June 2017 | Volume 5 | Issue 2

HIGHLIGHTS

• Reducing Sepsis Deaths in Newborns Through Home Visitation and Active Case Detection: Is it Realistic?

• The Importance of Mental Well-Being for Health Professionals During Complex Emergencies: It Is Time We Take It Seriously

• Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India

• Benefits and Limitations of Text Messages to Stimulate Higher Learning Among Community Providers: Participants' Views of an mHealth Intervention to Support Continuing Medical Education in Vietnam

• Increasing Access to Family Planning Choices Through Public-Sector Social Franchising: The Experience of Marie Stopes International in Mali

• Design Improvements for Personal Protective Equipment Used in Ebola and Other Epidemic Outbreaks

Situation de la campagne agropastorale au 30 juin 2017

I. Situation pluviométrique

Les cumuls de pluie enregistrés du 1er au 30 juin 2017 sont significatifs dans la majeure partie du Sahel. Des quantités importantes des pluies ont été enregistrées dans le Sud du Tchad, le centre et l’ouest du Niger, le Nord du Burkina, dans la majeure partie de la zone agricole du Mali, le sud du Sénégal, presque toute la Gambie, au Nord-ouest et au Nord-Est du Nigeria.

Quant au cumul saisonnier enregistré du 1e mai au 10 juillet 2017, il présente globalement les mêmes grandes tendances caractéristiques que celui du mois de juin. Sur cette période, les cumuls de pluies ont été très élevés dans le Sud du Tchad, l’Ouest du Niger, le Centre et le Sud-Ouest du Mali, le Centre du Nigeria et presque toute la Guinée.*

Sufficient rainfall and normal livelihood activities maintain Minimal (IPC Phase 1) outcomes across both countries

Key Messages

• In Liberia and Sierra Leone, the main season crops are performing well thanks to regular and sufficient rainfall. Across both countries, cumulative rainfall is normal to above normal. Following a short delay and rainfall deficits in April and May in southeastern and northeastern counties in Liberia, this has been offset by good rainfall distribution during the remainder of the season. Main harvests are expected to be average in each country since no major anomalies were reported.

• Across both countries, the lean season is still ongoing in many areas. Nonetheless, markets are functioning normally and continue to maintain adequate supplies of imported rice, cassava, and local rice for purchase and consumption. Some poor households are currently relying more on own produced or purchased cassava, instead of the imported rice in Liberia. In addition to this, the harvest of cowpea and vegetables in July in the two countries and early maturing maize and sorghum in Sierra Leone are improving food availability at the household level.

• In Sierra Leone, the weak national currency continues to contribute to above-average grain prices and reduced purchasing power for some poor households. Grain prices are also above average in Liberia. The current harvest and normal labor activities will allow poor households to meet their food needs through normal livelihood strategies. Between July 2017 and January 2018, poor households are expected to face Minimal acute food insecurity (IPC Phase 1) in Liberia and Sierra Leone.

Today, West Africa and the Sahel region is considered to be one of the main regions on the African continent to make significant progress in the area of security sector reform. Both at the policy and national levels.

During the past decades a number of countries in the West Africa region experienced conflicts, political turmoil and instability. In order to address the security challenges and to resolve conflicts, some countries like Sierra Leone, Liberia, Guinea, Burkina Faso and The Gambia have initiated processes aiming at transforming their security sector into democratically governed institutions in line with the rule of law and human rights principles. In June 2016, the Heads of States of the Economic Community of West African States (ECOWAS) adopted a policy framework on security sector reform and governance (SSRG) which is in coherence with the African Union as well as the UN SSR policies. ECOWAS is currently in the process of disseminating the policy throughout the region for better ownership and operationalisation.

While the regional policy was being developed by ECOWAS, security sector reform processes were initiated and implemented at national levels.

Sierra Leone for example, is often cited as one of the countries, which after 11 years long civil war, conducted a successful security sector reform process. Such endeavour contributed to consolidate peace and have since 2005, after the departure of the United Nations Peacekeeping Mission, prevented the country to relapse into conflict. During the past decade, Sierra Leone comprehensively transformed its security structures including those providing, governing, overseeing and managing security related issues.

In Guinea, after a long period under dictatorial and military rules marred with political instability and repeated military coups, the country elected democratically a new President in for first time in 2010. The new leadership embarked the country into a security sector reform process. Before then, the security sector was characterized by disorganization, confusion of roles on the ground, lack of civilian control, lack of means and efficiency, and the judicial system was dysfunctional while violations of human rights were rampant. This posed a real threat to the security of the people. The first years of the reform process helped clarify the roles and responsibilities of the defence and security forces, and allowed the armed forces to return into barracks. Since then, the military has not sought its way back into power. Nevertheless, much progress needs to be done concerning the management and behaviour of law enforcement agencies especially when it comes to conduct crowd control.

