(Formerly called IRIN) Journalism from the heart of crises

  • Killing us softly

    A recent public outcry in China, sparked by a damning documentary about air pollution, was based on well-founded fear:

    Of the 100 million people who viewed the film on the first day of its online release, 172,000 are likely to die each year from air pollution-related diseases, according to regional trends.* 

    Worldwide, pollution kills twice as many people each year as HIV/AIDS, malaria and tuberculosis combined,** but aid policy has consistently neglected it as a health risk, donors and experts say. 

    Air pollution alone killed seven million people in 2012, according to World Health Organization (WHO) figures released last year, most of them in low and middle-income countries (LMICs) in the Asia Pacific region.*** 

    In a self-critical report released late last month the World Bank acknowledged that it had treated air pollution as an afterthought, resulting in a dearth of analysis of the problem and spending on solutions. 

    “We now need to step up our game and adopt a more comprehensive approach to fixing air quality,” the authors wrote in Clean Air and Healthy Lungs. “If left unaddressed, these problems are expected to grow worse over time, as the world continues to urbanise at an unprecedented and challenging speed.”

    A second report released last month by several organisations – including the Global Alliance on Health and Pollution, an international consortium of UN organisations, governments, development banks, NGOs and academics – also called for more funding towards reducing pollution. 

    “Rich countries, multilateral agencies and organisations have forgotten the crippling impacts of pollution and fail to make it a priority in their foreign assistance,” the authors wrote. 

    Housebound in China 

    A dense haze obstructs visibility more often than not across China’s northern Hua Bei plain and two of its major river deltas. Less than one percent of the 500 largest cities in China meet WHO’s air quality guidelines. Anger over air pollution is a hot topic among China’s increasingly outspoken citizenry.  

    “Half of the days in 2014, I had to confine my daughter to my home like a prisoner because the air quality in Beijing was so poor,” China’s well-known journalist Chai Jing said in Under the Dome, the independent documentary she released last month, which investigated the causes of China’s air pollution.

    The film was shared on the Chinese social media portal Weibo more than 580,000 times before officials ordered websites to delete it

    Beyond the silo

    Traditionally left to environmental experts to tackle, the fight against pollution is increasingly recognised as requiring attention from health and development specialists too. 

    “Air pollution is the top environmental health risk and among the top modifiable health risks in the world,” said Professor Michael Brauer, a public health expert at the University of British Columbia in Canada and a member of the scientific advisory panel for the Climate and Clean Air Coalition, a consortium of governments and the UN Environment Programme. “Air pollution has been under-funded and its health impacts under-appreciated.”

    Pollution – especially outdoor or “ambient” air pollution – is also a major drag on economic performance and limits the opportunities of the poor, according to Ilmi Granoff, an environmental policy expert at the Overseas Development Institute, a London-based think tank. It causes premature death, illness, lost earnings and medical costs – all of which take their toll on both individual and national productivity.

    “Donors need to get out of the siloed thinking of pollution as an environmental problem distinct from economic development and poverty reduction,” Granoff said. 

    Pollution cleanup is indeed underfunded, he added, but pollution prevention is even more poorly prioritised: “It’s underfunded in much of the developed world, in aid, and in developing country priorities, so this isn’t just an aid problem.”

    Mounting evidence 

    Pollution kills in a variety of ways, according to relatively recent studies; air pollution is by far the most lethal form compared to soil and water pollution. 
     

    Microscopic particulate matter (PM) suspended in polluted air is the chief culprit in these deaths: the smaller the particles’ size, the deeper they are able to penetrate into the lungs.  Particles of less than 2.5 micrometres in diameter (PM2.5) are small enough to reach the alveoli, the deepest part of the lungs, and to enter the blood stream.  

    From there, PM2.5 causes inflammation and changes in heart rate, blood pressure, and blood clotting processes - the precursors to fatal stroke and heart disease.  PM2.5 irritates and corrodes the alveoli, which impairs lung function - a major precursor to chronic obstructive pulmonary disease. It also acts as a carcinogen.

    Most research looks at long-term exposure to PM2.5 but even studies looking at the hours immediately following bursts of especially high ambient PM2.5 (in developed countries) show a corresponding spike in life-threatening heart attacks, heart arrhythmias and stroke.

    Asia worst affected

    The overwhelming majority - 70 percent - of global air pollution deaths occur in the Western Pacific and Southeast Asia regions.  South Asia has eight of the top 10 and 33 of the top 50 cities with the worst PM concentrations in the world.  

     

    WHO says a city’s average annual PM levels should be 20 micrograms per cubic meter.  But cities such as Karachi, Gaborone, and Delhi have yearly PM averages above 200 micrograms per cubic meter. 

    The main source of PM2.5 in indoor air, or household air, is burning solid fuels for cooking and heating, using wood, coal, dung or crop leftovers - a common practice in rural areas of low and middle-income countries that lack electricity.  

    Almost three billion people live this way, the majority in the densely populated Asia Pacific region: India and China each hold about one quarter of all people who rely on solid fuels. For these people, the daily average dose of PM2.5 is often in the hundreds of micrograms per cubic meter. 

    Filling the gaps

    Unlike many other health risks air pollution is very cost-effective to address, Brauer said. Analysis of air quality interventions in the US suggests a return on investment of up to $30 for every dollar spent. 

    “We already know how to reduce these risks, as we have done exactly that in high income countries, so this is not a matter of searching for a cure - we know what works,” he said.

    But the World Bank report said that unless it starts gathering better data on local air quality in LMICs, the amounts and sources of air pollution and the full gamut of its health impacts, “it is not possible to appropriately target interventions in a cost-effective manner.”

    Granoff said there are also gaps in government capacity to monitor, regulate and enforce pollution policy. 

    Beijing hopes to bring PM2.5 concentrations down to safe levels by 2030, and has said it will fine big polluters. 

    The World Bank report said China is also charging all enterprises fees for the pollutants they discharge; establishing a nationwide PM2.5 monitoring network; instituting pollution control measures on motor vehicles; and controlling urban dust pollution.

    But enforcing environmental protections has been a longstanding problem in China.

    “Pollution policy will only succeed if citizens are aware of the harm, able to organise their concern [through advocacy campaigns], and have a responsive government that prioritises public welfare over the narrower interests of polluting sectors,” Granoff said. 

    While more people die from household air pollution than from ambient air pollution, the latter – through vehicles, smokestacks and open burning – still accounted for 3.7 million deaths in 2012, according to the WHO. 

    A change in the air

    Kaye Patdu, an air quality expert at Clean Air Asia, a Manila-based think tank - and the secretariat for the UN-backed Clean Air Asia Partnership, comprising more than 250 government, civil, academic, business and development organisations - said the aid community is finally starting to recognise the importance of tackling air pollution.  

    Last year’s inaugural UN Environment Assembly adopted a resolution calling for strengthened action on air pollution.  
    WHO Member States are planning to adopt a resolution on health and air quality at the upcoming World Health Assembly in May. 
    The proposed Sustainable Development Goals, which will set the post-2015 international development agenda, address city air quality and air, soil and water pollution. 

    None of the experts IRIN contacted could provide a breakdown of total aid spending on all forms of toxic pollution (air, water and soil pollution that is harmful to human health).  So IRIN asked each of the major global donors for their figures.  

    Three responded.  

