Overview

This Weekly Bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 46 events in the region. This week’s edition covers key ongoing events, including:

Plague in Madagascar

Marburg virus disease in Uganda

Cholera in Tanzania

Cholera in north-east Nigeria

Necrotizing cellulitis/fasciitis in São Tomé and Príncipe

Humanitarian crisis in South Sudan.

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 new and ongoing public health events currently being monitored in the region, as well as events that have recently been closed.

Major challenges include:

While progress has been made to control the outbreak of plague in Madagascar, the possibility of future flare-ups cannot be ruled out.
Sustaining ongoing response operations remains critical, calling for additional funding support.

The continuous propagation of cholera in Tanzania mainland, going on for over two years, remains a concern. This cholera outbreak needs to be brought to a halt.

By Lance Morrison

About three months ago, a deadly duo of flash floods and mudslides, triggered by unseasonal non-stop rain, rushed through Freetown, the capital of Sierra Leone. More than 5,900 people were affected by this disaster,  at least 500 were declared dead and hundreds more are still missing. Rise Against Hunger collaborated with Caritas Freetown, our in-country partner, to provide immediate relief in the form of 66,500 meals to those affected.

The story of the flood begins for Adama when she received an urgent call. She shared, “My uncle called and told me that our whole house is surrounded by water.”

She had stayed the night before at her sister’s apartment out of town. She visited so her sister could braid her hair, but by the time the plaits were finished, it was too dark to comfortably make her way home in Freetown. She took her sister’s invitation to spend the night.

She returned home with her sister in the early dawn to find her aunt and uncle floundering in the floodwaters. As much as they tried to reach out, it was at the risk of their own lives. The water was impassable. They felt useless, sitting on the sidelines as their family struggled to stay alive, but there was nothing they could do.

“I saw my uncle and aunty fighting for a way to escape from the water. We were just looking at each other crying holding our hands close to our chest.”

The current ripped at the house, breaking it down bit by slow bit like a cold countdown.

She said, “My family [members] were waving the last goodbye.”

“Their hands up fighting for life,” is the last memory she has of her aunt and uncle, because she collapsed in shock. She told this part of the story in tears. As she came to, she realized the flood that taken her relatives, and they were gone.

“How painful it is to watch your loved ones lose their lives,” she says.

Adama’s family was just one of the many to lose loved ones. Her husband spent the rest of that morning working with the help of others to prevent others from sharing similar fates, nearly losing his own life in the process. Adama and her husband, sister, and child joined other evacuees as they were escorted to a compound where they received Rise Against Hunger meals from Caritas Freetown.

Adama was one of the fortunate ones. Sabatu was also affected by the flood, but she shared a heavier-hearted tale.

“It is something that I don’t want or wish to remember as the pain is still fresh in my heart,” she said.

Sabatu lost her daughter, son-in-law, and grandchildren, not to mention her home, in the disaster. Hunger challenged her first, unable to find food, but she held on, buoyed by the love and concern she felt for her surviving grandchild.

“Help if not me but my grandchild,” she said.

They found food, shelter, and support from the local government and Caritas Freetown, but the hopelessness and debilitating hunger she remains fresh in her mind. Now, there’s a sliver of optimism, some hope to hold onto, despite the uncertainty they face.

The Rise Against Hunger meals “add some magic,” she said. “We can survive.”

Emergency relief not only saves lives but catalyzes the journey forward. Relief and recovery from disasters like this requires partnership, between people affected, first responders, local and national governments, organizations and individuals like you. Join in now and donate to the Global Emergency Relief Fund or host a Meal Packaging Event to continue to meet the immediate needs of people like Adama, Sabatu and their families.

Globally, at least 200 million girls and women alive today have undergone some form of female genital mutilation or cutting (FGM). Sierra Leone has one of the highest rates of FGM in the world, with nine in every 10 women and girls cut, many as young as five years old. During the Ebola crisis of 2014, a moratorium was placed on FGM as part of the emergency health measures. But now three years on, the practice has returned, even though the ban is still in place. While gender inequality, myths and cultural beliefs are at the root of the practice, for many rural women, FGM is also a matter of livelihood.

“We do it not out of love, but out of custom, ignorance and poverty,” says Mabinty Kamara, from Port Loko district, in the northern part of Sierra Leone, who has performed FGMs for 30 years as a rite-of-passage ceremony for girls transitioning to adulthood. “But this practice is very bad. It causes suffering to our children, it is a painful procedure,” she admits. In this part of Sierra Leone, Kamara and other traditional leaders who perform these rituals are called “Soweis”.

Performing Bondo Bush—as FGM is called in the local language—is an important source of revenue for the Soweis. They receive gifts from the children’s parents for performing the ritual. They also enjoy an elevated stature in the community as custodians of their culture, and are afraid that they would lose the respect they get, if they stop performing the ritual: “We do it because we think we do not have a choice,” says Kamara.

As Sierra Leone prepares for elections in 2018, the issue of FGM is culturally sensitive and politically charged. To bring an end to the practice, along with local and national partners UN Women is working to shift public opinion and engaging traditional and religious leaders, as well as Parliamentarians, to understand the negative impacts of FGM.

For instance, UN Women convened 35 Sierra Leonean journalists and anti-FGM activists for a four-day training to improve reporting on the issue through national and local media. Recently, in October 2017, during the International Day for Rural Women celebrations, nine villages and their chiefs from the Yoni chiefdom in Tonkolili District, in the northern part of Sierra Leone, came together to have a dialogue about women’s experiences with FGM. They collectively denounced the practice—a significant win in an area where FGM is rampant, and even the police cannot effectively intervene if the traditional leaders support the practice.

