Inter Press ServiceHealth – Inter Press Service http://www.ipsnews.net News and Views from the Global South Thu, 18 Jan 2018 16:29:44 +0000 en-US hourly 1 https://wordpress.org/?v=4.8.5 PPPs Likely to Undermine Public Health Commitmentshttp://www.ipsnews.net/2018/01/ppps-likely-undermine-public-health-commitments/?utm_source=rss&utm_medium=rss&utm_campaign=ppps-likely-undermine-public-health-commitments http://www.ipsnews.net/2018/01/ppps-likely-undermine-public-health-commitments/#respond Wed, 17 Jan 2018 08:50:30 +0000 Anis Chowdhury and Jomo Kwame Sundaram http://www.ipsnews.net/?p=153905 The United Nations Agenda 2030 for the Sustainable Development Goals (SDGs) is being touted in financial circles as offering huge investment opportunities requiring trillions of dollars. In 67 low- and middle-income countries, achieving SDG 3 — healthy lives and well-being for all, at all ages — is estimated to require new investments increasing over time, […]

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Capacity-building support for developing countries to safeguard the public interest in terms of public health and especially, to ensure that no one is left behind, is essential. Credit: IPS

By Anis Chowdhury and Jomo Kwame Sundaram
SYDNEY and KUALA LUMPUR , Jan 17 2018 (IPS)

The United Nations Agenda 2030 for the Sustainable Development Goals (SDGs) is being touted in financial circles as offering huge investment opportunities requiring trillions of dollars. In 67 low- and middle-income countries, achieving SDG 3 — healthy lives and well-being for all, at all ages — is estimated to require new investments increasing over time, from an initial $134 billion annually to $371 billion yearly by 2030, according to recent estimates by the World Health Organization (WHO) reported in The Lancet.

Selling PPPs
Deprived of fiscal and aid resources, none of these governments can finance such investments alone. The United Nations Intergovernmental Committee of Experts on Sustainable Development Financing estimated in 2014 that annual global savings (both public and private sources) were around US$22 trillion, while global financial assets were around US$218 trillion.

The third International Financing for Development Conference in Addis Ababa in mid-2015 recommended ‘blended finance’ as well as other public private partnerships (PPPs) to pool public and private resources and expertise to achieve the SDGs. Development finance institutions (DFIs), particularly the World Bank, are the main cheerleaders for these magic bullets.

Sensing the new opportunity for mega profits, the private sector has embraced the SDGs. The World Economic Forum now actively promotes PPPs with DEVEX, a private-sector driven network of development experts. A recent DEVEX opinion claims that PPPs can unlock billions for health financing. It invokes some philanthropy driven global partnership success stories — such as the Global Alliance for Vaccine Initiatives (GAVI) and the Global Fund to Fight Aids, TB and Malaria — to claim that national level PPPs will have similar results.

A managed equipment services (MES) arrangement with GE Healthcare in Kenya is also cited as a success story, ignoring criticisms. For example, Dr. Elly Nyaim, head of the Kenya Medical Association, has pointed out that MES has not addressed basic problems of Kenya’s health system, such as inappropriate training and non-payment of salaries to frontline health workers, encouraging emigration of well-trained health professionals to developed countries, further worsening Kenya’s already difficult health dilemmas.

It should be obvious to all that private sector participation in the development process is hardly novel, having long contributed to investments, growth and innovation. Not-for-profit civil society organisations (CSOs), especially faith-based ones, have also been significant for decades in education and health. Thus, in many developing countries such as Bangladesh and Indonesia, health and education outcomes are much better than what public expenditure alone could fund.

False claims
However, PPPs have a long and chequered history, especially in terms of ensuring access and equity, typically undermining the SDG’s overarching principle of “leaving no one behind”, including the SDG and WHO promise of universal health care. Also, partnerships with for-profit private entities have rarely yielded better fiscal outcomes, both in terms of finance and value for money (VfM).

Misleading claims regarding benefits and costs have been invoked to justify PPPs. Most claimed benefits of health PPPs do not stand up to critical scrutiny. As a policy tool, they are a typically inferior option to respond to infrastructure shortfalls in the face of budgetary constraints by moving expenditures off-budget and transferring costs to future governments as well as consumers and taxpayers.

Typically driven by political choices rather than real economic considerations, PPP incurred debt and risk are generally higher than for government borrowing and procurement. PPPs also appear to have limited innovation and raised transactions costs. PPP hospital building quality is not necessarily better, while facilities management services have generally reduced VfM compared to non-PPP hospitals. Underfunding and higher PPP costs lead to cuts in service provision to reduce deficits, harming public health.

Healthcare PPPs in low- and middle-income countries have raised concerns about: competition with other health programmes for funding, causing inefficiencies and wasting resources; discrepancies in costs and benefits between partners typically favouring the private sector; incompatibility with national health strategies; poor government negotiating positions vis-à-vis powerful pharmaceutical and other healthcare service companies from donor countries.

Perverted priorities

Rich and powerful private partners often reshape governmental and state-owned enterprise priorities and strategies, and redirect national health policies to better serve commercial interests and considerations. For example, relying on antiretroviral drugs from PPPs has resulted in conflicts with national authorities, generic suppliers and consumer interests, which have undermined health progress. Donor-funded PPPs are typically unsustainable, eventually harming national health strategies, policies, capacities and capabilities.

PPPs may divert domestic resources from national priorities, and thus undermine public health due to financial constraints they cause. Such redirection of investment exacerbates health disparities, adversely affecting vulnerable groups. Health workers often prefer to work for better funded foreign programmes, undermining the public sector.

PPPs can thus lead governments to abdicate their responsibilities for promoting and protecting citizens’ health. Partnership arrangements with the private sector are not subject to public oversight. Therefore, selecting private partners, setting targets and formulating operating guidelines are not transparent, they only aid in creating more scope for corruption.

PPPs are certainly not magic bullets to achieve the SDGs. While PPPs can mobilize private finance, this can also be achieved at lower cost through government borrowing. Instead of uncritically promoting blended finance and PPPs, the international community should provide capacity building support to developing countries to safeguard the public interest, especially equity, access and public health, to ensure that no one is left behind.

