(Formerly called IRIN) Journalism from the heart of crises

  • Venezuela: Millions at risk, at home and abroad

    Venezuela has the largest proven oil reserves in the world and is not engulfed in conflict. Yet its people have been fleeing on a scale and at a rate comparable in recent memory only to South Sudanese or Syrians at the height of their civil wars and the Rohingya from Myanmar.

     

    As chronicled by much of our reporting collected below, some three to four million people have escaped the economic meltdown since 2015 and tried to start afresh in countries like Brazil, Colombia, Ecuador, and Peru. This exodus has placed enormous pressure on the region; several governments have started making it tougher for migrants to enter and find jobs.

    The many millions more who have stayed in Venezuela face an acute humanitarian crisis denied by their own government: pervasive hunger, the resurgence of disease, an absence of basic medicines, and, in March, an electrical blackout that led to water shortages and the mass looting of the second city of Maracaibo.

    Amid ongoing political upheaval, President Nicolás Maduro has cast aside outside offers of aid, framing them as preludes to a foreign invasion and presenting accusations that the United States is once again interfering in Latin America.

    Meanwhile, the opposition, led by Juan Guaidó, the president of the National Assembly, has invited in assistance, from the United States and elsewhere.

    As aid becomes increasingly politicised, some international aid agencies have chosen to sit on the sidelines rather than risk their neutrality. Others run secretive and limited operations inside Venezuela that fly under the media radar.

    Local aid agencies, and others, have had to learn to adapt fast and fill the gaps as the Venezuelan people grow hungrier and sicker.

    A collection of our recent reporting from and about Venezuela is below.

    The crisis inside Venezuela

     

    • Hunger and survival in Venezuela

      Millions have fled Venezuela’s economic meltdown, but for millions more who remain no part of life remains untouched by the crisis, even death.

    Across the border and beyond

    Aid and politics

    A collection of our recent reporting
    Venezuela: Millions at risk, at home and abroad
  • Mozambique storm; North Korea aid; and conflict spikes in South Sudan, Syria, and Yemen: The Cheat Sheet

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

    On our radar

    UN warns of ‘worst humanitarian catastrophe’ in Syria

     

    The UN said it had received $6.97 billion in pledges at a Brussels donor conference for Syria this week, shy of the $8.8 billion it had asked for to aid Syrian refugees as well as those still in the country in 2019. While participants emphasised the need for a political solution to Syria’s war, now entering its ninth year, the uptick in violence in rebel-held northwestern Idlib province is a stark reminder that it is far from over. Conflict monitor Action on Armed Violence said Russian airstrikes in Idlib city killed 10 civilians and injured 45 on Wednesday; Russia said it was targeting weapons owned by the al-Qaeda linked group Tahrir al-Sham. A Russia-Turkey deal has so far been holding off a full-scale government offensive on the territory. UN relief chief Mark Lowcock warned the audience in Brussels that such an offensive would “create the worst humanitarian catastrophe the world has seen in the 21st century”.

     

    Storms, floods, and a cyclone batter southeast Africa

     

    Half a million people in Mozambique's fourth largest city of Beira were plunged into darkness when tropical Cyclone Idai made landfall late on Thursday night, knocking down trees and power lines and destroying homes. This follows a week of heavy rains and flooding across southeast Africa that has already killed at least 126 people in Malawi, Mozambique, and South Africa. More than a million people have been affected in all. In Mozambique, the floods have already destroyed more than 5,700 homes, while in neighbouring Malawi, over 230,000 people are left without shelter. Both countries are prone to extreme weather events. In Mozambique, floods in 2000 claimed at least 800 lives and another 100 in 2015. In Malawi, the 2015 floods left at least 100 people dead and more than 300,000 others displaced.

     

    North Korea sanctions disrupt aid programmes

     

    Broad economic sanctions against North Korea are disrupting humanitarian work and having a detrimental impact on ordinary citizens, a UN rights watchdog says. In a report to the Human Rights Council this week, the special rapporteur for rights in North Korea, Tomas Ojea Quintana, said aid programming continues to see significant delays due to UN and government-imposed sanctions. Banks, suppliers, and transport companies are afraid of running afoul of sanctions, leading to humanitarian supply chains breaking down. The US government has also imposed travel restrictions on its citizens and blocked the delivery of essential supplies like hospital equipment, he said. The UN this month called for $120 million in aid funding. But last year’s appeal was only one-quarter funded, and humanitarian aid only reached one third of the people targeted.

     

    Uptick of violence threatens Yemen peace bid

     

    The UN-brokered ceasefire deal for Yemen’s northern port city of Hodeidah suffered yet another blow this week, with a group of NGOs warning that there had been a “major outbreak of violence” in the city in the last few days. As we (and plenty of others) have pointed out, the Hodeidah agreement was meant to lead to further peace talks for the whole of Yemen. Don’t hold your breath. Just to the north of Hodeidah, in Hajjah province, recent airstrikes and renewed fighting have killed and injured civilians. UNICEF reported that more than 37,000 people were forced to flee their homes inside Hajjah in March alone, and humanitarians are having trouble accessing those who need help. As Nigel Tricks, East Africa and Yemen regional director for the Norwegian Refugee Council, put it in a Wednesday statement: “Whilst the eyes of the world are on Hodeidah, airstrikes and shells continue to rain down on civilians in other parts of Yemen, killing with impunity.”

     

    A backtrack from the UN’s refugee agency

     

    UNHCR has reversed a decision that could have seen tens of thousands of ethnic Chin refugees from Myanmar stripped of refugee status. Last year, the UN agency controversially began a review process to determine whether the refugees, originally from Chin State and other parts of western Myanmar, still required international protection. But UNHCR said this week that a “worsening security situation” in parts of Chin State “has affirmed that Chin refugees may still have ongoing international protection needs”. The agency also announced that it would stop its protection re-evaluation process for Chin refugees. In recent months, renewed clashes between Myanmar’s military and the Arakan Army, an ethnic Rakhine militia, have displaced thousands in Rakhine and southern Chin states, including more than 3,200 in Rakhine this month. But even before the latest violence, refugee rights groups say reviewing refugee protections for ethnic Chin was clearly premature. The Asia Pacific Refugee Rights Network says there are more than 33,000 Chin refugees living in Malaysia and India.

    In case you missed it:

     

    The Democratic Republic of Congo: Cases of deadly pneumonic plague have emerged along Uganda's border with the Democratic Republic of Congo, the World Health Organisation said, including in the Congolese province of Ituri, where health teams are struggling to tackle an ongoing Ebola outbreak.

     

    Rwanda-Uganda: Tension is rising between East African neighbours. Uganda denies it harasses Rwandan citizens and backs rebels. It says Rwanda is blocking trade. Rwanda’s president says it will never be "brought to its knees". His Ugandan counterpart said a “troublemaker” (unnamed) “cannot survive”. Regional mediation efforts have begun.