    A back-of-envelope calculation of all reported spending on toxic pollution by USAID, the European Commission and the World Bank suggests that between them they committed about US$10 billion over 10 years. This does not include aid spending on the diseases that pollution causes. The World Bank’s spending figures eclipsed those of other the other donors. 

    By very rough comparison, HIV/AIDS, malaria and tuberculosis, with half the death toll of air pollution, received $28 billion via public sector commitments to the Global Fund – the world’s largest financier of programs that tackle these diseases – over the same period, a fraction of total spending on these diseases. 

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    *Based on WHO statistics for per capita mortality rates in the Western Pacific region in 2012. 

    **The mortality figures for air pollution come from 2012 statistics and were released by WHO in 2014, while the figures for the infectious diseases come from 2013 statistics and were released by the Institute for Health Metrics and Evaluation in 2014 (the Global Burden of Disease study).

    ***Includes deaths from both household air pollution (4.3 million) and ambient air pollution (3.7 million): the combined death toll is less than the sum of the parts because many people are exposed to both. 

    For more: 

    The relationship between household air pollution and disease

    Ambient air pollution and the risk of acute ischemic stroke 

    Cardiovascular effects of exposure to ambient air pollution 

    Particulate air pollution and lung function  

    Long-term exposure to ambient air pollution and incidence of cerebrovascular events: Results from 11 European cohorts within the ESCAPE Project  

    OECD's The Cost of Air Pollution report
     

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    Killing us softly
  • Working to keep the peace: The impact of job schemes on ex-rebels

    Job-creation schemes are the traditional way to tackle the post-conflict problem of unemployed ex-fighters and to reduce the threat they can pose to peace and stability in fragile states.

    The theory - encapsulated in most demobilisation, disarmament and reintegration (DDR) programmes - is that jobs can be generated through training and capital inputs; that employment decreases the risks of re-recruitment; and once armed with a pay cheque, ex-combatants settle down and reintegrate more easily into society.

    Those assumptions were tested in a recent study exploring whether employment could reduce lawlessness and rebellion among high-risk men in Liberia. Of those who took part in the training scheme that was studied, 74 percent had fought in Liberia’s traumatic 14-year civil war.  The study concluded that training and cash incentives did encourage lawful employment, and as a result the men resisted being signed up by mercenary recruiters during a neigbouring conflict.  But there was no evidence employment improved their societal reintegration – they remained violent and anti-social.

    The NGO Action on Armed Violence (AoAV) works with ex-fighters and other troubled young men, typically involved in illegal mining and logging in remote “hotspots”, providing agricultural training and farm inputs. The income-generating scheme gave the researchers - Christopher Blattman of Columbia University and Jeannie Annan, of the International Rescue Committee - what they described as a unique opportunity to study employment-led rehabilitation.

    Their study found that even the highest risk men where “overwhelmingly interested in farming” as a result of the AoAV training. But although they spent 20 percent more time on farming, they didn’t abandon their illicit activities. Instead, they adjusted “their portfolio of occupations”, and saw a modest rise of $12 a month in earnings. Crucially the men reported “24 percent less engagement” with mercenary recruiters when Cote d’Ivoire’s short war erupted in 2011 – and none went to fight.

    The study’s findings were published in the Social Science Research Network.

    DDR employment programmes generally have a low success rate: Often the primary goal is to get a peace agreement signed, not sustained economic reintegration – a failing witnessed from the Central African Republic to the Democratic Republic of Congo.

    The study suggests that the single-trade focus of most DDR programmes fails to appreciate how, in the real world, the poor use multiple streams of income to mitigate risk. Liquid capital is key. The AoAV scheme demonstrated, almost accidentally, the power of cash incentives. As a result of a supply problem, roughly a third of the men expecting a second farm input installment were told to expect instead a cash payment – conditional on them not taking up mining or mercenary work. This financial inducement worked. 

    “The potential policy implication is that one-time transfers will not fully deter future criminal or mercenary opportunities. Ongoing incentives, such as cash-for-work programmes or other conditional transfers, could be important compliments,” the study noted.

    Despite the men’s relative economic success, the programme had “little effect on aggression, participation in community life and politics, or attitudes to violence and democracy” – in other words, little progress in terms of social integration. Furthermore, although AoAV’s intervention had a positive impact, an additional $12 a month earned was “not a high return” on the investment. 

    “Cost-effectiveness thus hinges on the hard-to-quantify social returns to lower crime and violence,” the study noted. In a fragile country recovering from conflict, that may well be a price worth paying.

    For further reading on DDR see:

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    How to help ex-rebels adjust to peace
  • Three words of advice for WHO Africa's new chief

    The World Health Organization says the number of new Ebola cases per week rose twice this month for the first time since December.

    This rise in incidence of new cases - if proven to be a trend - will be just one of the challenges facing WHO’s new regional director for Africa, Matshidiso Rebecca Moeti, as she attempts to overcome the multitude of criticism launched against WHO in recent months for its failure to act earlier and more competently during West Africa’s ongoing Ebola outbreak.

    “This is a critical moment for the WHO,” said Michael Merson, director of Duke University’s Global Health Institute. “It’s a real crossroads as to whether or not they’ll be able to reform and become an effective and efficient organization, particularly at the regional level.”

    Moeti, who officially took office 1 February, has vowed to make fighting Ebola WHO’s “highest priority,” while supporting countries to develop strategies to build up their health care systems, and reduce maternal and child mortality, tuberculosis, HIV/AIDS and non-communicable diseases.

    Many international observers say they have high hopes for Moeti, a medical doctor who has more than 35 years of experience working in the national and global public health sector. But she has a tough road ahead – particularly as the number of Ebola cases continues to rise, nearly a year after the outbreak was first declared.

    Here’s some advice from a few experts as Moeti begins her five-year term:

    1. Think Local

    Having competent and qualified staff on the ground, whose skills and expertise are matched to the needs of the country, is key to effectively implementing WHO policies and recommendations.

    “Everyone tends to discuss WHO at the global level and the regional level, but I don’t think this is where the problem lies,” said Fatou Francesca Mbow, an independent health consultant in West Africa. “It really lies in what the WHO is meant to be doing at country level. It is of no use to have very technical people sitting in Washington [D.C.] or Geneva, and then, where things are actually happening, [they become] politicians.”

    Mbow said that despite a wealth of technical documents being produced at headquarters, very often the staff from the field offices are appointed based on political motives. Country and field-level office meetings are often dominated by talk that, while politically correct, says “nothing of real meaning”.

    Staff reform at the local level will require both investing in employee development, including recruiting new and existing talent to the field offices, as well as making posts in “hardship” countries more attractive to the most qualified experts.

    “What often happens is that when people in-country are seen as being quite effective, they tend to get headhunted by the headquarters of the institutions that represent them,” said Sophie Harman, a senior lecturer in international politics at Queen Mary University of London. “So we see a type of brain-drain among people working in these sectors.”

    She said that improving salaries and offering more benefits, as well as taking into account what these people have to offer, could go a long way in incentivising them to stay at their field-level posts.

    “Good documents are interesting,” Mbow said. “But unless you have people at country level who understand them, who participate in writing them, who are able to implement them, who are passionate and committed to doing so, they’re just going to be reports.”

    2. Strengthen health systems

    There were many factors that contributed to the unprecedented spread of the Ebola outbreak, but inherently weak local health systems in the three most-affected countries meant that local clinics did not have the capacity, resources or expertise to handle even the smallest of caseloads.