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Fate of the Rohingyas – Part Twohttp://www.ipsnews.net/2018/01/fate-rohingyas-part-two/?utm_source=rss&utm_medium=rss&utm_campaign=fate-rohingyas-part-two http://www.ipsnews.net/2018/01/fate-rohingyas-part-two/#respond Tue, 16 Jan 2018 00:01:45 +0000 Naimul Haq http://www.ipsnews.net/?p=153883 With discussions underway between Bangladesh and Myanmar about the repatriation of more than a half a million Rohingya refugees, many critical questions remain, including how many people would be allowed back, who would monitor their safety, and whether the refugees even want to return to violence-scorched Rakhine state. A Joint Working Group (JWG) consisting of […]

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Rohingya refugees carry blankets at a camp in Bangladesh. Credit: Naimul Haq/IPS

Rohingya refugees carry blankets at a camp in Bangladesh. Credit: Naimul Haq/IPS

By Naimul Haq
DHAKA, Bangladesh, Jan 16 2018 (IPS)

With discussions underway between Bangladesh and Myanmar about the repatriation of more than a half a million Rohingya refugees, many critical questions remain, including how many people would be allowed back, who would monitor their safety, and whether the refugees even want to return to violence-scorched Rakhine state.

A Joint Working Group (JWG) consisting of government representatives from Myanmar and Bangladesh was formed on Dec. 19 and tasked with developing a specific instrument on the physical arrangement for the repatriation of returnees."Three elements of safety – physical, legal and material – must be met to ensure that return is voluntary and sustainable." --Caroline Gluck of UNHCR

A high-ranking Bangladeshi foreign ministry official who requested anonymity told IPS, “The Myanmar government has been repeatedly requested to allow access to press and international organisations so they can see the situation on the ground. Unless the world is convinced on the security issues, how can we expect that the traumatized people would volunteer to settle back in their homes where they suffered being beaten, tortured and shot at?”

He says, “The crimes committed by the Myanmar regime are unpardonable and they continue to be disrespectful to the global community demanding access for investigation of alleged genocide by the regime and the dominant Buddhist community.

“The parties who signed the deal need to consider meaningful and effective and peaceful refugee protection. In Myanmar, as a result of widespread human rights abuses, hundreds of thousands of people have fled the country and are living as refugees in camps or settlements also in Thailand and India. The same approach of reconciliation and effective intervention by the international community must be in place.”

A human right activist pointed out that the very people who are to return to Myanmar have no say in the agreement. Their voices are not reflected in the agreement which does not clearly outline how and when would the Rohingyas return home.

Asked about the future of the Rohingyas, Fiona Macgregor, International Organisation for Migration (IOM) spokesperson in Cox’s Bazar, told IPS, “Formal talks on repatriation have been held bilaterally between the governments of Bangladesh and Myanmar and IOM has not been involved in these.”

“According to IOM principles it is crucial that any such return must be voluntary, safe, sustainable and dignified. At present Rohingya people are still arriving from Myanmar every day who are in desperate need of humanitarian assistance. IOM continues to focus efforts on supporting the needs of these new arrivals, as well as those who have arrived since August 25, those who were living here prior to August and the local host community in Cox’s Bazar.”

Recently, top brass in the Myanmar regime said that it was “impossible to accept the number of persons proposed by Bangladesh” for return to Myanmar.

The deal outlines that Myanmar identify the refugees as “displaced residents.” Repatriation will require Myanmar-issued proof of residency, and Myanmar can refuse to repatriate anyone. Those who return would be settled in temporary locations and their movements will be restricted. In addition, only Rohingyas who fled to Bangladesh after October 2016 will be repatriated.

According to official sources, a meeting of the Joint Working Group supervising the repatriation will be held on January 15 in Myanmar’s capital to determine the field arrangement and logistics for repatriation with a fixed date to start repatriation.

As of January 7, a total of 655,500 Rohingya refugees had arrived in Cox’s Bazar after a spurt of violence against the minority Muslim Rohingya people beginning in August 2016, which left thousands dead, missing and wounded.

Caroline Gluck, Senior Public Information Officer at UNHCR Cox’s Bazar, Bangladesh, told IPS that the agency is currently appealing for 83.7 million dollars until the end of February 2018 to fund humanitarian operations.

In March, the UN and its partners will launch a Joint Response Plan, setting out funding needs to assist Rohingya refugees and host communities for the 10-month period to the end of the year.

Regarding the repatriation process, Gluck said, “Many refugees who fled to Bangladesh have suffered severe violence and trauma. Some have lost their loved ones and their homes have been destroyed. Any decision to return to Myanmar must be based on an informed and voluntary choice. Three elements of safety – physical, legal and material – must be met to ensure that return is voluntary and sustainable.

“While UNHCR was not party to the bilateral arrangement between Myanmar and Bangladesh, we are ready to engage with the Joint Working Group and play a constructive role in implementing the modalities of the arrangement in line with international standards.”

She added that UNHCR is ready to provide technical support to both governments, including registering the refugees in Bangladesh and to help determine the voluntary nature of their decision to return.

“As the UN Secretary-General has noted, restoring peace and stability, ensuring full humanitarian access and addressing the root causes of displacement are important pre-conditions to ensuring that returns are aligned with international standards.

“Equally important is the need to ensure that the refugees receive accurate information on the situation in areas of potential return, to achieve progress on documentation, and to ensure freedom of movement. It is critical that the returns are not rushed or premature, without the informed consent of refugees or the basic elements of lasting solutions in place.”

Gluck noted that while the numbers of refugees have significantly decreased, their needs remain urgent – for food, water, shelter and health care, as well as protection services and psychosocial help.

“The areas where the refugees are staying are extremely densely populated.  There is the risk of infectious disease outbreaks and fire hazards,” she said. “And, with the rainy season and monsoon rains approaching, we are very concerned at how this population, living in precarious circumstances, will be affected. UNHCR it working with partners to prepare for and minimize these risks.”

She said UNHCR has already provided upgraded shelter kits for 30,000 families; and will expand distributions for around 50,000 more this year. The kits include bamboo pieces and plastic tarpaulin, which will allow families to build stronger sturdier, waterproof shelters, better able to withstand heavy rains and winds.

