continues to face shortages of well-trained personnel, especially at middle-level clinical tiers such as midwives and specialist nurses. For example, there are only some 300 midwives for Sierra Leone’s seven million citizens. This causes vast challenges for health service delivery.

Rural areas face particular constraints with two thirds of health workers currently concentrated in just four urban centres: Freetown, Bo, Kenema and Bombali.

“Well-trained and motivated health workers are the bedrock of a strong and functioning healthcare system and will be critical for achieving good health in Sierra Leone,” said Dr. Anders Nordström, Country Representative of the World Health Organization in Sierra Leone. “An effective health workforce is not just about numbers, but also making sure that staff are trained, capable, and engaged to provide quality health services and ultimately save lives.”

Staffing challenges were exacerbated by the Ebola Virus Disease (EVD) outbreak, which exposed weaknesses in the country’s health system and knowledge gaps among its workers. In total, the epidemic caused 296 reported infections among frontline health staff, and 221 reported health worker deaths.

The Strategy outlines steps to improve trainings and management of health workers at various levels as well as planning and financing efforts to support implementation of the plan. Since close to half of the health workforce in Sierra Leone is currently made up of unsalaried workers, the Strategy will also guide efforts to absorb these workers into the workforce, and to improve rural retention rates.

“Having the right people in the right place at the right time underpins every aspect of health service delivery, which is why this strategy is so crucial for Sierra Leone,” said Deputy Minister 1 Madina Rahman from the Ministry of Health and Sanitation, speaking at a launch event in Freetown. “We hope for the support of all parties, from donors to implementing partners, education institutes and the private sector in implementing the 2017-2021 Human Resources for Health Strategy, so as to ensure the country can deliver a strong and resilient health system for its people.”

Deputy Minister Rahman added that significant actions have now been taken to improve the skills and quantity of health workers, with the overall health workforce experiencing more than 20 percent growth across the last five years. As well as improvements in the underlying information system, there have been major investments in the country’s College of Medicine and Allied Health Sciences, the country’s only medical training institution, as well as national midwifery and nursing training programmes.

Developed by the Ministry of Health and Sanitation, the Human Resources for Health Strategy 2017-21 is the product of extensive consultation with a range of stakeholders from across the health, education and private sectors. It is based on a Human Resources for Health Profile, which provided a situational analysis to inform the plan, and is accompanied by a refreshed Human Resources for Health Policy covering a five year period.

Activities in the area of health workforce development have been supported by the World Health Organization, Clinton Health Access Initiative, the UK Government, the African Development Bank and the EU-Luxembourg Universal Health Care Partnership,

The Human Resources for Health Policy, Strategy and Profile are available at http://www.afro.who.int/en/sierra-leone/highlights.html

Contacts
Kadrie Koroma
Public Relations Officer
Ministry of Health and Sanitation
Phone:+232 76 672962
Email: kadriekoroma@yahoo.com

Laura Keenan
Communications Lead
World Health Organization Sierra Leone
Phone: +232 78 633952
Email: keenanl@who.in

Despite recent rainfall, seasonal rain remains below-average across much of East Africa

Africa Weather Hazards

1. Below-average rainfall accumulations since late February have resulted in significant moisture deficits, which have already negatively impacted agricultural and pastoral activities in many parts of southern South Sudan, Kenya, Ethiopia, southern Somalia, and northern Tanzania.

2. Inconsistent rainfall since late December have led to moisture deficits and deteriorating ground conditions across many parts of western Angola.

3. Despite an increase in rainfall following the passage of Tropical Cyclone Enawo during early March, significant moisture deficits remain throughout central and eastern Madagascar.

4. The onset of heavy rains during the last week resulted in localized flooding in parts of Kenya. Although precipitation is forecast to be lower this week, continued moderate to locally heavy rains may trigger additional floods.

Central America and the Caribbean Weather Hazards

1. Since March, below-average rainfall has resulted in unseasonable dryness, signaling a delay in Primera rainfall. Degraded ground conditions have been reported across several departments in Guatemala, El Salvador, and western Honduras.