    WHO must now work with local governments, partners and other on-the-ground agencies in all African countries to train and employ more doctors and nurses, implement universal health care coverage, and invest in better vigilance and surveillance measures.

    “I think the real test will be… how the WHO turns this outbreak into an opportunity to use our energy and thoughts and actions to build health systems that will not only help people [day-to-day], but will be able to respond to health crises like this in the future,” said Chikwe Ihekweazu, a managing partner of the health consulting firm EpiAfric.

    Increasing the number of health workers will be particularly important post-outbreak in Guinea, Liberia and Sierra Leone, where more than 400 health workers have died from Ebola, including some of the countries’ top doctors and nurses.

    “The WHO also needs to help minimise the knock-on effect that the Ebola outbreak is having on other health priorities in the region, such as HIV/AIDS and maternal health,” Harman said. “What we are seeing is that because of Ebola, people are afraid and so they are not accessing health facilities, which might actually reverse some of the many gains we’ve seen in the MDGs [Millennium Development Goals].”

    3. Rebuild credibility

    Despite WHO having, admittedly, acted much too late, both in terms of identifying the Ebola outbreak and then mobilizing resources to contain it – and losing much of its credibility in the process – experts agree that WHO remains a much-needed and relevant global health body, particularly when it comes to technical expertise.

    “We all recognize that the WHO has had a fairly good history in the past,” Ihekweazu said. “And while it was certainly criticized for its slow response at the beginning of the outbreak…the WHO is seen as the leading organisation that provides guidance for countries and I think…we are at a stage where [Africa] needs the WHO as a mutual partner who provides leadership for the continent going forward.”

    Mbow agreed: “What I would say is that when you are criticised, take the blame fairly, but don’t lose sight. And don’t lose confidence in the resources you do have to offer.”

    Restoring donor confidence in WHO will be particularly important, as the regional office for Africa has the largest budgetary needs, the most countries, and, in many ways, the most challenging health problems to deal with.

    “No one wants harm done to the WHO,” Merson said. “We will be a much better, healthier planet, if the WHO is strong and effective… But it is never going to have a huge budget and so I think its strengths should be in standard-setting, norm-setting and providing the best technical sound advice in health that countries need.”

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    3 tips for WHO's new director for Africa
  • Who celebrity advocates are really targeting. And it’s not you.

    This week was a fanfare for celebrity humanitarians: Forest Whitaker appealed for peace in South Sudan alongside UN Under-Secretary-General for Humanitarian Affairs Valerie Amos; Angelina Jolie opened an academic centre on sexual violence in conflict with British Member of Parliament William Hague; and UNICEF Goodwill Ambassador David Beckham launched an initiative for children. 

    In recent years, aid agencies have increasingly used celebrity advocates to raise awareness and money for their causes. There’s just one snag: 

    It doesn’t actually work. At least not as much or in the ways we think. 

    According to research by Dan Brockington, a professor at the University of Manchester, public responses to celebrity activism are surprisingly muted. His work is the first quantitative research on the subject. 

    “Using celebrities for broader outreach, for reaching mass publics and attracting media attention is absolutely not the silver bullet it appears to be,” he told IRIN on the sidelines of a 6-8 February conference at the University of Sussex, where he presented research recently published in the book Celebrity Advocacy and International Development.

     

     
    In a survey he conducted with 2,000 British people, 95 percent of respondents recognized five or more of 12 charities listed to them, including the British Red Cross, Save the Children UK and Oxfam UK. But two-thirds of the respondents did not know a single “high-profile” advocate of any of the NGOs (In this case, music executive Simon Cowell and singers Victoria Beckham and Elton John respectively, among many others). 

    The realpolitik might not be that pleasant. But you'll achieve your goals. 

    Focus groups and interviews with more than 100 “celebrity liaison officers” and other media staff at NGOs further reinforced his findings. 

    What’s more, Brockington says, those who pay attention to celebrities do not necessarily know which causes they support. 

    “People who follow celebrities often do so because they are not political,” he said during the interview. “They are fun, light. You want to live their lives…[People] don’t engage with [celebrities] for the more worthy things.”  

    Celebrity stardom flat-lining 

    Despite the rise in the use of celebrity advocates (which, by the way, dates back to at least Victorian times), the mention of charities in broadsheet and tabloid articles about celebrities only increased ever so slightly between 1985 and 2010, according to a separate study by Brockington. “There has also been a decline in the proportion of newspaper articles mentioning development and humanitarian NGOs at all,” the study found. 

    The perception that celebrities engage the public in the first place may itself be overstated. 

    After a steady rise in coverage of celebrities in the British press over two decades, the percentage of articles mentioning the word celebrity (only a fraction of total articles about celebrities) stopped increasing around 2006 and is now hovering at about four percent of all articles studied, the research found, validating the findings of earlier studies on the same subject (The study looked at The Guardian, The Times, The Independent, Daily Mail, The Mirror and The Sun). 

    The magazine industry’s own statistics show a tapering off of readership in recent years after steady growth.

    Celebrities can be successful in engaging the public – Miley Cyrus made waves last year when she sent a homeless man to pick up her MTV Video Music Awards; Bob Geldof’s charity single on Ebola quickly rose to the top of the charts; and celebrity-driven telethons like the UK’s Comic Relief are generally quite successful. Leonardo DiCaprio’s speech at the opening of the Climate Summit 2014 garnered nearly 2 million views on YouTube – far more than many of the heads of state who also spoke at the summit.

    And the effectiveness of celebrity advocacy in non-Western contexts, which is much less studied, could well be higher. UNICEF, for example, uses more national than global celebrity ambassadors because they often resonate better with local audiences. Social media campaigns can also be extremely successful in some instances, though “not a game-changer”, according to Brockington (For a cold shower on this topic, see Paul Currion’s column on why KONY 2012 may have engaged the public, but ultimately failed).

    Influence without accountability 

    But on the whole, at least in the UK, public interest in celebrity appears to be lower than most people think, Brockington says. But the belief in star power - inaccurate as it may be - lingers: In his survey, 74 percent of respondents said they thought other people paid more attention to celebrities than they did. Statistically, this cannot actually be true, but it proves an important point: If people think that other people care about celebrities, it can become a self-fulfilling prophecy.

    Brockington found that while celebrities may not be as successful as we think in engaging the public, they are still successful at engaging politicians and decision-makers. 

    Why? 

    Because politicians - like most people - like being around celebrities. But also because politicians – also like most people - believe that celebrities express populist sentiment, even though, in fact, they often don’t. So they grant them access and influence. 

    Ben Affleck, for example, has briefed US Congress about the Democratic Republic of Congo and George Clooney has addressed the UN Security Council about Darfur.   

     

    For the small but growing number of academics studying the subject, the gap between celebrity advocacy and public engagement raises a major ethical question: If celebrities wield all this power and influence, yet do not represent popular sentiment, who are they accountable to?  

    “The celebrity is not beholden to his or her public in the same manner as the elected official,” writes Alexandra Cosima Budabin, of the University of Dayton, in an upcoming book: Celebrity Humanitarianism and North-South Relations. “Misguided proposals and ineffective interventions will not endanger a celebrity, whose position is assured by both financial and political elites.”  