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Thousands Still Dying at Sea En Route to Europehttp://www.ipsnews.net/2018/01/thousands-still-dying-sea-en-route-europe/?utm_source=rss&utm_medium=rss&utm_campaign=thousands-still-dying-sea-en-route-europe http://www.ipsnews.net/2018/01/thousands-still-dying-sea-en-route-europe/#respond Mon, 15 Jan 2018 07:39:23 +0000 Tharanga Yakupitiyage http://www.ipsnews.net/?p=153861 Amid concerns that 160 people may have drowned while attempting to cross the Mediterranean this week alone, the UN refugee agency have urged countries to offer more resettlement places. Though the influx of refugees and migrants has slowed, many are still embarking on dangerous journeys to Europe. “[We] have been advocating for a comprehensive approach […]

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Somali refugees on the Tunisian desert. Credit: IPS

By Tharanga Yakupitiyage
UNITED NATIONS, Jan 15 2018 (IPS)

Amid concerns that 160 people may have drowned while attempting to cross the Mediterranean this week alone, the UN refugee agency have urged countries to offer more resettlement places.

Though the influx of refugees and migrants has slowed, many are still embarking on dangerous journeys to Europe.

“[We] have been advocating for a comprehensive approach to address movements of migrants and refugees who embark on perilous journeys across the Sahara Desert and the Mediterranean,” said spokesperson for the Office of the UN High Commissioner for Refugees (UNHCR) William Spindler.

On Monday, the Italian coastguard picked up 60 survivors and recovered eight corpses. Up to 50, including 15 women and 6 children, are feared to have drowned.

Most recently on Wednesday, an inflatable boat carrying 100 refugees sank off the coast of Libya. Libya is among the major countries of departure for refugees.

Approximately 227,000 refugees are estimated to be in need of resettlement in 15 priority countries of asylum and transit along the Central Mediterranean route.

Despite appealing for just 40,000 resettlement places last year, UNHCR has thus far received 13,000 offers of resettlement places.

“Most of these are part of regular established global resettlement programmes and only a few represent additional places,” Spindler said.

After stories of migrants being sold at an auction and being held in horrific conditions in detention centers were revealed, both UNHCR and the International Organization for Migration (IOM) have helped evacuate hundreds of vulnerable refugees from Libya to Niger.

However, the European Union has continued its policy of assisting the Libyan Coast Guard to intercept and return migrants in the Mediterranean.

“The suffering of migrants detained in Libya is an outrage to the conscience of humanity…what was an already dire situation has now turned catastrophic,” said UN High Commissioner for Human Rights Zeid Ra’ad al-Hussein, adding that the EU’s policy is “inhuman.”

“We cannot be a silent witness to modern day slavery, rape and other sexual violence, and unlawful killings in the name of managing migration and preventing desperate and traumatized people from reaching Europe’s shores,” he continued, calling for the decriminalization of irregular migration in order to help protect migrants’ human rights.

Human rights officials have also criticized the EU-Turkey deal which returns migrants who have entered the Greek islands to Turkey. Many have found that asylum seekers are also not safe in Turkey as the country does not grant asylum or refugee status to non-Europeans.

UNHCR called for efforts to strengthen protection capacity and livelihood support in countries of first asylum, provide more regular and safe ways for refugees to find safety through resettlement or family reunification, and address the root causes of refugee displacement.

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The Data Revolution Should Not Leave Women and Girls Behindhttp://www.ipsnews.net/2018/01/data-revolution-not-leave-women-girls-behind/?utm_source=rss&utm_medium=rss&utm_campaign=data-revolution-not-leave-women-girls-behind http://www.ipsnews.net/2018/01/data-revolution-not-leave-women-girls-behind/#respond Tue, 09 Jan 2018 16:20:56 +0000 Jemimah Njuki http://www.ipsnews.net/?p=153800 Jemimah Njuki is an expert on agriculture, food security, and women’s empowerment and works as a senior program specialist with IDRC. She is an Aspen Institute New Voices Fellow.

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Most African farmers are women. Credit: IPS

By Jemimah Njuki
OTTAWA, Canada, Jan 9 2018 (IPS)

If there is one political principle that has been constant throughout the history of human civilization it is the fact that land is power. This is something that is particularly true, and often painfully so, for women who farm in Africa.

Though women in Africa are far more likely to farm than men, they are also much less likely to have secure rights to the land where they cultivate crops and they typically hold smaller plots of inferior quality.

As a researcher who studies the role of gender in agriculture, I want to do my part to address this injustice, because when women have stronger rights to land, their crop yields increase and they have higher incomes and more bargaining power within the household. Research has shown that stronger land rights leads to other benefits such as better child nutrition and improved educational attainment for girls.

But as I delve deeper in to the issue, I frequently encounter another political constant, which is the fact that information is power. And one manifestation of the chronic neglect of women in agriculture is the lack of data that would help illuminate and address their plight.

For example, the Bill & Melinda Gates Foundation has launched the Goal Keepers Initiative, which is making a concerted effort to track progress toward achieving the United Nation’s Sustainable Development Goals. Examining the first ever report on the program launched just a few weeks ago, the first thing I did was scroll down to the section on Goal 5, “Achieve Gender Equality and Empower all Women and Girls.” When examining the indicators related to gender, which include tracking the percentage of women who have secure land rights, I kept encountering the phrase, “Insufficient data” in big, bold red capital letters!

Without data, it is impossible to track progress or identify policies and interventions that are achieving gender equality. In order to develop solutions—whether around land rights or the many other challenges women and girls face–we need data that highlights current problems and assesses their impact.

A good example of how sex-specific data fosters progress is in financial inclusion. Sex-specific data gives us information about who is accessing which kind of products, which channels they use and what the gaps are. Being aware of these gaps is essential to overcome them, and this is impossible without data sets for both men and women. In Rwanda, use of sex-specific data has led to the targeting of groups who are excluded from the financial system, raising the financial inclusion index rise from 20 percent in 2008 to 42 percent in 2012.

A report by Data2X, an initiative of the United Nations Foundation, indicates that although close to 80 percent of countries globally regularly produce sex-specific statistics on mortality, labor force participation, and education and training, less than one-third of countries separate statistics by sex on informal employment, entrepreneurship (ownership and management of a firm or business) and unpaid work, or collect data about violence against women. This leads to an incomplete picture of women’s and men’s lives and the gaps that persist between them, which constrains the development of policies and programs to address these gaps.

A key challenge to collecting these data sets is investment. We need financial investments to collect data on the situation of women and girls at different levels –local, national and international. A study carried out by the UN Statistics Division in collaboration with the UN regional commissions in 2012, showed that out of 126 responding countries only 13 percent had a separate budget allocated to specific gender statistics, 47 percent relied on ad-hoc or project funds and the remaining 39 percent had no funds at all.