2. An observed increase in locust numbers in the Jutiapa, Chiquimula, and Zacapa departments of eastern Guatemala elevates risk of adverse effects on cropping activities

Desmidt, S., Hauck, V. 2017. Conflict management under the African Peace and Security Architecture (APSA). (Discussion Paper 211). Maastricht: ECDPM.

This Discussion Paper provides an analysis of the promotion of peace and security by African regional organisations through diplomacy, mediation and Peace Support Operations (PSOs) activities under the African Peace and Security Architecture (APSA). This work is rooted in a longer-term engagement of ECDPM through the APSA Impact Analysis project, supported by the German government through the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), and in collaboration with the Institute for Peace and Security Studies (IPSS) at the University of Addis Ababa.

This paper is directed towards a wider audience interested in the African Union (AU) and in the efforts by African regional organisations to promote peace and security on the continent. This work is also addressed to policy makers and practitioners seeking an update on existing information or a different lens to existing knowledge. The findings presented are the result of intensive desk research, covering the years 2013 to 2015.

• Confirmation des bonnes productions agropastorales comparées à celles de la campagne 2015-2016 et à la moyenne des cinq dernières années.

• Les analyses du Cadre Harmonisé indiquent qu’en période courante (mars, avril et mai 2017), 9,6 millions de personnes sont en situation de crise et au-delà en Afrique de l’Ouest.

• Augmentation du nombre de personnes déplacées dans la région du Lac Tchad et au Mali.

• La dépréciation des monnaies et l’insécurité civile constituent les principaux facteurs qui affectent les marchés en Afrique de l’ouest.

Les productions agricoles 2016-2017 sont globalement satisfaisantes pour le Sahel et l’Afrique de l’Ouest. La production céréalière attendue est estimée à plus de 67,2 millions de tonnes. Elle est en hausse de 10 pour cent à celle de l’année dernière et de 17 pour cent par rapport à la moyenne des cinq dernières années.
Toutefois, des baisses de production ont été enregistrées en Gambie, au Libéria, et en Mauritanie.

La situation pastorale est caractérisée par l’épuisement des ressources fourragères et le tarissement des points d’eau de surface et par conséquent par des difficultés alimentaires du cheptel dans certaines zones du Burkina Faso, du Mali, du Niger et du Tchad.

Le fonctionnement des marchés reste satisfaisant, excepté dans le bassin du lac Tchad dû à l’insécurité civile. Les prix des cultures de rente sont en légère hausse par rapport à la moyenne des cinq dernières années. La dépréciation des monnaies, au Nigeria, au Liberia, en Sierra Leone et au Ghana et l’insécurité civile autour du Lac Tchad et au Nord Mali sont les principaux facteurs qui affectent les prix et les flux entre les pays. Une augmentation des prix peut être anticipée pour les prochains mois.

Les analyses du Cadre Harmonisé conduites dans seize pays de l’espace CILSS, CEDEAO et UEMOA, indiquent qu’en période courante (mars, avril et mai 2017), 9,6 millions de personnes sont en situation de crise et au-delà contre 10,4 millions annoncés en novembre 2016. Cette situation est en partie liée à l’amélioration progressive de la situation sécuritaire et aux actions d’assistance humanitaires en cours notamment dans le Bassin du Lac Tchad en général et au Nord-Est du Nigeria en particulier. Si les interventions en cours ne sont pas renforcées et celles envisagées, pas mises en œuvre notamment au Burkina Faso, au nord du Mali, en Mauritanie, au Niger, au nord du Nigeria, au Sénégal et au Tchad, ces populations pourraient atteindre d’ici la période de soudure (juin- août), 13,8 millions dont 1,6 millions en urgence.

General Situation during April 2017

Forecast until mid-June 2017

The Desert Locust situation was calm during April due to poor rainfall and ecological conditions throughout most of the spring breeding areas in northwest Africa and the Arabian Peninsula. Low numbers of solitarious adults were present in Mauritania, Morocco, Algeria, Egypt and Iran. The situation continued to remain unclear in Yemen where surveys could not be conducted. During the forecast period, small-scale breeding could occur in parts of the interior in Saudi Arabia and Yemen, and in a few places in northeast Morocco, central Algeria and southeast Iran. Although this may cause locust numbers to increase slightly, they will remain below threatening levels and no signifi cant developments are likely.