“Ending Female Genital Mutilation is possible, but first we have to create an optimal means of survival for those who already consider initiation as employment,” said Fatmata Koroma, Sowei leader and community chief from the Tonkolili district, speaking at the event. She has stopped performing FGM ceremonies and is encouraging other Soweis to follow suit.

Also at the frontline of the fight against FGM are men like Reverend Osman Jessie Fornah, the National Superintendent of the Wesleyan Church of Sierra Leone, a UN Women HeForShe ambassador. Reverend Osman has been a pastor for 31 years and has seen the negative impact of FGM on his constituents. “It should be abolished in Sierra Leone,” he says. “Many times, I have witnessed girls bleeding to death because of FGM.”

Since 2009, Reverend Osman has been advocating against the practice, and results are evident. He succeeded in 50 church congregations across the country to take up the issue and develop teaching materials clarifying their religious position against FGM.

“We must encourage women to stand up, be strong and embrace change that will create better opportunities for them and their children,” says UN Women Country Representative Mary Okumu. “By rejecting the harmful traditional practice of FGM and child marriage, and by encouraging their girls to go to school, rural women of Sierra Leone can create a better future for the country.”

In addition to engaging traditional chiefs and parliamentarians through the HeForShe campaign, UN Women has supported rural women with cash transfer programmes and agricultural and poultry farming trainings funded by the Multi-Partnership Trust Fund.

“To end FGM, women need to be empowered economically,” concurs Fatmata Koroma, who is now focusing on agriculture as an alternative means of livelihood.

We failed this summer - let’s embrace it

by Sarah Klassen

For the nervous flyers out there, it’s comforting to know that flying has become the safest form of travel. It’s safe because we’ve recorded and learned from past failures - all captured in black boxes which are a compulsory part of all commercial aircrafts. Matthew Syed writes about this in his book ‘Black Box Thinking’. Syed reminds us that breakthroughs always begin with multiple failures and that true success lies in capturing, understanding and overcoming these failures. I think he’s onto something.

The Start Network launched the Crisis Anticipation Window in November 2016. For the first time, the 42 humanitarian charities that make up this network can apply for funding - ahead of a potential crisis. Start members can use forecasting information to raise an alert to the network about an escalating risk of a crisis. This alert can trigger Start Funds which support projects to mitigate potential damage. This approach is pretty intuitive and so far we’ve seen a lot of promising proactive aid interventions. We are no longer just waiting and reacting to chaos after it unfolds -humanitarians are on the offensive.

But right now, I don’t want to focus on our successes. I want to look inside the black boxes that emerged over the summer, because there’s so much in them that’s key to breakthrough for our network moving forward. And there’s too much at stake to not learn from our past.

NIGER

On 13 July, Start members raised concerns about potential flooding in Niger and submitted an anticipation alert to the network. When decision makers were considering the alert, they knew that there was a real risk of flooding in the country and they knew that communities were vulnerable. But they were also (rightly) concerned that the alert only focused on one area in the country that already had a relatively high NGO and UN presence and funding. Although they could have expanded the geographic scope of the alert to focus on the most vulnerable areas, they felt that not enough information was provided about the needs and risks in other areas and so the alert wasn’t activated.

On the 26 of August, torrential rains arrived in Niger - as expected. Within a week, the rain had destroyed hundreds of homes in the capital, Niamey. Niamey lies along the Niger River, so it’s particularly vulnerable to flooding. Thousands of people were forced from their homes. According to Niger’s government, flooding killed at least 44 people in Niamey and other parts of the country. Frustratingly, one of the main causes of flooding was simply the obstruction of drainage canals. Clearing drainage canals is one of the projects that could have been funded if the alert was activated.

What’s in the black box: There’s a lot to learn from this experience. Uncertainty was the ultimate stumbling block here. As a network, if we’re going to be proactive, we need a greater appetite for risk. Anticipating crises always involves a greater level of uncertainty than responding to something in front of you. If there is a clear risk, decision-makers should be empowered to broaden the scope of alerts to the most vulnerable areas - even when faced with uncertainty. The ECHO funded Crisis Anticipation window is a welcomed opportunity for humanitarians to experiment with proactive responses and to learn from these experiences along the way.

SIERRA LEONE

On 14 August, a mudslide linked to flooding killed more than 1000 people in Sierra Leone in a town called Regent on the outskirts of Freetown. The government initially pegged the death toll at 450, while rescuers warned that many of the more than 600 people still missing would likely not survive. It was a devastating and traumatic experience for the town’s residents. As funding often takes a while to arrive, the Start Network began responding rapidly to fill the critical gap immediately following the mudslide.

Storms and torrential downpours are common in Sierra Leone in August and September. Back in July, Start Members began talking about the escalating risk of flooding and landslides in the country. We knew that the risks were increasing. [Sierra Leone had seen 104cm of rain since 1 July]](https://reliefweb.int/sites/reliefweb.int/files/resources/Global%20Weather%20Hazard-17.07.27.pdf), which was three times more than expected during the rainy season according to the US National Weather Service’s Climate Prediction Center. We then discussed the potential flooding and landslides in Sierra Leone for two weeks. Many people in Regent live in informal settlements on steep hillsides. The country’s officials had warned against widespread unregulated construction on the hillsides. The uprooting of trees for construction on the hillside is also known to have made the soil particularly unstable and more vulnerable to collapse. The Sierra Leone metrological department didn’t issue a warning to hasten evacuations from the danger zones. As we were discussing and drafting the alert note, hundreds of people were killed.