In 2016, the Bill & Melinda Gates Foundation invested US $80M to improve the collection of sex specific data. In Uganda, the World Bank Living Standards Measurement Study is collaborating with the United Nations Evidence and Data for Gender Equality initiative and the Uganda Bureau of Statistics to collect and analyze asset ownership by different members of households.

It would help to know for example what assets women own so as to develop programs and policies that benefit both men and women and that close persistent gender gaps. At Canada’s International Development Research Centre, we are supporting sex-specific reporting and registration of vital and civil events—including births and deaths to help track progress on such indicators as women’s reproductive health and child mortality.

Globally, there is still no available data on how many women own customary land. One challenge is that the rules, norms, and customs which determine the distribution of land and resources are embedded in various institutions in society—family, kinship, community, markets, and states. For example, when I was visiting Mali in 2012, I attended a village’s community meeting where I witnessed the village chief grant a local women’s group a local deed so they could farm together and raise their incomes. But there was no formal document or record.

Without this data, when land is privatized or formalized, women often lose control of customary land. For example in post-independence Kenya, Uganda and Zimbabwe, during the land registration and formalization experience, lack of data and consideration of women in customary land rights led to the documentation of land in the name of the head of the household only, often a man. This gave the man authority to use, sell, and control the land, with women losing the customary access and rights that they had previously enjoyed.

International agencies and governments must commit to investing in collecting more data on women and girls. Closing this gender data gap is not only useful for tracking progress of where we are with the SDGs, but it can also point to what interventions are working, and what needs to be done to accelerate progress towards gender equality and the empowerment of women and girls.

What gets measured matters, and what matters gets measured. Women and girls matter.

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Marooned in Bangladesh, Rohingya Face Uncertain Futurehttp://www.ipsnews.net/2018/01/marooned-bangladesh-rohingya-face-uncertain-future/?utm_source=rss&utm_medium=rss&utm_campaign=marooned-bangladesh-rohingya-face-uncertain-future http://www.ipsnews.net/2018/01/marooned-bangladesh-rohingya-face-uncertain-future/#respond Wed, 03 Jan 2018 23:30:48 +0000 Sohara Mehroze http://www.ipsnews.net/?p=153729 In this special series of reports, IPS journalists travel to the border region between Bangladesh and Myanmar to speak with Rohingya refugees, humanitarian workers and officials about the still-unfolding human rights and health crises facing this long-marginalized and persecuted community.

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The Political Responsibility in the Collapse of Our Planethttp://www.ipsnews.net/2017/12/political-responsibility-collapse-planet/?utm_source=rss&utm_medium=rss&utm_campaign=political-responsibility-collapse-planet http://www.ipsnews.net/2017/12/political-responsibility-collapse-planet/#comments Wed, 27 Dec 2017 20:47:28 +0000 Roberto Savio http://www.ipsnews.net/?p=153685 Roberto Savio is founder of IPS Inter Press Service and President Emeritus

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The premises of a school inundated by floodwater. Shibaloy in Manikganj district, Bangladesh. Credit: Farid Ahmed/ IPS

By Roberto Savio
ROME, Dec 27 2017 (IPS)

On 20 December, Europe’s 28 Ministers of Environment met in Brussels, to discuss the plan for reducing emissions prepared by the Commission, to comply with the Paris Agreement on climate change. Well, it is now clear that we have lost the battle in keeping the planet as we have known it. Now, of course, this can be considered a personal opinion of mine, devoid of objectivity.

Therefore I will bring a lot of data, history and facts, to make it concrete. Data and facts have good value: they focus any debate, while ideas do not. So those who do not like facts, please stop reading here. You will escape a boring article, as probably all of mine are, because I am not looking to entertain, but to create awareness. If you stop reading, you will also lose a chance to know our sad destiny.

As common in politics now, interests have won over values and vision. The ministers decided (with some resistance from Denmark and Portugal), to reduce Europe’s commitment. This is going in the Trump direction, who left the Paris Agreement, to privilege American interests, without any attention to the planet. So, Europe is just following.

Of course, those alive now will not pay any price: the next generations will be the victims of a world more and more inhospitable. Few of the people who made to Paris in 2015, solemn engagements in the name of all humankind to save the planet, will be alive 30 years from now, when the change will become irreversible. And it will be also clear that humans are the only animals who do not defend nor protect their habitat.

While we talk on how to reduce the use of fossils, we are doing the opposite. At this very moment, we spend 10 million dollars per minute, to subsidize the fossils industry. Just counting direct subsidies, they are between 775 billion dollars to 1 trillion, according to the UN

First of all, the Paris’ Agreement was adopted by the 195 participating countries, of which 171 have already subscribed to the treaty, in just two years. Which is fine, except that the treaty is just a collection of good wishes, without any concrete engagement.

To start with, it does not set up specific and verifiable engagements. Every country will set its own targets, and will be responsible for its implementation. It is like to ask all citizens of a country to decide how much taxes they want to pay, and leave to them to comply, without any possible sanction.

Europe engaged in Paris in 2015, to reach 27% of renewable energies (by scaling down the use of fossils), fixing a target of 20% for 2020. Well, from 27%, it went down to 24.3%. In addition, the ministers decided to keep subsidies for the fossils industry, until 2030 instead of 2020, as planned. And while the proposal of the Commission was that fossils plants would lose subsidies if they did not cut their emissions to 500 grams of CO2 per ton by 2020, the ministers extended subsidies until 2025.

Finally, the Commission proposed to cut biofuels (fuels made with products for human consumption, like palm oil) to 3.8%. Well, the ministers, in spite of all their declarations about the fight against hunger in the world, decided to double that, at 7%.

Now let us go back to the real flaw of the Paris Agreement. Scientists took two decades to conclude with certitude that climate change is caused by human activities, despite a strong and well financed fight by the coal and fuel industry, to say otherwise.

The International Panel on Climate Change, is an organization under the auspices of the UN, whose members are 194 countries, but its strength comes from the more than 2.000 scientists from 154 countries who work together on climate. It took them from 1988, (when the IPCC was established), to 2013, to reach a definitive conclusion: the only way to stop the planet deteriorating more rapidly, emissions should not exceed 1.5 centigrade over what was the Earth’ temperature in 1850.