     

    Sudan: Diseases including measles, dysentery, and pneumonia are spreading rapidly in Darfur's Jebel Marra area, according to a rebel group, the Sudan Liberation Movement (SLM-AW), that controls much of the territory. It called for outside assistance, saying dozens of people had already died from a shortage of medicines and medical staff.

     

    Venezuela: Week-long power outages crippled water supplies and cut off telephone and internet services to millions of Venezuelans already struggling with shortages of food and medicines. Amid reports of chaos and looting in the second city of Maracaibo, President Nicolás Maduro blamed “sabotage” and “American imperialism”. Others pointed to a bush fire and crumbling infrastructure.

     

    Yemen: The US Senate voted for a second time on Wednesday to end US support for Saudi Arabia in Yemen’s war. The resolution is expected to pass the Democrat-controlled House of Representatives, but President Donald Trump has vowed to veto should it reach his desk.

     

    Weekend read

     

    In South Sudan, a ‘war on civilians’ despite six months of supposed peace

     

    On 15 December, South Sudan marked five years of war – almost 400,000 people dead, millions displaced, but also signs a peace deal was taking hold, with more people returning home to rebuild shattered lives. Sceptics, embittered by too many false dawns, advised against hoping too hard. It seems they were right. Not only, according to our weekend read, has fighting resumed, but it resumed some time ago – locals in the troubled Yei region even accuse the government of covering up violence to keep up the pretence of control. Tens of thousands of people have been newly displaced, Sam Mednick reports, many of them inaccessible to aid groups. Without new ideas and renewed international engagement, more violence and displacement appear inevitable, according to the International Crisis Group. First test ahead: the formation of a unity government in May.

     

    And finally…

     

    ‘Toothless’ UN migration document becomes far-right rallying cry

     

    Propaganda scrawled by a gunman involved in killing at least 49 people in New Zealand today referred to the Global Compact for Migration. A non-binding international agreement that one expert called “toothless” has become a rallying cry for the far-right and white supremacists worldwide. The three-year UN negotiation process aimed to agree “safe and orderly” migration after arrivals to Europe increased in 2015. It also hoped to stem xenophobia in wealthy countries and reassure developing nations that the walls were not going up entirely. But nationalist politicians pulled out of the process, led by President Trump, claiming the document would pave the way to more immigration. The compact sparked fierce political debate in New Zealand, even though it commits no member state to do anything. One analyst told IRIN it “doesn’t actually do much”. Well, you’d be forgiven for asking now whether it does, but in all the wrong ways.

    (TOP PHOTO: Families have taken shelter in a new makeshift camp north of Idlib, fleeing violence in southern rural Idlib. CREDIT: Aaref Watad/UNICEF)

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    Mozambique storm; North Korea aid; and conflict spikes in South Sudan, Syria, and Yemen
  • 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.

     

    lr/si/ag

    In Madagascar, 1,100 measles deaths are more about money than ‘vaccine hesitancy’
  • Q&A: How churches are leading the way in helping migrants with HIV

    Reverend Olav Fykse Tveit, general secretary of the World Council of Churches, took time out of a recent gathering to explain how faith-based organisations are forging better responses globally for migrants and refugees living with HIV/AIDS.

     

    Representing 350 Protestant, Orthodox, and Anglican churches, the WCC is driving forward international collaboration on the issue. Last month, it held a workshop at its headquarters in Geneva aimed at building stronger partnerships to improve the international response.

     

    In attendance were the International Organisation for Migration, the UN’s refugee agency, UNAIDS, faith-based groups, international and local NGOs, and representatives from civil society groups from around the world.

     

    “We cannot ignore faith-based organisations,” Michel Sidibé, the executive director of UNAIDS, stressed as he spoke to IRIN on the sidelines of the event, pointing out that such groups are responsible for more than half the health assistance in Africa.

     

    A major concern at the moment is Venezuelans living with HIV and, according to Sidibé, some 70 percent of health services for migrants at the Venezuela-Colombia border are provided by faith-based groups.

     

    The economic collapse has decimated Venezuela’s healthcare system and left many, including those with HIV or AIDS, short of vital medicines. Politics is also preventing most international humanitarian aid from entering the country.

    Read more on Venezuela: Millions at risk, at home and abroad

    An estimated eight percent of the 3.4 million Venezuelans who have left since 2015 are living with HIV or AIDS – or  272,000 people – according to UNAIDS.

     

    In the following interview, edited for length and clarity, Tveit discusses the oversized role the church plays in helping migrants and refugees living with HIV, how this role evolved, and what it is that faith-based groups can offer on this issue that other organisations can’t.

     

    IRIN: How are churches working with migrants living with HIV?

     

    Olav Fykse Tveit: Churches are often at the forefront of welcoming migrants, and work to ensure they are integrated into neighbourhoods in the local community. On the national and global level, we also raise our voices to defend the rights of refugees in particular, but we also raise issues related to migration more generally, such as unfortunate expressions of xenophobia and racism. On those issues, the World Council of Churches cooperates strongly with the Catholic church (not a WCC member), where it has become part of Pope Francis’ agenda.

     

    IRIN: Within the current crisis in Venezuela, eight percent of those fleeing the country are people with HIV who are unable to find medication or care for their illness. How are WCC member churches working in the region?

     

    Tveit: We have a history with partner organisations trying to address HIV/AIDS, not only as a disease but also within a contextual perspective, and even as an ethical and cultural issue. We know that attitudes within churches have been a challenge and a problem for HIV sufferers. Stigmatisation, exclusion, different moral attitudes have been an additional problem to their illness. A lot has changed, and we have been working consistently to make churches HIV/AIDS-friendly, and competent, by understanding the entirety of this challenge.

     

    We have worked on this in Africa and in other regions, including Latin America. The approach has to do with knowledge, but also with capacities. Many of our partner organisations have strong capacities in dealing with urgent refugee situations. They are quite aware of who the most vulnerable are. It is part of their ethos, in the way they work. This is what you see in Venezuela and why they are aware of this particular combination of problems that HIV patients who have also had to flee are facing.

     

    IRIN: What has the experience been for the WCC when working with more conservative churches on the issue of HIV amongst refugees and migrants?

     

    Tveit: The churches have learnt a lot through this reality of HIV/AIDS, which as I said, is more than an illness. It is a cultural and moral issue. As churches, we are called to care for those who are excluded for any reason. We need to make sure they are part of a fellowship that involves caring for those people with respect and dignity. In many churches, in all continents, there has been an awakening and an awareness-raising that has changed a lot of the attitudes.

     

    We hear from partner organisations such as UNAIDS that what we need now more than ever are faith-based organisations who are committed to work in a holistic way on these issues. In other words, not only to deal with just the medical dimension of the illness, but to consider the whole human being.

     

    IRIN: How about your engagement with the Catholic church on this issue?

     

    Tveit: The Catholic church is related to this programme through Caritas and its diaconal ministry, and has important initiatives. The programme that we developed is ecumenical, and we work with partners who are willing to work with us too, and share this commitment and objectives. It varies between country to country as to whom we are working with.