What’s in the black box: It’s important to take a step back and reflect on this experience: How can we learn from this moving forward? When we know a risk is escalating, humanitarians need to act- and we need to act quickly. Natural disasters don’t work according to our timelines. When multiple agencies are concerned about an escalating risk, we need to make sure that this quickly translates into action. If we’re uncertain about a risk- we can analyse it. The Start Network provides a small grant for inter-agency risk analysis. It’s called the ‘Analysis for Action Grant’ because when people come together to collectively analyse risk, they’re more likely to do something about it.

HURRICANE IRMA

You’ll have seen in the headlines that Irma was the most intense hurricane in the Atlantic since 2007. The category 5 storm caused widespread and catastrophic damage, particularly in parts of the northeastern Caribbean and the Florida Keys. Irma developed on 30 August near the Cape Verde Islands. Shortly after, Start Network members who were actively monitoring the hurricane raised it to the network. Still facing uncertainly about the possible impacts and final path of the hurricane, members raised an anticipation alert to respond to the approaching hurricane on 6 September. It made landfall on the coast of Barbuda later that day, and continued along its path of destruction until the 11 September.

Discussions around the alert on 6 September were complex and difficult, but ultimately, the alert wasn’t activated. Decision makers felt that it was raised too late to implement activities that could mitigate harm and loss related to the hurricane and that the scale of the crisis was seen to be beyond the scope of the Start Fund. It was also rightly pointed out that other sources of funding would be made available. Agencies involved in the alert likely walked away from the experience discouraged. Anticipating hurricanes is a very tricky business.

What’s in the black box: Although the alert wasn’t activated, this experience was a huge step forward for the network. The Start Fund seeks to enable quick and proactive aid interventions. It’s important to remember that in 2015 and 2016, for a variety of different reasons, our members in the region have only been able to raise alerts for hurricanes no sooner than 9 days after the storm has hit landfall. This time they raised the alert in advance. We’re moving in the right direction. Earlier alert activations- even very close to storm landfall, will allow our members to begin their project proposals sooner. This means we reach impacted people sooner.

I share these black box reflections because I believe they capture the journey that we’re on as a network. Working to shift the humanitarian sector from a reactive to a proactive way of working happens in small, sometimes painful, steps. We need to recognise this journey and we’ve got to keep embracing and learning from our ‘failures’ in order to move forward.

Acting in anticipation of humanitarian crises is new for many agencies. It can be difficult to know when to trigger an alert and what projects can be the most effective. We have created guidance notes to help our members anticipate various hazards. This month we are releasing two new guidance notes: anticipating disease outbreaks and tropical storms.

Read more about the Start Fund Crisis Anticipation Window.

INTRODUCTION

This report is part IOM’s effort to provide a comprehensive statistical overview of Libya’s current migration profile.

DTM Libya’s Migrant statistical information package* includes the below report, accompanied by a comprehensive user-friendly dataset, a set of maps and a key findings one pager.

15 November 2017: The political lens is zooming in on Sierra Leone as the country is poised to hold its next presidential and parliamentary elections scheduled for March 2018. As political debates intensify, a new document launched by civil society is seen as new hope for democracy and peace. Abdul Brima examines its priority areas.

The political atmosphere is heating up in Sierra Leone as the two leading parties, the ruling All People’s Congress (APC) and the main opposition Sierra Leone Peoples’ Party (SLPP), present their presidential hopefuls for the 2018 elections. Observers and political pundits anticipate a tightly contested battle for the presidency in next year’s elections given the formation of another viable political party with former United Nations Diplomat, Dr. Kandeh Kolleh Yumkella, viewed as its potential flagbearer.

As the political drama unfolds, civil society organisations (CSOs) have been busy traversing the length and breadth of the country, running advocacy campaign to educate young people about the power of their vote.

Citizens’ Manifesto: a new manifesto for peace?

A leading consortium, Standing Together for Democracy, comprised of civil society organisations (CSOs), carried out a nationwide survey with hundreds of youth actively involved in the outcome of a Citizens’ Manifesto tagged: “My Vote, My Life”.

The manifesto pushes for political reforms that lead to inclusivity and accountability in political parties’ activities ahead of the 2018 elections, and aims to change the “face and purpose of politics in Sierra Leone” for the better.

For a country that is ranked at the bottom of the human development index, the document notes, it is easy for everything to become a priority. This “Citizens’ Manifesto” is useful because it gives direction to aid development and reduces prospects for conflict at a time when political parties are preparing their campaigns.

Development for peace

Development and political analysts think the scope for meaningful development in a country that has experienced eleven years of brutal civil conflict will be greater if Sierra Leone can pivot its current political culture away from tribal and regional division.

Even after the civil war and the catastrophic destruction caused by the Ebola virus, violent clashes have persisted between party supporters in all parts of the country. The Standing Together for Democracy consortium believes violence and political division increases spending on security agencies and diverts funds away from addressing poverty.

The consortium says fears about political violence in 2018 are well founded as political parties have in the past mobilised votes on identity and used ethnicity to manipulate voters. The hope for the implementation of the Citizens’ Manifesto is that it will be crucial in curtailing these problems and helping voters understand the value of their votes. Let us now take a nosedive at two priority areas in the manifesto.

Women's political representation

Gender inequalities in political participation remain an important part of “democracy’s unresolved dilemma” of unequal participation. This is not a problem unique to Sierra Leone, although a few African countries like Malawi, Kenya, Liberia, have demonstrated commitment to providing space for women to occupy political leadership.

There is still a lot more to be done to increase women’s participation in politics. Beneath the rising sense of ethnic division, the 2016 World Peace Index ranked Sierra Leone the second most peaceful country in West Africa. But, is this really so? Should peace only be viewed as the absence of war or gunfire?

In a country where economic disparities between the rich and poor are ever rising, unemployment is the fate of university graduates and putting food on the table for mothers is an uphill struggle, it is important to practice a political culture characterised by wider participation, national development, non-violence, and women’s role is cardinal to achieving this.

