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 59 events in the region. This week’s edition covers key ongoing events, including:

• Ebola virus disease in the Democratic Republic of the Congo

• Cholera in Cameroon

• Cholera in Tanzania

• Humanitarian crisis in Central African Republic

• Humanitarian crisis in Ethiopia.

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 issues and challenges include:

• The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is evolving, with new confirmed cases and deaths occurring. Genomic sequencing has confirmed that the North Kivu outbreak is unrelated to the one that occurred in Equateur Region, though both were caused by the same Ebola virus strain. This finding is important to inform the response to the outbreak, particularly the application of new tools such as vaccines and therapeutic medicines.

The prime priority remains rapidly setting up effective response structures on the ground. Nonetheless, the prevailing insecurity in the affected province could influence several aspects of the response, including the model, strategy, timeliness, etc. Good progress has, so far, been made in the given circumstances. The national authorities and partners need to continue mobilizing the requisite resources to rapidly set up strong response structures and systems on the ground.

• Cameroon has been experiencing a cholera outbreak in the North Region since May 2018, and the Central Region was affected later in the year in July 2018. Littoral Region is also reporting increasing number of acute watery diarrhoea cases, though no laboratory confirmation of etiology has been made. While the outbreak remains insidious and is beginning to improve, there are key issues that require attention, including the high case fatality ratio and the delay in establishing the etiology of the acute watery diarrhoea in Littoral Region. Additionally, rising levels of insecurity and the presence of refugees and internally displaced people in several parts of the country are potential risk factors. This cholera outbreak calls for keen attention from the national authorities and partners to avoid escalation of the situation.

By Harriet Mason, Communications Officer, UNICEF Sierra Leone

FREETOWN, Sierra Leone – After a 20-minute-walk up a steep rocky path in the Dwarzark community, I arrived at the new home of Foday and Mamiesia Kallon and their 14-month-old son. It’s a fresh start following the tragic events of 14 August 2017 when flooding and a landslide killed at least 500 people in Freetown, and swept away part of the Kallon’s family home and all their belongings.

“That night was a nightmare. It was terrible,” said an almost teary Foday, describing the moment flood waters came rushing through the house. Foday’s family is one of the thousands that were affected. He says they lived a normal and happy life until the tragic incident: “We had the basic things we needed to run our lives. But even though we lost everything, we are thankful we are alive.”

To support many of those hit by the emergency, nearly two thousand affected households have been directly supported with cash to rebuild their lives, delivered through mobile money transfers, funded by UK aid from the British people (also known as DFID). The project was led by the Government’s National Commission for Social Action (NaCSA), with technical support from UNICEF and the World Food Programme, and support from the Anti-Corruption Commission (ACC). As part of the process, families received new mobile phones and SIM cards from UNICEF, which were then set up to receive the cash transfers.

The cash transfer scheme provided beneficiaries with mobile money up to the equivalent of $180 across three instalments to help families. Additionally, a one-off recovery aid cash transfer equivalent to $300, was provided to households like the Kallons who were living in temporary camps and displacement centres, to help them get resettled upon voluntarily leaving the camps. Unconditional cash transfers have been increasingly used in emergency response in recent years, as it allows households to prioritize their needs, often making it a more empowering and dignified form of support.

“The money UK aid gave to us has really helped us!” said Foday. “Apart from renting this place, we have used some to start a small business for my wife, and also made partial payment for a motorbike which I now run as a commercial transport,” he added.

According to Foday, deciding to invest was hard considering their other needs, but he was convinced that it will guarantee them a source of income to cover their living costs in the future. “Every week we use some of our earnings to offset the balance we owe for the motorbike and save some,” he said.

Even though memories of the tragic incidents of August 2017 still linger, families like Foday’s are striving to move on and rebuild their lives. “I say a big thank you to everyone who helped us. They did well for us,” said Foday. “The floods took away all we had, but we have started our lives afresh and we hope for nothing but the best.”

Fresh from an electoral cycle, Sierra Leone is slowly transitioning into a new political climate. Although the elections were largely peaceful, instances of alleged politically motivated violence were seen across the country. Intimidation, harassment, and hate speech resulted in internal displacements and injuries, and drew lines of division. Many of the victims of the violence resulting from these actions were women and children. Additionally, there are claims that the Sierra Leone Police did not properly address these incidents, further straining relations between police and some communities.

“Why did these incidents happen in these areas, and how do we make sure they do not happen again?”

This question from the Minister of State, Madam Francess Piagie Alghali, set the tone for the two-day workshop on peace and national social cohesion in post-election Sierra Leone. The workshop, jointly hosted by the Office of the Vice President and United Nations Development Programme (UNDP), was well attended by representatives from NGOs, national security institutions, Ministry of Internal Affairs (MIA), and donors—UK Aid and Irish Aid. The aim was to promote healing, reconciliation and social cohesion in communities affected by violence during the elections.

The workshop was officially opened by the Minister of State, Mr. Sunil Saigal, UN Resident Coordinator, and Ms. Chigomezgo Mtegha-Gelders, DfID Sierra Leone Governance Team Leader. Mr. Samuel Doe, UNDP Country Director, moderated the opening panel. During their respective addresses, all recognised the need for a commitment to strengthen national social cohesion across the country. As UN Resident Coordinator Sunil Saigal said, “all citizens of Sierra Leone must be and feel part of the country and society in order for development, and indeed peace and stability, to be achieved.” The DfID Head of Governance reminded participants that Sierra Leone, as a country in transition, is expected to go through periods of turbulence. “There will be progress but there will also be times when there is regression”. To sustain peace in such a society and maintain upward sustainable development trajectory emphasis must be on strengthening institutions, she underlined.