Western Region.

The situation remained calm in the region during April. Low numbers of adults were present in parts of northern Mauritania, Western Sahara and northeast Morocco, and in central Algeria. Limited breeding occurred near irrigated farms in the central Sahara of Algeria where small-scale ground control operations were undertaken. A lack of rainfall and poor ecological conditions will severely reduce spring breeding this year. Consequently, no signifi cant developments are likely. In Mauritania, low numbers of adults will gradually move south towards summer breeding areas in the southeast.

Central Region.

The locust situation remained calm as no locusts were reported in the region during April except for isolated adults in southeast Egypt.

Nevertheless, ecological conditions were favourable in parts of the interior of Saudi Arabia and Yemen where small-scale breeding could occur during the forecast period and cause locust numbers to increase slightly.

Both countries should stay alert because the situation continues to remain unclear in Yemen as surveys cannot be carried out. Elsewhere, no signifi cant developments are likely.

Eastern Region.

Scattered adults were present in southeast Iran where small-scale breeding is likely to occur during the forecast period. No locusts were present in adjacent areas of southwest Pakistan where conditions remained dry and unfavourable for breeding. No signifi cant developments are likely.

Jeddah, Kingdom of Saudi Arabia 08.05.2017: The Government of Sierra Leone has asked for the the support of Islamic Development Bank (IsDB) in agricultural development, road construction and Post-Ebola recovery plan. The President of Sierra Leone, Dr. Earmest Bai Koroma disclosed this when he received the President of IsDB, Dr. Bandar Hajjar at the Royal Guest House in Jeddah, Kingdom of Saudi Arabia.
President Koroma expressed his appreciation to IsDB for its support during the Ebola crisis, as well as its intervention in various sectors of development like agriculture and roads contruction.

“Everyone in Sierra Leone knows about IsDB projects. With your support, Ebola is now history. But we are still grappling with its effect. One of the major reasons why I am here is to seek support due to the diffciulty we are facing. We are now realising the economic effect of Ebola. We need the support of mulilateral institutions like IsDB to address our challenges,” said President Koroma.

The President of Sierra Leone further seeks the support of IsDB in the contruction of the ring road project, and pilgrims that are currently facing some difficulties.

In his remarks, IsDB President, Dr. Bandar Hajjar assured the President of Sierra Leone of IsDB commitment to the country. He pledged to collaborate with the country in completing all ongoing projects. “IsDB is ready to support Sierra Leone in promoting economic diversification through accelerated investment in infrastructure, promoting food security and connecting domestic value chains to global value chains. The IsDB Group is ready to extend support in tackling the binding constraints to growth, and leverage the power of the private sector to restore growth and build a competitive economy,” Dr. Hajjar stated.Currently there are 11 active projects in Sierra Leone worth US $145 million. IsDB has executed projects worth $300 million since Sierra Leone joined the Bank in 1982. US $6 million was dedicated to the fight against Ebola from Fael Khair programme in addition to US $300,000 humanitarian assistance in September 2014.

Preface

Through much of 2014 and into 2015, the international community witnessed an outbreak of Ebola virus disease in parts of West Africa that was unprecedented in scale, severity and complexity. The toll in illness and death was severe: more than 28,000 people were infected and more than 11,000 died. Some 16,000 children lost parents or caregivers to Ebola.

The impact of the outbreak went far beyond those grim figures. The three most-affected countries – Guinea, Liberia and Sierra Leone – were ill-equipped to respond.

As a result, the outbreak wrought serious humanitarian, economic, development and health consequences. Livelihoods were disrupted, fragile health systems were severely compromised and entire educational systems were either shut down or school openings delayed.

The outbreak revealed serious deficiencies in national and global response mechanisms aimed at controlling potential pandemics. It took the greater part of 2014 for the national and international response to help bring the outbreak under control.

The outbreak was ultimately contained thanks to efforts of affected communities themselves, local leaders and the massive deployment of international resources.

This report presents results from an evaluation of UNICEF’s response to the crisis. It documents and analyses UNICEF efforts, drawing out important lessons to prepare and strengthen UNICEF’s approach to addressing future public health emergencies.

