(Formerly called IRIN) Journalism from the heart of crises

  • In Madagascar, 1,100 measles deaths are more about money than ‘vaccine hesitancy’

    In a healthcare centre in the Madagascan capital of Antananarivo nine-year-old Faneva inches his arm forward. The nurse disinfects his skin before inserting the needle. A few seconds later, it’s all over. The young boy smiles in relief.

     

    This is the front line of efforts to combat Madagascar’s deadliest measles outbreak in living memory. The virus has killed more than 1,100 people – mostly children – since September, and infected nearly 100,000 more all across this large island nation.

     

    The outbreak is raging, at least in part, due to low immunisation rates. But unlike in more developed countries where parents refuse to vaccinate their children because of so-called “vaccine hesitancy”, the challenge in Madagascar is one of affordability and accessibility.

     

    Despite measures put in place to tackle the spread of measles, the response in Madagascar has been complicated by the high cost and logistical challenge of transporting the vaccine to health centres in remote districts, and storing it long enough at the required low temperature.

     

    Madagascar is among Africa’s poorest countries; 75 percent of its population of 26 million live on less than $2 per day. It faces a host of humanitarian challenges, including El Niño-induced droughts that fuel food insecurity; cyclones that displace tens of thousands annually; and severe health problems such as seasonal plague, chronic malnutrition, and now measles.

     

    One dose, or two?

     

    Faneva received his first dose of the measles vaccine when he was just nine months old, his father, Fanilo Andrianarivony, told IRIN. But his school now requires everyone who is nine years old or younger to be vaccinated with a second dose. In Faneva’s class at school, 15 pupils caught the virus between November and December, despite medical reports indicating they had been vaccinated as babies, their teacher said.

     

    Although a double dose of the vaccine – one at six to eight months, and a booster at least a month later – is recommended by international health bodies, the second dose is not yet part of the routine immunisation schedule recommended by Madagascar’s health ministry. As a result, very few parents take their children to receive a booster dose.

     

    "A single dose is only half effective,” said Jean-Benoît Manhes, the deputy representative for UNICEF in Madagascar. “To become 85 percent effective, a second dose is needed."

     

    Even with the double dose, there is still a 15 percent risk of contagion, Manhes said, explaining that “for individual coverage to work, you need mass immunity, up to 95 percent”.

     

    Reaching the required level of immunity is a huge challenge in Madagascar, where measles vaccination coverage – children who have received at least one dose of the vaccine – is barely 60 percent, according to the World Health Organisation. This low coverage rate has been one of the main drivers of the current outbreak, the WHO said.

     

    Lack of vaccines

     

    Poor health infrastructure and low levels of awareness are factors that have led to an increase in measles cases globally, not just in Madagascar, according to UNICEF. At the same time, complacency and vaccine hesitancy have caused the virus to re-emerge and spread in more developed countries that had been declared measles-free.

     

    “Global cases of measles are surging to alarmingly high levels,” UNICEF warned this month, with 10 countries accounting for over 74 percent of the total increase in 2018.

     

    "Almost all of these cases are preventable," UNICEF executive director Henrietta Fore said in a statement. "Measles may be the disease, but, all too often, the real infection is misinformation, mistrust, and complacency. We must do more to accurately inform every parent, to help us safely vaccinate every child."

     

     

    In Madagascar, UNICEF, the WHO, and the health ministry launched an immunisation campaign to target all 114 districts in the first quarter of this year.

     

    More than two million children, including Faneva, were immunised in January, and 1.4 million children were vaccinated in February. But the campaigns only reached 25 and 22 districts respectively, meaning another 67 districts still have to wait until the end of March or the beginning of April.

     

    "We are asking the authorities to send vaccines as quickly as possible to our region," a nurse working in a health centre in one of the yet-to-be-reached southern districts told IRIN, preferring her name not be used.

     

    The nurse said that in districts like hers the lack of vaccines means they can only vaccinate children under nine months old with the first routine dose. "It's heartbreaking to see the desperation of parents, but we can’t do anything until [more] vaccines arrive,” she said.

     

    To immunise all the nearly eight million children from nine months to nine years old, Madagascar needed $7 million; however, all the necessary funds were only collected this month. And even now, financial and logistical obstacles remain.

     

    "Ideally, a single national campaign at the same time for all the districts would have been perfect to interrupt the outbreak," UNICEF’s Manhes said.

     

    Help from the sun

     

    Sourcing the number of vaccines needed was a major challenge, and getting eight million doses at one time was “very complicated”, Manhes said.

     

    "Very few laboratories are producing the measles vaccine, and orders are still planned five years in advance," he explained. UNICEF had to negotiate with countries like the Democratic Republic of Congo, Uganda, and Yemen to get all the vaccines it needed.

     

    Even when stocks are available, disseminating the vaccines and syringes across Madagascar is no easy task due to the vast size of the island – roughly the same size as France or Spain but with notoriously tricky terrain and poor roads, especially in the more remote regions.

     

    In mid-February, the WHO said there was a gap of $3 million in the budget for the third and final vaccination campaign. But at the beginning of March, the Malagasy authorities, with the support of their technical and financial partners, said it would now be possible.

     

    On 5 March, UNICEF and the government ​​signed an agreement to supply 500 health centres in remote parts of the country with $4.5 million worth of solar refrigerators, allowing them to store the vaccines and cut back on shortages in areas where there is no electricity.

     

    "Health centres will be able to offer daily immunisation services when they are equipped with solar refrigerators," said Julio Rakotonirina, a professor of epidemiology who is Madagascar’s minister of public health.

    img_2973.jpg

    Iloniaina Alain/IRIN
    Mothers wait for their children to be vaccinated at a basic health centre in northern Madagascar.

    Manhes explained how difficult it is in remote, rural regions far from the capital. "It can happen that parents come to the [health] centre with their children and there is no vaccine,” he said. “When they come back a week later, the centre is closed because the staff went to get their pay. A week later, they come back but the vaccine is out of date or no longer effective because the cold chain has broken down. Do you think they will come back a fourth time, especially if their village is a few hours walk from this centre?”

     

    For Manhes, these broader failings are driving the upsurge in epidemics like the current one. "It is important that Madagascar adopts a sustainable and strengthened health system," he said.

     

    "I did not expect that not being vaccinated could kill him”

     

    Other health and humanitarian concerns in Madagascar also risk worsening the effects of the epidemic. With 47 percent of Malagasy children under age five facing chronic malnutrition, there are risks of serious complications and death if they contract measles, the UN’s emergency aid coordination body, OCHA, said.

     

    "Malnutrition that strikes one child in two, also makes the measles bed in Madagascar,” said the WHO representative in Madagascar, Dr. Charlotte Faty Ndiaye.

     

    While families with children unprotected from the virus live in fear, others, like the parents of four-year-old Rado, mourn the outbreak’s latest victims.

     

    "He had coughed a lot and had a very high fever," Rado’s mother, Haingo Nomenjanahary, recalled of the days when her son first became ill.

     

    She took him to the health centre only when rashes developed on his face and body. "We were rushed to the hospital, but the doctors did not save my son," she said.

     

    Rado had never been vaccinated against measles. "He had another [different] vaccine at six months, but when he was nine months old, I had no time to take him to the basic health centre,” Nomenjanahary said. "I did not expect that not being vaccinated could kill him.”

     

    Rado’s one-year-old sister, Ravaka, is luckier than her brother. Nomenjanahary now knows that to protect her youngest daughter she has to take her to be vaccinated, and a few weeks after her son died, she did just that.

     

    Ravaka received her first dose of the measles vaccine at 11 months. "I hope that now she is immune to this danger," her mother said. "And if God still gives me children, I'll take them to the basic health centre to be vaccinated," she promised.

     

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    In Madagascar, 1,100 measles deaths are more about money than ‘vaccine hesitancy’
  • Rival Venezuela pop concerts, the “triple nexus”, arming US aid officials: The Cheat Sheet

    IRIN editors give their weekly take on humanitarian news, trends, and developments from around the globe.

    On our radar

    Civilians may still be trapped in last Islamic State pocket in Syria

    A reported 2,000 people were evacuated from so-called Islamic State’s last pocket of territory in eastern Syria this week, but the US-backed Syrian Democratic Forces said there may still be civilians remaining in the village of Baghouz. Once screened for membership in the extremist group, many leaving the territory are taken to al-Hol camp. The UN says 61 young children have died since December on the way there or soon after arrival. The World Health Organisation’s head in Syria told IRIN recently that the security checks were delaying urgent healthcare and that local authorities had denied a request to set up a medical waystation. The SDF denied the charges, but since then UN agencies say they have set up just such a transit site “to address the high number of child deaths”. Some people who had fled Baghouz told Human Rights Watch of hunger and being trapped under heavy shelling, air strikes, and IS threats.