    Celebrities’ increasingly powerful voices on issues of humanitarian aid, poverty reduction and famine has allowed them to “often decide for the suffering receivers” and eliminate public scrutiny and debate, according to Ilan Kapoor, a professor at York University in Canada and author of Celebrity Humanitarianism: The Ideology of Global Charity. 

    “…Mostly unelected, private individuals and organizations have, for all intents and purposes, taken over what should primarily be state/public functions,” he writes

    A Machiavellian approach?

    Perhaps even more interestingly, Brockington found in his interviews with staff of NGOs with celebrity advocates that liaison officers know the impact on the public is limited, but use celebrities anyway because they can access and influence not the general public but decision-makers. 

    “The realpolitik might not be that pleasant,” he told the University of Sussex conference, “but you’ll achieve your goals.”

    UNICEF’s announcement of a new initiative for children by its Goodwill Ambassador David Beckham may reflect a clear understanding of this precise point. It reads: “David will use his powerful global voice, influence and connections to raise vital funds and encourage world leaders to create lasting positive change for children,” the statement said. 

    Malene Kamp Jensen, of UNICEF’s Goodwill Ambassador Program – one of the first and largest of its kind, acknowledges that sending a message to policy-makers is a “very, very important role” of celebrity ambassadors: “They do have certain access and platforms.” 

    But she says it is important to engage all segments of society: “You communicate to as many people as possible… I don’t think you can just say: ‘Forget the public; let’s lean on the policy makers. It’s very much a collective effort.” 

    For Jeffrey Brez, of the UN’s Messenger of Peace Programme, the target audience depends on the specific goal in that instance. 

    “Is there a treaty about to be ratified and you need a few extra votes? Is it a humanitarian crisis and you need a bump of visibility to help Congress push through appropriations for humanitarian aid? There are so many moments when they can come in and give you a little boost. It depends … what you’re trying to achieve.”

     

    Celebrity advocacy "industry" 

    Brez and Jensen both challenge the suggestion that celebrities are seen to be a silver bullet to public engagement, insisting they are just one tool in the toolbox. 

    “We’re always looking just to incrementally move the needle,” Brez says. But he complains that he and his colleagues lack real research to assess just how much impact their outreach has. 

    When Project Runway All Stars shot its Season Finale at UN Headquarters, 2 million fashion fans – not the UN’s traditional audience – were exposed to its work in a positive light. But how much did they retain? Did their perceptions of the UN change? 

    Brockington cautions not to read too much into his findings: celebrity advocacy can work, he says, but must be used strategically, for example to influence elites or fundraise among existing supporters. 

    But he says celebrity liaison officers are themselves frustrated by their NGO colleagues’ expectations that if they just throw a celebrity at something, the organisation will be instantly successful at captivating the public imagination. 

    Could the bubble eventually burst if more people become aware of the limits of celebrity advocacy? Unlikely, Brockington says, given what has now become a celebrity advocacy “industry”, in to which NGOs invest a lot of time and resources.  

    “There is a fair bit of smoke and mirrors in this… [but] a lot of people are vested in this. They want it to work. There’s all sorts of strong collective interests in sustaining it.”

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    Does celebrity advocacy actually work?
  • After Ebola: What next for West Africa’s health systems

    As rates of Ebola infection fall in Guinea, Liberia and Sierra Leone, planning has begun on how to rebuild public health systems and learn lessons from the outbreak.

    Nobody is declaring victory yet. But in Sierra Leone, the worst-affected country, there were 117 new confirmed cases reported in the week to 18 January, the latest statistics available, compared with 184 the previous week and 248 the week before that. Guinea halved its cases in the week to 18 January – down to 20 – and Liberia held steady at eight. 

    The epidemic is not over until there are zero cases over two incubation periods – the equivalent of 42 days. “It’s like being only a little bit pregnant – there’s no such thing as a little Ebola. We have to get to zero, there can be no reservoirs of Ebola,”  Margaret Harris, spokesperson of the World Health Organization (WHO), told IRIN. 

    But after 21,724 cases and 8,641 deaths in nine countries since the epidemic began in Guinea last year, there is some light. And health workers are already starting to look at what’s next. “Right now important meetings are going on in each country to work out what needs to be done to rebuild - in some significant respects to build health systems almost anew - and to build back better,” said Harris. 

    A European Union donor conference is due at the beginning of March in Brussels. “What we want to see as a country is a resilient health system that can withstand shocks,” Liberia’s Assistant Health Minister Tolbert Nyenswah told IRIN. “Our plan [to be presented in Brussels] will be finalized by the end of February. It will be well costed with tangible goals.”

    Ebola tested the public health systems in the three West African countries to near destruction – most places in the world would have also struggled. But where the three failed was at the basic “nitty-gritty” level of “standard surveillance, testing and monitoring, the containment of cases, the bread and butter of public health”, said Adia Benton, a social anthropologist at Brown University in Rhode Island.

    Citizen and state

    A successful malaria campaign in Sierra Leone last week, which reached 2.5 million people, and a planned polio and measles vaccination programme in Liberia, are positive signs for the health services. But the list of necessary reforms is long: stronger surveillance; healthcare that will work after the international partners leave; access to affordable services. The list must also embrace longer-term structural changes, including the relationship between citizen and state.

    According to Antonio Vigilante, Deputy Special Representative for the Consolidation of Democractic Governance in the UN Mission in Liberia, and Resident Coordinator, “there is a golden opportunity to have a different start, to have a more balanced development that leaves outcomes in the hands of the people. It’s a very delicate stage, full of opportunities, which should not be missed.”

    Liberia is one of the world’s poorest countries and Ebola has been a tragic addition to the burden. It has destroyed livelihoods; already dizzying rates of unemployment have worsened; and food prices have soared. Both rural and urban communities are suffering.

    Vigilante is worried the economic impact of Ebola, and the interruption of immunization and reproductive health services during the crisis, could put more people at risk than the virus itself did. “A number of [social protection] measures in the recovery phase would need to be universal,” he said. One example would be if Liberia scaled up its pilot Social Transfer Programme, launched in 2009, to provide just US$40 per year to two million children. There would be sizeable “knock on effects on local markets and entrepreneurship” at minimal cost, according to the Washington-based Centre for Global Development

    Lesson learned: “Community, community, community. Engagement, engagement, engagement”

    Schools are due to re-open on 2 February in Liberia, and a strong case could be made for a universal school feeding programme to attract and retain children in class. “Even before Ebola many children were out of school,” UNICEF spokesman in Liberia, Rukshan Ratnam, noted.

    Money matters

    But will the donors come to the party? Donors pledged $1.5 billion to a UN coordinated appeal for Ebola last year, but $500 million is still unpaid. “If we cannot close that funding gap we will snatch defeat from the jaws of victory. It’s as simple as that,” Bruce Aylward, WHO assistant director-general in charge of the Ebola response, told reporters on 23 January. 

    Wasted dollars can be expected in a crisis when the priority is effectiveness - stopping the outbreak - rather than efficiency in how the money is spent. That equation will change if Ebola does not come roaring back with the rains in April, and donors begin to look at competing needs.

    There is potential to re-purpose Ebola infrastructure - some of it now idle with a glut in treatment facilities - if donors are willing to be flexible, said Vigilante. Laboratories used for testing could be incorporated into national laboratory services; some of the more permanent treatment units could be re-launched as community-based health facilities; contact tracers could be used as community mobilizers. 