It can be recalled, in his address at the State Opening of Parliament in May this year, H.E President Julius Maada Bio committed the Government to promoting unity and national cohesion across the country. Several NGOs were there to answer his call, alongside the Office of the Vice President and UNDP. The NGOs with whom UNDP is collaborating to support the effort of the Government include the Institute for Governance Reform (IGR), Fambul Tok, Campaign for Good Governance (CGG), WANEP, and the National Election Watch (NEW). The project is supported by the UN Peacebuilding Fund.

The workshop concluded with a statement of hope and affirmation from the Honourable Minister of State; “The Vice President’s office is committed to this exercise and we want to take resilient steps towards peace.”

Article written by Claire Flynn-Byrne

“The fact that no new cases of wild poliovirus have been detected in Nigeria points to the improved surveillance and rapid response protocols Rotary and its Global Polio Eradication Initiative partners have established, particularly in insecure and inaccessible areas,” said Michael K. McGovern, chair of Rotary’s International PolioPlus Committee. “While this progress is promising, it’s time to redouble our efforts so we can continue to maintain the political and financial support necessary to end polio for good.”

While significant strides have been made against the paralyzing disease, wild poliovirus is still a threat in parts of the world, with 10 cases in Afghanistan and three cases in Pakistan this year so far. As long as a single child has polio, all children are at risk, which underscores the need for ongoing funding and political commitment to eradication.

To support polio eradication efforts in countries where polio remains endemic, Rotary is allocating the majority of the funds it announced today to Afghanistan ($22.9 million), Pakistan ($21.7 million), and Nigeria ($16.1 million).

Further funding will support efforts to keep 12 vulnerable African countries polio-free:

Cameroon ($98,600)

Central African Republic ($394,400)

Chad ($1.71 million)

Democratic Republic of the Congo ($10.4 million)

Guinea ($527,300)

Madagascar ($690,000)

Mali ($923,200)

Niger ($85,300)

Sierra Leone ($245,300)

Somalia ($776,200)

South Sudan ($3.5 million)

Sudan ($2.6 million)

Africa will also see $5.8 million in funding for surveillance activities and $467,800 for technical assistance. Additional funding will go to Bangladesh ($504,200), Indonesia ($157,800), Myanmar ($197,200), and Nepal ($160,500), with an additional $96,300 funding surveillance in Southeast Asia. The remainder of the funding ($6.6 million) will go to the World Health Organization (WHO) for research activities.

Rotary has committed to raising $50 million a year to be matched 2-to-1 by the Bill & Melinda Gates Foundation, yielding $450 for polio eradication activities over a three-year period. To date, Rotary has contributed more than $1.8 billion to fight the disease, including matching funds from the Gates Foundation, and countless volunteer hours since launching its polio immunization program, PolioPlus, in 1985. In 1988, Rotary became a core partner in the Global Polio Eradication Initiative with the WHO, UNICEF, and the U.S. Centers for Disease Control and Prevention. The Gates Foundation later joined. Since the initiative launched, the incidence of polio has plummeted by more than 99.9 percent, from about 350,000 cases in 1988 to 22 confirmed in 2017.

About Rotary

Rotary brings together a global network of community leaders dedicated to tackling the world’s most pressing humanitarian challenges. We connect 1.2 million members from more than 35,000 Rotary clubs in almost every country in the world. Their service improves lives both locally and internationally, from helping those in need in their own communities to working toward a polio-free world. Visit rotary.org and endpolio.org for more about Rotary and its efforts to eradicate polio.

Contact: Audrey Carl, audrey.carl@rotary.org, 847-866-3424

Certain events in our lives are so momentous that we shall always remember where we were and what we did when those events occurred. Many of us will surely remember where we were in the early hours of 14 August 2017, when we received the news of the mudslide in Regent. It turned out to be one of the worst natural disaster in Africa in recent years, and there is no doubt that the impact on the individuals affected and on the community was both dramatic and profound. No-one who has seen the devastation caused on 14 August last year, the loss of life and the effect on survivors could avoid being touched by the situation.

I am sure we shall never forget the terrible events that unfolded early on that Monday morning, just as we must not forget those who perished in the disaster, or indeed survivors who may still be suffering from trauma and those, who have lost loved ones.

I would like to pay tribute to all those men and women, who went to the site from the early hours, and for several days, to help in the search and rescue efforts, who were out digging through the mud and debris in the hope of finding survivors. I pay tribute to all those who helped care for the survivors by bringing food, shelter and other critical supplies to meet basic needs, and indeed those who helped provide for those, who lost their lives.

I commend the national leadership ,from the highest levels down and for taking swift action, through the National Security Coordinator and the Office of National Security to bring all critical actors together to responded rapidly to a complex crisis. The disaster brought about, yet again, a clear demonstration of the ability of the international community to work closely together in partnership with the national authorities to support the Government-led response. I am very pleased to note that the UN family were also among the first responders.