UNICEF country offices began responding to the Ebola outbreak in early 2014. In early September, a corporate-level emergency was declared, under which, in coordination with many partners, UNICEF mobilized an agency-wide response to the crisis. The response was sustained through 2015.
This report sets out the findings, conclusions and recommendations of an evaluation of UNICEF’s response to the Ebola outbreak in West Africa. The evaluation served an accountability function and enabled stakeholders to offer feedback; it supported organizational learning by identifying key lessons for UNICEF; and it prompted strategic consideration by providing recommendations to UNICEF on preparing for future public health emergencies.

The evaluation drew on a wide range of other learning exercises and assessments.
To complement these, the evaluation focused selectively on the strategic challenge of coordinating UNICEF’s levels, programmes and operational functions (i.e. how these elements combined to deliver an effective response). As such, it does not provide detailed information or a technical assessment of implementation.

The evaluation found that UNICEF and partners made useful contributions to stopping Ebola transmission and that those contributions depended foremost on the organization’s innovative community-based implementation model, participation in the larger international public health response with national governments, and the mobilization of corporate capacities through the Level 3 Simplified Standard Operating Procedure resource management functions.

However, the impact of these contributions was diminished by important factors. These include missed opportunities for containing the outbreak in March 2014, delays in operationalizing the community-based response, differing understandings of the rationale for intervention and weaknesses in performance management and monitoring systems. Moreover, UNICEF was challenged in its efforts to promptly and adequately address Ebola’s secondary humanitarian consequences and specific effects on children.

The Ebola epidemic in West Africa was a grim reminder of the stark threat posed to humanity by communicable diseases. In the aftermath of the outbreak, there is widespread agreement that such threats will continue to arise from time to time. Drawing on the key findings from this evaluation, the recommendations presented in this report are therefore primarily focused on how UNICEF can be better prepared and capacitated to deal with future health emergencies.

The evaluation was conducted by a team headed by Andrew Lawday, and including Kerren Hedlund, Nigel Clarke, Steve Powell, Annie Lloyd, Tamba Emile Sandounou, Lynn Owen, and Alistair Hallam. It benefited from information, perspectives and feedback provided by UNICEF colleagues in the Guinea, Liberia and Sierra Leone UNICEF country offices, the UNICEF West and Central Africa Regional Office in Dakar, Senegal, as well as UNICEF Headquarters. The Evaluation Reference Group provided important contributions and guidance throughout the process. Finally,
I would like to recognize Beth Plowman, who served as Evaluation Manager with support provided by Abdoulaye Seye.

We would also like to acknowledge the contributions made to this evaluation by staff in partner organizations, as well as by national officials and community members who shared their stories with the evaluation team. They gave time and attention to the evaluation during a period of enormous stress and pressure. We hope that the results of the evaluation are used to prevent or contain similar emergencies in future years, and to alleviate the concomitant loss and suffering experienced by those affected.

Colin Kirk
**Director, Evaluation Office
UNICEF

by Harriet Mason

NGELEHUN, Sierra Leone, 8 May 2017 – Nurse-in-charge Elizabeth Kadie Momoh at the Ngelehun Community Health Post has just finished checking a pregnant woman in the facility’s labour room and heads to a sink to wash her hands. Clean water gushes out as she opens the tap.

The availability of running water is taken for granted in health facilities in most parts of the world. But a year ago in this health post, it was, you could say, a pipe dream.

“We had a well but fetching water from it was very strenuous, especially when the water level was down,” said Elizabeth. “During some previous dry seasons we could not use the well because it dried up. We [staff and patients] had to find other wells and streams outside the facility to get water. When pregnant women came to deliver, they or their relatives had to go and fetch water to wash the equipment, clean the delivery room and launder their clothes,” said Elizabeth.

Lack of running water is bad news if you want to stop the spread of infection. Providing access to sufficient quantities of safe water, to facilities for the sanitary disposal of waste, and to sound hygiene behaviours are vital to reduce the spread of infectious diseases.

Despite the challenges, these health facilities continue to be in high demand. The facility where nurse Elizabeth works serves a population of more than 5,800 people across six villages, attending to an average of 269 people a month (with over 60 per cent of them being children under the age of five).