     

    “One after the other”: Tropical storms swarm the Pacific

    The cyclone season has put parts of the southwestern Pacific on high alert. Cyclone Oma threatened the Solomon Islands and Vanuatu for five days, sending over 1,000 to evacuation centres. The storm later brushed New Caledonia’s coast and was due to push towards Australia. Earlier this month, the cyclone warning system in Tonga sent out repeated alerts as four separate “extreme tropical weather systems” threatened the country. Tonga escaped severe damage, but the country’s head meteorologist said facing so many in quick succession was exceptional. Storms in the Pacific islands needn’t cause headline-grabbing death tolls to leave a lasting impact; officials in Vanuatu and the Solomon Islands were expecting food shortages after Oma wiped out some smallholdings. Vast distances make repairs and recovery difficult. For more on preparing for Pacific disaster, see our recent story on women fighting for a seat at the table: Fiji’s storm-watchers.

     

    South Sudan rights violations may amount to war crimes

    Despite the signing of last year's peace agreement in South Sudan, ongoing violations including rape and sexual violence "may amount to international crimes, including war crimes and crimes against humanity," according to a new UN report. Investigators with the Commission on Human Rights in South Sudan noted a "confirmed pattern" in the way combatants attacked and destroyed villages, plundered homes, and took women as sexual slaves. Sexual violence has worsened markedly since the commission's last update in December 2017; those targeted included children, the elderly, and pregnant women. Many sides of the conflict, including the army, national security forces, and rebel groups, were blamed for the violence, while the commission also investigated sexual exploitation and abuse by UN peacekeepers. South Sudan remains one of the world’s worst humanitarian crises: 4.5 million people are displaced, seven million are in need of aid, and nearly 60 percent of the population will face severe food insecurity this year.

    Joining up billions in development, humanitarian, and peace spending

    The “triple nexus” may sound like an ice skating move, but it’s the new orthodoxy in aid. A “recommendation” was adopted today by members of the Organisation for Economic Co-operation and Development. The OECD says its donor states command over $74 billion of international funding in “fragile” situations. The new Development Assistance Committee policy says long-term development, peacemaking, and emergency relief should have complementary goals and together could “avoid the occurrence of humanitarian needs”. One aid agency nexus-watcher told IRIN that after much discussion in the aid community it was a relief to see clear definitions and terminology emerge. A source familiar with the discussions said “more must be done to prevent crises and deal with structural issues and root causes, rather than leaving the humanitarian system to pick up the pieces”. The text refers six times to continued respect for humanitarian principles: critics question how humanitarian neutrality and independence sit with politically-flavoured development and peace efforts.

    In case you missed it

    Burkina Faso: More than 100,000 people have been displaced by instability and fighting in the West African country, according to the UN. Tens of thousands have fled this year, as rising militancy and attacks by armed groups affect the North, Sahel, and Eastern regions.

     

    Madagascar: More than 900 people have died since a measles epidemic began in the huge island nation in September, the WHO said. Over 68,000 cases have been documented; those most at risk are infants from nine to 11 months old.

     

    Myanmar: Restrictions on humanitarian access in Rakhine State are affecting some 95,000 people due to ongoing clashes between the military and the Arakan Army, an ethnic Rakhine insurgent group, according to the UN’s humanitarian coordination arm. More than 5,500 people have been displaced since December.

     

    Refugee resettlement 2018: UNHCR says 55,692 refugees were permanently resettled in 2018. The UN refugee agency says that’s only about five percent of those they think were eligible. Despite deep cuts in its quota, the US took in more than any other nation. IRIN explored the numbers here.

     

    Yemen: UN envoy for Yemen Martin Griffiths told the Security Council on 19 February that the two main sides in Yemen’s war had agreed to withdraw from a small port and oil facility near the Red Sea city of Hodeidah, in a first step towards implementing a much-discussed ceasefire deal for the city.

     

     

    Weekend read

    Opinion: Why the Venezuelan opposition’s high-stakes aid gamble must pay off

    As we write this, Venezuela is top of many media headlines as a quarter of a million people are estimated to be assembling on the border, in Colombia. The presidents of Colombia and Chile are expected – and maybe even Richard Branson. He is backing the concert they’re all there to see, Venezuela Aid Live. The event’s sponsors say it will raise $100 million to help the millions of Venezuelans living with shortages of, well, nearly everything. Branson even suggests that the performance could help persuade Venezuela’s military to defy orders and open the border – sealed tight by President Nicolás Maduro – to aid shipments; shipments that opposition leader Juan Guaidó is inviting. Meanwhile, on the Venezuelan side of the border, Maduro is hosting his own benefit concerts on Friday and Saturday. What’s a humanitarian to make of all this? Analyst and columnist Francisco Toro offers a reality check in his essay on what he calls the “increasingly blatant politicisation of aid”. $100 million for food and medicine, for instance, “is completely out of proportion” with the scale of need in Venezuela. And if you’re concerned about the politicisation of aid, you might like to check out this from The Guardian, on the politicisation of, um, bread.

    And finally

    US-armed donor proposal stirs alarm

    A new type of US government aid official could be embedded with US intelligence or military forces in insecure hotspots to work on certain tactical projects. They would be “super enablers”, according to a proposal developed by consultants hired by USAID. The proposed two-person Rapid Expeditionary Development (RED) teams would be physically fit, armed, and able to deploy where USAID can’t send civilians. The proposals met with some support in the US military and intelligence communities, and mixed views from within USAID, the 75-page report said. The concept, first reported by Devex, has been met with dismay by some in the humanitarian Twittersphere, earning reactions such as “wannabe SEALS” and “incredibly unwise”. Also, it’s been met with a humanitarian principles meme (a Ranger tab is a badge indicating completion of a very tough two-month US Army training course):

    (TOP PHOTO: Some of those fleeing besieged IS territory in Syria. CREDIT: Constantin Gouvy/IRIN)

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    Rival Venezuela pop concerts, the “triple nexus”, arming US aid officials
  • Madagascar measles, Venezuela aid, and a dodgy data deal: The Cheat Sheet

    IRIN editors give their weekly take on humanitarian news, trends, and developments from around the globe.

    On our radar

    MSF rejects claims it didn’t follow plans to avoid Yemen bombing

    An investigation into the bombing of a Médecins Sans Frontières cholera treatment centre in Yemen in June 2018 has “dismayed” the NGO. A panel appointed by the Saudi Arabia-led alliance found that the new and still-empty building had been bombed by the coalition in “an unintended error”. The investigators, however, disputed details of how the location’s coordinates were supplied to Riyadh and whether there were markings on the roof of the building identifying it as a humanitarian site. At a Riyadh press conference in mid-January, the official spokesman for the investigators said the coalition was acting on intelligence the building was used for arms and ammunition storage. MSF said the findings were “unacceptable and contradictory”, noting that under international law, “It is the sole responsibility of armed parties to the conflict to proactively take all necessary measures to ensure that protected facilities are not attacked.” For more on notifications and coordinates, read our IRIN explainer on “deconfliction”.

    Measles kills more than 300 in Madagascar

    Madagascar is suffering its worst measles outbreak in decades. More than 50,000 people have been infected and at least 300 killed, most of them children, according to health officials. Cases have been reported in all major towns and cities, as well as in rural areas. Supported by the World Health Organisation and UNICEF, the government has initiated fresh vaccination campaigns. Deaths from measles are avoidable if such campaigns are thorough enough. The virus gained ground in Madagascar as immunisation rates fell below 50 percent (from the recommended 90 percent), mostly due to access difficulties. This IRIN story from the archives is evidence that this is not a new problem: health experts were expressing concerns about falling rates (then from 81 percent to 64 percent) as far back as 2011. Although worst hit, Madagascar is not alone in having to tackle the virus. Measles has also struck parts of the United States and Europe, where cases tripled last year. Health authorities in the Philippines are also urging immunisations following an outbreak in Manila and nearby regions that has left 1,500 people infected and caused at least 25 deaths.

    Atrocities feared amid rising militancy in Burkina Faso

    Attacks and counter-attacks between militants and security forces in Burkina Faso are taking a heavy toll on civilians. This week, jihadists attacked the northern village of Kain near the Malian border, killing 14 people. Security forces retaliated, launching ground and air assaults that left 146 militants dead. Soon after, another attack in Oursi in the Sahel Region left 21 militants and five gendarmes dead. Human Rights Watch has called out atrocities on both sides, saying the army "executed" some suspected militants in front of their own families. The UN says persistent armed attacks and violence displaced 36,000 people in January alone, as insecurity risks impeded access to aid. For three years, Burkina Faso has been battling an escalating wave of attacks, while regional Sahel neighbours Mali and Niger face similar threats. Rising militancy across Africa is a trend we’re  watching in 2019.