In other words, our planet is deteriorating already, and we cannot revert that. We have emitted too much gas and pollution, that are at work already. But by halting this process, we can stabilize it, but never cancel what we did cause, at least for thousands of years.

The Industrial revolution is considered to start in 1746, when industrial mills replaced individual weavers. But it started in great scale in the second half of the 19th century, with the second industrial revolution.

This involved the use of science in the production, by inventing engines, railways, creating factories, and other means of industrial production. We started to register temperatures in 1850, when this was done with thermometers.

So, we can see how coal, fossils and other fuels started to interact with the atmosphere. What the scientists concluded was that if we went over 1,5 centigrade of the 1.850’s temperature, we would irreversibly cross a red line: we will not be able to change the trend, and climate will be out of control, with very dramatic consequences for the planet.

Roberto Savio

Paris conference is a final act of a process who started in Rio de Janeiro in 1992, with the Conference on Environment and Development, where two leaders have now passe away, Boutros Boutros Ghali and Maurice Strong, ran the first summit of heads of state on the issue of environment.

Incidentally, it is worth remembering that Strong, a man who spent all his life to make environment a central issue, did open up the conference for the first time to representatives of civil society, beyond governmental delegations. Over 20.000 organizations, academicians, activist come to Rio, starting the creation of a global civil society recognized by the international community.

In 1997, as a result of Rio Conference, the Kyoto Treaty was adopted, with the aim to reduce emissions. The results show that during the nearly two decades bringing to Paris, the results are very modest. Coal went from 45,05% in 1950, to 28.64 in 2016, also because of new technologies, but petrol increased from19.46, to 33.91 and renewables were a negligible reality.

So, Paris was left with a very urgent task, after having lost already two decades. And according to the World Bank, in 2014 , there are 1,017 billion people without electricity, with Africa where only 20% of people has access to electricity. For all these people we should provide renewable energy, to avoid a dramatic increase of emissions.

Paris was supposed to be really a global agreement, unlike Tokyo. So, to bring as many countries as possible on board, it is a little known dirty secret that the UN decided to put as a goal not the very tight 1,5 centigrade as a target, but a more palatable 2 centigrade. But unfortunately, the consensus is that we have already passed the 1.5 centigrade. And the United Nations Environment Program (UNEP), has estimated that the engagements taken by the countries in Paris, if not changed, will bring us to 6 centigrade, an increase that according to the scientific community would make a large part of the earth inhabitable.

In fact, in the last four years we had the hottest summers since 1850. And in 2017 we have the highest record of emissions in history, because they have reached 41.5 gigatons. Of those, 90% comes from activities related to human actions, while renewables (cost for which has now become competitive with fossils), still cover only 18% of the energy consumed in the world. And now let us move to another important dirty secret.

While we talk on how to reduce the use of fossils, we are doing the opposite. At this very moment, we spend 10 million dollars per minute, to subsidize the fossils industry.

Just counting direct subsidies, they are between 775 billion dollars to 1 trillion, according to the UN. The official figure just in the G20 is 444 billion. But then, the International Monetary Fund accepted the economists’ view that subsidies are not only cash: it is the use of the earth and society, like destruction of soil, use of water, political tariffs (the so-called externalities, the cost which exists but are external to the budget of the companies).

If we do that, we reach the staggering amount of 5.3 trillion: they were 4.9 trillion in 2013. That is 6.5% of the global Gross National Product…and that is what it costs to governments, society and earth, to use fossils.

That was nowhere in in the news media. Few know the strength of the fossils industry. Trump wants to reopen the mines, not only because that brings him votes by those who lost an obsolete job, but because the fossils industry is a strong backer of the Republican party.

The billionaire Koch brothers, the largest owners of coal mines in the US, have declared that they have spent 800 million dollars in the last electoral campaign. Someone might say: these things happen in the US but according to the respected Transparency International, there are over 40.000 lobbyists in Europe, working to exercise political influence.

The Corporate Europe Observatory, which studies the financial sector, found out that it spends just in Brussels 120 million a year, and employs 1.700 lobbyists. It found that they lobbied against regulations, with more than 700 organizations, which outnumbered trade unions and civil society organizations, by a factor of seven.

The power of the fossils industry explains why in 2009 governments helped the sector with 557 billion dollars, and only 43 to 46 billion dollars to all renewable industry (International Energy Agency estimates).

It is clear that citizens have no idea that a part of their money is going to keep alive, with good profits, a sector which is well aware that they are key in the destruction of our planet.

A sector that knows well that they are now emitting 400 particles of CO2 per million, when the red line was considered 350 particles PM. But people do not know, and this is a spectacular feast of hypocrisy that goes on.

The UN, in 2015, conducted an extensive poll, with the participation of 9.7 million people. They were asked to choose as their priorities six themes out of 16. The first of the themes presented was climate change. Well, the first one chosen, with 6.5 million of preferences, was “a good education”. The second and third, with over 5 million of preferences, were “a better health system”, and “better opportunities for work”. The last of the 16 themes, with less than 2 million, was the “climate change. “And this was also in the preferences of the least developed countries, who are going to be the major victims of climate change.

The 4.3 millions poorest participants, from the least developed countries, put again education first (3 million preferences); climate change was last, with 561.000 votes…Not even in Polynesia, Micronesia and Melanesia, islands which could disappear, climate change was at the first place. This is an ample proof that people do not realize where we are: at a threshold of the survival of our planet, as we have known it for several thousand years.

So, if citizens are not aware, and therefore not concerned, why should the politicians be? The answer is because they are elected by citizens to represent their interests, and they can make more informed decisions.How does this ring in your ears? With lobbyist all over fighting for interests, what can be well sold as jobs and stability?

 

Holstein cows in a feedlot. Credit: Bigstock

 

And now, let us bring a last dirty secret, to show how far we are from really addressing the control of our climate. In addition to what we said, there is a very important issue, that has even been discussed in Paris: the agreements are entirely about the reduction of emissions by the fossils’ industry. Other emissions have been left entirely out.

Now, a new documentary, the Cowspiracy: The Sustainability Secret, produced by Leonardo di Caprio, has ordered several data presented by vegans, on the impact of animals in the climate change. They are considered somehow exaggerated. But their dimensions are so big, that they add anyhow another nail to our coffin.