In Burkina Faso after the popular uprising of 2014 that led to the first democratic elections, the new President Roch Marc Christian Kaboré requested the United Nations support to initiate the reform of the security sector. Given the challenges faced during the previous regime and the role played by the military, the national authorities have taken actions in view of conducting a reform process that will lead to the depoliticisation and professionalization of the defence and security forces, as well as their submission to civilian democratic control and the rule of law.

In The Gambia, after 22 years of military rule by the former President Yaya Jammeh, the country is confronted with the challenge to build the foundations of long-term peace and development. The new dispensation that came to power in February 2017 is facing a high level of distrust in the national armed forces, the police and other security actors in ensuring the security of the state and the people. Going forward, the government’s priority would be to carry out urgent reforms of the security sector including defence, police, justice, corrections, judiciary, border management and customs with a focus on cross-border cooperation between The Gambia, Senegal and Guinea-Bissau, as well as relevant commissions within the parliament and independent oversight actors and civil society organisations. Such reform will take into consideration the security needs of the population in order to restore confidence that will facilitate the consolidation of the embryonic democratic system.

The 2016 Health Sector Performance Report (HSPR) presents an assessment of how the health system in Sierra Leone has performed in 2016 –the first full year of health sector reconstruction after the Ebola epidemic. It is the first time that Sierra Leone has reported on a complete range of internationally agreed indicators that span the entire health system, and as such makes a significant improvement on previous HSPRs. This new, robust approach to monitoring and evaluation will support the Ministry of Health and Sanitation (MoHS) to engage in effective health sector planning and decision-making going forwards.

The report reflects and builds on the mid-year review and annual review workshops that brought together a wide range of stakeholders to report on their activities, reflect on the challenges they faced, and look forward to 2017 to build on our shared successes. This included not only elected officials of the Government of Sierra Leone (GoSL) and representatives of Ministries, Departments, and Agencies, but also development partners and a much larger role for civil society representatives than has ever been seen before. As such, I am confident that the report provides a comprehensive and honest assessment of how the health sector has performed this last year.

The MoHS remains committed to improving the health of the population through prioritising evidence-based, cost-effective interventions. This is the premise behind the strategic Health Sector Recovery Plan 2015-2020 and the operational Basic Package of Essential Health Services 2015-2020, and this is what will enable the Ministry to achieve the health-related targets in the Agenda for Prosperity 2013-2018. As this year’s HSPR shows, we are making steady progress in this direction.

The Government recognises the contribution of all actors in the health system to achieving our shared goals. This includes first and foremost the hard work of frontline health workers from doctors, nurses, and midwives,to community health workers (CHWs); but also the hard work of managers and technical staff across the MoHS at district and central level; health development partners; civil society representatives; the private sector; and of course the communities themselves. Under the Government’s leadership, and particularly the leadership of the Ministry, a strong, collaborative working relationship amongst all stakeholders will continue to be fostered to improve the health of the population.

Last year I committed to the annual publication and dissemination of the HSPR, and this year again I re-affirm this commitment. It is truly the most important report the MoHS produces, and I am proud to share it with all of you. I encourage all of us to use its findings to inform future plans to improve health in Sierra Leone, so that together we can deliver a strong, resilient health system that meets the needs of the whole population.

Dr Abu Bakarr Fofannah
Honourable Minister of Health and Sanitation

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 is compared to last year and the recent five-year average. 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.

Despite heavy rains in other parts of East Africa, dryness remains in northern Ethiopia and Eritrea

Africa Weather Hazards

1. Several weeks of above-normal rainfall has led to saturated ground conditions and increased the risk of flooding in Ethiopia, Sudan, and South Sudan. Heavy rainfall is forecast over the region during early August.

2. Despite a slight increase in early August, below-average rainfall across parts of Eritrea, Ethiopia, Djibouti, and western Somalia since early July have led to high seasonal moisture deficits.

3. A delayed start of seasonal rains has resulted in the rapid development of moisture deficits across many areas in northern Senegal and southern Mauritania.

"The disaster is so serious that I myself feel broken"

By Christo Johnson

FREETOWN, Aug 14 (Reuters) - More than 200 people were killed when a mudslide struck the outskirts of Sierra Leone's capital Freetown on Monday, sweeping away homes.

The Red Cross said at least 205 bodies had been taken to the central morgue in Freetown. Police and military personnel were at the scene in the mountain town of Regent searching for people trapped in the debris.