    “We certainly lost staff as a result of Ebola. But the converse of that is there was a very rapid upskilling as people were trained to work in the treatment units or as contact tracers. It’s a group we should build on,” said Harris. “It’s really important we don’t lose them in the transition to a normal service.”

    Local heroes

    Among the lessons learned across the region has been the importance of consulting, engaging and empowering local communities: their lack of trust in central government was a major handicap in tackling the epidemic. “Community, community, community. Engagement, engagement, engagement,” said Harris. “We need to listen more. We need to do a lot of work with sociologists and anthropologists.”

    Liberia in particular has a highly centralized system of government, but local communities have emerged as critical players in the response with a new can-do attitude. “People given a chance can do a fantastic job,” said Vigilante. 

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    After Ebola
  • Nice and dirty – the importance of soil

    Be it laterite, loam, peat or clay, soil is life. It's the foundation of food security, and so the UN has declared 2015 as the year to draw attention to the stuff.

    As much as 95 percent of our food comes from the soil, but 33 percent of global soils are degraded, and experts say we may only have 60 years of nutrient-rich top soil left - it is not a renewable resource. 

    Africa is especially hard hit. Land degradation denudes the top soil, shrinking yields and the ability of the earth to absorb harmful greenhouse gases. In sub-Saharan Africa, an estimated 65 percent of agricultural land is degraded. That costs the continent US$68 billion a year, and affects 180 million people - mainly the rural poor, already struggling to eke out a living.  But better land management practices could deliver up to $1.4 trillion globally in increased crop production. 

    So how to implement sustainable policies that protect the food security of future generations? The uptake of sound soil management approaches is currently low. Farmers are under pressure to abandon effective traditional methods in favour of practices that deliver quicker, short-term, returns. 

    Further reading on the issue
     2015 – International Year of Soils
     FAO Soils Portal
     Agriculture for Impact
     The Comprehensive Africa Agriculture Development Programme
     AGRA
     United Nations Convention to Combat Desertification
     Africa Soil Information Service

    But a report - No Ordinary Matter: Conserving, Restoring, and Enhancing Africa’s Soils - released in December 2014, points to potential pathways. These include combining targeted and selected use of fertilisers alongside traditional methods such as application of livestock manure, intercropping with nitrogen-fixing legumes or covering farmland with crop residues. The goal is an ambitious - if contradictory sounding - “Sustainable Intensification” of agriculture.

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    Nice and dirty – the importance of soil
  • Central African peacekeeping force gears up for action

    With hundreds of soldiers from its member states successfully completing a series of joint exercises and manoeuvres in Congo, the Economic Community of Central African States (CEEAC) says its Multinational Force for Central Africa (FOMAC), is now ready to intervene in local conflicts and be part of global anti-terrorism initiatives.

    The recently completed Loango 2014 operations brought troops from eight of CEEAC’s 10 member countries (Angola, Burundi, Cameroon, CAR, Chad, Congo, Democratic Republic of Congo, Equatorial Guinea, Gabon, and Sao Tome et Principe - Rwanda may rejoin) to Loango in the south of Congo.

    During 10 days of intense exercises, Congolese, Angolan and Cameroonian soldiers disembarked from a vessel supplied by Equatorial Guinea. On land, they constructed a field hospital and staged simulated exercises in which hostages were liberated and a rebel leader was captured and removed to a safe location. The operations involved both ordinary soldiers and more specialist parachute units. In overall command was Congolese Chief of Staff Gen Blanchard Guy Okoï.

    Presidents Denis Sassou of Congo, Ali Bongo Ondimba of Gabon and Obianga Nguema of Equatorial Guinea were among the guests at a closing ceremony on 29 October. Ahmad Allam-Mi, a former Chadian foreign minister, now CEEAC’s secretary-general, said the organization had shown how quickly it could respond to human needs in time of crisis. “Our force is capable of bringing help to the population,” Allam-Mi emphasized.

    There was a strong emphasis in Loango on fighting terrorism in central Africa. Gabon Defence Minister Ernest Mpouho Epigat pointed to the challenges posed by maritime piracy, but also warned that the Nigerian Islamist movement Boko Haram was in striking distance of central African nations. “Cameroon is now on the frontline,” Epigat warned. “It is good that the countries of the sub-region hold this kind of exercise to see how we can pool our personnel and resources to respond to these threats and push them as far away as we can.”

    A bit of history

    Until recently, CEEAC was seen as slow to develop a serious military profile. Formed in 1983, it was virtually moribund for much of the 1990s, falling victim to regional rivalries and having a lack of shared priorities. Geographically, it seems an incongruous grouping of nations, stretching from Sao Tomé and Principe in the Atlantic to Chad.

    CEEAC used an extraordinary summit in Libreville (Gabon) in February 1998 to put itself on a new footing. At a subsequent meeting in Malabo (Equatorial Guinea) in 1999, heads of state outlined the need to work more closely on peace and security issues. Tracing CEEAC’s history, security analyst Angela Meyer observed in Peace and Security Cooperation in Central Africa: Challenges and Prospects: “The lessons from years of conflict and crises made it clear that regional economic cooperation could not succeed without regional peace and security.”

    Progress was initially slow. Member states were bitterly divided over the conflict in the Democratic Republic of Congo, which broke out in 1998. Chad and Angola sent troops to defend embattled President Laurent Kabila; Rwanda and Burundi backed rebels advancing on Kinshasa.

    Stronger regional framework takes shape

    But a stronger regional security framework did take shape. The Council of Peace and Security of Central Africa (COPAX), operational since 2004, was set up to guide regional policy on defence and security and given a mandate not only to deploy civilian and military missions, but to help mediate in crises.

    The Commission of Defence and Security, made up of military and police chiefs, works under a regional Planning Element and military headquarters, based in Libreville. CEEAC has at its disposal a Strategic Analysis Group and a Rapid Alert Mechanism for Central Africa, operating as an early warning system. Pointe Noire in Congo hosts a Regional Centre for Maritime Security.

    The collective security initiatives taken in Central Africa are in line with priorities outlined for the African Union’s (AU) African Peace and Security Architecture (APSA), which stresses the need for viable regional structures that replicate what the AU is doing at continental level. For example, the AU wants to see regional versions of its Peace and Security Council (PSC) and its Continental Early Warning System, which CEEAC’s MARAC seeks to emulate.

    Critical to the AU’s long-term security plans is the African Standby Force (ASF), which has the right to intervene in a member state “in grave circumstances, namely war crimes, genocide and crimes against humanity”. The ASF’s viability is premised on efficient standby arrangements with Africa’s five sub-regions, which should “enable Africans to respond swiftly to a crisis unhampered by any heavy political and instrumental burden.” 

    In principle, each regional bloc now has its own contingent earmarked for ASF deployments, with FOMAC joining parallel forces in other parts of the continent. An AU review of APSA’s progress in 2010 acknowledged serious problems with each region in delivering on commitments, pointing to ongoing conflicts and a lack of operational capacity as major handicaps. 

    FOMAC - a force in progress

    FOMAC was not singled out for criticism, but clearly needed to become more professional and better coordinated.

    Set up in 2002, FOMAC’s standing orders identified the force as being made up of military, police, gendarmerie and civilian personnel, ready to carry out “peace, security and humanitarian assistance missions”. FOMAC’s duties also extend to disarmament and demobilization work and control of fraud and organizational crimes.