Animals emit not CO2, but methane which is at least 25 % more damaging than C02. There is recognition by the UN, that while all means of transportation, from cars to planes, contribute to 13% of emissions, cows do with 18%…

And the real problem is the use of water, a key theme that we have no way to address in this article. Water is considered even by military strategist to be soon the cause of conflicts, as petrol has been for a long time.

One pound of beef uses 2.500 gallons of water. That means that a hamburger is the equivalent of two months of showers…! And to have 1 gallon of milk, you need 100 gallons of water. And people worldwide, use one tenth of what cows need.

Cattle uses 33% of all water, 45% of the earth, and are the cause of 91% of the Amazon deforestation. They also produce waste 130 times more than human beings. Pig raising in the Netherlands is creating serious problems because theirs waste acidity is reducing usable land. And consumption of meat is increasing in Asia and Africa, very fast,it is considered a mark of reaching the choices of rich societies.

Beside this serious impact on the planet, there is also a strong paradox of sustainability for our human population. We are now 7.5 billion people, and we will reach soon 9 billion. The total food production worldwide could feed 13 to 14 billion people. Of this a considerable part goes wasted, and does not reach people (theme for an article by itself). But the food for animals could feed 6 billion people.

And we have one billion people starving. This is proof how far we are from using resources rationally for the people living on earth. We have enough resources for everybody, but we cannot administer them rationally. The number of obese has reached the number of those starving.

The logical solution in this situation would be to reach an agreement on a global governance, in the interest of the planet of humankind. Well, we are going in the opposite direction. The international system is besieged by nationalism, who make increasingly impossible to reach meaningful solutions.

 

Globally, 75 percent of coral reefs are under threat from overfishing, habitat destruction, pollution and acidification of the seas due to climate change. Credit: Bigstock

 

Let us conclude with a last example: overfishing. Its now two decades that the World Trade Organization (which is not part of the UN, and was built against the UN) tries to reach an agreement on over- fishing with mega nets, who scoop up an enormous quantity of fishe: 2.7 trillion, of which they keep only one fifth, and they throw back four fifth.

Well, at the last WTO conference on the 13 December in Buenos Aires, governments were again not able to reach an agreement on how to limit illicit fishing. Big fishes are now down at 10% of 1970.And we are exploiting one third of all stocks.

It is estimated that illegal fishing puts between 10 billion and 23 billion on the black market, according to a study by 17 specialized agencies, with a full list of names. And again, governments spend 20 billion per year to finance the increase of their fishing industry…another example of how interest win on the common good.

I think now we have enough data, to realize the inability of governments to take seriously their responsibilities, because they have the necessary information to know that we are going toward a disaster.

In a normal world, Trump’s declaration that Climate control is a Chinese hoax, and it is invented against the interest of United States, should have caused more global emotion.

Also, because while Trump’s internal policies are an American question, climate is affecting all the 7.5 billion in the planet, and Trump was elected by less than a quarter of eligible voters: nearly 63 million. Too little to take decisions which affect all humankind.

And now European ministers are following, as a proverb says, money speaks and ideas murmur.. And there are many who are preparing to speculate on climate change. Now that we have lost 70% of the ice of the North Pole, the maritime industry is gearing to use the Northern Route, which will cut cost and time by a 17%.

And the British wine industry, since the warming of the planet, is increasing production by 5% each year. The vineyards planted in Kent or Sussex, with a calcar soil, are now bought from producers of Champagne, who plan to move there. The UK is already producing 5 million bottles of wine and sparkling wines, which are all sold. This Christmas, local sparkling wine will exceed champagnes, caves, prosecco and other traditional Christmas drinks.

We have all seen, at no avail, the increase of hurricanes and storms, also in Europe, and a record spread of wildfires. The UN estimates that at least 800 million people will be displaced by climate change making uninhabitable several parts of the world. Where they will go? Not to the United States or Europe, where they are seen as invaders.

We forget that the Syrian crisis came after four years of drought (1996-2000) which displaced over a million peasants to the towns. The ensuing discontent fuelled the war, with now 400.000 dead and six million refugees.

When citizens will awake to the damages, it will be too late. Scientists think that it will become clearly evident after thirty years. So why do we worry now ? That is a problem for the next generation, and companies will continue to make money until the last minute, with complicity of governments and their support,so, let us ride the climate change tide.

Let us buy a good bottle of British champagne, let us drink it on a luxury cruise line over the Pole, and let the orchestra play, as they did in the Titanic until the last minute!

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How a Venezuelan Living with HIV Could Change the Way Mexico Deals with Refugeeshttp://www.ipsnews.net/2017/12/how-a-venezuelan-living-with-hiv-could-change-the-way-mexico-deals-with-refugees/?utm_source=rss&utm_medium=rss&utm_campaign=how-a-venezuelan-living-with-hiv-could-change-the-way-mexico-deals-with-refugees http://www.ipsnews.net/2017/12/how-a-venezuelan-living-with-hiv-could-change-the-way-mexico-deals-with-refugees/#respond Thu, 21 Dec 2017 12:03:46 +0000 Josefina Salomon http://www.ipsnews.net/?p=153662 Josefina Salomon is Media Manager at Amnesty International

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Daniel (not his real name), is a Venezuelan living with HIV. Mexico gave him refugee status, based on a humanitarian cause. Credit: Sergio Ortiz/ Amnistía Internacional

Daniel (not his real name), is a Venezuelan living with HIV. Mexico gave him refugee status, based on a humanitarian cause. Credit: Sergio Ortiz/ Amnistía Internacional

By Josefina Salomon
MEXICO CITY, Dec 21 2017 (IPS)

As Daniel*, a 26-year-old architect, stood before a visibly exhausted doctor in the main public hospital of the once-idyllic beach resort town of Isla Margarita, northern Venezuela, a terrifying premonition took hold of him.

“We are not doing tests until further notice. The machine is not working and we don’t have any reagents,” the man in the white coat told him.

It was early June 2015. Venezuela was on the verge of a humanitarian crisis that was forcing people to queue for basic food and medical supplies. A couple of days before, Daniel had been diagnosed with HIV during a routine health check.

The tests being discussed were essential to establish the type of treatment he needed. But the main hospital in one of the richest states in Venezuela did not have the necessary supplies to carry them out.