The United Nations, as One, played its part both in the immediate response and in the recovery phase, supporting the Government in carrying out required damage, loss and risk assessments, and preparing recovery strategies, both for the immediate, medium, and for the longer term in disaster prevention and management, and urban and environmental planning.

According to the World Risk Report 2017, Sierra Leone ranks in the top 15 most vulnerable countries to disaster risk worldwide, and disasters, both natural and man-made, have destroyed or, at the very least, severely disrupted the achievement of Sierra Leone’s development objectives during the most recent decates. A catalyst for change, the mudslide disaster of August 2017 raised awareness about prevention and preparedness, as well as the critical need for longer-term environmental protection. It is our hope that all future investments in sustainable development will be risk-informed.

In partnership with the Office of National Security, the United Nations is engaged in disaster risk management in order to enhance resilience to natural and man-made disasters in the most vulnerable communities in Sierra Leone. UN support improves national and local capacities to anticipate, plan and mitigate the effects of disasters. 450 volunteers from affected communities were enlisted in cash-for-work resilience building activities, over 200 District Disaster Management Committees have been trained, and hazards have been mapped out in all 16 districts, with focus on improving the capacity of community volunteers as front-line responders.

We want to use this opportunity to call on all Sierra Leoneans to follow in the footsteps of the courageous, dedicated and resilient people of the affected communities.

Remediating the landslide area, part of the Freetown Emergency Recovery Project, is supported by the United Nations with funding from the World Bank. Established in August 2017 to support the government’s resilient recovery programme, it aims to rehabilitate and rebuild damaged infrastructure, and strengthening disaster risk management and early warning capacities.

The landslide remediation project entails technical studies, environmental, social and economic assessments needed to ensure that all environmental and social safeguards have been considered – identifying and removing rocks in precarious positions, re-profiling slopes through earthen removal or addition, rationalizing and formalizing river beds and re-planting trees. Also following support from the UN, many of these trees will carry fruits and nuts to benefit the surrounding community and reduce the likelihood of them being felled for firewood.

The global Sustainable Development Goals officially came into force on 1st January 2016, setting the wheels in motion to end poverty, protect the planet, and ensure prosperity for all by 2030. Disaster prevention is very much part of longer-term sustainable development. We are pleased, therefore, to see that disaster prevention, together with the environment, is the focus of one of the clusters being organized to implement the eight priorities determined by the Government, and urge the Government to hold the issue high on its agenda as an integral part of the national development planning, just as the SDGs should be firmly at the centre of national development.

The UN Country Team in Sierra Leone – with 15 resident UN agencies, funds and programmes, three non-resident agencies, and the International Monetary Fund, the World Bank and the African Development Bank – will continue to build our work, together with our many partners in Sierra Leone to ensure that Disaster Risk Reduction remains a cross-cutting necessity in the country’s national development process, and new development agenda. We are also pleased to see that the Mayor of Freetown and the Freetown City Council are addressing the issue as an urgent priority.

Indeed, prevention and preparedness are best ensured in times when there is no crisis. Therefore the issue should not receive attention only during the rainy season, but should continue to be addressed with urgency even when the rains stop.

On this day, as Sierra Leone remembers the thousands of people affected by last year’s disaster, and the significant destruction and damage to critical infrastructure that occurred as a result of it, I am here to tell you that the UN family in Sierra Leone stands ready to lend whatever support possible to the development of policies and to their implementation for the short, medium and long term, working together to close the energy gap, enhance national prevention and recovery capacities, and promote lasting, nature-based solutions for a sustainable and even more resilient Sierra Leone, so that together we can ensure that no-one is left behind.

Thank you.

The Girls’ Education Challenge (GEC) aims to improve the learning opportunities and outcomes for up to one million of the world’s most marginalised girls. Access to a good quality education will give these girls the chance of a better future for themselves, their families and their communities.

These projects were selected through an open and transparent process and assessed for their ability to implement new and effective ways to get girls into school, keep them there and make sure they receive a good quality education in ways which are sustainable beyond the GEC funding.

This booklet outlines the 37 projects that have so far been selected to receive funding through the ‘Step Change’, ‘Innovation’ and ‘Strategic Partnerships’ funding windows. It summarises the objectives, interventions and location of each project’s activities. Please note that detailed information, including the names of organisations, has not been provided for regions where there are issues of security for project staff, teachers and girls, but contact can be facilitated by the Fund Manager on request. Please also note, as projects progress through the programme, GEC budget figures and the number of marginalised girls will be subject to change.

They were selected under three funding windows:

1. Step Change: scaling up successful interventions that are already having a positive impact.

2. Innovation: applying new interventions such as technological innovations, developing new partnerships, adapting proven solutions for new geographies, communities or age groups.

3. Strategic Partnerships: creating new partnerships with the private sector including, Discovery Communications, The Coca Cola Company, Avanti Communications and Ericsson.

The GEC projects and partnerships are implementing a diverse range of interventions to provide girls with access to education, materials, safe spaces to learn and a ‘voice’. They are helping to mobilise and build capacity within governments, communities and schools, training and mentoring teachers, governors and community leaders. Projects are targeting marginalised girls, disabled girls and migrant communities, with more than half of the target group living in high-risk and conflict-affected environments such as Afghanistan, Somalia and South Sudan

By Zoe Tabary

LONDON, Aug 14 (Thomson Reuters Foundation) - Sierra Leone's capital Freetown must tackle deforestation, poor housing and decrepit drainage if it is to prevent the next disaster, its mayor said one year after a devastating mudslide killed an estimated 1,000 people and left thousands of others homeless.