This is why it requires that presidential candidates and political parties commit to giving 40 percent local council and parliamentary nominations to women. It says, “we believe that increased women’s representation in governance will help change the face of politics and improve the quality of representation in parliament and communities”.

Women make up over fifty percent of Sierra Leone’s population, but currently, occupy only eleven percent of the country’s parliamentary seats. This must change if peace is to last.

Youth political representation

“Young people should now think of voting on issues and not on tribal or regional basis or because politicians supply them drugs to wreak havoc and promise them better lives,” says Andrew Lavalie, Executive Director of Institute for Governance Reform, one of the leading civil society organizations behind the Citizens’ Manifesto.

He observed that young people have been consistently used by politicians and that it is time to change that narrative by giving young people the chance to assume leadership positions.

It is against this backdrop that the Citizens’ Manifesto is calling political parties and presidential candidates to give young people greater political access and participation. The manifesto demands at least 15% allocation of local council and parliamentary nominations to people under thirty-five. It says: “a large number of university graduates go jobless for years while many youths are mobilized for political violence.” This view is widely held by other Sierra Leoneans especially traders who sell cheap alcohol that politicians usually use as bait to lure young people into political rallies.

Amadu Kallon, a trader at Abacha Street, one of the busiest commercial business centres in Freetown, said: “Youths are being used by politicians. In the run-up to the primaries and constituency elections, I sold bundles of alcoholic contents worth millions of Leones to youth leaders for consumption at rallies organised by political aspirants. The Citizens’ Manifesto is, therefore, challenging politicians to take concrete actions that will “reclaim youths from violence and include them in leadership.”

In Sierra Leone where youth are vulnerable to manipulation and can be enticed into perpetrating violence during election campaigns, rising unemployment, lack of education and abject poverty exacerbates the problem. The stakes for conflicts, planned and pre-financed by ill-motivated politicians, are high as the country prepares for the decisive 2018 elections.

Bottom-up hope, top-down commitment

Political leaders made the commitment during the launch of the manifesto to work in line with the document, as well as agreeing they should adopt parts in their manifestos come March 2018.

Former Chairman and Leader of the SLPP, Chief Sumanoh Kapen, stated that the Manifesto targeted three key areas including social contract, social conscience and social engineering. He emphasised that the future and hope of Sierra Leone is in the youth and that the manifesto could not have come at a better time. Andrew Lavali of IGR noted that; “this document is the voice and aspirations of the ordinary Sierra Leonean, and the recommendations should be taken seriously because they have a role to play in advancing the country’s democracy.”

It is clear that one of the ongoing drivers of hate and violence is the reluctance of the political class to embrace the many opportunities for a sustainable solution to violence and political extremism. Impunity, inequality, and skewed resource distribution remain the biggest drivers of politics in Sierra Leone, reminiscent of the pre-war situation described in the Truth and Reconciliation Commission Report.

The Citizens’ Manifesto attempts to address these institutional challenges within the country’s political setup by presenting an opportunity for political parties to embrace reforms. The manifesto pushes for reforms that “disarm the tools for violent mobilisation as we count down to 2018.”

As the elections loom, ordinary people remain eager to see whether the Citizens’ Manifesto will be adopted and its recommendations taken seriously.

About the author

Abdul Brima is Insight on Conflict's Local Correspondent in Sierra Leone. A radio producer and presenter on BBC Media Action Sierra Leone, he has worked with rural communities on conflict and development issues in Sierra Leone and Liberia.

Abidjan, 16 November, 2017 - A newly released nutrition report by the World Health Organization (WHO) Regional Office for Africa has revealed that undernutrition is still persistent in the region and the number of stunted children has increased. The Africa Nutrition Report, launched today in Abidjan, Ivory Coast also indicates that a growing number of children under five years old are overweight. The Report describes the current status in relation to six global nutrition targets that member states have committed to achieve by 2025, and underscores findings from the recently released Global Nutrition Report.

The nutrition targets call for a 40 percent reduction in the number of children under-five who are stunted, 50 percent reduction of anaemia in women of reproductive age, 30 percent reduction in low birth weight, no increase in childhood overweight, increasing the rate of exclusive breastfeeding to at least 50 percent and reducing wasting to less than 5 percent.

The Report, the first of its kind by WHO in the African region uses data from national surveys of forty-seven countries dating as far back as 2000, as well as joint malnutrition estimates published annually by UNICEF, WHO and the World Bank. It raises the alarm on critical gaps in the nutrition data available across the countries. For 19 out of the 47 countries, the ‘current’ nutrition data reflects the situation in 2012 or earlier. In two countries, the most recent surveys pre-date 2000.

According to the WHO Regional Director for Africa Dr Matshidiso Moeti, “The numbers and trends highlighted in the report show that we need to work harder to avoid the long-term consequences of malnutrition and poor health on our children’s future prosperity, including the increased risk of diet-related noncommunicable diseases such as diabetes and hypertension.” She added that the Report underscores the need to work harder on collecting and using accurate data given that nutrition information available for most countries is more than five years old, and the use of routine data for nutrition monitoring is extremely limited.

The Report points out that while the prevalence of stunting decreased between 2000 and 2016, the absolute numbers of stunted children are in fact increasing: from 50.4 million in 2000 to 58.5 million in 2016. Stunting, or impaired growth and development happens when children experience poor nutrition, disease and lack of psychosocial stimulation. It typically occurs before a child reaches the age of two, and the long-term consequences include poor school performance, low adult wages, lost productivity and increased risk of nutrition-related chronic diseases in adults.