     

    IRIN: How has it been to work on this issue with the Catholic church in some of the countries where the hierarchy may take a traditionalist approach to issues involving sex?

     

    Tveit: It’s not just the Catholic church that sometimes is described as conservative. Some of our member churches also may have a conservative approach to some of these very important issues…

     

    The churches in Africa are responsible for more than half of the health services and play an important role in developing health services that correspond to people’s needs and building confidence amongst local people...

     

    IRIN: Are faith-based organisations then filling a gap left by other organisations that may be seen as too politicised, to act as more “neutral” humanitarian – and particularly health – aid providers?

     

    Tveit: Christian churches have had a double contribution on this issue. On the one hand we have medical services, and therefore we are willing to contribute. We can also contribute in dealing with attitudes, dealing with stigmatisation both in the churches, but also outside within the communities. But we also have something to contribute together with others. We don’t say that we can fix what others cannot, but we can offer a long-term perspective, which appears to be important for UNAIDS. The medical dimension of it has been dealt with to a large extent, but now the issue is the implementation of it, to help people to live their whole life with this disease, in a proper way and with dignity.

     

    IRIN: How is the WCC involved in the issue of HIV and migrants elsewhere in the world?

     

    Tveit: Since 2002, we have worked in Africa on a programme called the Ecumenical HIV and AIDS Initiative in Africa. It was later expanded to other continents. It was a response to a call from church leaders in Africa. We subsequently developed a programme focused on building understanding and competence among theological students who would become deacons, pastors, and servants to the church. As a result, we have seen important changes and another level of understanding and solidarity with HIV-positive people, in Africa and in other regions.

     

    IRIN: Given the knowledge that your member churches have on the ground and the critical role they play in providing health services, what presence do you have within the international organisations?

     

    Tveit: Since the establishment of the WCC in 1948 there has been a lot of cooperation with the UN and UN-based institutions. Cooperation with the World Health Organisation has been quite strong over the years, and we are now revitalising it…

     

    IRIN: Where does funding come from for programmes helping migrants living with HIV, as churches on the ground may have limited resources?

     

    Tveit: Some of the initiatives we are building, such as competence-building and networking, are funded through our partners who have this programme on their agenda. Funding comes from churches, but also from other donors, including state agencies. NORAD, the Norwegian government’s development agency, has supported our projects for HIV and AIDS, where it has seen the importance of taking a holistic approach to the issue, including changing attitudes, and a long-term perspective. Investing in churches and church-based health services is a very good investment. Most of those involved in this work are very committed, highly competent, and with the willingness to go the extra mile to offer their services, which adds a lot of value and pays off in an economic sense.

     

    (TOP PHOTO: A Venezuelan migrant with HIV who left for Ecuador because he was being treated with expired retroviral drugs and his health was declining. CREDIT: Santiago Escobar-Jaramillo/UNHCR)

    Q&A: How churches are leading the way in helping migrants with HIV
    "We can offer a long-term perspective, which appears to be important for UNAIDS”
  • Nigerian challenges, cash aid headaches, and making mental health matter: The Cheat Sheet

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

    On our radar

     

    New term, old problems for Nigeria’s Buhari

     

    Nigeria's Muhammadu Buhari, who won a second presidential term this week, faces a variety of security challenges: a decade-long and resurgent Boko Haram insurgency in the northeast; endemic insecurity in the oil-producing Niger Delta south, and – less reported but often the most deadly – spiralling violence between pastoralist Fulani herders and local farmers in the northwest. Despite Buhari's 2015 claim that Boko Haram was "technically defeated", jihadists continue gaining ground across Lake Chad and West Africa, where the humanitarian fallout is, if anything, worsening. For a comprehensive look at the causes and the consequences of militancy in the Sahel region, check out this curation of our long-term reporting. And for a personal and graphic account of covering Boko Haram over the course of several years, this reporter’s diary from Chika Oduah is a must-read.

     

    Headaches in the ‘cash revolution’?

     

    Humanitarian cash aid programmes in Kenya’s drought-prone northeast are plagued with problems, according to this recent article by Kenyan journalist Anthony Langat published by Devex. Beneficiaries describe them as confusing, unreliable, and wide open to corruption. Families report not receiving what they think they’re due and/or not knowing what they ought to get, and they say there’s no effective system to address complaints. Local leaders are accused of manipulating lists of entitled families, and money transfer agents allegedly skim off unauthorised transfer fees. The Kenyan government and the UN’s World Food Programme – who run different cash initiatives in the area – say some problems are simply clerical, such as wrongly registered mobile phone numbers or ID cards. Earlier research from NGO Ground Truth Solutions showed that 62 percent of a sample of Kenyans enrolled in cash aid projects said they were satisfied with the service. However, 88 percent “did not know “how aid agencies decide who gets cash support”.

     

    UN peers into a dark Myanmar mirror

     

    The UN is launching an inquiry into its actions in Myanmar, where critics accuse it of inaction and “complicity” in the face of widespread rights abuses that led to the violent exodus of more than 700,000 Rohingya. The UN this week confirmed the appointment of Gert Rosenthal, a Guatemalan diplomat, to lead an internal review of UN operations in Myanmar. The news, first reported by The Guardian, follows a Human Rights Council resolution urging a probe into whether the UN did “everything possible to prevent or mitigate the unfolding crises”, including the military’s Rohingya purge and abuses against minorities elsewhere in the country. Critics say the UN mission in Myanmar was “glaringly dysfunctional”, marred by infighting over how to engage with the government. A UN-mandated fact-finding mission has warned that problems continue and said that some UN entities refused to cooperate with its own investigation. In a statement, UN spokesman in Myanmar Stanislav Saling said the review will look at how the UN “works on the ground and possible lessons learned for the future”. It’s unclear whether Rosenthal’s findings will be made public.

     

    Growing recognition for mental health

     

    In humanitarian terms, psycho-social support is often treated as the poor cousin to aid like food and shelter, with few mental health services available in crisis settings, as we recently reported from South Sudan. But just as the economic cost and importance of mental health is increasingly being recognised in society at large, so the issue is picking up steam in humanitarian contexts too. On the sidelines of this week’s UN pledging conference for Yemen, Dutch Development Cooperation Minister Sigrid Kaag urged humanitarian donors to invest more in mental health (“second line” healthcare, which includes mental health, makes up only $72 million of the $4.2 billion appeal for Yemen). The Netherlands is funding the development of tools to help aid agencies integrate mental health services into their work and will host a conference later this year to mobilise commitments from others. Psychiatrists argue that mental health support is not just a human right; it also strengthens people’s ability to benefit from other aid, such as education or livelihood programmes.  