    Compared to the experience gained by Economic Community of West African States (ECOWAS) troops in West African conflicts, including Liberia, Sierra Leone and Guinea-Bissau, Central African soldiers saw little combat in regional missions, but no shortage of capacity-building and practical collaboration.

    Loango 14, which was months in the planning, was the latest in a series of multinational training events, going back nearly a decade, which have become increasing ambitious in their scale and objectives. Chad played host to the Barh el Ghazel exercises in 2005 and 2007. Over 3,500 personnel took part in Kwanza 2010 in Angola.

    Filling a vacuum in CAR

    It was the succession of crises in CAR which gave Central African troops their first exposure to a regional war zone. FOMUC, the multinational force of the six-nation Economic and Monetary Community of Central Africa (CEMAC), was stationed in Bangui with a brief to support the CAR Armed Forces, which had been hit by a wave of mutinies, threatening the rule of President Ange-Félix Patassé. (CEMAC members are: Gabon, Cameroon, CAR, Chad, Congo and Equatorial Guinea).

    FOMUC was superseded in 2008 by the Mission of Consolidation of Peace in CAR (MICOPAX - a specific mission of FOMAC). Funded in part by the EU and working closely with French troops, its mandate was to help establish peace and security.

    After a long period of low-intensity guerrilla activity and hesitant peacebuilding, MICOPAX was hinting at a withdrawal by September 2012. A Chadian commander told Radio France Internationale (RFI): “Elections have been held and we are now in a phase of consolidating the peace.” 

    But the emergence of Séléka, a newly formed, heavily armed rebel coalition ended that complacency. As Séléka made critical territorial gains from December 2012, CEEAC called for more troops, but could not prevent the fall of Bangui.

    As CEEAC tried, with difficulty, to drive the peace process outside CAR, MICOPAX numbers tripled, with over 2,000 troops deployed. MICOPAX 2’s brief was ambitious: to guarantee security, provide protection and help restore police and judicial system. The leading contributors were Congo, Burundi, Chad and Rwanda, although Rwanda had left CEEAC in 2007.

    Often overshadowed by the French military presence, FOMAC again faced accusations of poor leadership and incoherence and having little real presence outside Bangui. FOMAC’s Chadian contingent was accused of aligning itself with the Séléka rebels, a charge strongly denied by the Chadian authorities.

    In December 2013, after lengthy talks between the AU and CEEAC, peacekeeping operations were formally transferred to the African-led International Support Mission to the Central African Republic (MISCA), which in turn transferred authority to the UN Multidimensional Integrated Stabilization Mission in CAR (MINUSCA) in September 2014. 

    Troops from CEMAC countries still make up the vast majority of troops deployed in the CAR.

    The verdict on MICOPAX

    FOMAC’s role in the country has been much criticised. But Alex Vines, head of the Africa programme at the Royal Institute of International Affairs (Chatham House), said FOMAC soldiers had endeavoured to protect the civilian population, perhaps more effectively than other outside forces. “It was not a particularly exemplary operation”, Vines told IRIN. “But the troops were there in very difficult circumstances.”

    Vines, who has authored a 10-year study of the AU’s approach to continental security, A Decade of African Peace and Security, Architecture, said all of the regional forces meant to contribute to the ASF fell short of the AU’s requirements. He noted the lack of a regional leader, the role played (controversially) by Nigeria in West Africa in the past, and also of states, like Angola, having a stake in different regional blocs.

    Rwanda rejoins the fold

    Rwanda pulled out of CEEAC in 2007, pleading insufficient funds, and engagements in too many other regional blocs, the East Africa Community (EAC), for example. The deployment of Rwanda troops in the CAR as part of MICOPAX suggested that Rwanda was ready to re-engage with CEEAC. This was confirmed by Rwandan Foreign Minister Louise Mushikiwab at Loanga, who said her country had come a long way from the genocide of 1994 and wanted to play a full role in CEEAC. “We have decided to rejoin our brothers and sisters in Central Africa with whom we share an important heritage,” Mushikiwabo explained. “At the next of its summits, we will reintegrate with CEEAC. With great pleasure we will come back into the heart of the family.”

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    CEEAC peace force gears up for action
  • An ambitious plan to end statelessness

    It is now 60 years since stateless people received recognition in international law, and the UN has two conventions (1954 and 1961) dedicated to their protection and the regularization of their situation. Yet an estimated 10 million people worldwide still suffer the problems and indignities of having no nationality.

    “It may be a bit of understatement to say that these are the two least loved multilateral human rights treaties,” said Mark Manly, head of the UN Refugee Agency’s (UNHCR) statelessness unit. “For many years they were pretty much forgotten and that was in large part because they had no UN agency promoting them.” 

    Manly has responsibility for the issue of statelessness, even though most stateless people neither are, nor have ever been, refugees, and this week UNHCR launched an ambitious plan to try to end statelessness over the next 10 years. 

    The plan breaks down the issue into 10 action points, addressing the main reasons why people end up stateless. Sometimes it's because children were not registered at birth, or because discriminatory laws prevent their mothers from passing on their own nationality. Some are the victims of ethnic discrimination by countries which refuse to recognize members of their community as citizens; others, especially in Eastern Europe and the former Soviet Union, have fallen down the cracks between countries, as it were, after boundaries were redrawn and states divided. 

    In some of the world's major situations of statelessness UNHCR is already involved. In 1989 tens of thousands of Black African Mauritanians fled to Senegal to get away from murderous ethnic persecution. A large number of the refugees who came scrambling across the river border had no papers. Their Mauritanian identity cards had been confiscated or torn up by members of the security forces or by their fellow citizens, who told them, “Tu n'est pas Maure; alors tu n'est pas Mauritanian” (You are not a Moor, an Arab, so you are not a Mauritanian).

    Senegalese nationality law is generous, and allows them to apply for citizenship after five years' residence, but many have preferred to go home to Mauritania, assisted by UNHCR which supplied them with travel documents under an agreement governing their return. But large numbers are now finding themselves effectively stateless. Manly told IRIN: “What that agreement says, if I remember correctly, is that the nationality of the refugees is 'presumed' - they are presumed to be Mauritanian. However, many people have faced real problems in getting the documentation to prove that they really are Mauritanian, so there is clearly an issue.” 

    “Some 24,000 have returned,” adds Bronwen Manby, a consultant who has worked on this issue. “But the Mauritanian organizations are telling us that only about a third have got their documents. It's the standard sort of situation,” she told IRIN, “where in principle, of course - but then documents were destroyed, and then they find that the name is Mohamed with one 'm' instead of Mohammed with two 'm's, and then it's in French and not in Arabic - there needs to be more pressure on the Mauritanian government to sort out the situation.”

    Laws discriminating against women

    In the Middle East a lot of statelessness is the result of laws discriminating against women, which only allow nationality to be passed through the father - a problem if the father is not there to register his child or is himself stateless. Laura van Waas, who runs the Statelessness Programme at Tilburg University, says it can have a devastating effect on all members of a family. 