    Aid stuck on Venezuela border

    As a former Venezuelan diplomat now working with the opposition as a go-between with international aid groups in Geneva told IRIN  this week, the current situation is “something that doesn’t make any sense”. The Venezuelan people are desperately short of food and medicine, some three to four million people have fled the country since 2015, and their president, Nicolás Maduro, is refusing to allow humanitarian aid in. That’s not to say the offers of assistance, from the United States in particular, might not be something of a Trojan Horse. Maduro says, “no one will enter, not one invading soldier”, and the United States has a chequered past of military intervention and regime change in Latin America. For now, the aid arriving in the Colombian border town of Cúcuta is going nowhere. Maduro’s forces have blocked the bridge into Venezuela and seem to have no intention of allowing it in. Opposition leader and self-declared president-in-waiting Juan Guaidó has suggested stockpiling it in three locations at the border in the hope this will change. More from on this unfolding story next week.

    Mixed picture in South Sudan as refugees return

    Political violence has “dropped dramatically" since the signing of September's peace deal, David Shearer, the UN envoy in South Sudan, said in the same week that nine people were killed in clashes between rebel factions in the Western Equatoria region. More than 20,000 South Sudanese refugees have so far voluntarily returned from neighbouring Uganda, according to Joel Boutroue, the UN refugee agency's representative in Uganda. However, in December, UNHCR said that despite reduced violence in some areas, South Sudan was not yet "conducive” for the safe return of refugees. Although Shearer praised some of the "positive" developments in recent months, including rebel leader Riek Machar's plan to return to Juba in May, he also flagged concerns about ongoing conflict and a loss of momentum in the peace process, with recent meetings reportedly lacking substance or real outcomes.

    One to listen to:

    In this week’s story on Yemen’s shaky ceasefire deal, we mentioned that Yemeni rights watchdog Mwatana for Human Rights had documented 624 civilian cases of arbitrary detention, enforced disappearance, and torture in 2018. Here’s your chance to find out more about where that number came from: Radya al-Mutawakel, the organisation’s co-founder, is interviewed at length on the latest episode of the International Rescue Committee’s podcast, “Displaced”. She talks about the challenges of independently verifying information on human rights violations in the midst of a divisive war, including airstrikes, torture, disappearances, and detention, and explains why she thinks it is important to build what she calls a “human rights memory” in Yemen. Al-Mutawakel and Mwatana’s latest challenge? Figuring out how to document starvation as a  violation, as the link between victim and perpetrator is not always clear cut.

    In case you missed it

    Ethiopia: In 2009, Ethiopia banned local NGOs from raising more than 10 percent of income from abroad. The provision in the law governing civil society was criticised as a means to stifle dissent. Local media report that new rules lifting the limit have passed the Ethiopian parliament this week, part of wide-ranging reforms under Prime Minister Abiy Ahmed.

     

    Syria: A joint UN-Syrian Arab Red Crescent aid convoy arrived on Thursday at Rukban, an informal camp located in a no man’s land near the Syria-Jordan border. The last delivery of aid to more than 40,000 people sheltering in the area known as “the berm” was in November.

     

    Tonga: Authorities in the Pacific Island nation are warning of gale-force winds, floods, and damaging waves as a tropical depression brushes past the country over the weekend. Last year, Cyclone Gita landed a direct hit on parts of Tonga, including its main island, Tongatapu.

     

    Yemen: This week’s Amman talks on a Yemen prisoner swap have not yet resulted in agreement on the lists of names to be exchanged, but a UN spokesman said separate talks on a UN boat had yielded a “preliminary compromise” on withdrawing forces from Hodeidah. For background, read this.

     

    Weekend read

    New UN deal with data mining firm Palantir raises protection concerns

    Unless you’ve been living under a rock for the past few days, you’ll be aware of our weekend read: CIA-funded data-mining company Palantir signs a $45 million five-year deal to help the UN’s World Food Programme pool its data and find cost-saving efficiencies. To say data privacy and protection activists are unamused is an understatement: this is a company that provided software to US customs officials to help them deport migrants. “The recipients of WFP aid are already in extremely vulnerable situations; they should not be put at additional risk of harm or exploitation,” Privacy International told IRIN’s Ben Parker. But WFP insists there will be no “data-sharing”, and hit back with a statement outlining its thinking and the safeguards it feels are in place. This wasn’t enough, however, to assuage critics, who penned an open letter to WFP urging them to reconsider the agreement and be more transparent. As Centre for Innovation protection experts suggest here, this isn’t a new conundrum, and the Palantir furore might jolt the humanitarian sector into some belated engagement on data privacy and protection concerns.

     

    And finally...

    Hot in here

    The last four years have been the four warmest years on record, according to separate analyses released this week by organisations including NASA and the WMO, the UN’s meteorological agency. Analysts say it’s a “clear sign” of long-term climate change, along with “extreme and high-impact weather” that affected millions. The WMO says the average global temperature in 2018 was 1.0° Celsius above pre-industrial levels – climate scientists say temperature rise must be limited to less than 2.0° to stave off the worst impacts.

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    Madagascar measles, Venezuela aid, and a dodgy data deal
  • Trump pullouts, aid from mining firms, and that Amnesty ad: The Cheat Sheet

    IRIN editors give their weekly take on humanitarian news, trends, and developments from around the globe.

     

    On our radar

     

    Trouble at the top

     

    The overall coordination body for humanitarian aid lacks a vision, mission, strategy, and sound funding, according to a UN audit. The Inter-Agency Standing Committee, or IASC, formed in 1991, brings together the UN agencies, the Red Cross/Red Crescent Movement, and NGOs in a humanitarian über-cabinet. It is chaired by the head of the UN Office for the Coordination of Humanitarian Affairs, Mark Lowcock. His office says he has been working to sort out the group since the period of the audit (2016 to mid-2017). A well-placed senior aid official, who asked for anonymity due to the sensitivities, said the committee was making progress on a few issues, such as preventing sexual abuse. The audit revealed problems found in confidential reviews in 2003 and 2014 persisted, notably “insufficient commitment to collective leadership”. The official said there is a “fundamental problem”: if members don’t have stronger incentives to cooperate, further attention to the IASC’s structure "is going to be tinkering at the edges".

     

    Strange bedfellows: mining firms and humanitarians?

     

    In February, a magnitude-7.5 earthquake rattled Papua New Guinea’s remote highlands region, toppling villages, killing dozens, and leaving some 270,000 in need of help. Aid groups requested $62 million to respond. International donors have pitched in, but the largest contribution – equivalent to nearly two thirds of the appeal – came from the private sector, including the mining, oil, and gas industries. A briefing released this week by the Melbourne-based Humanitarian Advisory Group explores how extractives companies responded. It’s a polarising issue for many in the aid sector: some organisations, researchers note, refuse to work with or accept money from extractives companies, which have been accused of causing environmental damage and “serious human rights problems” in the past. The HAG briefing notes that extractives companies often responded faster than aid groups after this year’s earthquake, and used their logistics resources to access remote areas blocked by the damage. But they also lacked formal training on humanitarian practices and principles: some aid workers thought companies were targeting only communities in their business areas, for example; others said companies dumped supplies without monitoring to ensure they actually reached their intended targets. Despite the problems, the researchers conclude there is “enormous potential” for engaging extractives companies in disaster response in the Pacific.

     

    Concerns around aid operations in South Sudan

     

    Médecins Sans Frontières is concerned its operations in South Sudan may be at risk due to revelations it made about mass rapes in the town of Bentiu in November. This week officials from the medical NGO said the report that at least 125 women and girls were raped by armed men – some in military uniform – had caused friction. “The government of South Sudan is not happy,” an MSF official was anonymously quoted as saying by Kenyan newspaper The East African. “So who knows, maybe our massive operations in Bentiu will come to a close and place at a risk thousands of lives.” The UN condemned the attacks, sent a team of human rights investigators to Bentiu, and called for the culprits to face justice. Human Rights Watch also called for an urgent investigation into the violence. Under pressure, the South Sudanese government sent an investigation team to Bentiu, but this week it claimed there was a “lack of evidence” to substantiate the rape allegations.

     

    Amnesty backs down over “offensive” online campaign

     

    Human rights group Amnesty International was forced to pull an online campaign about refugees in Greece after a cover photo was accused of being “fetishised and eroticised”. The picture, in an online magazine produced at its Dutch branch, showed a model apparently naked except for life jackets, intended as a parody of a fashion shoot. After protests on social media, Amnesty Netherlands apologised for “any offence caused” and for the “error of judgement”, but replaced the picture with a model with barbed wire over her eyes. Later, the parent organisation, Amnesty International, also apologised and took the whole project offline.

     

    Healthcare boost for Yazidis in Iraq’s Sinjar

     

    Some good news for a change. You may recall a series of three stories we did back in March and April on the Yazidis in Iraq’s Sinjar province, where the religious minority fled massacres and enslavement by so-called Islamic State in 2014. Reporter Tom Westcott found that tens of thousands of families had been returning to towns and villages once ruled by IS, only to face a healthcare crisis. In the bullet-ridden hospital of Sinjar town itself, one doctor with no ambulance was struggling to meet the needs of the many returnees. Today, the situation is greatly improved, Westcott reports. The hospital has moved to new and better premises, has several ambulances, and is being assisted by NGOs. In a visit on 15 December, Nadia Murad said she planned to use her $1 million Nobel Peace Prize money to build another hospital in Sinjar, her hometown.