Rapid urbanisation in the growing city is driving residents to claim "any trees and land they can find" to build homes, making landslides and flooding more likely in times of heavy rain, said Freetown Mayor Yvonne Aki Sawyerr.

"Our city has no future if we don't save the environment," she told the Thomson Reuters Foundation in a phone interview on Monday. "And that's not me being a tree-hugger. That's being pragmatic."

Originally big enough for 400,000 residents, Freetown has mushroomed since Sierra Leone won independence from Britain in 1961 and is now home to an estimated 2 million people.

People flocked to the city during the country's decade-long civil war that ended in 2002, and the rampant, unplanned construction that followed destroyed forests that offered vital protection against mudslides.

A fifth of the population lives in slum conditions with no sewage or basic services, according to the United Nations, and 60 percent live on less than $1.25 a day.

Some 3,000 people lost their homes in the 2017 mudslide.

"The mudslide broke my heart because it was preventable," said Aki Sawyerr, who said the disaster made her "more determined than ever" to run for office.

"You have a growing population living on a densely populated and steep piece of land. That makes any heavy rain dangerous," she said.

Since Aki Sawyerr was elected in March as the city's first female mayor in more than three decades, she has pushed a raft of measures to reduce flooding, such as unblocking gutters to allow rainwater to flow and encouraging residents to minimise waste.

Eric Hubbard of Catholic Relief Services, a charity, said such measures are crucial to preventing flooding disasters in Freetown's slums.

Mapping flood-prone neighbourhoods and cleaning up the drainage system in Dwarzak – a slum in western Freetown – has made the area flood-free for the first time in 15 years, he said.

"One of the key things going forward will be proper waste management and waste disposal," he said. "Although people in Sierra Leone are accustomed to natural disasters, we're trying to focus on behaviour change."

Insufficient funding remains a major obstacle to upgrading the city's infrastructure, said Aki Sawyerr.

"There's a reluctance for people to pay taxes because of poor public services, but we need taxes to fund those services, so that's a vicious circle we must break," she said.

The mayor said she needed more staff from climate change specialists to operations officers.

"We are better prepared than we were last year, but we're not there yet", she said. "(Freetown) is a beautiful place but our beauty is under threat."

(Reporting by Zoe Tabary @zoetabary, Editing by Ellen Wulfhorst. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)

Aimee Ansari

August 2014 was a scary time in West Africa. Ebola was spreading rapidly and the international community was waking up to a disaster that ultimately killed more than 11,000 people.

Read the full report on IRIN.

Flooding recorded in the Sahel, while dryness strengthens in Ethiopia

1. The forecast for abovenormal rains during the outlook period is likely to cause flooding in Mali, Burkina Faso, and western Niger.

2. Several weeks of above-average rainfall has damaged infrastructure and caused fatalities in Sudan. Continuing rainfall may trigger additional floods through mid-August.

3. Poorly distributed rainfall since June has resulted in significant moisture deficits and deteriorated ground conditions across parts of western Uganda, northeastern DRC, and southern South Sudan.

4. Rainfall deficits are increasing across parts of Ethiopia. The SNNPR, central Oromia, and northern Somali States show signs of moisture stress and degraded ground conditions.

5. Several weeks delay to the start of rains in western Senegal has led to abnormal dryness

By Sabrina Mahtani, Amnesty International West Africa researcher

16 August 2018, 12:39 UTC

“I felt like it was me they had killed that day,” says Asatu*, reaching for a piece of multi-coloured cloth to wipe away her tears. Exactly two years ago today, her 16-year-old son was shot by the police as he came home from school.

She rushed to town after receiving a phone call and found her son’s body lying in an omolanke (a wheel barrow). After he was shot dead during the demonstration several young people had carried his body to the Town Chief to show him the reality of the police actions. Such deaths happen all too frequently in Sierra Leone.

Mariama’s* son was also shot dead that day by the police. “My son was 17 years old,” she says, her voice breaking. “He loved football and music. He was attending Kabala Secondary School. This year, he should have taken his senior secondary school exam.

“On the day he was killed, I told him to go and buy me something. Later there was panic. Tear gas. People running everywhere. Someone told me they [the police] had shot him. I fainted.” Often the justification for the police’s disproportionate use of force against demonstrators is that their demonstration was “illegal”. But obtaining permission from the police is often impossible—and not even a proper legal requirement.

Take what happened in Kabala, a small hilly town in northern Sierra Leone. Two years ago to the day (16 August), young people from the town decided to hold a peaceful protest over government plans to move the construction of a planned “youth village” from their district to another district. The proposed youth village would have offered training and trade opportunities for young people in the area, a beacon of hope in a country with high rates of youth unemployment.

Youth leaders requested permission from the police to hold the demonstration but were told they had to request this 21 days in advance. There are no provisions in Sierra Leone’s laws---that already fall short of international standards on the right to peaceful assembly—to require this.