    “It's not just the stateless child who is affected by this. It's the mother, who has nationality, who feels guilty for whom she has chosen to marry. Her children are suffering and she sees that as the result of her life choices. And it's the young men who are perhaps the worst affected. This is seen as a women's rights issue, but if you are a young women who couldn't get nationality through your mother, in most of the countries we are looking at you can acquire nationality through your husband, and your children will take his nationality. But if you are a young stateless man, you can't acquire nationality through marriage, and because your children have to acquire their nationality through you, they will also be stateless.”

    In countries like Lebanon, where ID cards were first introduced in the 1920s, but not everyone bothered to register, this kind of statelessness has persisted through several generations, resulting in whole families which, although Lebanese, are non-citizens, unable to travel, and with no access to state schooling or health care. It could be sorted out with a bit of goodwill, but as in many countries, political considerations - in this case questions of religious and ethnic balance - mean goodwill may be in short supply.

    Egypt and Kuwait provide further examples.

    In situations like that of Myanmar, where the government is so reluctant to accept the Muslim community in Rakhine State as Burmese citizens, goodwill seems totally lacking. But elsewhere a lot can be done to reduce statelessness, with improvements to nationality laws, better coordination when states and boundaries change, simpler bureaucratic procedures, and a greater effort to make sure all children get registered.

    Attitudes changing?

    Manly says he is seeing a real change of attitudes, with governments increasingly willing to ratify the conventions, enter into discussions on the issue and make the necessary changes. 

    “The taboo has now been broken,” he says. “Governments now increasingly accept that this is not purely an issue of their sovereign discretion, but that issues of statelessness are of legitimate concern for the international community... Governments have also perceived that it is not in their interests to have a very large disenfranchized and frequently undocumented population in their territories... Ministries of the interior round the world don't want to have tens or hundreds of thousands of people who are undocumented. They want to know who is in their territory, and to be able to control them.”

    “In the past four years, more countries have acceded to the 1961 Convention on the Reduction of Statelessness than in the four decades following its adoption,” says the new UNHCR report. 

    So the UNHCR is hopeful that their campaign can bring down the numbers of stateless people in areas like the Middle East and the Former Soviet Union. 

    But Bronwen Manby warns that in parts of Africa where she has worked, a push to regularize citizenship could actually increase numbers elsewhere. “Nigeria, for instance, has a large number of people who are absolutely undocumented, but everybody somehow gets by, because that's Nigeria. But it's of concern in the context of increasing efforts to reduce the number of undocumented people for security reasons. Once you really start being strict about ID documents, all the people who have managed to get by with a bit of cash, or a bit of magouille, as they say in French, are going to find it much more difficult to get an ID from somewhere, and I think a problem of statelessness is going to be revealed which is already there but has never been identified.”

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    An ambitious plan to end statelessness
  • Exporting Ebola - who's really at risk?

    More than 50 percent of Americans report being afraid of a mass Ebola outbreak on US soil, according to a Harvard poll earlier this month, but health experts say the true risk is further spread of the virus within the West African region. 

    Unlike the US, which currently has four specialized isolation units, access to state-of-the-art laboratories, medical equipment, protective gear, and medicines, as well as doctors and nurses who have been specially trained in infection control, many West African nations remain ill-equipped to deal with the potential arrival of an Ebola case. 

    “Given that these countries have limited medical and public health resources, they may have difficulty quickly identifying and effectively responding to imported Ebola cases,” said Kamran Khan, a professor at the University of Toronto’s Division of Infectious Diseases and co-author of a new study on the likelihood of West Africa’s Ebola outbreak spreading overseas via air travel.  

    The risk of Ebola being spread through commercial air travel is real. Two cases have already been carried out of the region by airline passengers: one to Nigeria and one to the USA, and both of those travellers infected others before the outbreak could be contained. The question of how big of a risk this really is, is what was tackled by Khan and his team. 

    Their assessment, which was published this week in the London-based journal The Lancet, found that no more than three infected airline passengers a month will travel out of the affected countries between now and the end of the year, even if there were no screening at any of the points of departure.

    This estimate was based on evaluations of airline timetables, passenger traffic records and projections for the number of Ebola cases in Guinea, Liberia and Sierra Leone over the coming months.

    Additionally, the authors point out that that the populations of many of these countries are small and, with the exception of Nigeria, are not frequent international air travellers.  

    Passenger numbers have been further reduced by many airlines closing their routes from Freetown, Conakry and Monrovia, and by the slowdown in business travel because of the outbreak.

    Ghana, Senegal at greatest risk

    In addition to looking at how many people are flying out of the Ebola zone, Khan and his colleagues looked at where travellers go. In 2013, only 29 percent of African travellers went to first world destinations, with London and Paris topping the list. 

    Most of the others were flying to other lower or lower-middle income countries, generally within the West African region. The favourite destination was Ghana, with 17.5 percent of passenger traffic, followed by Senegal, with 14.4 percent. Then, after London and Paris, came The Gambia, with 6.8 percent of the traffic, and Côte d'Ivoire and Morocco with just over 5 percent each. Nigeria is ninth on the list and the USA 12th - at a slightly lower risk than China.

    The World Health Organization (WHO) says they are most concerned about Ebola spreading to countries that share a land border with the affected countries, such as Côte d’Ivoire, Mali, Senegal and Guinea Bissau, and those that have high-volume travel and trade routes with the affected countries, such as Cameroon, Burkina Faso, South Sudan, Mauritania and The Gambia. 

    “We recognize that it [Ebola] could travel elsewhere, such as the US and Spain… but these countries elsewhere are already well-equipped to handle a disease like Ebola,” said Isabelle Nuttall, WHO’s director of Global Capacities, Alert and Response. “When we think about the neighbouring African countries, we have a bigger concern. They really need to be better prepared.”

    “The best approach to minimize risks to the global community is to control the epidemic at its source. While screening travellers arriving at airports outside West Africa may offer a sense of security, this would have at best marginal benefits.”

    In Senegal, just one hospital - Hôpital Principal in Dakar’s Fann neighbourhood - has set aside an isolation unit to treat Ebola patients. This is where a Guinean student, who travelled by road to Senegal and soon after tested positive for Ebola, was treated in late August. 

    Plans are under way to open five treatment centres along Senegal’s border with Guinea, according to the Ministry of Health’s disease control unit, but work on them has not yet started. 

    In Ghana, there are three small Ebola treatment units under construction in the Tema, Kumasi and Tamale regions. In the capital, Accra, three teaching hospitals have been identified to hold suspected cases before they are referred to one of these centres. Progress, however, has been slow, according to local reporters. 

    A needle-in-a-haystack problem

    Screening is now in place for arriving and departing passengers at all three international airports in Guinea, Liberia and Sierra Leone: all passengers are temperature-checked and must fill out a brief health survey. Had this been in place at the time, it would certainly have caught Patrick Sawyer, the man who took Ebola to Nigeria, who was ill before he got on the plane. 

    It would not, however, have caught Thomas Duncan, from Liberia, who had no symptoms until after he arrived in the US in September. 

    The US now requires passengers coming from any of the three affected countries to first go through an enhanced screening process at one of five airports, before continuing on to their final destination. 

    At both Accra and Dakar airports health workers check the temperature of all passengers arriving from regional transit hubs such as Casablanca.

    But for countries such as the UK, for instance, which has no direct flights from any of the three countries, once you start arrival screening for passengers on connecting flights you have a true needle-in-a-haystack problem. The Lancet article authors calculate that you would have to sift through more than 2,500 travellers before you found even one who had set foot in Liberia, Guinea or Sierra Leone during the past 21 days. 
     