    In case you missed it:

     

    AFGHANISTAN/SYRIA: President Donald Trump ordered a full US withdrawal from Syria and the drawdown of about half the 14,000 remaining American troops in Afghanistan. Critics rounded on both decisions as premature, with particular concern raised over the possibility of a new humanitarian disaster if the situation unravels in northern Syria. US Defence Secretary James Mattis announced his resignation on the back of the moves.

     

    THE DEMOCRATIC REPUBLIC OF CONGO: Elections to replace President Joseph Kabila were postponed yet again this week, following a previous delay of more than two years. The country is on the cusp of its first ever democratic transfer of power, but a host of humanitarian crises – from Ebola to protracted conflicts – awaits the next leader.

     

    MADAGASCAR: The leading candidates in Madagascar’s election – both former presidents – have each claimed victory in this week’s polls. Marc Ravalomanana, who came to power in 2002, is up against Andry Rajoelina, who ousted him in a military coup in 2009. Rajoelina then ruled for five years until he was forced out in protests led by Ravalomanana. Official results are due next week. Nine in 10 of Madagascar’s 25 million population live on less than $2 a day, and the island faces huge health and malnutrition problems, made worse by drought and devastating El Niños.

     

    MYANMAR: Clashes between Myanmar soldiers and the Arakan Army, an armed group that advocates for the ethnic Rakhine community, have displaced hundreds of civilians this month in western Myanmar.

     

    Weekend read

     

    A generation of unschooled Cameroonians, another generation of conflict?

     

    Latest UN estimates put the number of people forced from their homes by conflict between Cameroon’s anglophone minority and the francophone-majority state at 437,500. Many have taken to hiding in the bush, including tens of thousands of school-age children. An untold number are missing out on an education as the insurgency escalates, school attacks and kidnappings spike, and separatist fighters demand schools stay closed. Our weekend read includes interviews with parents, officials, and kidnapped children, and explores how education was the starting point for this crisis, and how a generation of children now risks being recruited by armed groups and perpetuating the conflict.

    For more on the origins of the conflict and the motivations of the separatists, read our two-part special report, the first from inside rebel ranks.

    And finally…

     

    A vaccine with wings

     

    This week in a remote corner of the Pacific Island nation of Vanuatu, a commercial drone buzzed 40 kilometres above rocky terrain to deliver an important payload: vaccines to immunise 18 people, including a one-month-old child. It could be an early step toward Vanuatu’s health ministry integrating drone technology into its immunisation programme, which is challenged by scattered communities and inaccessible terrain. According to UNICEF, only one third of Vanuatu’s populated islands have airfields or roads, and one in five children in remote areas don’t have access to vaccines. Aid groups and health agencies have been testing humanitarian uses for drones for years. A US company uses drones to deliver medical supplies in Rwanda; humanitarians have explored using drones for post-disaster mapping; a non-profit in Fiji is trialling drones to unleash a swarm of dengue-fighting mosquitoes. In Vanuatu, proponents of the ongoing vaccine delivery trials say this week’s successful handoff is a ”big leap for global health”.

     

    To our readers: This is the last Cheat Sheet of 2018. We’ll be back on 11 January, but watch for special Friday coverage during the next two weeks. Best wishes for a brighter 2019.

     

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    Trump pullouts, aid from mining firms, and that Amnesty ad
  • “Nowhere to go” on the front lines of climate change

    In a report released this week during the UN climate change summit in Poland, the UN Environment Programme warned of a widening gap between the cost of adaptation in developing countries – as much as $500 billion annually by 2050 – and what wealthier nations have promised.

     

    But while global leaders negotiate a path forward, communities on the front lines of climate change are already struggling to adjust to the impacts of extreme weather, shifting seasons, and volatile temperatures.

     

    IRIN reporters met with people coping with staggering changes to their ways of life. For some, the shifts have been life-altering: a family forced to flee their land for a city slum; a fisherman trying to farm because the seas are no longer productive; a drought-stricken herder who abandoned his livelihood only to see his new one threatened.

     

    Their stories, presented below, are a snapshot of everyday efforts to cope – and a sign of the enormity of adapting to climate change for those already living with its impacts.

     

    Lower-income countries say previous global commitments of $100 billion a year in climate financing for vulnerable nations are already short of what’s needed, and fail to account for the spiralling costs of disaster-inflicted loss and damages.

     

    “There are limits to the extent to which human and natural systems can adapt,” a bloc of 47 least-developed countries warned. “People are already suffering from the devastation that climate change brings.”

    “Nowhere to go” on the front lines of climate change
    “I have nowhere else to turn”
    From land to lake, drought threatens livelihoods in Kenya’s Turkana
    Fishermen with fish on the shore of Lake Turkana

    Severe drought forced lifelong pastoralist Eperit Naporon to abandon his goat herd to become a fisherman on northern Kenya’s Lake Turkana. But climate change is again threatening his livelihood.

     

    When 200 of his goats died during a drought last year, Naporon decided he had to find another way to feed his family and survive. For decades he had fished the waters of Lake Turkana – the world’s largest desert lake – not as a job, but to supplement the family’s diet. Now, the former herder is a full-time fisherman, supplying his catch to small-scale traders along the shore.

     

    But already, fish in the water have dwindled. “We used to get big and many fish very close to the shores. Now we have to go deeper in conflicted areas with our neighbours as that’s the only way to get a catch,” said the 43-year-old father of nine.

     

    “And what you bring home is much smaller fish compared to what we caught years ago.”

     

    Turkana County has long experienced periods of recurrent drought. However, increasing temperatures and shifting precipitation patterns are expected to increase the rates of evaporation at Lake Turkana. Government meteorological data show temperatures in Turkana County increased between two and three degrees Celsius (3.5 and 5.5°F) between 1967 and 2012.

     

    Naporon says the droughts have become longer, more frequent, and more economically damaging: “Nowadays, it dries almost annually. And when it hits, we lose everything... the cows, the goats; it's frustrating.”

     

    Now his second source of hope, the desert lake, is also under threat – not only from high levels of evaporation due to increased temperatures, but also from human interference.

     

    Hydroelectric and irrigation projects constructed along the Omo River will dramatically reduce freshwater input from the river into Lake Turkana, increasing its salinity levels and reducing fish-breeding areas and mature fish populations. The Omo River provides 90 percent of the water in Lake Turkana.

     

    As world leaders deliberate how to implement climate commitments aimed at limiting global temperature rise, the best Naporon can do is hope that the source of his current livelihood holds.

     

    “This is my only hope! I have nowhere else to turn,” he said. “Yes, I still keep a few goats, but with them dying in huge numbers nearly annually, it is no longer possible. So, this lake has to yield.”

    “When the river erodes, it takes away everything”
    Displaced by erosion, climate migrants cause Bangladesh’s slums to swell
    Portrait of a woman close up

    Raima Begum has little idea about global warming, but she’s living proof of the toll climate change is already exacting on the coastal communities of low-lying Bangladesh.

     

    In 2009, the Meghna River swallowed up her entire home and land on Bhola, an island perched near the mouth of the river on the Bay of Bengal. Bhola has gradually been shrinking over decades due to soil erosion exacerbated by rising sea levels and frequent flooding.

     

    “When the river erodes, it takes away everything,” Begum said.

     

    With her land and possessions gone, the 30-year-old mother of two made the lengthy upriver journey here to Kallyanpur Pora Bastee, a slum community on the margins of Bangladesh’s crowded capital, Dhaka. She wasn’t alone: residents say 80 percent of the people here are migrants from Bhola.

     

    Begum’s journey is part of a familiar rural exodus in Bangladesh, where some 300,000 to 400,000 new migrants head to urban centres like Dhaka each year. Reasons for migration are often complex, but wrapped in the economic motivations are environmental pressures – like drought, floods, and disappearing land – that force people like Begum to leave.

     

    Research by the World Bank warns there could be more than 40 million “internal climate migrants” in South Asia by 2050 – one third of them in Bangladesh.

     

    Today, river erosion claims about 10,000 hectares of land each year. Climate change accelerates this damage by increasing the risk and magnitude of extreme disasters such as Bangladesh’s worsening annual floods. A 2013 study on climate change’s impacts suggested that erosion along Bangladesh’s three major rivers could increase by 13 percent by 2050. Researchers say this rising loss of land could swell the ranks of Bangladesh’s climate migrants, like Begum and her family.

     

    The Begums lived off the land back on Bhola. But in the slums of Dhaka, they struggle to make ends meet. Her husband earns less than $100 a month, which is mostly taken up by rent and medicine for her ill son. She blames her family’s problems on the erosion that robbed them of their home, and drove them to the unfamiliar capital.

     

    “Isn’t erosion doing harm to us? Isn’t it our loss?” she said. “We’re now suffering in a foreign land.”