     

    Bond-holders in pandemic finance scheme untouched by Ebola outbreak

     

    On Thursday, the World Bank announced it was to provide up to $80 million of new funding to combat Ebola in the Democratic Republic of Congo. Of that sum, $20 million is from its Pandemic Emergency Financing Facility, or PEF, set up after the 2013-2016 outbreak of Ebola in West Africa. PEF is a leading example of harnessing private capital and donor resources in humanitarian response. Private investors in PEF bonds can lose their investment if a major epidemic happens. Otherwise they get interest (paid by conventional donors) at a rate described last month as “chunky” by the Financial Times. The catch? PEF investors haven’t paid out a penny in Congo. That’s because the outbreak hasn’t spread to a second country, one of the conditions for a payout. IRIN asked a disaster insurance expert about PEF last year; he said it was “quite expensive”.

      

    In case you missed it:

     

    The Democratic Republic of Congo: Médecins Sans Frontières has suspended work at two Ebola treatment centres after the facilities in Butembo and Katwa were partially destroyed in two separate attacks in the space of four days this week. The caretaker of one patient was reported to have died trying to flee. The motivation of the unidentified assailants remains unclear. The outbreak, which began seven months ago, continues, with 555 deaths and counting.

     

    Gaza: A UN commission of inquiry said in a report released Thursday that Israeli soldiers may have committed war crimes or crimes against humanity in shooting unarmed civilians during mass Palestinian protests at the Gaza border last year.

     

    Indonesia: The country has recorded its first polio case since 2006. The World Health Organisation says a strain of vaccine-derived polio was confirmed this month in a child in a remote village of Papua province, one of Indonesia’s poorest regions. The WHO says the case is not linked to a polio outbreak in neighbouring Papua New Guinea.

     

    Iraq: Human Rights Watch says authorities in Mosul and other parts of the northern Iraqi province of Nineveh are harassing, threatening, and arresting aid workers, sometimes accusing them of ties to so-called Islamic State in an effort to change lists of people eligible for humanitarian assistance.

     

    Pakistan: Shortages of nutritional food and safe water could be leading to “alarmingly high” rates of disease and malnutrition in drought-hit Pakistan, especially for women and children, according to the International Federation of Red Cross and Red Crescent Societies.

     

    Somalia: Al-Shabab militants set off two deadly blasts outside a hotel in Mogadishu on Thursday, before seizing a nearby building. Soldiers battled through the night to try to dislodge them. As conflict and insecurity continue across the country, a new report revealed that 320,000 Somalis fled their homes in 2018 – a 58 percent rise on 2017. Some 2.6 million Somalis are now internally displaced.

     

    Weekend read

     

    UN probes substandard food aid for mothers and children

    The difficulty with this story, to steal from Donald Rumsfeld, are the known unknowns. The World Food Programme purchased 50,000 tonnes of porridge mix for mothers and malnourished children, and a proportion of it was lacking key nutrition-enhancing ingredients. It was sent to crisis zones around the world. It likely came from one of two producers who have a duopoly over the market. The deficiencies should have been picked up by third-party inspectors before the food aid was dispatched. But let’s look at what we don’t know – not for a lack of digging by IRIN’s Ben Parker or contributor Lorenzo D’Agostino in Rome. Where exactly did the faulty food aid go? What effect did the lack of protein and fat have on breastfeeding mothers, babies, and children? Which company produced the substandard porridge mix and why? How come the inspectors failed to find fault with the product? Who was told what, and when? Is operational error, negligence, or fraud, or a combination to blame? We await the findings of the investigation with interest.

     

    And finally...

    Life resumes on Vanuatu’s volcanic Ambae Island

     

    The most explosive volcanic eruption anywhere in the world last year came courtesy of Manaro Voui on Ambae Island, part of the Pacific nation of Vanuatu. The volcano spewed more than 540,000 tonnes of sulphur dioxide into the air, according to NASA. Volcanologists may be fascinated by Manaro Voui’s rumblings, but for 11,000 Ambae residents, the eruptions have been life-changing. They covered parts of the island with volcanic ash, which destroyed crops and homes and polluted drinking water. Residents have repeatedly been forced to evacuate, and at one point the government declared the entire island uninhabitable. For now, the volcano continues to be a in a state of “major unrest”, but some residents are moving back, and the government is preparing to begin a new school term for some returning students.

    (TOP PHOTO: Destroyed cars by the side of the road after a suicide bomber detonated their vest in Maiduguri, Borno State, Nigeria, in 2017. CREDIT: Ashley Gilbertson/VII Photo)

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    Nigerian challenges, cash aid headaches, and making mental health matter
  • North Korea’s silent health crisis

    Questions over the future of denuclearisation and economic sanctions dominate the build-up to this week’s summit between the United States and North Korea. But what’s missing is a focus on a key issue affecting ordinary North Koreans: the country’s silent healthcare crisis.

     

    North Korean leader Kim Jong-un and US President Donald Trump are scheduled to begin talks on 27 February in Hanoi, Vietnam – the second encounter between the two men after last June’s summit in Singapore, which sparked reams of analysis but few tangible results.

     

    Speculation abounds over what might materialise this time: concessions on sanctions, a path toward denuclearisation, perhaps even – if comments from South Korean officials this week are to be believed – an official peace declaration.

    As the two leaders meet, however, everyday North Koreans are struggling with widespread malnutrition and food insecurity. The UN says many North Koreans have difficulty accessing basic services, while more than 40 percent of the country’s population need some form of humanitarian aid.

     

    Health indicators have improved in the two decades since the country’s 1990s famine – during which hundreds of thousands of people starved to death. But there are still major problems. Levels of malnutrition, maternal health, and tuberculosis are worrying enough, but a lack of accurate data on HIV/AIDS and hepatitis B presents new cause for alarm.

     

    Malnutrition: The common denominator

     

    North Korea is frequently portrayed as an unknowable, impenetrable land. However, a substantial amount of data on health indicators is readily available. While it must be treated with caution – malnutrition figures, for example, don’t include political prisoners languishing in camps – the data can be useful for showing longer-term trends.

    Undernourishment is a common denominator for many of the health problems afflicting North Koreans.

    When it comes to the effects of malnutrition, the data shows an improvement in the two decades since the famine ended – but also clear indications of a continuing problem. In 1998, a UNICEF survey found evidence of child stunting – when a child’s height falls considerably below what would be expected at that age. About 62 percent of children younger than seven years of age showed stunted growth, while 60 percent were considered underweight. In 2017, UNICEF’s Multiple Indicator Cluster Survey – drawn from household survey data – reported that roughly 19 percent of children were stunted, while about 9.3 percent were underweight.

     

    This is clearly an improvement. But one in five children are still considered stunted. The children in the 1998 survey are now in their 20s, many likely with children of their own. Today, the World Food Programme estimates that 10.9 million people are undernourished – about 43 percent of the population. And undernourishment is a common denominator for many of the health problems afflicting North Koreans.