    Some passengers from the Ebola-affected regions of West Africa arriving at London's Heathrow airport in the past week have been surprised to be asked whether they would like to be checked for fever. The staff administering the checks in London did not seem to regard them as urgent enough to be compulsory, perhaps reflecting the expert advice that they are of very little practical use in detecting people carrying the Ebola virus.

    “The best approach to minimize risks to the global community is to control the epidemic at its source,” said Khan. “While screening travellers arriving at airports outside West Africa may offer a sense of security, this would have at best marginal benefits.”

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    Exporting Ebola - who's really at risk?
  • Liberians in US face worsening Ebola stigma

    Africans living in the US from the three Ebola-affected countries of Liberia, Guinea and Sierra Leone, are under enormous pressure trying to help their families and ravaged communities back home. And they face an additional challenge: stigma. 

    For the residents of “Little Liberia”, one of Liberia’s biggest emigrant communities in Staten Island, New York, the path to integration has been strewn with hurdles. Many of the several thousand residents came decades ago as refugees from the civil war in Liberia. Eking out a living, attaining resident status, integrating with at times unfriendly neighbours and, in recent months, helping those families hard hit by Ebola at home, has been an uphill battle. 

    But when Thomas Eric Duncan, a Liberian, was diagnosed with Ebola in a Dallas hospital last month, “all hell broke loose here,” Oretha Bestman-Yates, president of the Staten Island Liberian Community, told IRIN. 

    When news that Bestman-Yates had travelled to Liberia in July reached her hospital employer she was told to put herself in quarantine. But even after the 21-day period elapsed on 5 August, she says she has still not been allowed to return to work. 

    "You bought Ebola to the US!"

    Now she spends her days trying to help residents who are not only battling with the loss of family and friends in Liberia but are struggling to make ends meet here at home.  “People try to avoid you, pull away from you. I’ve had people tell me, ‘We brought Ebola to the United States,’” she says. Many of the Staten Island Liberians are employed in hospitals and nursing homes and are being told not to touch patients. “Parents are telling their children to stay away from our children at school,” she said.

    As news broke that two of the nurses who cared for Duncan, who died on 8 October, had contracted Ebola, panic began to sweep through the American public. The news that one of the nurses, Amber Vinson, had flown on a domestic flight shortly before coming down with the disease, galvanized fears of an outbreak. 

    Now there seems a growing perception that anyone of African descent may be carrying Ebola. And whether that person visited any of the affected countries recently appears to be of little relevance. 

    Two Nigerian students were refused admission to Navarro College in Texas, because of a new college policy denying entry to students from countries affected by Ebola – even though Nigeria successfully brought its small outbreak under control. An airplane bound for Nigeria was grounded at JFK yesterday because staff refused to clean it. Furthermore, parents from a school in Jackson, Mississippi, withdrew their children from school when it was revealed that the principal had recently travelled to Zambia – in southern Africa. 

    Where's West Africa?

    In a navel-gazing society, where West Africa is a vague and homogenous region and where the whole continent is usually spoken about as if it is one country, there is little nuanced understanding in the general population about exactly where the disease is located – not to mention how it is spread. Said Bobby Digi, a local activist from Staten Island. “There is not a lot of knowledge in the US about Africa – let alone West Africa. They are painting the whole area with a very broad brush.” 

    Digi says Liberians have struggled for decades to be accepted on Staten Island where there have been long-standing tensions with the community, including with local African Americans, who fear losing their jobs. Liberians feel a sense of shame, he said, that Duncan died in the country where they now live. Although the NYC health department is conducting awareness campaigns to educate the public and eradicate stigma, Digi slated the department for not knowing how to access the Liberian population. “They didn’t have basic statistics. They were picking my brain. I was floored by that,” he said.  

    In Dallas, where Duncan died and where there is also a large Liberian community, stigma against Liberians is clearly on the increase. Alben Tarty, communications director for the Liberian Community Association of Dallas-Fort Worth, told IRIN he had minutes ago spoken to relatives of Duncan’s fiancée, Louise Troh, who had just been given clearance to join the community again. “When they came out of the house they were referred to as the Ebola people, children must keep away from them, someone literally ran from them. They are fearful of going back to work next week,” he said. 

    Tarty, who has been living in the US for 12 years and whose doctor friend died in Monrovia last week, says there are strong perceptions in the Liberian community that Duncan was mistreated by the hospital there to discourage other Liberians from travelling to the US to seek treatment. 

    "This is not a West African problem. It’s a global problem and we have to fight it with education.” 

    A man with no health insurance or social security number, Duncan was given second-rate treatment in a country with one of the world’s best health care systems, Tarty said, adding: “There are so many things happening that are making the Liberian community very angry.” 

    However, Tarty described the Liberian community in Dallas as “formidable”. “We are a very strong community.” Enormous resources had been raised to help affected families and healthcare workers back home, he said. 

    Tarty said he hoped stigma was unique to individuals and not organizations and employers. Lots of people – including Liberians – “don’t understand how the virus is transmitted,” he said, adding that Liberians were stigmatizing each other too. “We can’t blame those who don’t understand how the virus is transmitted. If Liberians are still confused then we can expect the greater community to be even more confused.”

    Anecdotally, the evidence of stigma in other parts of New York City - not just Staten Island - is mounting. From elevators, to subways to school playgrounds, comments are being made. When a person of African descent sneezes, the retort is, “I hope you don’t have Ebola,” said Charles Cooper, chairman of the Bronx African Council, which looks after the interests of the roughly 80,000 Bronx residents originally from the three affected countries and around 200,000 immigrants from the continent as a whole.  

    Cooper, who last visited family and friends in Liberia a year ago, says the community is already struggling to get finances for affected families back home. Furthermore, those making a living here from products sourced there, are no longer able to get the supplies, given closed borders and the collapsing economies of Liberia and Sierra Leone. Another stress they don’t need is a new form of discrimination from their neighbours. 

    Politics of hysteria

    “It plays into existing stigma,” he said. “Unfortunately it’s not something that’s going to be short-lived. It will continue for a while since the Ebola virus is not going to be eradicated any time soon.”  But “there is a level of hysteria that needs to be counter-acted,” he said. “Ever since the inception of Ebola we’ve been working together and focusing on the African community and prevention countrywide.” 

    On the political stage, the same hysteria is playing out, with Republicans accusing President Barack Obama of mishandling the crisis and calling for travel bans to and from the three affected countries. Right-wing commentators are also having a field day. Said prominent conservative pundit Phyllis Schlafly: “The idea that anybody can just walk in and carry this disease with them is an outrage, and it is Obama’s fault because he’s responsible for doing it.” 

    She said Obama didn’t want America to “believe that we’re exceptional. He wants us to be just like everybody else, and if Africa is suffering from Ebola we ought to join the group and be suffering from it too.” 

    Bestman-Yates said that although stigma on Staten Island was “getting worse, we are trying our best to educate people”. Asked whether she believed things could turn violent, she said, “I hope not,” adding however that a man screamed at her when she was being interviewed recently by a TV crew. Situations like this make her worry about the “Stop Ebola” pin she wears, though she continues to wear it. “We want people to know about it. This is not a West African problem. It’s a global problem and we have to fight it with education.” 

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    Liberians in US face Ebola stigma

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