    “When there is no rain, you can’t grow anything”
    In Madagascar, “no rain” pushes farmers to the city
    Woman and child in front of a food market stall

    In a quiet corner of a market in Morondava, a city on Madagascar’s west coast, Alatsoa is tidying her stall: she sells spices and pulses, neatly displayed in their wholesale sacks.

     

    But this wasn’t always her life. Alatsoa, her husband, and their two sons arrived in the city in 2013 after drought in their home region of Androy in southern Madagascar made it impossible to continue working as farmers.

     

    “We grew maize and yam and sold it in local markets,” she said. “But when there is no rain, you can’t grow anything.”

    “No rain” has become an increasingly common concern in Androy as a result of climate change. The region has been in the grips of unprecedented drought since 2013, accentuated by an El Niño phenomenon that brought prolonged rain shortages. This has triggered a humanitarian crisis, with more than a million people now facing food shortages and malnutrition.

     

    This may be a sign of worse to come: forecasts agree that temperatures in the southernmost region will increase, drought will become more common, and rainfall more variable. With farming dependent almost entirely on rainfall, and very little in the way of formal irrigation or modern farming practices in Androy, drought has a disproportionate impact on this poor, underdeveloped region.

    “There is famine there, there is no water. Our future would have been very bleak if we had stayed,” said Alatsoa. “We would have managed to survive, but not live.”

     

    Climate change exacerbates internal migration flows in Madagascar, according to the UN. This trend is clear in Morondava’s market, where dozens of traders from Androy sell produce including bananas, mangoes, and poultry.

    Accompanying Alatsoa at the market, her youngest child Riantsoa, who was born in Morondava, is now three and looks small for her age. But she is likely in better health than many children back in Androy: the World Food Programme estimates that nearly half the children under the age of five in Madagascar suffer from chronic malnutrition or stunting, and the south is the worst-affected region.

     

    “Life here is good,” Alatsoa said. “We eat well and we are healthy. That’s the most important thing.”

     

    But she hopes that one day things will improve enough for the family to return to Androy. “When you’re old, you must go back to your homeland,” she said.

    “It’s all gone”
    Rising sea levels uproot coastal communities in Liberia
    A family in front of a broken building

    Before the sea removed a large chunk of his home in August, 30-year-old Lawrence Saweh sold dry goods at the market.

     

    “The sea damaged what I used to do for work,” he said. “I’m not doing anything now. It’s all gone.”

     

    Over the space of a weekend, his five-room house in the Funday quarter of Monrovia’s New Kru Town district was reduced to two. The sea tore through the concrete structure, demolishing the external walls and claiming what was inside, including his stock of goods to sell and his mother’s bed.

     

    Anything spared by the water was taken by looters who arrived once the sea had receded. “They even stole the zinc roofing,” he said, looking up at the sunlight streaming in from large holes through the remains of his home.

     

    In this coastal suburb, which sits on Bushrod Island, a portion of the capital that lies between the Saint Paul River and the Atlantic Ocean, many homes consist of a hotchpotch of corrugated iron sheets stuck into the sand.

     

    But Saweh’s home wasn’t always a beachside district.

     

    Since the 1970s, coastal erosion has reduced the size of Monrovia’s beachside communities by between two and seven metres annually and the densely populated New Kru Town, which is situated less than a metre above sea level, is among the worst-hit areas. Today, fishing boats nudge against the exposed foundations of Saweh’s home; 30 years ago, the neighbourhood extended more than 200 metres further out.

     

    Rising sea levels caused by climate change are expected to continue causing destruction to Monrovia’s coastal communities. A defence barrier is being built nearby, but this comes as small consolation to Saweh, whose home remains vulnerable and unprotected. “The sea is still finding a way,” he said, watching the saltwater washing into a channel behind his house.

     

    Saweh’s options are limited in the likely event of further destruction. “Where will I go?” he asked. “There’s nowhere to go; no money. That’s why we’re still here.”

    “I can’t predict it anymore”
    Warming oceans, erratic storms disrupt Indonesian fishing villages
    A fisherman in front of a boat and the sea

    Tuna fisherman Salsabila Makatika no longer trusts the ocean that has sustained his community for generations.

     

    Salsabila depends on tuna to support his family of 11 in Asilulu village, a small fishing community on Ambon Island near Indonesia’s eastern edges. But fish that used to be plentiful at the start of the traditional fishing season in early March now appear weeks later. And the storm season that once set in toward the end of the year begins weeks earlier, effectively shrinking his window to make a living.

     

    “I can’t predict it anymore,” said Salsabila, 51. “With the sudden wind changes, I can’t operate. I’ve gone many times out to the ocean but come back with nothing.”

     

    Climate researchers say ocean warming – one consequence of climate change – has already had a “profound” effect on global fisheries, shrinking fish catches in some regions and increasing them elsewhere. Climate change is expected to drive tuna stock here in the western Pacific further eastward and to higher latitudes. The Intergovernmental Panel on Climate Change has predicted that Indonesia will be among the hardest hit in Asia by this ongoing “redistribution” of fisheries.

     

    The volatility is already having an impact here in northern Ambon, where 90 percent of the families depend on fisheries. The tuna is sold to Indonesian companies, who ship it around the country and further abroad.

     

    Salsabila said he used to regularly return with seven large tuna in his boat’s icebox; these days, he catches two at most.

     

    This new reality has pushed some fishing families here to try and diversify their income: catching other types of fish, or balancing their fishing with farming. But other varieties of fish fetch far lower prices, and the amount of land suitable for farming on Ambon is relatively small, said Subair Abdullah, a professor at Ambon Islamic State University who has researched how Asilulu fishers are adapting to climate change.

     

    Subair believes the changing climate is putting the fishing community here at risk of a “food crisis” for which they are not prepared.

     

    “The fishermen impacted aren’t yet aware that what they’re experiencing is climate change,” Subair said. “It makes it hard to adapt.”

    This story was reported by Sophie Mbugua in Kenya, AZM Anas in Bangladesh, Emilie Filou in Madagascar, Lucinda Rouse in Liberia, and Ian Morse in Indonesia.

    (TOP PHOTO: Fishermen in Madagascar, threatened by the effects of global warming. CREDIT: Marco Longari/AFP)

  • From alms and Artificial Intelligence to Malala and Madagascar: The Cheat Sheet

    Our editors’ Friday roundup of humanitarian trends and developments.

     

    On our radar:

     

    Alms race

     

    The Muslim holy month of Ramadan begins next week. As well as fasting and prayer, it's a time for charity in the form of alms known as zakat. NGOs often mount Ramadan fundraising campaigns, an extra source of scarce humanitarian funding. A 2015 study on zakat by consultancy Development Initiatives found billions in play but "conflicting opinions on whether non-Muslims can benefit from zakat and where it can be used." No such doubts blocked one fund, however. A Malaysian state zakat initiative gave $1.2 million for a Red Cross water and agriculture project in Kenya last year, and the communities helped were largely Christian – a deal brokered by the International Federation of Red Cross and Red Crescent Societies. Meanwhile, British NGO Islamic Relief put out a new advert just before Ramadan to encourage donations, with a message about do-it-yourself aid expeditions. In the three-minute video, well-meaning young Yusuf raises money online in the UK and sets off for Niger to personally deliver his own package of aid.

     

    Let's just say, things don't go as he planned…

     

    Madagascar on edge

    Keep an eye on Madagascar. Following contested changes to the country’s electoral laws, things are in danger of unravelling. That’s the warning the Institute of Security Studies issued to the Southern African Development Community this week regarding intensifying violence between supporters of two former presidents and the government of President Hery Rajaonarimampianina; two people were killed during protests in April. The Pretoria-based research institute predicted “another full-scale crisis” unless a free election takes place with a level-playing field. The tension is fuelled by fears that popular ex-presidents Marc Ravalomanana and Andry Rajoelina could be barred from the race. Amnesty International has urged the government to refrain from criminalising freedom of peaceful assembly and called on the opposition not to intimidate or harass citizens, including schoolchildren, into joining its demonstrations.

     

    In Myanmar, displacement goes way beyond the Rohingya

     

    With so much attention on Rohingya refugees in Bangladesh, it’s easy to forget that Myanmar also has multiple internal displacement crises on its hands. More than 100,000 people are still uprooted in the north, and aid groups say more than 6,800 people have joined them since early April, fleeing indiscriminate shelling by the military in its clashes with a Kachin rebel group.

     

    Elsewhere, a trickle of refugees returned this week to eastern Myanmar after decades in camps in Thailand. The UN’s refugee agency, UNHCR, announced it had helped 93 people return under a voluntary programme. If that strikes you as an infinitesimally small number, you’re right. Almost 100,000 people live in camps along the Thailand-Myanmar border, according to The Border Consortium, which represents aid groups that have worked with the refugees since the 1980s. While Myanmar’s political reforms once filled donors with hope, a national peace process has stalled and many refugees in Thailand aren’t sure if it’s safe to return. Aid funding has fallen, both in the camps and in eastern Myanmar, leaving refugees with an unenviable choice. While the UNHCR returns programme is ongoing, many refugees don’t want to take part because their names could be given to Myanmar’s government. Instead, an estimated 18,000 refugees have returned home on their own since 2012, with no official support.  