Read more on Thomson Reuters Foundation

Several hundred people are reported dead with many more missing after a devastating series of mudslides and floods ripped through communities in and around Sierra Leone’s capital city of Freetown. The country’s vice president told news organizations that hundreds of people could be lying dead underneath the rubble, and search and rescue efforts are continuing. Thousands are estimated to be homeless after the storm inundated densely populated hillsides.

Direct Relief has been communicating with the Medical Research Centre, a local health organization based in Sierra Leone that has been a long-standing partner. The MRC is in close contact with Sierra Leone’s Ministry of Health, and Direct Relief has made a large inventory of medicines and supplies available to MRC, including a Hurricane Preparedness Pack that is designed for weather-related disasters.

Freetown has received triple the amount of rain usually seen, more than 41 inches since July 1, according to the National Weather Service’s Climate Prediction Center.

Freetown is a dense coastal city of more than 1 million people, and many affected by the storm were living in unsecured structures that were swept away by the deluge of water. Poor infrastructure and drainage can also exacerbate flooding conditions, and entire communities in the Freetown area have been washed away.

A hillside in the Regent area, which is about 15 miles east of Freetown, collapsed early Monday morning in the wake of heavy rains. News reports stated that properties in the Mt. Sugar Loaf area had been deluged by mud and flood waters as a result of the storms.

Storms and torrential downpours are expected during the August and September months each year as monsoonal weather patterns move across Africa from east to west. The storms produce high amounts of rain in a short amount of time, often prompting severe flash floodings, like what was seen in Freetown on Sunday night and early Monday.

Freetown experienced flooding from similar storms in 2015, and the aftermath left 10 people dead and thousands homeless.

Direct Relief has a long history of responding to flood-related disasters and the secondary health issues that can arise in their wake.

Common health risks typically seen after a flooding disaster include an increase in dehydration, diarrheal diseases, vector-borne diseases, malnutrition, and a lack of access to chronic care medications. Most of these issues come as a result of stagnant water, compromised water supplies, damaged crops, and a lack of access to food and medical supply chains.

Direct Relief stands ready to respond to the disaster as needed.

August 14, 2017
Press Release
AUC Chairperson

It is with deep shock that the chairperson of the Commission of the African Union (AU), Moussa Faki Mahamat, has learnt of the catastrophic mudslides that killed more than 300 people and left hundreds more destitute on the outskirts of Sierra Leone's capital, Freetown.

"My thoughts and prayers go out to the families who lost loved ones. The entire AU family stands united with the people and government of Sierra Leone during this difficult time," said the Chairperson."

The Chairperson appeals to all Africans and the diaspora, as well as to international partners, to support Sierra Leone and its public health system respond to this disaster, which occurred only two years after the country successfully ended transmission from the deadliest Ebola outbreak in living memory.

Red Cross volunteers are digging for survivors and supporting distraught families in the wake of heavy flooding and mudslides that have ripped through Sierra Leone’s capital Freetown.

Current estimates indicate that as many as 3,000 have been made homeless, although this figure is expected to rise as the picture becomes clearer.

Abdul Nasir, the Programme Coordinator for the International Federation of Red Cross and Red Crescent Societies (IFRC) has been working alongside these teams, and has described the devastation:

“In places, entire communities seem to have been washed away and whatever is left is covered in mud,” he said. “Red Cross volunteers have been on site since this morning and have been digging with their bare hands and whatever tools available to find survivors. They are also caring for and helping family members who are desperately waiting for news of their loved ones.”

The mudslides come following three days of torrential rains. Communication lines and electricity have been disrupted and the full extent and damage from the mudslides have yet to be determined.

SG/SM/18642

The following statement was issued today by the Spokesman for UN Secretary-General António Guterres:

The Secretary-General is saddened by the deaths and devastation caused by the mudslide and flooding in the town of Regent, Sierra Leone, and throughout Freetown.

The Secretary-General extends his condolences to the people and Government of Sierra Leone for the loss of life and destruction caused by this natural disaster.

The Secretary-General reiterates to the Government and people of Sierra Leone the full solidarity of the United Nations with the ongoing rescue efforts.

For information media. Not an official record.

FAIRFIELD, Conn. (August 14, 2017)— Dozens of children are likely to be among the hundreds of casualties in a devastating mudslide in Sierra Leone that buried houses and trapped families in their homes, Save the Children has warned.

The government of Sierra Leone is currently leading a search and rescue effort in the wake of the tragedy that struck near the capital Freetown early on Monday morning. Save the Children is assessing the situation and preparing to respond if required.