Lead author of the Report, Dr. Adelheid Onyango, who is WHO Africa’s Adviser for Nutrition, says while overweight rates in children might still be low, the proportion and numbers are increasing in all age groups. Among adults for example, overweight, including obesity, affects about one in three women, with rates of over 40 percent in Gabon, Ghana and Lesotho.

According to Dr Felicitas Zawaira, Director of WHO-AFRO’s Family and Reproductive Health, Malnutrition, beyond its obvious physical and development impacts also harms economic growth: worldwide, between 3 to 16 percent of GDP is lost annually due to stunting alone.

Wasting, or low-weight compared to the height of a child, is a strong predictor of mortality among children under five. The Report finds that many countries in the African region still have wasting rates above the target of 5 percent or below, and persistent famine, flooding, and civil crises in some countries pose enduring challenges to meeting the target. Only 17 countries have so-called “acceptable” levels of wasting, below 5 percent, while 19 have poor prevalence (5 to 9 percent). Six countries have rates between 10 to 14 percent, representing a serious public health emergency, and three countries exceed the 15 percent critical public health emergency threshold (Eritrea 15.3 percent, Niger 18.7 percent, and South Sudan 22.7 percent).

Joint UNICEF, WHO and World Bank 2016 estimates show that the number of overweight children in Africa increased by more than 50 percent between 2000 and 2015. The Report found that 24 countries have rates between 3 and 10 percent; above this range are Algeria (12.4 percent), Botswana (11.2 percent), Comoros (10.9 percent), Seychelles (10.2 percent), and South Africa (10.9 percent).

“African Governments can, and should, take measures to prevent and reduce undernutrition by creating favourable environments for improved infant and young child feeding, improved water supplies and sanitation, and offering healthier foods in schools among other measures,” said Dr Francesco Branca, Director of the Nutrition Department at the WHO Headquarters in Geneva. Dr Branca emphasized the need to reduce consumption of refined carbohydrates and foods high in sugars and fat, which can be achieved by making sugary drinks less affordable and less appealing through taxation, labelling, and changing marketing practices.

For more information, please contact:
Maureen Nkandu
Regional Communication Manager
WHO Regional Office for Africa
Tel: +47 24139982
Email: nkandum@who.int

FREETOWN, November 16 2017 --- At a handover ceremony today, WHO in collaboration with the African Development Bank (AfDB) donated 75 vehicles to Sierra Leone’s Ministry of Health and Sanitation (MoHS). The vehicles, which include 18 cars and 57 motorbikes, will be used to support disease surveillance and response to outbreaks and other public health emergencies.

The surveillance vehicles as well as rain gear and helmets are being dispatched to the District Health Management Teams and to the national Emergency Operations Centre, and will facilitate the rapid deployment of Rapid Response Teams (RRTs) when there is need.

“Logistical equipment is a necessary component of a well-functioning surveillance system and we are grateful to WHO and partners for this kind donation,” said Dr Brima Kargbo, Chief Medical Officer at the MoHS. “I’m confident that these vehicles will make a difference in terms of providing and getting the real information we need for timely outbreak detection and response.”

Following the 2014-15 Ebola outbreak, multi-disciplinary RRTs were established and trained nationally and in all districts to be deployed whenever there is a suspected outbreak or other public health emergency.

RRTs consist of Surveillance Officers, Lab Technicians, Clinicians, Environmental Health experts, Social Mobilisation Officers, veterinarians and other responders, and undertake various functions including case investigations, sample collections, active case search and contact tracing, early treatment and referrals, and other response operations as required.

“With support from AfDB, WHO is pleased to be supporting the Ministry in creating a robust surveillance system that is able to quickly detect and immediately respond to potential outbreaks and other public health emergencies, whether this be a known or a new and emerging threat,” said Dr. Janet Kayita, Health Services Lead at WHO, speaking at the event. “The Rapid Response Teams have a crucial part to play in safeguarding public health and these vehicles will provide important logistical support in this regard.”

Safety and rain gear have also been deployed as part of the package, which including the vehicles has a total monetary value of over USD 580,000.

Contacts
Saffea Gborie, gboriesa@who.int, +232 76 777 878
Laura Keenan, keenanl@who.int, +232 786 33952

Introduction

It is easy to take a toilet for granted – lock the door, do your business, flush when finished, and forget all about it. But for 2.3 billion people worldwide – almost one in three – such a normal part of daily life is out of reach. A lack of decent toilets and clean water causes diarrhoeal diseases that, on average, claim the lives of almost 800 children every day – one every two minutes.

The health impacts of poor sanitation trap people in poverty, making it difficult to get an education or to work to support their families.

It goes without saying that everyone without this basic human right is affected, but it’s worse for some than others. For example, women and girls, people who are transgender or intersex, older people, and people with disabilities all have their own specific needs and challenges in accessing toilets.

The State of the World’s Toilets 2017 explores how the lack of decent toilets around the world prevents women and girls from fulfilling their potential. Using new data from Unicef and the World Health Organization’s Joint Monitoring Programme, we reveal the countries where women are struggling most to access a toilet, and highlight those that have made significant progress. We recommend ways to overcome the challenge of making a decent toilet normal for everyone by 2030, and to ensure these services meet the needs of women and girls everywhere.

FREETOWN, November 16 2017 --- At a handover ceremony today, the World Health Organization in collaboration with the African Development Bank (AfDB) donated 75 vehicles to Sierra Leone’s Ministry of Health and Sanitation. The vehicles, which include 18 cars and 57 motorbikes, will be used to support disease surveillance and response to outbreaks and other public health emergencies.

The surveillance vehicles as well as rain gear and helmets are being dispatched to the District Health Management Teams and to the national Emergency Operations Centre, and will facilitate the rapid deployment of Rapid Response Teams (RRTs) when there is need.