Josefina Salomon. Credit: Amnistía Internacional

Josefina Salomon. Credit: Amnistía Internacional

In much of the world, advances in treatment has meant HIV is now a chronic, manageable condition similar to diabetes, but in Venezuela it can now mean serious illness and risk of death.

Daniel’s premonition was brutally simple: no test. No treatment. No future.

 

The lack of everything

“Eventually doctors told me I was going to have to wait at least three months to have the tests done and start the treatment. I could not wait that long,” Daniel recalls.

In response to this crushing setback, he chose an option that most Venezuelans could not afford. He got hold of all the money he could, and went to a private health center.

But in Venezuela, where people can barely keep up with the ever-growing exchange rate and you need a couple of stacks of bills to buy a pizza, this was trickier than he thought.

At the time, Daniel made 180,000 bolivares (the Venezuelan currency) a month, way higher than the minimum salary which was then at nearly 10,000 bolivares. The test cost 120,000.

Daniel needed one test every four months to ensure he was receiving the right treatment.

After the tests, his doctors prescribed an anti-retroviral – vital to keeping his immune system strong and preventing opportunistic illnesses from wreaking havoc on the body – and multivitamins to keep his immune system healthy. With a diagnosis and a prescription, Daniel went on a quest across the country.

He eventually got hold of 30 pills, enough to last a month, but finding over-the-counter multivitamins was nearly impossible.

By 2015, understocked pharmacies were used to seeing clients with prescriptions for one medicine and a long list of alternative medicines.

According to a report by a coalition of social and health organizations in Venezuela, in 2015 most public hospitals had an 80% shortage of medicines and a 70% shortage of medical supplies. Meanwhile, 60% of equipment simply did not work, and more than 50% of health professionals had fled the country.

The situation has deteriorated even further since then. By March 2016, there was an 85% shortage of basic medicines and medical supplies across the country.

 

Humanitarian crisis

In Venezuela, 90% of medicines and medical supplies are imported. These are paid for with foreign currency, which is administered and tightly controlled by the state.

In 2010, when the Venezuelan economy began spiraling out of control, the late President Hugo Chavez restricted the amount of foreign currency it allocated to the health and food sectors. Between 2014 and 2015, his successor Nicolas Maduro cut it by 65%. With none of these drugs being produced domestically, over time seven out of every 10 medicines simply disappeared.

The crisis was exacerbated when, due to Venezuela’s growing debts since 2010, most international drug suppliers stopped selling to the country.

The government stopped publishing any kind of health statistics, including causes of death, at least three years ago. The number of deaths caused by the collapse of the country’s health system is therefore impossible to know, but experts fear the number might be in the thousands.

When it comes to HIV, the picture is even more dire.

Feliciano Reyna, founder of Acción Solidaria, a local organization responding to HIV & AIDS in the country, says the health system is in a critical state.

“We are going through a humanitarian crisis. In 2014, the government accepted medicines from the Panamerican Health Organization but they were not enough and there are no signs that there will be medicines available next year. We estimate that approximately 77,000 people will not have medicines after February. We have gone back decades,” he said from his office in Caracas.

Feliciano’s organization receives donations of medicines from private individuals which he gives to the hundreds of desperate people that knock on his door every day.

“The damage this situation causes is incalculable. The uncertainty, the anxiety. People might receive their medicines today but they do not know what they will do next month.”

 

 

Daniel's hands. Credit: Sergio Ortiz/Amnistía Internacional

Daniel’s hands. Credit: Sergio Ortiz/Amnistía Internacional

 

A life-changing letter

Life for Daniel became increasingly unbearable.

As months went by and prices for the tests he needed increased sharply, he began struggling to afford them. Working long hours at a studio in Isla Margarita, he didn’t have time to line up in seemingly endless queues in the few state-owned shops that sold food at “controlled prices”.

He grew more and more stressed and his health deteriorated. His weight dropped from 78kg to 64kg.

“Every time I went to have a test done, it would be 100 or 200% more expensive. I knew the time would come when I was not going to be able to pay the medical tests and consultations. That’s when I knew that the only option was to leave, at any cost,” he says.

When I meet Daniel in Mexico he is sitting behind a desk at his minimalist design studio in a small, bright house on the outskirts of Merida, southern Mexico. He shares the place with his partner, also from Venezuela.

Daniel is happy. He should be.

A few days earlier, he received a letter that would change his life.

It is a 21-page document from the Mexican Commission for Refugee Aid COMAR for its Spanish acronym), and it demonstrates a new trend in how the Mexican government decides who it will accept as a refugee, and who it won’t.

The document details the current state of affairs in Venezuela and argues that the lack of essential, life-saving medicines are part of the “massive human rights violations” in the country which merits Mexico granting asylum in this case.

Daniel’s story is one of a very small handful. He is one of the first Venezuelans to be taken by Mexico as a refugee on the basis of not being able to find life-saving medical treatment in his homeland.

Mexico has, in recent years, turned away more asylum seekers than it allows in. Most arrive from Central America, fleeing horrendous rates of violent crime.

Traditionally, in order to be considered a refugee in Mexico, an individual has to show that his or her life would be in danger at home, due to war or generalized violence. Being ill would not help anyone qualify as a refugee.

Daniel’s lawyers used a piece of legislation little known outside of Latin America – the Cartagena Declaration on Refugees – to argue that the lack of medicines in Venezuela posed such a risk to his life that it qualified as a “grave human rights violation”.
But Daniel’s lawyers used a piece of legislation little known outside of Latin America – the Cartagena Declaration on Refugees – to argue that the lack of medicines in Venezuela posed such a risk to his life that it qualified as a “grave human rights violation”.

Experts believe this technicality could open the door for thousands of Venezuelan refugees.

Carolina Carreño from Sin Fronteras, the organization that helped secure Daniel’s asylum, does not go overboard in her praise of the Mexican authorities.

“We celebrate that the government has taken this case, but they are just doing what the law says. There are still many challenges when it comes to the way refugees are treated in this country. There are problems when it comes to identifying the people who are in great need of international protection, and the help they need once they are taken as refugees.”

 

Mass exodus

Daniel’s desperation to leave the country is not unusual. The number of Venezuelans fleeing the country has rocketed in recent years.

According to the latest available data from the United Nations High Commission for Refugees, 100,000 Venezuelans applied for asylum across the world between January 2014 and October 2017 – the numbers doubling in the first half of 2017. Many Venezuelans feel the only way to escape the crisis is to leave home all together.