"The mudslide swept down from the hills on the outskirts of Freetown early this morning and spared nothing in its path," said Sasha Ekanayake, Save the Children’s Sierra Leone Country Director. "Houses are buried and entire families are missing, including children.

"Save the Children is deeply concerned about the safety of children in the affected area. We are assessing and preparing to support the government in its response. A major concern right now is that children may have become separated during the mudslide and flood. Any response should prioritize reuniting children with families where possible, or ensuring access to appropriate care."

In addition to the mudslide, low-lying areas of Freetown have been affected by torrential flooding that destroyed buildings and left homes underwater.

"As the flood water recedes we need to ensure that children are given safe shelter and are protected from the spread of deadly waterborne diseases," Sasha Ekanayake added.

"We are still in the rainy season and must be prepared to respond in the event of further emergencies to come."

Save the Children gives children in the United States and around the world a healthy start, the opportunity to learn and protection from harm. We invest in childhood — every day, in times of crisis and for our future. Follow us on Twitter and Facebook.

Freetown, Sierra Leone – IsraAID staff in Sierra Leone will support displaced flood survivors with food and essential items, clean water and sanitation solutions and psychological assistance and stress relief.

Incessant rainfall on Sunday night and Monday left the capital of Sierra Leone, Freetown in a state of emergency. Torrents of water rushed through the city in the early hours of Monday, sweeping up entire homes, creating mudslides and leaving massive destruction in its wake. Over 300 people have lost their lives after the heavy rains deluged the city’s inadequate drainage system. The government of Sierra Leone is calling this the most devastating floods the capital has experienced.

“People are overwhelmed by the enormity of the disaster,” said Andra Weissberger, IsraAID’s Country Director in Sierra Leone; “bodies were carried through the streets in the rushing water. Our staff was helping retrieve them so that the Red Cross could come and collect them. Many of the bodies recovered were severed, leaving it difficult to give an accurate picture of the death toll.”

Other testimonials include a man volunteering at a dig site; he noted how he found a woman holding two small children in her arms and a man right next to her. “Even in the mud, she was protecting her children.”

This disaster has overwhelmingly affected the most impoverished in Freetown, an already vulnerable population. Those in the path of the flooding reside in makeshift settlements that are unable to support the fast-moving water and mud as it overwhelms the area. An estimated 2,500 people have been left homeless and are at high risk of a Cholera outbreak.

IsraAID's support to Sierra Leone is done in partnership with AJC and the Israeli Embassy.

IsraAID in Sierra Leone:
IsraAID has been working in Sierra Leone since 2014, when the organization sent professionals to support the Ebola epidemic survivors. Since then, IsraAID has helped train many local professionals in psychological assistance, stress relief, and self-care.

About IsraAID:
IsraAID is a leading humanitarian non-governmental organization, committed to providing life-saving emergency relief and durable solutions for populations affected by natural disasters, epidemics, and post-conflict situations. Since its inception in 2001, IsraAID has become synonymous with a rapid response to humanitarian crises. Its medical teams, search and rescue units, post trauma experts, community specialists and other professionals have led international responses in natural disasters and civil strife around the world. After the initial emergency period, IsraAID shifts to long-term programs, all to accompany communities and governments as they strive to build a better tomorrow. As of 2017, IsraAID has responded to crises in 41 countries, and has on-going programs in 17 countries. IsraAID has a roster of 1100 specialists, of which over 300 are PSS experts and is ready to deploy its team immediately for the response of an emergency.

• Heavy rainfall in Regent area, Freetown, has caused important floods and landslides. At present, 312 people are reported killed and at least 2 000 have lost their home.
• Body management is a challenge at this point. Needs assessments are hampered by lack of access for the time being. Needs are expected as regards water, hygiene and sanitation and shelter. The situation is being monitored by DG ECHO. Authorities has so far not requested assistance.

The hunt for survivors of a devastating mudslide on the outskirts of Sierra Leone’s capital has continued, with 270 bodies recovered so far, according to the mayor of Freetown.

A mass burial will be held later today to free up space in the city’s central morgue, which has been overwhelmed with bodies.

A national emergency has been called after the city suffered heavy flooding, thought to be the worst in Africa over the past two decades. The country’s interior minister, Paolo Conteh, warned that thousands of people were still missing.

Read more on the Guardian.

Red Cross staff and volunteers are frantically working alongside emergency officials to rescue survivors and assist desperate communities that have lost their homes and loved ones in yesterday’s mudslides in and around the capital Freetown.

The most severe mudslides – triggered by three days of heavy rains – occurred yesterday in the coastal suburb of Racecourse on the city’s eastern edge, as well as in Regent and Lumley where thousands of makeshift settlements are home to the city’s poorest communities.