     

    Undernourishment in pregnant women

     

    Indicators gauging maternal health in North Korea vary widely. The maternal mortality ratio estimates the proportion of women who die during pregnancy – essentially the risk associated with pregnancy in a given country. World Bank data suggests the maternal mortality ratio in North Korea has fallen steadily since a peak in 1999. However, data from North Korea’s own Central Bureau of Statistics says the maternal mortality ratio has fluctuated and even risen in recent years: from 72 per 100,000 live births, to 62.7 in 2014, then a notable jump to 82 in 2015.

     

    Even using the World Bank’s more optimistic figures, North Korea’s maternal mortality ratio still hasn’t reached pre-famine levels – estimated at 56 deaths per 100,000 live births in 1992. And it’s still far off the mark set by South Korea, where the ratio is 11.

     

    Current indicators suggest cause for concern. According to UNICEF, nearly one in three women of reproductive age are undernourished, and nearly one in four are underweight. And the UN agency says it couldn’t distribute nutritional supplements to 95 percent of pregnant and lactating women during a nationwide child health campaign last year, due to funding shortfalls.

     

    Tuberculosis trouble ahead

     

    There is a funding crisis for tuberculosis treatment in North Korea, and the disease may be killing people at an increasing rate. World Health Organisation estimates for tuberculosis deaths in North Korea are on the rise: from a low of 42 deaths per 100,000 people in 2015, to 63 in 2017.

     

    The Global Fund – the donor agency financing treatment for HIV, tuberculosis, and malaria around the world – pulled funding for tuberculosis and malaria programmes last year citing oversight concerns in North Korea’s ”unique operating environment”. The decision was met with worried opinion pieces, open letters, and pleas of concern from the medical community.

     

    With the impact of sanctions and the Global Fund’s withdrawal, there are fears this upward trend may continue. In an open letter published in the British medical journal The Lancet, the director of the Korean American Medical Association, which works on tuberculosis treatment programmes in North Korea, warned that medicine rationing triggered by drugs shortages could fuel the ”rapid creation of drug-resistant TB strains”.

     

    North Korea already struggles with multidrug-resistant tuberculosis, which cannot be cured with the two most powerful drugs usually used to treat TB. The WHO estimated there were 4,100 such cases in the country in 2017, but less than half of affected patients had started treatment.

     

    The Eugene Bell Foundation is another prominent NGO working on tuberculosis in North Korea. However, the group says its 12 treatment centres for multidrug-resistant tuberculosis can only hold 1,500 patients combined, meaning many North Koreans are unable to access its programmes.

     

    Misplaced HIV assumptions?

     

    Malnutrition, maternal mortality, and tuberculosis are relatively well documented in North Korea, but much less is known about the prevalence of HIV/AIDS and hepatitis B. This is particularly concerning given the scarcity of medical infrastructure, accurate screening, and specialised doctors and medicines.

     

    The prevalence of HIV is one of the least understood health issues in North Korea. The government has claimed there are no HIV cases in the entire country. But the situation is opaque at best, hidden by stigma and the government’s reluctance to acknowledge the issue let alone openly tackle it. UN agency reports from the late 1990s and early 2000s mirrored the government’s assumptions that the country’s long isolation, low (official) migration, low drug use, and conservative sexual attitudes made HIV and AIDS a non-issue.

     

    Over time, however, UN reports suggest multiple factors that could lead to a growing vulnerability among North Koreans. Surveys and analyses – conducted by UN agencies on reproductive health between 2002 and 2012 – point to increasing vulnerabilities to HIV transmission particularly among women. Condom use is extremely low, while the quality of blood transfusion is often poor. These conditions are amplified in border regions and in disadvantaged remote areas.

     

    UN agencies note that on North Korea’s northern border with China, drug use and prostitution are on the rise, as are cross-border mobility and trafficking. A 2014 study  by the South Korean Ministry of Unification noted that HIV-testing facilities and materials have long been scarcely available in North Korea, which challenges past assumptions of a nearly HIV-free country. Rather than a lack of infections, what we see in North Korea may actually be insufficient testing and misplaced assumptions.  

     

    Healthcare not on the agenda

     

    For North Koreans grappling with the long-term impacts of an inadequate health system, a peace agreement and an end to hostilities will not, on their own, bring an improvement to their lives.

    Available health statistics do not point to a country with a “brighter future”, but to a nation that will need prolonged and extensive care.

    To reverse the impacts of years of undernutrition, North Koreans need reliable and consistent treatment delivered through a robust and well-functioning health system. That will require significant commitment from both the North Korean government and the wary international community. Without adequate funding, access, and the increased capacity to cope with today’s health burdens – including the ones we don’t yet fully grasp – many ordinary North Koreans will continue to struggle to live a full and healthy life.

     

    North Korea may be keen to see the end of punishing UN sanctions, and long-term American objectives ahead of this week’s summit are clear: “the complete, verifiable denuclearisation of the peninsula”.

     

    Realistically, however, the available health statistics do not point to a country with a “brighter future”, as repeatedly promised by US officials, but to a nation that will need prolonged and extensive care.

    (TOP PHOTO: North Koreans gather in Pyongyang on 16 February 2019. CREDIT: Ed Jones/AFP)

    gs-nzc/il/ag

    ...

    The authors are researching a book about North Korea and international cooperation.

    North Korea’s silent health crisis
    There’s a healthcare emergency in North Korea, and a peace declaration won’t fix it
  • First Person: To stop Ebola, ask the rebels to help

    The Democratic Republic of Congo is in the midst of its 10th Ebola outbreak. Since the first case was declared in the northeastern town of Beni in August 2018, almost 800 cases have been confirmed in 19 different health zones, and more than 500 people have died.

     

    I’ve worked on four Ebola outbreaks across Africa and have often found myself in tricky situations with local people who view outsiders with suspicion. During the 2014 outbreak in Guinea, for example, my team and I were threatened by villagers who ran after us with machetes.

    It only took a few days in Butembo before I was surrounded by an angry mob chanting “kill him”.

    It only took a few days in Butembo, responding to the current outbreak in eastern Congo, before I was surrounded by an angry mob chanting “kill him”, after they refused to allow our surveillance team to investigate a death in their neighbourhood.

    Such experiences have taught me that keeping your calm and speaking respectfully are the best ways to de-escalate tense and violent situations.

    But I still wasn’t prepared for my first experience of going face-to-face with Mai-Mai rebel leaders to negotiate access in Congo so our health teams could reach affected communities.

     

    Since this outbreak erupted in North Kivu province last August, health teams knew they would face big challenges. The virus had resurfaced in a densely populated, heavily travelled urban region where about 100 armed groups operate, restricting the response. The risk of rapid geographic spread was very high.

     

    Ebola is a highly contagious virus, and when a person contracts the disease all those they come into contact with need to be screened for symptoms.

     

    As the Ebola response coordinator in Butembo, my role was to organise surveillance activities to find these contacts as quickly as possible – that means before they start showing symptoms, become contagious, and spread the virus.

     

    Very early on in this outbreak we got an indication of just how hard this was going to be. Six days after I arrived in Beni, the epicentre, we heard that 30 contacts of confirmed Ebola patients had fled to Butembo, about 60 kilometres away and home to over a million people.