Last year, UNICEF implementing partner SILPA, with funds from the Swedish National Committee for UNICEF, rehabilitated the facility’s toilets and water well, installed a water supply system, and built an incinerator (for burning of waste), all in line with the new WASH in health standards and guidelines under the Sierra Leone H.E. The President’s post-Ebola recovery priorities. The new water, sanitation and hygiene facilities, installed through UNICEF support, are well appreciated.

“Now we can wash all our equipment at the centre’s premises each time we use them. Our new mothers even have a bathroom where they can freshen up before leaving the delivery room,” said Elizabeth. “Other patients do not need to be reminded to wash their hands when they come here because they always meet soap and a bucket of water at each entrance of the facility.”

It’s in these sorts of improved conditions that a total of 279 deliveries were done at the facility between January 2015 and September 2016.

A few minutes from the centre, we met Haja Sillah who had just moved home with the two-day-old baby boy she delivered at the Ngelehun Health Post. “The improvement in the water and sanitation facilities at the centre really inspires us to go to there when we need to,” said Haja.

“I had a better experience this time than I did when I went to deliver my older children. This time I was able to have a bath in the delivery room just after I gave birth. My relatives also had enough water and space to launder my clothes and that of my child. I was a little reluctant to leave because I felt so comfortable!” she said.

Nurse Elizabeth was also positive. “Now my motivation for the job has increased. I can even concentrate more on the job because I don’t have to worry about or spend time trying to fetch water for use at the facility or my quarters,” she said.

In a country where there are not enough trained health personnel to be stationed in communities, it is important to keep available personnel satisfied and motivated to stay in the job fighting to reduce the high rates of infant and maternal deaths.

PROJECTED FOOD ASSISTANCE NEEDS FOR NOVEMBER 2017

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

Key highlights

• Despite governments' and partners' efforts, the food security and nutrition situation is still alarming in the Lake Chad Basin (Niger-Nigeria-Chad) and in the north of Mali, where 5 million people are classified in Crisis, Emergency and Famine (CH phase 3, 4 and 5).

• The food security and nutrition situation is expected to deteriorate from June 2017 with the depletion of food stocks during the lean season in most of the countries. People displacement and insecurity aggravate the severity of food insecurity, with the effect of increasing the number of people in crisis and emergency phases (CH 3 and 4).

• Although food availability is generally satisfactory, civil insecurity is the main cause of livelihoods disruption and severe food insecurity in the Lake Chad Basin and northern Mali. Moreover, households’ access to food is limited by the seasonal increase of market prices and deterioration of the terms of trade between livestock/cereal, coupled with the currency depreciation, particularly in Nigeria, Liberia, Sierra Leone and Ghana.

• As a result, the nutrition situation is worrying, with the global acute malnutrition (GAM) rates above the alert thresholds, particularly in the areas affected by insecurity, mainly due to insufficient access to drinking water, associated with inappropriate feeding practices, and limited access to health services.

• Immediate humanitarian assistance is needed for people in Crisis, Emergency and Famine (CH phase 3, 4 and 5) to save their lives, protect their livelihoods as well as prevent loss of assets and reduce acute malnutrition. Interventions aimed at supporting the resilience of people facing stressed food insecurity (CH Phase 2) are also needed in order to avoid the worsening of their situation.

General Situation during April 2017

Forecast until mid-June 2017

The Desert Locust situation was calm during April due to poor rainfall and ecological conditions throughout most of the spring breeding areas in northwest Africa and the Arabian Peninsula. Low numbers of solitarious adults were present in Mauritania, Morocco, Algeria, Egypt and Iran. The situation continued to remain unclear in Yemen where surveys could not be conducted. During the forecast period, small-scale breeding could occur in parts of the interior in Saudi Arabia and Yemen, and in a few places in northeast Morocco, central Algeria and southeast Iran. Although this may cause locust numbers to increase slightly, they will remain below threatening levels and no signifi cant developments are likely.

Western Region.

The situation remained calm in the region during April. Low numbers of adults were present in parts of northern Mauritania, Western Sahara and northeast Morocco, and in central Algeria. Limited breeding occurred near irrigated farms in the central Sahara of Algeria where small-scale ground control operations were undertaken. A lack of rainfall and poor ecological conditions will severely reduce spring breeding this year. Consequently, no signifi cant developments are likely. In Mauritania, low numbers of adults will gradually move south towards summer breeding areas in the southeast.