“I have never seen anything like it,” said Abdul Nasim, Programme Coordinator of the International Federation of Red Cross and Red Crescent Societies (IFRC). “A river of mud came out of nowhere and swallowed entire communities, just wiped them away. We are racing against time, more flooding and the risk of disease to help these affected communities survive and cope with their loss.”

Response teams, including dozens of Sierra Leone Red Cross (SLRCS) volunteers have been recovering people from the mud and debris, helping evacuate residents, transferring bodies to morgues and providing medical care to the injured.

“Our staff and volunteers, many of whom come from the affected areas, are shocked by the sheer destruction of this disaster,” said Constant Kargbo, SLRCS Secretary General. “The needs are massive. Damaged roads, power outages and broken communication lines present huge challenges for our volunteers to reach and support the affected communities.”

At least 260 people have been recovered. However, with 600 still missing, this figure is likely to increase. An estimated 3,000 or more people are believed to have lost their homes and are in immediate need of emergency assistance and shelter.

The IFRC has today released more than 270,000 Swiss francs from its Disaster Relief Emergency Fund (DREF) to bolster initial search and rescue and recovery efforts. These emergency funds will enable volunteers to assist more than 9,000 people with search and rescue, first aid, health care, water, sanitation and hygiene promotion and emergency food.

Situation overview

• Torrential rains have led to a series of significant floods and mudslides on 14 August in several areas of Freetown, the capital of Sierra Leone. Emergency support is being provided for the two different types of responses: floods and mudslides.

• According to Freetown Mayor, rescue workers have recovered 270 bodies so far, mainly from the Regent neighborhood where the mudslide happened. As rescue operations are still ongoing, the death toll is expected to rise.

• Sierra Leone’s Office of National Security (ONS) estimates that more than 3,000 people have lost their homes.

• The Government is currently evaluating the needs of Internally Displaced Persons but is currently requesting affected people to evacuate and stay with relatives

• Heavy rains fell in the area last night and rescue efforts are on-going. However, rescue teams lack the right equipment and are facing difficult conditions with large amounts of mud and debris.

• ONS has recommended the voluntary evacuation of several disaster-prone areas as floodwaters continue to damage infrastructure and homes.

• Communication lines and electricity have been disrupted in some parts of the capital, and extensive damage to roads, infrastructure and houses is also expected.

• In 2015 floods and torrential rains made over 9,000 people temporarily homeless in Freetown but this year’s disaster is unprecedented by the number of people killed in the mudslide.

Coordination

• The Disaster Management Department of the Office of National Security oversees the overall coordination and response, with military and police involved in rescue operations in affected areas.

• The Red Cross of Sierra Leone has deployed three rescue teams and eleven vehicles in support of the Government with support from IFRC.

• Resident Coordinator Sunil Saigal has designated WFP Country Director Housainou Taal as the Incident Coordinator for the UN system. OCHA’s Regional Office for West and Central Africa has been liaising closely with the RC’s Office to provide any support required, including on reporting, mapping and needs assessments, and remains on standby should any surge support be requested.

• Several NGOs and bilateral partners are also involved, including Save The Children, Caritas,
  DFID, Israid, and MSF.

Oxfam is providing clean water and hygiene kits to survivors of yesterday’s mudslide on the outskirts of Freetown, Sierra Leone.

The international agency initially plans to help almost 2,000 households amidst concerns that continued heavy rains, overcrowding and inadequate water and sanitation systems will leave people extremely vulnerable to outbreaks of cholera and other diseases.

Daniel Byrne, part of the Oxfam team that visited the worst affected areas, said: “We saw mass destruction – people were pulling bodies out with their bare hands. We didn’t see any survivors from the homes that had been submerged. Neighbors have been taking in people who have lost their homes. We spoke to one person who has taken thirty people into their home which has just three rooms.

“These are some of the poorest areas in Freetown. Water and sanitation in homes is at best very basic, but at worst non-existent. Overcrowding is a serious health risk and a potential breeding ground for the spread of disease.”

More than 300 people have died, with an estimated 3,000 people made homeless by the mudslide, which was caused by heavy rains. People are being moved to response centers set up in local schools and police stations, but the Sierra Leone Office of National Security expressed serious concerns about the health situation, warning that water and sanitation must be urgently addressed in order to mitigate the risk of a cholera epidemic.

Oxfam’s Sierra Leone country director Thynn Thynn said: “The disaster has left thousands of extremely poor people without a home. The city experiences floods every year but not on this scale. Oxfam is working with its partners in Freetown to help survivors and prevent any outbreaks of diseases."