    More than Malala

     

    We’re not sure who actually reads 300-page reports, but this one covers a scary and important reality – indiscriminate and deadly attacks on schools, universities, students, and staff are becoming more widespread. This exhaustive research from the Global Coalition to Prevent Education from Attack contains plenty of facts and figures: the headline number is 12,700 attacks from 2013 to 2017, harming more than 21,000 students and educators. In many countries, female students and teachers are targeted because of their gender (see: Malala, but also plenty of other girls). For those without the patience to get through the whole thing, you can skip to helpful country profiles, and you don’t need to read it all to get the point. As GCPEA’s Executive Director Diya Nijhowne puts it: “Teaching and learning has become increasingly dangerous.”

     

    Getting to grips with cholera

     

    Last year, the World Health Organisation and Yemeni authorities cancelled plans to vaccinate against cholera: a huge epidemic was raging, supplies were uncertain, and permissions, security, and access difficult. On 6 May, a new operation to vaccinate 350,000 people in and around the port of Aden began. This time, a total of 4.6 million doses have been earmarked for Yemen with funding from the vaccine alliance, GAVI. Improvements in the effectiveness and supply of the cholera vaccine mean it’s now feasible to control outbreaks better than ever. In the first four months of 2018, 15 million doses of the oral vaccine have been allocated, more than the 11 million used in the whole of 2017. Billed the “largest cholera vaccination drive in history”, two million people in Malawi, Nigeria, South Sudan, Uganda, and Zambia are to get the oral vaccine in upcoming campaigns. Speaking at a briefing in Geneva, GAVI chief Seth Berkley also said that thanks to access allowing vaccination and good immunisation coverage a cholera epidemic “never came” to the high-risk refugee camps of Rohingya in Bangladesh. Another round of vaccinations for up to one million people there is underway, but a senior WHO official warned: “we’re not out of the woods yet”.

     

    Keep in mind:

     

    AI for good

     

    Satellites, cities, health, and trust: four themes pack the programme for an Artificial Intelligence conference in Geneva next week. The AI for Good Summit brings together academics, philanthropists and development types to come up with ideas for good bots to help with the sustainable development goals. You can’t get to the International Telecommunications Union in Geneva in person? The event will also be available on webcast. Oh yes, and a little nugget: one of the conference sponsors is Saudi Arabia, which granted “citizenship” to a robot last year called Sophia, drawing scorn from women’s rights activists.

     

    Our weekend read:

     

    Niger sends Sudanese refugees back to Libya

     

    Last week, we drew your attention to the arrest of more than 100 Sudanese refugees and asylum seekers in Agadez. They are part of a reversal of usual migration trends that has seen some 1,700 Sudanese refugees and asylum seekers moving south to Niger from Libya in search of more secure lives, prompted, at least in part, by European Union efforts to stem migration.

     

    On 10 May, we published this exclusive story about the deportation of 135 of those arrested Sudanese from Niger back to Libya. They were forcefully loaded onto trucks and taken from Agadez on 7 May. Since then, their whereabouts had been unknown. The regular IRIN contributor who broke the story, Eric Reidy, reached one of the deported Sudanese by phone this afternoon. He said they are still stranded at the Madama border crossing, in a no man’s land between Niger and Libya, uncertain where to go from there. “We left Libya because of the security situation to apply for asylum,” the Sudanese man said. But now they can’t go back to Niger. “No one will try because we were in Agadez and they kicked us out,” he said.

     

    And finally:

     

    Four calendars for the Rohingya  

     

    “We will distribute food at the end of the month.” Straightforward, right? Not in Bangladesh’s crowded Rohingya refugee camps. The Rohingya use four different calendars: the Bangla calendar used in parts of South Asia, the Gregorian or Western calendar, an Islamic calendar for religious occasions, and the Burmese calendar for some official documents back in Myanmar – from where an estimated 693,000 Rohingya have fled since August 2017. But not all these calendars overlap, and some Rohingya refer to all four depending on the subject, according to BBC Media Action, Internews, and Translators Without Borders, which have been collecting feedback from Rohingya refugees.

     

    So what does this mean for the Rohingya and the local and international aid workers assisting them? Be aware of the nuances, and “communicate clearly,” the groups advise. Aid groups have already been criticised for not doing enough to listen to the Rohingya themselves – including relying on complaints boxes with English instructions, despite high levels of illiteracy among the Rohingya. The Rohingya dialect is most similar to the Chittagonian spoken by locals in Cox’s Bazar, but a step removed from Bangla, Bangladesh’s dominant tongue. Failing to recognise these differences could be disastrous, according to a separate Translators Without Borders study on language barriers. In Bangla, the word used to describe a cyclone is jhor. In Rohingya, the same word may describe heavy rain – but not a storm. With cyclone and monsoon season imminent, such subtleties, TWB says, “could be the difference of life and death”.

    (TOP PHOTO: Posters for Madagascar's President Hery Rajaonarimampianina. CREDIT: Zo Andriamifidisoa/Flickr)

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    From alms and Artificial Intelligence to Malala and Madagascar
  • School for Syrians, France’s Indian Ocean border and British NGOs say sorry: The Cheat Sheet

    Every week, IRIN’s team of specialist editors scans the humanitarian horizon to curate a reading list on important and unfolding trends and events around the globe:

     

    This just in

     

    Whatever the Security Council decides, this is everything you need to know about Syria’s Eastern Ghouta: a new briefing from contributor Aron Lund.

     

    Syria and Turkey

     

    The vast majority of Turkey’s 3.7 million refugees do not live in camps, and as a report from the International Crisis Group points out, hostility towards Syrians in the cities of Istanbul, Ankara and Izmir is growing. At least 35 people died in violence between refugees and locals last year. One tried and tested (elsewhere, at least) avenue towards coexistence is education. Turkey plans to phase out refugee-only schools where students study in Arabic by the end of 2018 and shift them  to the Turkish curriculum in the Turkish language. How and if this will work is not yet clear – watch this space for an update soon.

     

    Meanwhile, Turkish troops and their Syrian allies are working together in a very different sort of way, fighting US-backed Kurdish troops in the northern Syrian enclave of Afrin. So far this has meant loss of life and mass displacement, but this week a key advisor to President Recep Tayyip Erdogan added a new dimension, saying he expects tens of thousands of Syrians to return to Afrin after the military operation is complete. Given current violence (not to mention the sentiments of the Kurdish residents of Afrin) this does seem a stretch, but might it provide a window into Turkish strategic thinking?

     

    America’s endless war

     

    The death of four US special forces soldiers in Niger last year continues to resonate in the US media. In a reconstruction of the soldiers’ final hours, The New York Times this week also told a broader story of the sprawl of US military intervention around the globe. Initially based on a narrow mandate after 9/11, US special forces are now engaged in an almost unlimited war. Previously unremarkable Niger is now the Department of Defence’s second largest deployment in Africa outside Djibouti. And that footprint will be larger still once a giant drone base in Agadez is completed. Joe Penny of the Intercept does a comprehensive dive into the issues, from the constitutional legality of the base, to the political economy of Agadez and, vividly, local opposition to the US presence.

    Also noting the potential for destabilisation, War on the Rocks warns that “terrorism is not a useful lens for understanding violence in the Sahel, nor is counterterrorism a proper policy response”. Indeed. And a new Rand report  sifts through historical data from around the world and concludes that US military assistance is “associated with increased state repression and incidence of civil war” rather than stability. If you need to know where to avoid, see IRIN’s map on foreign military bases in Africa.

     

    Disaster insurance: dull but fast

     

    Days after powerful Cyclone Gita barged across Tonga’s main island last week, a new disaster insurance scheme paid out more than $3.5 million to help the Pacific Island country’s recovery. The World Bank says it’s the first payment made by the Pacific Catastrophe Risk Insurance Company, which was set up in 2016 to support select countries in the disaster-prone Pacific Islands. Proponents say disaster insurance is an innovative solution for quickly dispatching funding where it’s needed, even if the concept itself may sound rather dull — as an IRIN op-ed pointed out during last year’s destructive Caribbean hurricane season.

     

    Funding for disaster preparedness and response is a big issue in many Pacific Island countries, where resources are scarce and aid is often slowly filtered through the labyrinthine international system. But while disaster insurance may act fast, it’s still just one part of the overall funding picture. After Cyclone Pam struck Vanuatu in 2015, the pilot predecessor of the Pacific insurance scheme released $1.9 million directly to the country within two weeks. Total losses and damages, though, were pegged at more than $400 million — two thirds of Vanuatu’s GDP.