Youth groups decided to meet the next day to discuss what to do. Eyewitnesses told me that the police fired tear gas outside the meeting venue to disrupt the meeting and stop the youth from protesting. People started to run, scared by the loud noise and overpowering smell. Eventually some young people started to throw stones at police officers. The police fired bullets back at them, in violation of international standards which state that firearms must never be used to disperse a crowd and should only be used when there is a real and imminent threat to life.

Four men were also injured by gunshot wounds. Brima* was shot in the back. He struggles to walk and often uses a wheelchair. “I used to do construction work,” he told me. “Now I can’t do anything.” He has not received any compensation from the government or any assistance.

The Independent Police Complaints Board (IPCB) investigated the incident and named police officers, suspected of being involved in the shooting, that they recommended be criminally investigated. Yet two years on there is still no justice. The officers have just been transferred to another town. I met one of the officers and found out that, instead of facing disciplinary action, he had been promoted. “I want to see the police officers who did this go to court,” Brima told me.

The people of Kabala are not alone. Across Sierra Leone, there are survivors of police brutality who are still waiting for justice or compensation. Abdulai*, a university student, was shot during a student protest in the southern city of Bo last year. He lives with a bullet in his heart and needs medical treatment abroad but cannot afford it. He has not received any compensation and no police officer has been disciplined or investigated, let alone brought to justice in connection with his shooting despite recommendations made by the IPCB.

Survivors of police brutality are hopeful that they will finally receive justice and compensation following the election of a new government in April that has promised a break with the past.

“Maybe the new government will do something if there is enough pressure” a man who was shot during a workers’ protest in 2007, when two people were killed and at least nine people injured, told me. No police officer has been prosecuted in more than a decade over that incident despite recommendations by a government appointed Commission of Inquiry which named police officers to be investigated.

University student Abdulai, shot during the Bo student protest in 2017, wants to hold a peaceful march to commemorate the loss of young lives in Kabala and across the country in other protests. But he isn’t sure whether he will be granted permission by the police. Despite the risks, he told me he felt a duty to insist on demanding accountability: “I believe I have a duty to try and change things after my experience,” he told me. “To fight for justice so this will not keep happening.”

When I met him last month the newly appointed Deputy Attorney General, Abdulai Bangurah, told me that his office would look into the backlog of cases. The government has made fighting corruption a priority. Families who have lost loved ones hope that the authorities will place the same urgency on combating impunity in the police force - after all, security sector reform is meaningless unless there are consequences for the excessive use of force.

• Names changed to protect the identities of those interviewed.

It has been the driest start to a summer in over 45 years in the UK. Yet, much of the country had water in reserve when it began, ensuring a continued safe supply for drinking and washing. Millions around the world are not that lucky: despite high rainfall, they go thirsty.

In some of the wettest countries in the world - where rainy days bring a lot more water than the 1248mm average that falls yearly in the UK, according to World Bank data - clean water is extremely hard to get, especially for those living in poverty.

Unlike the UK where it rains all year round, many of these countries face heavy rainfall in one season and severe drought in the next - both exacerbated by climate change - putting water resources under heavy strain.

In some regions, climate change is making water sources increasingly unreliable as flooding contaminates previously drinkable water. Yet, the problem is often not a physical lack of water: some places have significant underground reserves - known as 'groundwater' - because of abundant rainfall. Here, thirsty communities cannot get sufficient clean water because of a lack of investment in the infrastructure needed to deliver a reliable supply, indicating a lack of political prioritisation.

Jonathan Farr, senior policy analyst on water security and climate change at WaterAid, said:

"Not having clean water to drink is not, for most people, due to a lack of rain. For the one in nine people around the world - 844 million - who do not have clean water close to home it is usually because there is not enough investment in systems to ensure rainwater is captured, stored, treated and piped effectively."

"WaterAid calls for governments to prioritise the provision of safe water, and works with decision makers to provide lasting services that ensure that no one is left behind."

"In 2015, world leaders pledged to bring safe water and toilets to everyone, everywhere by 2030. In July, during a high-level meeting in New York, they renewed this promise and now it is time to act."

Countries where rainfall is higher than in the UK, yet access to clean water is low include:

Papua New Guinea. The impacts of climate change - rising seas and extreme weather - have tainted groundwater, meaning that even though an average of 3055mm of rain falls each year, most of the water is unsafe to drink. The number of people with access to clean water close to home is decreasing: 4.83 million people (or 63 percent of the population) do not have clean water available within a half hour trip.

Sierra Leone. Sierra Leone is twice as wet as the UK with 2427mm of rain on average each year, yet, 4 out of 10 people (42%) lack basic access to clean water. The Ebola outbreak was aided by a lack of clean water as health centres and communities struggled to maintain the high hygiene standards needed to halt the spread of the virus.

Liberia. High on the list of the world's wettest countries with 2421mm of rainfall on average each year, a third of the population remains without access to clean water, or 1.36 million people. Liberia is still recovering from two devastating civil wars that wiped out much of the country's infrastructure and the 2014 Ebola outbreak demonstrates the urgency to rebuild. 8 in 10 people don't have toilets and go out in the open, risking contaminating water sources, many of which are already at risk from industrial and mining pollution.