Central Region.

The locust situation remained calm as no locusts were reported in the region during April except for isolated adults in southeast Egypt.

Nevertheless, ecological conditions were favourable in parts of the interior of Saudi Arabia and Yemen where small-scale breeding could occur during the forecast period and cause locust numbers to increase slightly.

Both countries should stay alert because the situation continues to remain unclear in Yemen as surveys cannot be carried out. Elsewhere, no signifi cant developments are likely.

Eastern Region.

Scattered adults were present in southeast Iran where small-scale breeding is likely to occur during the forecast period. No locusts were present in adjacent areas of southwest Pakistan where conditions remained dry and unfavourable for breeding. No signifi cant developments are likely.

The West African Ebola outbreak that took the World by surprise may have been over, going on two years now, but those the virus infected and survived are still struggling with many health and socio-economic challenges. The disease may no longer be present in the region, but affected persons and communities are yet to get over the nightmare and move on with life. The World may no longer view Ebola as imminent threat to life, but those who lost their loved ones are still mourning and psychologically traumatized in the aftermath. From our fieldwork experience with Ebola survivors for more than two years, we can attest with confidence that we are far from meeting the needs of Ebola survivors. Some of their pressing needs include quality health care on an ongoing basis, including mental health, food, livelihoods—economic opportunities, and full community integration.

In 2014, like many other humanitarian organizations, Tzu Chi Foundation responded to help the people of Sierra Leone when Ebola threatened their livelihoods and lives. The founder of the organization, Dharma Master Cheng Yen with her wisdom and humanitarian spirit, mobilized her volunteers to coordinate relief support for Sierra Leone in the form of multi-functional beds, blankets, food supplies, and medical supplies. Tzu Chi sent more relief support to Sierra Leone with love throughout the years 2015 and 2016. Additional relief included latex gloves, stethoscopes, new clothes, new shoes, and 200 tons of rice.

Tzu Chi volunteers successfully distributed all donations across Sierra Leone directly into the hands of Ebola survivors, with strong support from our local partners Healey International Relief Foundation, Caritas Freetown, and Lanyi Foundation. The Tzu Chi Sierra Leone partnership is proud of being the first and only NGO partnership to reach all Ebola survivors in every corner of Sierra Leone. Additional partners for the Tzu Chi 2016 relief distributions were the Ministry of Social Welfare, Gender and Children Affairs and the Sierra Leone Association of Ebola Survivors—a nonprofit organization established by Ebola survivors to advocate the needs of Ebola survivors in Sierra Leone. A total of 3,488 Ebola survivors benefited from Tzu Chi relief.

From our nationwide experience, Ebola survivors need committed and consistent support from all angles, including psychosocial support, hunger prevention, food security, quality health care, and sustainable enterprise development initiatives. Understanding the challenges with recovery when hungry, Master Cheng Yen committed in early 2017 to support Sierra Leone Ebola survivors and other vulnerable persons with 300 tons of rice and medical supplies. The consignments of food support will ship in three batches of five containers each, with distributions beginning June and ending December 2017. Healey International Relief Foundation, Caritas Freetown, and Lanyi Foundation have again agreed to be part of the partnership and continue providing support to the success of Tzu Chi projects in Sierra Leone. The food supplies will primarily benefit Ebola survivors, Ebola orphans, children with developmental disabilities, amputees and war wounded, and other Ebola affected persons.

The Buddhist Tzu Chi Foundation has also committed to continue its support to Sierra Leone health facilities. In 2015 and 2016, a good number of government, private, and religious-funded clinics and hospitals benefited from various supports, including seven of the most utilized government hospitals: Connaught Hospital, PCMH Hospital, Wilberforce Military Hospital, Bo Government Hospital, Kambia Government Hospital, Kenema Government Hospital, and Port Loko Government Hospital. To improve the Sierra Leone health sector, Tzu Chi Foundation will continue providing medical equipment in the form of hospital beds and consumables. A consignment of hospital beds will arrive in Sierra Leone before the end of the raining season. This renewed commitment to the people of Sierra Leone demonstrates Tzu Chi’s culture of selfless service to humanity with compassion and relief.