     

    Sorry, say British NGOs

     

    In a sign of mutual solidarity that took some time coming, 23 UK NGO executives promised to do more to prevent sexual exploitation and abuse. In a joint letter, Oxfam, Save the Children and other major groups tried to shore up public confidence following a toxic scandal, while not denying they may have a problem: “As we take every necessary step to right these deep wrongs, we also have a clear responsibility to ensure that the communities we seek to help are not the ones punished for our mistakes.” The move comes after the glare of publicity moved, at least temporarily, onto Save the Children from Oxfam; former Save CEO Justin Forsyth stepped down from his job at UNICEF after his own workplace misconduct at the British agency was exposed by the BBC. The priority measures highlighted in the joint letter were: more funding, better systems and legal methods for work references and background checks.

     

    Why are children dying from measles in Indonesia?

     

    Vaccine-preventable measles is killing children in Indonesia’s Papua province and pointing an international spotlight on the central government. Measles and malnutrition have killed dozens of children in the eastern province since an outbreak began last October, according to the UN’s humanitarian aid coordination arm. It’s become a sensitive issue for the Indonesian government: a BBC journalist was ejected from Papua after tweeting photos of food deliveries.

     

    Indonesia’s military has for decades suppressed an independence movement in Papua and West Papua. Today, the two provinces lag behind the rest of the country on a range of key health indicators; infant, child and maternal mortality rates are among the highest in the country. The outbreak comes after Indonesia had touted a large-scale measles vaccination campaign (half-funded by major international donors), leading critics to question why vaccinations hadn’t reached children in the Papua district hardest hit by the outbreak.

     

    In case you missed it

     

    The other European migration frontline


    Drownings, deportations, recriminations and xenophobia: the vestiges of France’s colonial past provide the ingredients of a rolling migration crisis in the present-day Indian Ocean. A risky sea crossing has claimed the lives of up to 10,000 people since 1995. The unresolved crisis sees some 20,000 people a year thrown out from a tiny speck of France near Madagascar to the neighbouring island nation of Comoros. The whole situation adds up to lives uprooted, hopes dashed, and a surprising source of support for the right-wing party of Marine le Pen in France. IRIN visited Mayotte to find out more.
    School for Syrians, France’s Indian Ocean border and British NGOs say sorry
  • Afghan attacks, Raqqa redux, and plague in Madagascar: The Cheat Sheet

    Every week, IRIN’s team of specialist editors scans the humanitarian horizon to curate a reading list on important and unfolding trends and events around the globe:

     

    AU and EU: new BFFs?

     

    African and European leaders are scheduled to meet in a summit in November at a time when relations have reached a turning point, the International Crisis Group says in a report released this week. The African Union has launched potentially transformative reforms that will shake up its peacekeeping operations and should increase its financial self-sufficiency. Because of Brexit, the EU is losing one of its most influential and internationally engaged members – with implications for Africa. One component critical to reshaping AU-EU relations is the Cotonou Agreement, a partnership between the EU and 79 countries from sub-Saharan Africa, the Caribbean, and the Pacific that expires in 2020 and will be renegotiated over the next two years. It’s unclear what shape the post-Cotonou settlement will take, and the future of the linked European Development Fund is equally uncertain. The AU’s reform of its peace and security architecture also has consequences for the EU – its chief funder. There are many points of friction: For the AU, the EU’s “paternalism” grates, while Brussels worries that it’s perceived as a “cash machine” – not to mention serious divergences over the migration issue. But there are deep-shared strategic interests. Both sides “must confront key areas of disagreement and frustration,” says the ICG. “In this context, the AU-EU summit comes at a particularly opportune moment.”

     

    Biggest plague outbreak since 2008 (probably)

     

    In Madagascar, 94 people have died in the worst outbreak of plague since 2008. Since 1 August, there have been 1,153 suspected cases, according to the WHO. This outbreak is nearly three times bigger than the typical seasonal outbreaks the island has every year, and it's reached the capital city, Antananarivo. Also bad: The pneumonic variant that can spread directly from human to human is responsible for two thirds of the cases. Speaking to reporters in Geneva, Ibrahima Soce Fall, the WHO’s emergency director for Africa, said the outbreak could be contained quickly and that all strains tested so far are treatable with standard antibiotics. The likelihood of international spread is minimal, he argued. However, the WHO's own literature admits the pneumonic form can produce "terrifying" outbreaks. The International Federation of the Red Cross and Red Crescent Societies has appealed for 5.5 million Swiss francs to support its work on the outbreak, which “involves illness, fear, stigma and discrimination”. Justifying the hefty investment, IFRC Secretary General Elhadj As Sy said: “we are adopting a ‘no regrets’ approach to this response”. In recent years, Madagascar has reported three quarters of the cases of human plague worldwide – a sign, according to a study, of the "deteriorating fabric” of the country’s health system. However, not all cases are reported to the WHO: Weak surveillance in northeastern Democratic Republic of Congo, another endemic country (it reported 1,962 cases in 2008), may hide continuing outbreaks there. 

     

    New lows in Afghanistan

     

    It has been a deadly week in Afghanistan: Multiple attacks claimed by the Taliban have killed at least 100 people and injured hundreds more. Taliban militants targeted an Afghan Army base in Kandahar Province, killing 43 soldiers — the majority of the troops stationed there, according to media reports. Separate attacks in Paktya and Ghazni provinces killed at least 60 and injured at least another 200, according to the UN mission. These attacks are just the latest signs of Afghanistan’s deteriorating security situation. More than 8,000 civilians have been killed or injured in conflict through the first nine months of this year – a figure that has Afghanistan on a path to near record-high levels of casualties. The violence also underscores the Taliban’s mounting influence in certain parts of the country. It’s estimated that the government now only has control or even influence in less than 60 percent of the country’s districts. With a mild winter expected in the coming months, observers are predicting even greater insecurity as the country hobbles toward parliamentary elections scheduled for July 2018. This week, IRIN crunched some numbers that show the costs of Afghanistan’s increasingly fragile security situation. Next week, we’ll take a look at how this instability is impacting the health system – and some of Afghanistan’s most vulnerable groups.

     

    Raqqa redux

     

    After more than four years, so-called Islamic State is finally on the back foot in Iraq and Syria. This week, US-backed militias declared victory in Raqqa – the Syrian city that has been called the caliphate’s capital. Raqqa has been under bombardment by an international coalition for years, but the endgame has been particularly brutal, resulting in a disturbing uptick in civilian casualties. While Raqqa is not the last territory IS holds in Syria or Iraq (see: al-Qaim), it is a symbolic one, and there’s reason to worry the group’s territorial losses will lead to a proliferation of attacks elsewhere from a spreading network. The end of these battles also marks the beginning of a whole host of new challenges: There will likely be conflict over who will control the Raqqa area, and – not unconnected – who will make money off its reconstruction. More than 312,000 people have been displaced inside Raqqa province in the past year – Save the Children says camps in the area are “bursting at the seams”. With much of the city reportedly damaged or destroyed, it’s unlikely they’ll be able to go home anytime soon.

     

    Did you miss it?

     

    Bleak outlook for South Sudan

     

    This week, Norwegian Refugee Council head Jan Egeland wrote in an IRIN op-ed that “an air of possibility” now hangs over South Sudan as belligerent parties gather for another round of peace talks. Conflict since 2013 has claimed untold thousands of lives, created almost four million refugees, and left two thirds of the population – some 7.6 million people – dependent on humanitarian aid. Egeland noted that the international community’s support for South Sudan had “waned” since it midwifed a landmark 2005 deal that halted an earlier conflict. However, in a paper just published by the Small Arms Survey, a Geneva-based think tank, Canadian academic John Young is less optimistic. A year after President Salva Kiir and the opposition, led by former vice president Riek Machar, signed a peace agreement, “international peacemakers are reduced to making appeals to end the violence that are ignored.” Young argues that South Sudan is still at war partly because the mediators of the 2005 deal misread the dynamics of a conflict that first began in the mid-1950s, and consequently came up with an ill-fated formula to resolve it. Young concludes that “none of the belligerents has demonstrated the capacity to conclusively defeat the other, and without strong and effective international interlocutors there is no credible track to end the war.”

     

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    Afghan attacks, Raqqa redux, and plague in Madagascar
  • A crisis ‘lost in the ocean’

    Drought-prone southern Madagascar is facing yet another food emergency this year. An unusually strong El Niño season means the rains have failed once more. Prices in local markets have skyrocketed, leaving more than 665,000 people in urgent need of food aid.

    This giant Indian Ocean island is one of the most vulnerable countries in the world to natural disaster. Madagascar’s semi-arid, deep southern regions of Androy, Anosy, and Atsimo Andrefana have faced emergencies year upon year. The recent El Niño has just made an already bad situation worse.

    Dami is nearly three years old but weighs only 6.9 kilograms. Underneath his dusty white t-shirt and blue shorts, his limbs are about the size of a carrot but his belly is swollen: a sure sign of malnutrition.

    He sucks on a sachet of high-energy Plumpy’Nut, a peanut-based, ready-to-eat food. When he fumbles and drops the packet on the ground, his sister snatches it up and chews at it: she is also hungry.

    Tempting cacti

    The current drought, one of the worst seen, has scorched rice and cassava crops, leaving 80 percent of people without a secure food supply. Many agrarian communities are now reliant on food aid – and cacti.