    Finding people who don’t want to be found is not an easy task.

    Finding people who don’t want to be found is not an easy task. It’s made even more difficult when those affected live in inaccessible areas controlled by armed rebel groups, including the Mai-Mai – self-defense militias feared by the local population because of years of crimes, including torture, kidnapping, and indiscriminate killings.

     

    Less than two months after I arrived in Butembo, we heard that the body of an eight-month-old boy who died from Ebola was in the Mai-Mai village of Tinge. Because the risk of Ebola spreading is most severe immediately after a patient dies, I knew we needed to gain access to people in Tinge as our only way of saving lives and avoiding disaster.

    I told our health teams and international partners we had to go to that village to vaccinate people. Everybody thought I was crazy.

     

    The Mai-Mai are known to be well armed and unafraid of the authorities. Even our national police and army don’t dare venture into some of these rebel-controlled zones. Only my driver and the titulaire – the nurse overseeing that health zone – agreed to join this uncertain and risky mission.

    The following morning, I got into the car not knowing if I would even come back alive. After a 45-minute drive on windy roads, followed by a 35-minute walk along muddy forest trails, we finally reached Tinge. About 50 people were gathered under big dark green tarpaulins, mourning the baby boy.

    We were greeted by a woman who asked what we were doing in their village. I told her I had to see the village chief because I had something important to tell him. She pointed me to his house.

    As an epidemiologist with a specialisation in molecular biology, my colleagues jokingly nicknamed me “the complete man” because I can perform all the tasks in the surveillance toolkits: investigate and validate alerts, take samples from suspect cases, and even test these samples in the laboratory.

    However, in this situation, my skills weren’t that useful. What we needed even more was to find a way to convince the sceptical local community to collaborate with us and stop Ebola.

     

    As I entered the house of the village chief, my heart was racing. I had heard so many scary stories about Mai-Mai fighters that I didn’t know what to expect.

     

    In the house, I saw five men at the dining table, waiting for lunch to be served. They were covered with the amulets the Mai-Mai use to protect themselves. The chief was sitting on a chair with large banana leaves beneath his feet.

    To my surprise, when they saw me, they invited me to join them at the table. A woman brought a small stool and hot water to wash my hands, before we were served pondu (cassava leaves), fufu (cassava flour with water) and one piece of meat.

     

    My hosts remained silent, observing and analysing my behaviour. Only when I began eating did the atmosphere lighten. My hosts started smiling and talking. The chief told me they appreciated my humility by agreeing to eat with them.

    That is when our conversation finally started. They had never heard about Ebola nor the vaccination. So I spent more than 30 minutes explaining the virus to them, how it spreads, what the preventative measures are, and how the vaccination works.

    Without saying a word, the village chief went outside and gathered the villagers. He said a few words in their local dialect while making big gestures. Then he allowed the titulaire to list all those who had been in contact with the baby boy so we could follow the chain of transmission. In total, 75 people came forward.

     

    Before leaving, we agreed to meet the next day in a neutral zone where vaccination teams and police agents would be allowed to come. At 8am, everyone arrived and our teams began vaccinating.

     

    Not a single person in that village developed the virus.

     

    After making contact with the chief of Tinge, I was able to meet other Mai-Mai chiefs, including a group that controls the area linking Butembo to the major city of Goma. I visited their village in December, where I spoke to a group of fighters for two hours, answering all the questions they had about Ebola.

    Later, in a one-on-one meeting with the chief, I called the Minister of Health and arranged for them to speak. The chief warmly thanked the minister for his commitment to ending the Ebola outbreak, guaranteeing that his fighters would not harm the response teams. A week later, I returned to the village with several boxes of medicines the minister sent the Mai-Mai to cement this collaboration.

    Earning trust during such a deadly outbreak is always hard. Which showed me yet again that respect, compassion, and humility can go a long way – even saving your life and the life of an entire community.

     

    (TOP PHOTO: Dr Shako with Mai-Mai fighters after a discussion about Ebola and negotiations with their leader in Rutshuru. CREDIT: Dr Jean-Christophe Shako)

    First Person: To stop Ebola, ask the rebels to help
    “I had heard so many scary stories about Mai-Mai fighters that I didn’t know what to expect"
  • As Afghanistan’s capital grows, its residents scramble for clean water

    Twice a week, Farid Rahimi gets up at dawn, wraps a blanket around his shoulders to keep warm, gathers his empty jerrycans, and waits beside the tap outside his house in a hillside neighbourhood above Kabul.

     

    At 7am sharp, water bursts from the pipes, filling Rahimi’s tank and buckets. He labours away, saving every drop until – just an hour later – the last drop falls.

     

    “We can’t afford to miss it,” said the 35-year-old. “It’s barely enough.“

     

    Afghanistan’s capital is running dry – its groundwater levels depleted by an expanding population and the long-term impacts of climate change. But its teeming informal settlements continue to grow as decades-long conflict and – more recently – drought drive people like Rahimi into the cities, straining already scarce water supplies.

     

    With large numbers migrating to Kabul, the city’s resources are overstretched and aid agencies and the government are facing a new problem: how to adjust to a shifting population still dependent on some form of humanitarian assistance.

    e21b5337_1920.jpg

    Stefanie Glinski/IRIN
    Farid Rahimi prepares to fill jerrycans with water. His family has access to clean drinking water twice a week for only an hour. Rahimi fills up every available bucket and jerrycan to make sure the water lasts through the rest of the week.

    Rahimi came to Kabul nine years ago to find safety and better job opportunities, but he says it hasn’t been easy. He now shares his house with 12 family members and each month he pays a steep 1,500 Afghani, or $20, for water from a private company.

     

    “Last year we shut down our well,” Rahimi said. “There wasn’t any water left. A few years ago, the situation was a lot better.”

     

    On the move

     

    The UN says more than half a million people in Afghanistan were forced to leave their homes in 2018 due to conflict and drought. An even greater number of Afghans, more than 800,000, returned from Pakistan and Iran during the same year. About seven percent of Kabul’s population are either displaced by war or returnees who previously fled the country, according to estimates from the UN’s migration agency, IOM.

    The majority migrate toward cities, which are now home to one third of Afghanistan’s population of 36 million. According to UN Habitat, 80 percent of urban areas in Kabul are informal settlements.

    e21b4210_1920.jpg

    Stefanie Glinski/IRIN
    Kabul’s outskirts are home to informal settlements where the majority of residents are people displaced from the countryside by fighting and drought. While some families arrived in recent months, others have lived in these settlements for years.

    In Rahimi’s case this means that a muddy, unpaved road winds its way through his neighbourhood and up an overpopulated hill, where simple mud or concrete houses have been built on “grab land”, claimed by those who arrived in Kabul over the past decade without initially registering or even purchasing the property. Electricity is available sporadically, while health facilities and schools are either absent or far away. A private company is in the process of installing water pipes throughout the neighbourhood, but most public services are yet to be provided by the government.