“Logistical equipment is a necessary component of a well-functioning surveillance system and we are grateful to WHO and partners for this kind donation,” said Dr. Brima Kargbo, Chief Medical Officer at the MoHS. “I’m confident that these vehicles will make a difference in terms of providing and getting the real information we need for timely outbreak detection and response.”

Following the 2014-15 Ebola outbreak, multi-disciplinary RRTs were established and trained nationally and in all districts to be deployed whenever there is a suspected outbreak or other public health emergency. The response teams consist of Surveillance Officers, Lab Technicians, Clinicians, Environmental Health experts, Social Mobilisation Officers, veterinarians and other responders, and undertake case investigations, sample collections, active case search and contact tracing, early treatment and referrals, and other response operations as required.

“With support from AfDB, WHO is pleased to be supporting the Ministry in creating a robust surveillance system that is able to quickly detect and immediately respond to potential outbreaks and other public health emergencies, whether this be a known or a new and emerging threat,” said Dr. Janet Kayita, Health Services Lead at WHO. “The Rapid Response Teams have a crucial part to play in safeguarding public health and these vehicles will provide important logistical support in this regard.”

Safety and rain gear have also been deployed as part of the package, which including the vehicles has a total monetary value of over USD 580,000.

November 12th marked World Pneumonia Day. Save the Children has launched a global campaign to stop the disease in its tracks, with the publication of our flagship report Fighting for Breath. In a series of blogs, we take a close look at the challenges and successes of countries around the world in beating pneumonia.

Sierra Leone’s Reproductive, Newborn and Child Health Policy 2011 defined pneumonia as the most common cause of under-five mortality, and responsible for 24% of all under-five deaths. WHO data shows that there were 6,630 under-five deaths in 2004, falling to 3,705 in 2015 – a 43% drop over the past 10 years, with pneumonia accounting for just 14% of all under-five mortality in 2015.

RECOVERING FROM WAR

The eleven-year civil war in Sierra Leone ended in 2002, at which point public health expenditure was as low as 3% of the country’s GDP. The impact of the civil war was further compounded by low investment in health, leading to severe shortages of health workers, as well as infrastructure and equipment, resulting in very high maternal and infant mortality rates.

Just over a decade since the civil war, the country was faced with the EVD crisis in 2014-15. These crises have resulted in a severe shortage of health workers, with just four doctors per 100,000 population. Sierra Leone also has one of the world’s lowest skilled health professional density at 1.9 per 10,000 people.

Although Sierra Leone does not have a specific pneumonia policy, several guidelines have been put in place by the government to address the challenge posed by pneumonia and its contribution to the disease burden in Sierra Leone.

FALLING INVESTMENT IN HEALTH

The government launched the Free Health Care Initiative (FHCI) in 2010 and abolished user fees for pregnant & lactating women and under-fives. But this commitment has not been supported with adequate resources, with public health expenditure fluctuating between 2.8% of the GDP in 2003 to 1.9% in 2014. Per capita government expenditure on health was $46 in 2010 and is at $15 in 2014. In the same period, external resources for health as a percentage of total expenditure on health rose from 13.3% in 2010, peaked at 32.1% in 2013 and has since fallen to 17.1% in 2014. Out of pocket payments have risen from 71.3% of total health expenditure in 2002 to 80% in 2008 and has steadily dropped to 61% in 2014, which is still much higher than the WHO recommended rate of 15-20%. Sierra Leone’s national systems suffer from chronic inefficiencies and leakages within the system. In 2012, GAVI conducted a Financial Management Assessment which unearthed the misuse of $523,303 of the health system strengthening tranche due to weak financial systems.

With donor confidence on the ebb, it is important for Sierra Leone to increase its tax based domestic financing for health. This can prove quite daunting for a country which lost 14% of its GDP in 2011 alone to tax exemptions. There has been an average $200 million annual loss between 2010-12 just from tax exemptions on goods and services granted to companies, non-governmental organisations, and embassies.

U5MR FALLING AGAINST ALL ODDS

Despite these challenges, and the low levels of resourcing for health, Sierra Leone has managed to almost halve the number of deaths due to pneumonia since 2004 with the disease no longer being the biggest killer of under-fives. This could be attributed to the FHCI, which ensures that pregnant women and children under five have access to free health care, despite the inefficiencies and lack of resourcing which plague the initiative.

The FHCI has also invested in community health workers who are the first line of care for pneumonia. Sierra Leone has more than 15,000 Community Health Workers (CHW) who are trained to diagnose and treat pneumonia at the community level using antibiotics, and this has enabled care seeking behaviour for pneumonia to increase from 48% in 2005 to 72% in 2013.

Hib 3 and PCV were rolled out in 2007 and 2011 respectively and coverage is high for both at 84% in 2016. Another reason Sierra Leone has been successful in reducing pneumonia deaths could be attributed to the improving exclusive breastfeeding rates in the country which has risen from 8% in 2005 to 59% in 2014.

PREDICTABLE, STABLE SUPPORT

A weak health system, which has been further weakened by the EVD crisis, now needs predictable external support to rebuild and strengthen its national health system if it is to maintain the momentum they have achieved in reducing deaths due to pneumonia. At a time like this, external support seems to be falling quite dramatically. This dangerous trend needs to be reversed if Sierra Leone is to continue combatting pneumonia and making progress towards SDG3.

INTRODUCTION

This report is part IOM’s effort to provide a comprehensive statistical overview of Libya’s current migration profile.
DTM Libya’s Migrant statistical information package* includes the below report, accompanied by a comprehensive user-friendly dataset, a set of maps and a key findings one pager.