    “This drought is the worst I have ever seen. Last year, there was drought, but we had some rain. But this year there has been almost nothing”

    The red fruit of the cacti is an emergency food in the south, but they are hard to digest and can cause bowel problems that exacerbate the effects of malnutrition.

    Dami is one of eight children born to 38-year-old Ambahinky Kazy, who is poor and struggles to find work. She wants her children to become teachers, but none of them have been to school.

    Dami was given the Plumpy’Nut following a UNICEF screening in Ambondro village, in Androy region. The examination found his mid-upper arm circumference was just 10 centimetres: in the danger zone.

    It takes up to 90 sachets of Plumpy’Nut for a child to recover, but this is made difficult as families often regard the “medicine” as food, sharing it out among other hungry siblings.

    Kazy has been in and out of the UNICEF programme with her different children over a period of four years, a fact that underlines the region’s unrelenting poverty.

    Nearly one million children in Madagascar suffer from acute malnutrition, and the island nation has one of the highest rates of under-five stunting in the world.

    The malnutrition crisis is the main health issue for the government, according to Health Minister Mamy Lalatiana Andriamanarivo. It “continues to be alarming for us, especially in the south”, he said.

    Weak response

    While the government says it considers tackling the food crisis a priority, its efforts are stifled by poor funding (much of the health budget is reliant on foreign aid) and implementation issues. It has made little progress in building resilience in communities vulnerable to climatic shocks, and infrastructure is crumbling: more roads are lost than are built each year.

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    Food aid distribution southern Madagascar
    Tom Maguire/IRIN

    It’s partly the lasting impact of a four-year political crisis during which donors froze development assistance. That “affected government institutional capacity, economic growth and social development efforts”, says the World Food Programme.

    Food insecurity doesn’t affect just poor single mothers and their children. The entire community is impacted.

    “I always worry, every day,” said Damy Miarorala, the mayor of Ambondro. “This drought is the worst I have ever seen. Last year, there was drought, but we had some rain. But this year there has been almost nothing.”

    There were deaths last year - especially among children - due to malnutrition, and reports again this year that people are succumbing.

    “My worst worry is the deaths from people not eating. Some people are eating the red cactus, which is bad for their health,” said Miarorala.

    The mayor’s friend, Malafeno, laughed when asked if he was hungry, and showed off his baggy clothes. When the clothes fitted properly, he weighed 90 kilograms. Now, he is down to just 63.

    Under the radar

    It’s hard for Madagascar to get the help it needs as it’s “a bit lost in the ocean”, explained Willem van Milink, the country’s WFP representative.

    Madagascar is “off the map” and forgotten by the international community, say aid workers. Its food crisis is grinding and constantly severe but lacks the dramatic numbers or cataclysmic event needed to gain significant relief and development attention from donors.

    “We have nothing left to grab on to ...We are just waiting for death to come”

    Yet, the drought is likely already a symptom of one of the most pressing global issues: climate change.

    Rains have not fallen as they should for five years, according to Chief Voasaotsy of Anjampaly village in the Tsihombe district. A hailstorm in 2010 destroyed their crop of maize, sweet potatoes, and watermelon. The soil then became less fertile and the harvest has not recovered since. 

    “We have nothing left to grab on to,” said Voasaotsy. He scraped the spines off a cactus leaf and bit into it, demonstrating how the villagers eat, outside of their once-daily ration of maize delivered by WFP.

    His desperation was evident as he explained how the villagers had to sell their property and livestock to buy food, which they used to grow themselves. Half the village has migrated, moving north. The remaining half cannot sell their land as everyone wants to leave. At least five people have died of hunger.

    “Our life is waiting upon the rain,” Voasaotsy continued.  “But we are hopeless. We are just waiting for death to come.”

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    A crisis ‘lost in the ocean’
    Drought and climate change in Madagascar
  • Polio hopes and Zika fears in the vaccine race

    It’s busy times for the vaccine industry – a new vaccine against dengue fever has been deployed in the Philippines, research for a vaccine against Zika virus is gaining steam (although questions remain over the threat it poses), the Ebola outbreak refuses to go away, and a yellow fever outbreak in Angola has exposed an alarming lack of stockpiles.

    Against this backdrop, the biggest-ever effort in human immunisation might finally be reaching the beginning of the end. Wild polio, once crippling hundreds of thousands a year, is found now in only two countries – Afghanistan and Pakistan. There have been just nine reported cases so far in 2016.

    If polio were in full retreat in 2017, it would mark 40 years since the last natural case of smallpox – the first disease to be completely wiped out in human history, in 1977.

    The multi-agency polio eradication programme led by the WHO since 1988 shows that the road to eradicating any disease is long and expensive, even one with relatively simple characteristics (unlike a number of other diseases on the global agenda, polio can only survive in humans; there’s no reservoir in animals or insects). The Polio Eradication Initiative has a budget of more than $1 billion per year.

    The research and development stages of any drug or vaccine take years, but that’s only one ingredient. Public education and mobilisation, funding, and, inevitably, tackling anti-vaccine suspicion and rumours, have all played their part in the twists and turns of the polio campaign. The same will surely be true of any future eradication programme.

    The next steps of the anti-polio drive require a synchronised switch in the type of vaccine, due between now and 1 May in 155 countries, and then, in the years to follow, a gradual transition to injectable vaccines to replace the oral drops so many countries are familiar with.

    Unintended consequences

    Until this year, the most common oral vaccine protected against all three types of polio. Since type two is now eradicated in the wild, the new version of the vaccine only protects against types one and three.

    Some surprising data is a factor behind this move.

    While the number of naturally-acquired cases of polio last year were 74, the total number was 106. How?

    In a tiny minority of cases – the WHO suggests it’s a 2.7 million to one chance – the oral polio vaccine backfires and causes paralysis: the signature symptom of polio.

    Given the right circumstances, both in the patient’s stomach and an unhygienic environment, the polio virus can further survive in faeces and be transmitted to others. This, circulating vaccine-derived polio virus (cVDPV) is most commonly a variant of type two, so it makes sense to remove the pathogen from the vaccine now if it’s not present in the wild.

    In 2015, 32 cVDPV cases were reported from Madagascar, Laos, Guinea, Myanmar, Nigeria and Ukraine.

    Therefore, the old oral polio vaccine was in fact the cause of about a third of cases of polio-related paralysis last year. Governments accept the rare incidents of vaccine-derived polio as an acceptable price to pay along the road to worldwide eradication. Using only the new bivalent (two-pronged) vaccine should reduce this unintended consequence significantly, while concentrating firepower on the remaining two types. Developed countries now tend to use the injectable polio vaccine, which carries no risk of vaccine-derived polio. The rest of the world should also graduate to the injectable model if the frontline battle against polio can be won by the oral vaccine.

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    Ben Parker/IRIN
    A Sanofi Pasteur employee visually checks a vial of vaccine. Manual and automated quality control is a significant part of the vaccine manufacturing process.

    What about Zika?

    Vaccine controversies, unfounded in science, have surfaced in Europe and the United States in recent years. There is no proof of a link between autism and vaccines, and a dropoff in vaccination rates has caused an upswing in cases of measles. Such scares and debates have always accompanied vaccines and are inevitable part of the public conversation, according to Sanofi Pasteur spokesman Alain Bernal.

    Much of the recent media hype involving vaccines has centred on the Zika virus, which has exploded in the Americas this year and has been categorised as a public health emergency of international concern by the World Health Organization.

    Sanofi Pasteur head of global research, Nick Jackson, told IRIN that in addition to being a major producer of polio and other vaccines it is among a number of bodies moving towards early-stage “wet experiments” on Zika.

    For Zika, there is a particular lack of data and research on the virus, its mosquito hosts and means of transmission. There’s also debate about the normal incidence of various congenital and neurological conditions that have so far been linked to it. Building baseline data will be critical both for researchers and for subsequent public confidence in any vaccine. A recent review of expert opinion by Scientific American explores a range of risks and complicating factors, all suggesting a quick win in vaccine research unlikely.

    One of the conditions that may be linked to Zika in adults is a severe neurological disorder called Guillain-Barré syndrome (GBS). “What is tricky is to be able to measure the level of GBS without vaccination… The background level exists naturally. It’s very important for a vaccine producer to demonstrate the level of these events before the vaccination, so that after the vaccination people don’t blame the vaccine,” Bernal told IRIN.

    Pressure for Zika treatment and prevention is an acute international priority according to the WHO – and the outbreak’s development in the Americas has triggered the early promise of US cash and research resources. At a recent consultation in the US, researchers, drug company officials, medical journals and public health officials compared notes. “Ebola’s scary because we know what it can do. Zika’s scary because we don’t know yet what it can do,” said Jackson.

    [Sanofi Pasteur provided travel expenses for IRIN's visit to its facilities in Lyon.]

     
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    Might this be the year polio is defeated?
    Polio hopes and Zika fears in the vaccine race

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