    Read more: As conflict spreads, chronic displacement becomes a powderkeg in Afghanistan

    But when people from rural areas leave their homes for the cities, they may also leave behind the humanitarian aid they had previously relied on.

     

    Pir Mohammed arrived in Kabul five months ago, escaping violence and bombings in his native Helmand province, a Taliban heartland in southern Afghanistan.

     

    The 35-year-old had hoped the move would make his life safer and easier. But the family lives in a tent in the middle of Afghanistan’s bitter winter; his cousin has pneumonia.

     

    “It’s just so cold. In Helmand, we received some assistance. Here, we were told the government would help us, but nothing has happened so far,” Mohammed said, while digging a trench outside his shelter to prevent water from leaking into the tent.

    e21b4661_1920.jpg

    Stefanie Glinski/IRIN
    Pir Mohammed shovels dirt in front of his cousin's tent. His family arrived in Kabul five months ago, fleeing fighting and air strikes in Helmand province. He says it’s safer in Kabul, but he can’t access the humanitarian aid he relied on back home.

    Much of the snow falling onto the family’s home is melted and used as drinking water. The current winter has been harsh, with temperatures dropping well below zero most nights.

     

    Rethinking aid

     

    Alison Parker, UNICEF’s communications chief, said the urban shift means aid groups must also rethink how to help people who may still need assistance in the cities.

     

    “Rurally, it’s easier because you engage with communities at the local level. In Kabul, we need to engage with the government and other actors,” Parker said. “It needs a shift in thought and more players need to be on board.”

     

    Yet city planning and humanitarian work often do not go hand in hand, says the city’s deputy mayor, Shoaib Rahim. “Humanitarian services are meeting immediate needs, but urban planning is for the long term,” he said.

     

    While aid agencies do provide some services in urban areas, especially in places where newly displaced people have settled, both private companies and the government take up large – yet still insufficient – chunks of the work.

     

    “Aid professionals often distinguish between humanitarian work and development, but they are intertwined,” said Oxfam Afghanistan country director Ruby Ajanee.

     

    The majority of former refugees and asylum seekers returning from abroad, for example, settle in urban areas, where they may need both short-term aid and and more long-lasting help.

     

    “While their immediate needs for food and shelter are addressed by humanitarian agencies, the long-term development needs of reintegration are addressed by the development agencies, with often a disconnect from the humanitarian agencies,” Ajanee said. “These two sectors have to work together seamlessly where humanitarian effort is linked with development work.”

     

    Rainfall patterns

     

    Comparatively, urban residents are still better off than their rural counterparts. The proportion of people with access to basic water is 63 percent countrywide – 89 percent for the urban population and 53 percent for rural households, according to UNICEF. But migration patterns and a changing climate point to long-term strains on water supplies.

     

    e21b5657_1920.jpg

    Stefanie Glinski/IRIN
    A man draws water from a public pump in Kabul. Many households lack access to water in their homes, and groundwater levels have been depleted in recent years.

    Afghanistan is one of the world’s top eight countries affected by climate change-induced water shortages, says Paulos Workneh, who heads the water, sanitation and hygiene programme for UNICEF in Afghanistan. As groundwater deteriorates, city dwellers are robbed of their main source of clean water.

     

    “Most of Kabul’s water was accessed through wells, but the situation is now under stress,” Workneh said. “Surface water is polluted by industrial waste, pit latrines and chemicals leaping into the rivers. With rainfall patterns decreasing, sources don’t fill up as quickly anymore.”

     

    While Kabul is starting to tackle the issue of informally built properties – including the registration of many houses initially constructed without permission – one fact remains: the capital grew too quickly.

     

    “The city had 4.6 million people in 2002 and, by 2012, the numbers went up to 7.1 million,” said Koussay Boulaich of UN Habitat, which is offering technical support to a government project responding to the city’s urbanisation trend.

     

    By 2050, one in two Afghans will live in cities, Boulaich said. A similar shift will be needed among the many humanitarian and development groups now concentrating their work in Afghanistan’s rural areas.

     

    “Imagine how important the correlation between urbanisation and development is,” Boulaich said. “In some areas, humanitarian and development work merge, supporting the government in providing long-term sustainable solutions, and urbanisation has to be one of these areas.”

    e21b5353_1920.jpg

    Stefanie Glinski/IRIN
    A private company has started drilling and construction for new water pipes in this Kabul neighbourhood. Informally built homes line the hillsides in the background.

    Reverse city planning

     

    One of the government’s programmes for urban development, including water, is its “City for All” scheme, which aims to turn the country’s urban migration into economic growth, increase living standards, and even contribute to peace. As part of the plan, informal areas in Kabul are now being registered, roads are being built, and water systems are being set up slowly, with technical help from international agencies.

     

    Mohammed Atik, 60, lives in a Kabul neighbourhood currently undergoing development.

    “The government has built the pipes in our area. There are none in my house yet, but I do see progress,” he said.

     

    For now, however, his household well has dried up. He gets water for his family only by filling up buckets at a neighbour’s house, and he’s worried what will happen if this supply also evaporates.

     

    “I just hope we don't run further out of water,” Atik said. “We’re already using a lot less than a few years ago.”

     

    In Rahimi’s hillside neighbourhood, the government has promised to pave the road in the coming months, while mainly private companies supply the available water.

     

    Merza Mohammed, a 42-year-old employee with Absharan Tagyet, the company laying pipes down Rahimi’s street, said the new infrastructure will serve roughly 1,300 households – though at a price more expensive than the city government’s standard rates.

     

    “We’re a local business supplying areas that the government has not yet reached,” he said.

     

    A few years ago, water was more widely available throughout the city. But prices have more than doubled, he said.

     

    “Today, we’re scrambling. Water is becoming a pricey commodity in Afghanistan.”

    (TOP PHOTO: Winter has been harsh in Kabul, with temperatures dropping well below zero degrees Celsius most nights. CREDIT: Stefanie Glinski/IRIN)

    sg/il/ag

    “Here, we were told the government would help us, but nothing has happened so far”
    As Afghanistan’s capital grows, its residents scramble for clean water
  • Briefing: How the Rohingya crisis in Bangladesh is changing

    Aid groups and authorities in Bangladesh are preparing to ask for more than $900 million in donor funding to help Rohingya refugees in the sprawling refugee settlements of southern Bangladesh.

     

    But nearly 18 months after 700,000 Rohingya fled a violent military crackdown in Myanmar in August 2017, the aid sector finds itself shifting from emergency response to dealing with a protracted crisis.

     

    The camps are now home to nearly one million Rohingya, including previous generations of refugees who fled their homes in Myanmar’s Rakhine State.

     

    “This is like a major city,” said Rachel Wolff, response director for World Vision, one of more than 100 NGOs, UN agencies, and government bodies now working in Cox’s Bazar.