Key messages

Education is lifesaving. Education is crucial for both the protection and healthy development of girls and boys affected by crises. It can rebuild their lives; restore their sense of normality and safety, and provide them with important life skills. It helps children to be self-sufficient, to be heard, and to have more influence on issues that affect them. It is also one of the best tools to invest in their long-term future, and in the peace, stability and economic growth of their countries.

Education in emergencies actions can help prevent, reduce, mitigate and respond to emergency-related academic, financial, social, institutional, physical and infrastructural barriers to children's education, while ensuring the provision of safe, inclusive and quality education.

In 2017, the EU dedicates 6% of its annual humanitarian aid budget to education in emergencies, one of the most underfunded sectors of humanitarian aid. In 2018, this amount will increase to 8%.

4.7 million girls and boys in 52 countries have benefited from EUfunded education in emergencies actions between 2012 and 2017.

Government help has been slow to reach hundreds of families displaced by the disaster in August, who fear they will have nowhere to go

The government of Sierra Leone has started closing down the emergency camps housing hundreds of families displaced by August’s deadly landslides, despite many people saying they still have nowhere to go.

Read the full story on The Guardian.

On Friday, November 17, Sierra Leone President Dr. Ernest Bai Koroma, and U.S. Ambassador to Sierra Leone, Maria E. Brewer, formally launched the President’s Malaria Initiative (PMI) in Sierra Leone.

“Today, we celebrate the new partnership between PMI and the Government of Sierra Leone. With the first year’s planned contribution of $15 million, PMI joins other donors and partners to expand access to proven and effective malaria prevention and control tools,” Ambassador Brewer said during the formal launch event.

Malaria is a public health challenge that the Government of Sierra Leone, the U.S. Government, and partners are united in fighting. Over 2 million outpatient visits are due to malaria every year in Sierra Leone, of which about a million patients are children under five years of age.

PMI will work together with the Government of Sierra Leone, under Ministry of Health and Sanitation and National Malaria Control Program (NMCP) leadership; and in collaboration with malaria stakeholders, to scale up a comprehensive, integrated package of life-saving interventions in communities. This includes both prevention (insecticide treated mosquito nets and indoor residual spraying) and control (diagnostics and treatment) interventions. PMI support includes mosquito surveillance, malaria case management, monitoring and evaluation of impact, and behavior change communication activities.

USAID Administer Mark Green announced the expansion of the President’s Malaria Initiative to Sierra Leone and four other countries at the UN General Assembly in September. With the addition of Sierra Leone and the other four new focus countries, PMI will have programs in 24 countries in sub-Saharan Africa. Almost 90 million additional people at risk of malaria in West and Central Africa will benefit from this expansion.

Joining the launch event were members of the President’s cabinet, representatives of the U.S. government, local and international donors and organizations, and partners contributing to the elimination of malaria in Sierra Leone.

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

Cumulative surveys: 627 This snapshot forms part of a wider, ongoing data gathering project with respondents who have recently transited the Central Mediterranean route through North Africa on their way to Europe. To date, data has been gathered from 627 respondents in Italy, with respondents coming from Nigeria (26.5%), Eritrea (12.3%), Gambia (9.9%), Côte d’Ivoire (8%), Bangladesh (7.3%), Mali (6.7%), Senegal (6.2%), Ghana (4.6%), Guinea (3.6%), Pakistan (3%), Cameroon (2.1%), Togo (1.4%), Ethiopia (1.4%), Sudan (1.3%) as well as (cumulatively 5.9%) Burkina Faso, Morocco, Niger, Sierra Leone, Syria, Egypt, Liberia, Democratic Republic of the Congo (DRC), Central African Republic (CAR), Guinea-Bissau, Libya, Afghanistan, Somalia and Nepal.

Findings in this snapshot are based on 34 surveys conducted during the month of August. The largest group of respondents are from Nigeria (14), while 6 are from Eritrea, 3 each from Mali and Côte d’Ivoire, 2 from Gambia and 1 each from Morocco, Senegal, Egypt, Yemen, Ethiopia and Guinea. In terms of demographics, 9 respondents are female while 25 are male and just over half (18) of those interviewed are between the ages of 18 and 25, while 8 are between the ages of 26 and 31 and a further 8 are between the ages of 32 and 40.

INTENTIONS

• 14 (41%) of those interviewed reported that they had set out on their journeys with the intention of reaching Italy, while 5 (15%) reported other EU countries (such as France and Germany) as their intended destinations and 1 (3%) reported that Sudan had been his intended destination. A relatively large segment (12 or 35%) reported that they had set out without plans for a particular destination.

• With regards to their intentions to remain in Italy or to travel onwards, 25 planned to remain in Italy while 8 reported that they intended to travel onwards and 1 was, at the time of the interview, undecided.

JOURNEY

• 19 (56%) respondents reported seeking information before undertaking the journey while 15 (44%) said that they did not actively seek such information. Those who did seek information did so by talking with migrants abroad and/or smugglers, humanitarian organizations and friends/family and/or through accessing social media for information.

• 2 of those interviewed during the month of August had been returned from Germany to Italy. The remaining 32 respondents travelled to Italy by boat through the Central Mediterranean route using the services of smugglers with 31 of them embarking from Libya and 1 from Egypt. Of those who transited through Libya, 18 had travelled to Libya by jeep, 10 by car, 1 had flown directly in and 1 declined to answer the question.

• With regards to respondents’ lengths of stay in Libya, 17 reported that they had remained in the country for a period between 1 and 6 months, 7 reported staying between 6 months and 1 year and 5 reported staying between 1 and 2 years, while 3 respondents declined to answer the question.