Recent seasonal rainfall helps partially alleviate abnormal dryness in East Africa

1. Despite rainfall during early March, significant long-term moisture deficits remain throughout central and eastern Madagascar due to very poor rains earlier in the season.

2. Inconsistent rainfall since late December have led to moisture deficits and deteriorating ground conditions across many parts of western Angola.

3. Below-average rainfall accumulations since late February have resulted in moisture deficits, which have already negatively impacted agricultural and pastoral activities in many parts of southern South Sudan, Kenya, Ethiopia, southern Somalia, and northern Tanzania.

4. The onset of heavy rains last week resulted in flooding in parts of Kenya. Continued rains may trigger additional floods and elevate river levels.

5. Several consecutive weeks of below-average rainfall has led to early season moisture deficits in parts of Ghana.

6. Shabelle river levels have been rising since late April, creating a high risk for flooding along the middle and lower portions of the basin. Additional seasonal rainfall next week is expected to sustain the risk.

CHAPTER 1: INTRODUCTION

1.1 Background

Currently, the world is faced with an unprecedented call for action at a moment in which four countries have been identified as at risk of famine, and demand for humanitarian and resilience assistance is escalating. Against this background, informing the global and national food security community on the risk of food crises and on the severity of such crises is of fundamental importance. In recent years, stakeholders have made major investments to improve food security analysis and related early warning systems in order to prevent and tackle food crises more efficiently. Although significant improvements have been made over time in the methods and technologies used to improve the quality and timeliness of food security assessments and monitoring systems, a comprehensive global pictures of food crises is still often missing. Partial geographical coverage and a lack of comparable data within a standardised system make it difficult to get a full global picture of food crises at any given time.

The European Union, WFP and FAO have joined forces to coordinate the compilation of analyses to increase the impact of humanitarian and resilience responses through the preparation of the “Global report on Food Crises”. The Global Report enhances coordination and decision-making through a neutral analysis that informs program planning and implementation. The key objective and strength of the report is to establish a consultative and consensus-based process to compile food insecurity analysis from throughout the world into a global public product to inform annual planning and resource allocation decisions. Technical, operational and financial partners require evidence-based information to ensure appropriate planning and resources to tackle the consequences of food security crises within an evolving humanitarian financing landscape. The World Humanitarian Summit has prompted a major rethink of the way response financing is delivered in crisis settings, highlighting the need for more long-term development investments to address risk, prevent crises and build resilience.

Since 2013 , the European Commission has worked to develop ways to compare and clarify the results of food security analyses across partners and geographical areas to provide a comprehensive overview of the global food security situation. In 2015, the Joint Research Centre of the European Commission (ECJRC) produced an annual report on food insecurity hotspots to inform decisions on food crisis allocations at the global level. In 2016, to increase the inclusiveness and transparency of the report, the European Commission invited FAO and WFP to contribute by providing additional food security data and analysis. Following the successful experience of the 2016 analysis, the three organizations agreed to move forward, involving additional partners in the global assessment of the food crisis situation, with the aim of producing a consensusbased yearly report from early 2017. The initiative was cemented with the launch of the Global Network for Food Insecurity, Risk Reduction and Food Crises Response on 23 May 2016 in Istanbul, Turkey. It was then agreed to undertake this effort under the umbrella of the “Food Security Information Network” (FSIN), an already structured global initiative cosponsored by FAO, WFP and IFPRI.

Overview

• This weekly bulletin focuses on selected public health emergencies occurring in the WHO African region. WHO AFRO is currently monitoring 47 events: three Grade 3, six Grade 2, two Grade 1, and 36 ungraded events.

• This week, three new events have been reported: outbreaks of Ebola virus disease in the Democratic Republic of Congo, dengue fever in Côte d’Ivoire and Crimean-Congo haemorrhagic fever in Senegal (imported from Mauritania). The bulletin also focuses on key ongoing events in the region, including the grade 3 humanitarian crises in Nigeria and South Sudan, the grade 2 humanitarian crisis in the Central African Republic and meningitis outbreak in Nigeria as well as the undiagnosed illness in Liberia.