Myanmar. After decades of military rule, high hopes generated by the reallocation of budgets to national services are frustrated by increasingly intense hot dry seasons, a decrease in rainfall - from 1981mm on average between 1961-1990 to 1566mm between 1991 and 2015 average a year - and depletion of groundwater reserves, which are contributing to water scarcity in Myanmar. Some 17.5 million people - or 32.5% of the population - do not have clean water close to home, including almost 40% of rural residents.

Madagascar. The fourth biggest island in the world gets 1422mm of rain on average each year and faces both severe drought and devastating floods at different times of the year - especially in the country's southern region. Nearly half the country's inhabitants do not have clean water close to home, leaving 12 million people without.

ENDS

For more information, please contact:

In London: Yola Verbruggen, Senior Media Officer, YolaVerbruggen@wateraid.orgYolaVerbruggen@wateraid.org or +44 (0)207 793 4909

Or call our after-hours press line on +44 (0)7887 521 552 or email pressoffice@wateraid.orgpressoffice@wateraid.org .

***Notes to Editors:**

Data Rainfall data from the World Bank's Climate Change Knowledge Portal, found here, was used to calculate the average yearly rainfall in mm between 1991 and 2015. Country-specific data from WASHwatch, found here

WaterAid

WaterAid is working to make clean water, decent toilets and good hygiene normal for everyone, everywhere within a generation. The international not-for-profit organisation works in 34 countries to change the lives of the poorest and most marginalised people. Since 1981, WaterAid has reached 25.8 million people with clean water and 25.1 million people with decent toilets. For more information, visit www.wateraid.orghttp://www.wateraid.org, follow @wateraid or @WaterAidPress on Twitter, or find WaterAid UK on Facebook at www.facebook.com/wateraid.

· 844 million people in the world - one in nine - do not have clean water close to home.[1]

· 2.3 billion people in the world - almost one in three - do not have a decent toilet of their own.[2]

· Around 289,000 children under five die every year from diarrhoeal diseases caused by poor water and sanitation. That's almost 800 children a day, or one child every two minutes.[3]

· Every £1 invested in water and toilets returns an average of £4 in increased productivity.[4]

· Just £15 can provide one person with clean water.[5]

· To find out if countries are keeping their promises on water and sanitation, see the online database www.WASHwatch.orghttp://www.WASHwatch.org

[1] WHO/UNICEF Joint Monitoring Programme (JMP) Progress on drinking water, sanitation and hygiene: 2017 update and SDG Baselineshttps://washdata.org/reports [2] WHO/UNICEF Joint Monitoring Programme (JMP) Progress on drinking water, sanitation and hygiene: 2017 update and SDG Baselineshttps://washdata.org/reports

[3] washwatch.org

[4] World Health organization (2012) Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage

[5] www.wateraid.org

The International Organization for Migration – IOM works with national and local authorities also local partners to identify and understand migration movements in West and Central Africa. Flow monitoring Point (FMP) is an activity that quantifies and qualifies flows, migrant profiles, trends and migration routes at a given point of entry, transit or exit. Since February 2016, IOM Niger has been monitoring migration flows at two points in the Agadez region of Niger in Arlit and Séguédine.

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 60 events in the region. This week’s edition covers key ongoing events, including:

• Ebola virus disease in the Democratic Republic of the Congo

• Typhoid fever in Zimbabwe

• Measles in Chad

• Cholera in Niger

• Humanitarian crisis in Democratic Republic of the Congo.

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 issues and challenges include:

• The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo has rapidly evolved in the last week, with several new cases and deaths occurring. More new cases are expected to occur in the coming days and weeks as people who were earlier exposed to infections develop illness. Similarly, the actions taken now to avert further exposures to infections will be critical in containing this outbreak.
  Meticulous identification and rigorous monitoring of potential contacts, rapid investigation and immediate isolation of suspected cases form the bedrock of the strategies to contain the current outbreak. Aware of the prevailing circumstances, the topmost priority remains strengthening these aspects of the response as well as other components of the response structures on the ground.

• The Zimbabwe Ministry of Health and Child Care has reported a confirmed typhoid fever outbreak in Gweru city, Midlands Province. The outbreak started in early-July 2018 and quickly evolved to affect many people. The affected city is situated between Harare and Bulawayo, putting both cities at high risk of importing the disease. Harare city has had large outbreaks of typhoid fever in the recent past, causing significant public health and socio-economic consequences. The current typhoid fever outbreak in Gweru city calls for immediate attention from the national authorities and partners to avoid escalation of the situation and further spread of the disease to the neighbouring cities, especially Harare.

Summary

The monthly risk briefing provides information on global weather, volcanic, human and health events where members may consider using the Start Fund’s Crisis Anticipation Window. It reports on new, emerging or deteriorating situations; therefore, ongoing events that are considered to be unchanged are not featured and risks that are beyond the scope and scale of the Start Fund are also not featured.

This monthly risk briefing is collated by the Start Network Anticipation team using information from academia and research institutes, government departments, ACAPS, global risk indexes, risk information provided by Start Members and their partners, and the media. Key risks are shared and collated each month with FOREWARN input.