     

    There are slim prospects of a quick return home: the UN says Rakhine State is not yet safe for the Rohingya, who have faced generations of marginalisation and disenfranchisement, and most of the refugees say they won’t go back until their rights are guaranteed.

    A generation of young Rohingya have spent another year without formal schooling or ways to earn a living.

    The dimensions of the response are changing as the months pass: medical operations focused on saving lives in 2017 must now also think of everyday illnesses and healthcare needs; a generation of young Rohingya have spent another year without formal schooling or ways to earn a living; women reported sexual violence at the hands of Myanmar's military, but today the violence happens within the cramped confines of the camps.

     

    Here are some of the biggest issues coming up in delivering aid in city-sized camps, as the crisis continues to evolve and pushes toward a second full year:

     

    Healthcare: from bullet wounds to diabetes

     

    Healthcare workers responding in the early days of the 2017 refugee outflow treated traumatic injuries like bullet and knife wounds, and rushed to implement mass vaccination campaigns and ensure access to safe water.

     

    But as the refugee crisis prolongs, longer-term health needs also become a pressing concern.

     

    “You go through this emergency response and then you say, OK, we don’t know when or if the situation for these refugees will improve, so we need to start addressing things like diabetes… and high blood pressure,” said Jessica Patti, medical coordinator for Médecins Sans Frontières, which runs four field hospitals and several clinics in the camps.

     

    Read more: A new normal in humanitarian aid: treating middle-class diseases

     

    Major gaps in health services have emerged in the crowded camps: treatment for chronic diseases, care for sexual violence survivors, and mental health and psychiatric services for a population stuck in limbo.

     

    The Inter Sector Coordination Group, the UN-led body coordinating aid efforts in the camps, says treatment for non-communicable diseases, as well as malaria, tuberculosis, and HIV is “insufficient”, and that health facilities are unevenly distributed – services are bunched close together in some areas, while refugees in more distant settlements may go without.

    “Congestion is the recipe for all disaster.”

    “After an emergency, everybody sort of comes in, responds, sets up,” Patti said. “But I think we’re at a point now where people need to take a step back and say, OK, maybe some of these services are redundant and need to consider closing, re-evaluating, or moving where we are, to allow for more space in the camps for people to live.”

     

    Overcrowding

     

    The extreme lack of space in the camps cuts through the entire response: health risks from poor hygiene and sanitation soar if latrine standards are inadequate. There’s not enough room for classrooms, nor for storm shelters or comprehensive evacuation plans for the upcoming cyclone and monsoon season.

     

    “Congestion is the recipe for all disaster,” said Rezaul Chowdhury, who leads COAST, a local NGO based in Cox’s Bazar.

     

    The majority of the refugees now live in massive Kutupalong camp, carved out of undulating, flood-prone land.

     

    The amount of useable space available per person – less than 10 square metres in some areas – falls far below minimum international standards for refugee camps.

     

    Needs of women and girls

     

    This severe congestion also adds to the risks faced by women and girls, whose health and protection needs are already “critically underserved” in the camps, according to the Inter-agency Working Group on Reproductive Health in Crises, a coalition of aid organisations.

     

    “The fact that it's such a crowded camp, who's the most affected? It's women and girls,” Wolff said.

     

    “They don't have a space and, being from a culture where, not all, but some portion of males, husbands, and community leaders, are pressuring them to stay in their homes – we're talking about homes that are actually glorified hovels; stay in your plastic shelter – it’s just beyond what I think a human woman could tolerate.”

     

    Schools and livelihoods: a lost generation

     

    There are more than half a million school-age children and young adults in the camps and surrounding areas, but for the past 18 months few have been able to access formal education.

     

    Worried that Rohingya children educated in Bangladesh will integrate into local society and not return home, Bangladesh’s government has placed strict limits on formal education – Rohingya students are not permitted to study using the Bangladeshi curriculum.

     

    Instead, education services are largely limited to informal classrooms run by a range of NGOs and community groups. But aid groups have been slow to finalise an alternative curriculum, and some Rohingya parents have criticised the quality of education on offer. Aid groups say this informal schooling is available to only half of children 14 years old and younger.

     

    At the same time, only primary-level education is allowed, meaning there are few opportunities for Rohingya who are 15 and older. Fewer than 5,000 adolescents have any access to schooling or life-skills training, out of more than 117,000 who may need it, according to aid groups.

    "You are developing a young generation with a lot of frustration.”

    “Without formal education, without skills-building, things to do actively, and preparing for their futures, how do they start to think about where their life is going?” said Wolff. “I think all of us really hope to move a bit faster and get into more self-reliance activities for the refugees, especially the youth.”

     

    Critics say there has been a lack of long-term planning on education, including coordinated advocacy to convince the government to change its rules.

     

    “The Rohingya are getting older. They are growing,” said Chowdhury. “If you don’t have education, then you are developing a young generation with a lot of frustration.”

     

    Host communities: rising tensions

     

    The massive influxes of refugees – and the aid groups that followed them – have raised tensions among Bangladeshis in Cox’s Bazar. Some say they’ve seen their income plummet as they compete for increasingly scarce resources or services.

     

    A January survey by Ground Truth Solutions, which researches the views of people in crises, pointed to rising tensions among the host communities: “Their attitudes have shifted from the start of the crisis, where they felt much more supportive and welcoming of Rohingya but now are much less so, feeling that Rohingya have ‘been here too long’.”

     

    Aid groups and the government also warn of a “potential deterioration” of relations between Rohingya and the local communities. The upcoming response plan is expected to place a greater emphasis on building social cohesion and on development projects to improve education and access to water and food in host communities. Some of these projects were started last year, but the UN coordination body said a “severe funding gap” put a limit on this assistance.

     

    Planning for the future

     

    The upcoming appeal – north of $900 million – represents one of the largest humanitarian appeals for a crisis this year. But the 2018 Rohingya appeal went underfunded through much of the year, which aid groups said had a direct impact on the quality of services available.

     

    Chowdhury said the aid community continues to concentrate on short-term goals, without planning for a future when funding will wane. He said local NGOs and aid workers have effectively been left out of planning, while international aid groups have done little to build skills among the local organisations that call Bangladesh home.

     

    “When the funds dry out, when UN agencies and all the experts fly out, there should not be a burden on the local people,” Chowdhury said. “There should be an opportunity for the local people.”

     

    At the same time, the future of the Rohingya in Bangladesh is inextricably tied to the government itself, which is in charge of the humanitarian response but also says the refugees must one day return home.

     

    Highly criticised plans to begin refugee returns to Myanmar last year were called off when Rohingya refused to go. The government has also floated plans to resettle some Rohingya on Bhasan Char, a disaster-prone island that rights groups say would be even more precarious than the refugees’ current camp shelters.

    (TOP PHOTO: Young Rohingya refugees play at Balukhali refugee camp in Ukhia on 4 February 2019. CREDIT: Munir Uz Zaman/AFP)

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    Briefing: How the Rohingya crisis in Bangladesh is changing
  • 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

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