• For each of these events, a brief description followed by public health measures implemented and an interpretation of the situation is provided.

A table is provided at the end of the bulletin with information on all public health events currently being monitored in the region.

Major challenges to be addressed include:

• The unprecedented occurrence of acute public health events in the African Region, calling for full implementation of the IHR and the regional strategy on health security and emergencies in the African Region.

• There are subtle public health emergencies in the region that require comprehensive response and actions including advocacy and multi-sector engagement

New Events

Ebola Virus Disease Democratic Republic of Congo

11 Cases
3 Deaths
27.3% CFR

Event description

On 11 May 2017, the Ministry of Health of the Democratic Republic of Congo (DRC) notified WHO of an outbreak of Ebola virus dis- ease (EVD) in Likati health zone in Bas Uele province located in the north-eastern part of the country. The index case, a 39-year-old male, presented to the local health facility on 22 April 2017 with acute on- set fever, asthenia, vomiting, bloody diarrhoea, haematuria, epistaxis, and extreme fatigue. He was immediately referred to Likati health district facility but he died in transit. On 24 April 2017, a motorcycle rider (who transported the index case) and another person who supported the index case during transportation developed acute febrile illness. The motor cycle rider subsequently died on 26 April 2017.
Preliminary outbreak investigation carried out by the health team obtained 5 blood samples that were shipped to the Institut National de Recherché Biomédicale (INRB) in Kinshasa. Laboratory results re- leased on 11 May 2017 indicated that one of the five samples tested positive for Ebola virus Zaire subtype by polymerase chain reaction (PCR) assay.
As of 13 May 2017, a total of 11 suspected cases including 3 deaths (case fatality rate of 27.3%) have been reported. Detailed epidemiological investigation and risk assessment are being conducted and the findings will be communicated accordingly.

Public health actions

• The Ministry of Health convened an emergency meeting on 11 May 2017 involving various sectors of government and partners including CDC, MSF, WHO, etc. The meeting aimed to design response strategies, mobilize immediate resources needed and mount an effective response to the EVD outbreak. • The Minister of Health, accompanied by the WHO Representative, held a press conference on 12 May 2017, intended to alert the general public to take necessary preventive measures while allaying anxiety and fear.
Preliminary outbreak investigation is being conducted by the national, provincial and health district teams, with support from WHO and other partners.
• The Provincial Government has mobilized initial funds to facilitate immediate operational activities in the field.
• WHO held a three-level teleconference on 12 May 2017 to review the situation, conduct risk assessment and guide the overall response to the outbreak. The potential risk of this outbreak was ranked as high at national and regional level.
• On 12 May 2017, WHO released a press statement to inform the global community on the EVD outbreak in DRC.
• The Regional Director of WHO AFRO is set to meet the national authorities on 13 May 2017 to reiterate the availability of WHO to closely work with the Ministry of Health and other sectors to rapidly contain the outbreak and avoid unnecessary interference with travel and trade. She will also be meeting with in-country partners to enhance partnership and coordination of response to this highly dangerous pathogen.
• WHO is deploying a surge team following the request from the government.

Situation interpretation

An outbreak of Ebola virus disease has been confirmed in the DRC, coming days after rumours of unexplained clusters of illness and deaths. The affected locality, situated in the north-eastern part of the country, is remote and isolated with limited transport and communication net- works including telephone connectivity. The locality is 350 km from Kisangani and cannot be access by car (has only 20 km of road). The public health infrastructure and health care system in the affected area is weak.

These circumstances, in addition to other factors, impeded the timely transmission of the information on this suspected outbreak. The delay to detect and con rm this outbreak may mean that the disease could have spread in the local communities. This therefore calls for a swift, extensive and rapid response in order to curtail further propagation and mitigate any impact and consequences.

The Ministry of Health has rapidly solicited for support from partners (in particular WHO), a call that we must respond to. Based on the lessons learnt from the West African EVD outbreaks, WHO calls for strong multi-sector collaboration and the support of global stakeholders to quickly bring this outbreak to an end. WHO is ready to provide the leadership and technical expertise required to mount a coordinated and effective response to the outbreak.