There have been reports that a volcanic eruption can happen at any time in The Democratic Republic of Congo, following an increase in the intensity of volcanic activity. With the current level of preparedness, an eruption would be disastrous, leading to loss of life, livelihoods and homes. The rainy season aproaches parts of West Africa, with increased chances of above-average rainfall in in eastern Guinea Conakry, Sierra Leone, western Liberia, northern Cote D’ivoire, southern Mali, western Burkina Faso, south-eastern Niger, north-eastern Nigeria, central and southern Chad and western Sudan. Risk of flooding in these areas has been flagged as a high risk relevance. There is also an ongoing risk of landslides in northern Vietnam and in the areas close to the border with Lao PDR, with higher than average rainfall forecast for northern Lao PDR.

Download this month's risk briefing to learn about the risk of volcanic eruption in The DRC; flooding in West Africa & Vietnam (with a possibility of landslides); outbreak of Cholera in Cameroon; election violence in Mali & political distress in Zimbabwe; drought in Central America as a result of very little rain over the past month and floods in Pakistan.

Flooding continues in West Africa, while dryness strengthens in Ethiopia

1. The forecast for above- normal rains during the outlook period is likely to cause flooding in Mali, Burkina Faso, and western Niger.
   
2. Several weeks of above-average rainfall has damaged infrastructure and caused fatalities in Sudan. Continuing rainfall may trigger additional floods through mid-August.
   
3. Poorly distributed rainfall since June has resulted in significant moisture deficits and deteriorated ground conditions across parts of western Uganda, northeastern DRC, and southern South Sudan.
   
4. Rainfall deficits are increasing across parts of Ethiopia. The SNNPR, central Oromia, and northern Somali States show signs of moisture stress and degraded ground conditions.
   
5. Several weeks delay to the start of rains in western Senegal has led to abnormal dryness

Paul Jawor, an MSF water and sanitation (WATSAN) expert based in Barcelona, has been working on the post-Ebola response in Sierra Leone since 2016. His role is to ensure that MSF’s approach to water, sanitation and hygiene is up to standard.

Here, Paul recounts the progress he has seen in the Mongo and Kabala regions in the north of the country over the last three years.

I visit MSF’s projects in Sierra Leone, in the Mongo and Kabala regions in the north of the country, at roughly the same time each year. Since 2016, part of my work has been to ensure that we are reaching the right standards in water and sanitation.

2016

When I first visited at the beginning of the mission in 2016, the conditions were really bad. There was no clean water, and there wasn’t enough of the little water that was available.

There was no separation of medical waste, which is a big problem, as it means that potentially dangerous items like needles are not disposed of correctly. And there were animals – goats, dogs, chickens – running around the hospital!

The deadly Ebola outbreak of 2014-2015 led to many of medical staff either fleeing or falling victim to the disease. Of 1,100 health workers in Sierra Leone, over 300 were infected with Ebola, and many medical facilities were dangerously understaffed.

Services were collapsing, especially in the northern region which was one of the locations Ebola had first appeared in the country.

In the town of Kabala, we wanted to help support the failing medical facilities, especially maternity and pediatrics departments, so we began to support the hospital in Koinadugu as well as some peripheral medical centres and health posts in Mongo.

In the first year, the reality was that WASH [water, sanitation and hygiene] standards were much lower than was acceptable – medical facilities should be achieving a score of 100 to show that they meet the necessary standards for good sanitation and hygiene, and Mongo and Kabala scored 30 and 28 respectively. There was a lot of room for improvement.

2017

When I returned in 2017, there had been a remarkable improvement. The waste management area had been set up and handwashing points were ready. Staff had some proper protective equipment in case of the emergence of highly contagious diseases like Ebola.

The team was well on the way to finishing the replacement of water pipes feeding the MSF-supported medical structures to supply clean water and reduce waste. There were 48 trained hygienists working in the structures.

2018

In 2018 there was even further improvement, even though the biggest jumps in standard had been done the previous year. The waste management area had been completed and waste was being separated and disposed of correctly.

We had worked on the two boreholes to improve the water supply and were directly injecting chlorine into all the water supply to ensure that it was suitable for drinking.

For vector control – that is limiting the spread of disease through mosquitos, rats, dogs and so on – there was also progress. Each bed had a mosquito net, there were screens on the windows to prevent them entering the wards, and most importantly, there were no more goats and dogs inside the buildings!

It was great to see these improvements so clearly evolving gradually every year, and to know that by raising these standards we were ensuring that fewer people would leave medical facilities with new infections.

We also learnt important lessons that we will be able to take forward both within and outside of Sierra Leone, like in the recent case of the emergence again of Ebola in the Democratic Republic of Congo.

If we need to respond to an emergency again, here in Sierra Leone, we will be able to start from an even higher level.

by Nellie Peyton | @nelliepeyton | Thomson Reuters Foundation

Rights activists say the state should address the stigma faced by pregnant girls rather than ostracise them.

DAKAR, Aug 23 (Thomson Reuters Foundation) - Pregnant schoolgirls in Sierra Leone will be banned from classes and exams despite sweeping new government measures to improve access to education for all, a state spokesman said on Thursday.

The West African country introduced the ban on pregnant girls in 2015 after a rise in rape, abuse and poverty during the deadly Ebola outbreak fuelled a spike in teenage pregnancies.

Activists say the law has increased shame and stigma for pregnant girls and set thousands back in their studies. Some hoped the change of government in April, when President Julius Maada Bio took office, would bring a change of policy.

The new government announced this week that it will make education free for all starting in September, hoping to reduce drop-out rates that are driven by girls. But it will still enforce the ban on pregnant students, education ministry spokesman Brima Turay told the Thomson Reuters Foundation.