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

Cumulative surveys: 662 This snapshot forms part of a wider, ongoing data gathering project with respondents who have recently transited the Central Mediterranean route through North Africa on their way to Europe. To date, data has been gathered from 662 respondents in Italy, coming from Nigeria (25.2%), Eritrea (14.2%), Gambia (10%), Côte d’Ivoire (8%),
Bangladesh (7%), Mali (6.5%), Senegal (5.9%), Ghana (4.5%), Guinea (3.3%), Pakistan (2.9%), Cameroon (2%), Sudan (1.5%), Ethiopia (1.4%), Togo (1.4%), Syria (1.1%) as well as (cumulatively 5.1%) Burkina Faso, Morocco, Niger, Sierra Leone, Egypt,
Liberia, Democratic Republic of the Congo (DRC), Central African Republic (CAR),
Chad, Yemen, Guinea-Bissau, Libya, Afghanistan, Somalia and Nepal.

Findings in this snapshot are based on 35 surveys conducted during the month of September. The largest group of respondents are from Eritrea (17), while 4 are from Gambia, 3 each from Côte d’Ivoire and Syria, 2 from Sudan and 1 each from Morocco, Nigeria, Mali, Egypt, Chad and Ghana. In terms of demographics, 3 respondents are female while 32 are male. The largest group (23) is between the ages of 18 and 25, while 6 are between the ages of 26 and 31, a further 5 are between the ages of 32 and 40 and 1 respondent is between 40 and 60.

INTENTIONS

• 21 respondents reported changing their plans on intended destination during their journey with only 4 of those interviewed beginning their journeys with the intention of reaching Italy. 11 out of the 35 respondents had intended Libya as their final destination, while 9 had initially planned to go to Germany, 1 to Algeria, 1 to Holland, 1 to Finland, 1 to Belgium, 1 to Switzerland, 2 to Sudan, 1 to Niger and 3 reported not having a planned destination.

• With regards to their intentions to remain in Italy or to travel onwards, 20 reported that they intended to travel onwards while 14 planned to remain in Italy and 1 person at the time of the interview was still undecided. Those who expressed a wish to travel onwards intended to move onto other European countries for the most part with the vast majority reporting Germany, France, and Sweden as their intended destinations. One respondent expressed a wish to return to Eritrea.

JOURNEY

• 16 respondents reported gathering information before undertaking the journey while 19 said that he did not actively seek such information.
  With regards to sources of information, 14 reported the source of information as migrants abroad and/or smugglers, humanitarian organizations and friends/family while 2 reported accessing social media for information.

• All respondents traveled from Libya to Italy by boat using the services of smugglers. 30 respondents arrived in Libya by car/jeep, 3 flew in directly, 1 arrived by lorry and 1 by bus. The majority of respondents, 20, arrived to Libya from Sudan, 8 from Niger, 2 from Egypt, and 1 each from Algeria and Tunisia. 3 declined to indicate intermediate steps between their countries of origin and Libya.

RISKS AND ABUSES

• 23 respondents reported witnessing one or more deaths along their journey. Of those who reported witnessing deaths, 22 reported the deaths to have taken place in Libya and 1 reported the death/s to have taken place in the Sahara Desert.

• Of the 35 interviewees, 30 reported experiencing and/or witnessing physical abuse during their journey. Of those who reported physical abuse, the vast majority (27) said that abuse took place in Libya while 2 said it had taken place in Sudan and 1 person declined to answer the question. Furthermore, a large group of those who reported abuse (12 out of 30) said that smugglers were the perpetrators, 6 said armed groups were responsible for the abuse, 5 said bandits, 2 said police forces were responsible and 1 each said civilians and Asma boys were the culprits. 1 person declined to answer this question.

• 26 reported experiencing and/or witnessing detention with the majority (23 out of 26) reporting the location of detention as Libya and 3 reporting Sudan. 14 were and/or witnessed others forced into labour. 7 reported having their own or witnessing others’ documents being destroyed in Libya with the majority reporting smugglers and Asma boys as the culprits. 26 respondents reported witnessing and/or experiencing robbery along their journey.

Summary

The private sector can both exacerbate drivers of conflict and contribute to peacebuilding in post-conflict states. There is a relatively small body of literature on the role of the private sector in building peace. Most of the evidence takes the form or NGO and international organisation reports and evaluations. Examples of successful interventions are often dated and evaluations lack rigour. Analysis of success factors is also lacking. It is therefore difficult to establish causality between many of the initiatives discussed in this report and improvements in peace and stability. There is very little literature looking at private sector involvement in peacebuilding in post-conflict Least Developed Countries (LDCs). The literature reviewed for this study is largely gender blind.

Question

What lessons have we learnt on the effectiveness of various refugee settlement approaches (integration in towns/communities, informal settlements, formal settlements, camps) with regard to:
1. Supporting protection for refugees and host communities: how do respective approaches help to uphold refugees’ rights, protect them from e.g. exploitation and abuse, support social cohesion and enable their access to formal and informal protection mechanisms and services?
2. Delivering assistance and supporting self-reliance among refugees and host communities: how do various models enable or not self-reliance, help manage public health risks, and deliver wider economic benefits to the host communities?

Summary

This review of the effectiveness of different approaches to refugee settlement shows that the ‘traditional’ approach of setting up refugee camps is ineffective in many respects – particularly in terms of promoting self-reliance – and hence to be avoided. The recommendation in policy circles is now for alternatives to camps that provide economic opportunities to refugees, allow mixing with host populations, do not set up parallel service delivery systems, and seek to benefit both refugees and host communities. However, perhaps because the policy shift away from camps is only recent, there is less clarity about what these alternatives would look like in practice and very few large-scale examples of this.