"They are not allowed to go to mainstream schooling. It still remains a policy," Turay said by telephone.

Only 56 percent of Sierra Leonean girls aged 15 to 24 are literate, compared to 73 percent of boys in the same age range, according to the United Nations.

The previous government set up alternate, part-time learning centres for visibly pregnant girls, saying that allowing them to attend regular schools would undermine their ability to do well, expose them to ridicule and encourage others to get pregnant.

Those learning centres will re-open this fall with more funding, Turay said, but they will still have classes only three days a week so as not to tire the girls.

"You would not want to overload a pregnant person when they probably don't even want to be there," Turay said.

Rights activists said the state should address the prejudice rather than ostracise the girls.

"The fact that they may be stigmatised is not an opt-out for the government. They have a duty to address this, such as by making sure teachers make pregnant girls feel welcome," Sabrina Mahtani, a researcher for rights group Amnesty International, told the Thomson Reuters Foundation.

The launch of free education will still benefit many girls, said aid group Save the Children, since unaffordable school fees are one of the reasons why many drop out and marry young.

Others questioned the initiative.

"Is education really free if a huge proportion of children of school-going age have been banned from school?" said Judy Gitau-Nkuranga of women's rights group Equality Now.

Equality Now and partners in May sued the government for its pregnancy ban in West Africa's regional court. The case is pending. (Reporting by Nellie Peyton; editing by Lyndsay Griffiths. Please credit Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, and climate change. Visit www.trust.org)

This Weekly Bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 60 events in the region. This week’s edition covers key ongoing events, including:

• Ebola virus disease in the Democratic Republic of the Congo Cholera in Nigeria
• Cholera in Tanzania
• Typhoid fever in Zimbabwe

• Humanitarian crisis in Ethiopia

  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 issues and challenges include:

• The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces of the Democratic Republic of the Congo continues to evolve. The number of new cases and deaths rapidly increased in the past weeks, presumably due to exposures to infections that occurred before the outbreak was detected and appropriate containment measures put in place. With all components of the response functioning, it is hoped that new infections are minimised and further transmissions are curtailed. The coming days and weeks are thus critical to the evolution of the outbreak. In the light of the prevailing circumstances, including the insecurity in the affected provinces, the priority remains consolidating all components of the response structures on the ground.

• Nigeria has been experiencing a cholera outbreak since the beginning of the year, with several states affected. Although the number of states with active transmission has reduced significantly in the recent past weeks, intense transmission continues in Katsina, Sokoto and Zamfara states, all in the northern part of the country. These states already have underlying vulnerabilities favouring propagation of cholera. The case fatality ratio (for the reporting week) was particularly high in Sokoto State, signifying underlying problems. While the overall cholera outbreak situation has shown some signs of improving, it remains a serious public health problem to the country and a potential threat to the neighbouring countries. Some of the affected states share borders with other countries in the region. This cholera outbreak calls for more attention from all stakeholders in and around Nigeria.

CITATION

Morin C, Bost I, Mercier A, Dozon J, Atlani-Duault L. Information Circulation in times of Ebola: Twitter and the Sexual Transmission of Ebola by Survivors. PLOS Currents Outbreaks. 2018 Aug 28 . Edition 1. doi: 10.1371/currents.outbreaks.4e35a9446b89c1b46f8308099840d48f.

AUTHORS

Celine Morin, Ida Bost, Arnaud Mercier, Jean-Pierre Dozon, Laetitia Atlani-Duault

ABSTRACT

Introduction: The 2013-2015 outbreak of Ebola was by far the largest to date, affecting Guinea, Liberia, Sierra Leone, and secondarily, Nigeria, Senegal and the United States. Such an event raises questions about the circulation of health information across social networks. This article presents an analysis of tweets concerning a specific theme: the sexual transmission of the virus by survivors, at a time when there was a great uncertainty about the duration and even the possibility of such transmission.

Methods: This article combines quantitative and qualitative analysis. From a sample of 50,000 tweets containing the words “Ebola” in French and English, posted between March 15 and November 8, 2014, we created a graphic representation of the number of tweets over time, and identified two peaks: the first between July 27 and August 16, 2014 (633 tweets) and the second between September 28 and November 8, 2014 (2,577 tweets). This sample was divided into two parts, and every accessible publication was analyzed and coded according to the authors’ objectives, feelings expressed and/or publication type.

Results: While the results confirm the significant role played by mainstream media in disseminating information, media did not create the debate around the sexual transmission of Ebola and Twitter does not fully reflect mainstream media contents. Social media rather work like a “filter”: in the case of Ebola, Twitter preceded and amplified the debate with focusing more than the mainstream media on the sexual transmission, as expressed in jokes, questions and criticism.

Discussion: Online debates can of course feed on journalistic or official information, but they also show great autonomy, tinged with emotions or criticisms. Although numerous studies have shown how this can lead to rumors and disinformation, our research suggests that this relative autonomy makes it possible for Twitter users to bring into the public sphere some types of information that have not been widely addressed. Our results encourage further research to understand how this “filter” works during health crises, with the potential to help public health authorities to adjust official communications accordingly. Without a doubt, the health authorities would be well advised to put in place a special watch on the comments circulating on social media (in addition to that used by the health monitoring agencies).