Mexico is among the top seven countries where Venezuelans are fleeing to, according to the UNHCR. The others are Brazil, Costa Rica, Panama, Peru, Spain and the USA.

However, the number of refugees is likely to be far higher as many flee to neighbouring countries – for example Colombia – and never apply for asylum.

According to figures from COMAR, just one Venezuelan applied for asylum in Mexico in 2013. In the first half of 2017, that number rose to 2676 – second only to the number of people applying for asylum from violence-ridden Honduras.

As the “Venezuelan exodus” has grown, countries in the Americas have tried to rise to the challenge and developed strategies to deal with the new influx of refugees.

Colombia, for example, created a special stay permit for Venezuelans who entered the country legally before July 2017 and had a stamped passport. This measure is supposed to benefit 210,000 people, however has only benefited about 65.000 people.

Brazil created a two-year temporary residence permit on humanitarian grounds, giving thousands of people the right to work.

In February 2017, Peru created a temporary residence permit which benefited 11,000 people.

But Mexico’s decision to give refugee status to Daniel, based on a humanitarian cause, left even his lawyers surprised.

 

A long way from home

Yet the journey from Venezuela to Mexico was far from smooth.

When Daniel arrived in Cancun in March 2017, his dreams of safety were cut short when immigration authorities detained him at the airport and rejected his claim for asylum – despite the fact that he had a thick folder full of documents proving that he needed protection.

Daniel was put on a plane back to Maracaibo, Venezuela.

But he didn’t give up. He couldn’t afford to.

Daniel and his partner, who was already living in Mexico, consulted with lawyers from a Mexican organization helping refugees. They spent three months developing a water-tight case.

Meanwhile, the situation in Venezuela had deteriorated even further.

Daniel’s neighborhood had become increasingly dangerous, and he had to walk 16km to the travel agency to buy a plane ticket to Mexico as there was no other form of transport available, nor gas for the cars.

“I realized we were reaching rock bottom. I was wondering what I was going to do if I had to stay there, to get hold of my medicines. There were many shops that were not even open because they were scared of being robbed and because people had no way of getting there. It was a bit apocalyptic.”

Daniel knew this attempt at asylum would be his last. He was not going to be able to gather the money to travel again.

Arriving at Mexico City airport in May 2017, he handed over a letter requesting asylum. He was let in. The next day, he went to COMAR to make a formal request for asylum.

Following three months of relentless interviews, where he repeatedly had to recall his predicament in Venezuela, Daniel finally received the asylum letter he had so desperately fought for.

He is now where he wanted to be. With his partner, working in a studio in Merida, and with good chance of living healthily with HIV. He has a future, and he hopes others will not be denied theirs.

“I never thought I was going to need to apply for asylum in another country. But today, I feel very lucky. I just ask governments to help other people like me – we only need a chance.”

 

*Not his real name

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Rise of Teenage Pregnancy Deters Development Goalshttp://www.ipsnews.net/2017/12/rise-teenage-pregnancy-deters-development-goals/?utm_source=rss&utm_medium=rss&utm_campaign=rise-teenage-pregnancy-deters-development-goals http://www.ipsnews.net/2017/12/rise-teenage-pregnancy-deters-development-goals/#respond Tue, 19 Dec 2017 20:02:45 +0000 Lorenzo Jmenez http://www.ipsnews.net/?p=153624 Lorenzo Jiménez de Luis, is UN Resident Coordinator and UNDP Resident Representative in Dominican Republic

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Teenage pregnancy: 2 out of 10 women between the ages of 15 and 19 in the Dominican Republic have been pregnant or have been mothers

Teenage mom with her baby. Credit: IPS

By Lorenzo Jiménez de Luis
SANTO DOMINGO, Dominican Republic, Dec 19 2017 (IPS)

A few years ago, someone shared a video with me that deeply impacted me. It was called “The Girl Effect”. In three minutes, the video demonstrates the fate of millions of girls and teenagers around the world.

Years later, when I arrived in the Dominican Republic and studied its challenges in terms of human development, I remembered that video and concluded that if the Dominican Republic does not resolve the problem of teenage pregnancy, despite its high sustained economic growth, its important social transformation and its modernization, it will never reach the Sustainable Development Goals by 2030.

A few days ago, the United Nations Development Programme (UNDP) launched its 2017 National Human Development Report for Dominican Republic devoted to this topic. This report is complemented in turn by another report presented by UNICEF and the World Bank in August and also by the report presented in November by the National Statistics Office (ONE in Spanish) and the United Nations Population Fund (UNFPA).

The three documents make up a global and coherent product of a sinister reality. Two out of 10 women between the ages of 15 and 19 in the Dominican Republic have been pregnant or have been mothers; representing 15.9% of the country’s population. Surely it will be a higher percentage given that pregnancies begin to occur as early as twelve years of age.

The causes of this sinister reality, briefly described, are multiple; but its consequences are clear: low or very low quality of life, poor welfare, recurrent poverty, exclusion.

The link between poverty and child and teenage pregnancy is clear, and the UNDP National Human Development Report shows that the mentioned link is to be found in the opportunity cost that teenage pregnancy represents for the human development of these young women. That is, the opportunities that they lose as a consequence of those early pregnancies or maternities.

This reality, I insist sinister indeed, worsens when considered that it has an equally quantifiable impact on the young pregnant woman, on the family environment of the pregnant girl or teenager and of course also on the child, the product of that pregnancy.

We are talking about half of the population of the country. The good news, however, is that the spooky effects of teen pregnancy are not necessarily irreversible.

The trend could be reversed if a new architecture of policies that affect and integrate prevention is urgently introduced, as well as the mitigation of the effects of pregnancy through care and protection policies. Policies that ensure greater opportunities.

A new architecture with a multidimensional character, that reaches the local level (territorial approach) and is implemented over time.

If the above is adopted and introduced soon, the possibilities of complying with the commitments acquired by the State can be fulfilled. If it is not the case; I am afraid that we will be talking about a country with a half future. The one of the privileged half of the population.

 

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Production Diversity, Diet Diversity and Nutrition in Sub -Saharan Africahttp://www.ipsnews.net/2017/12/production-diversity-diet-diversity-nutrition-sub-saharan-africa/?utm_source=rss&utm_medium=rss&utm_campaign=production-diversity-diet-diversity-nutrition-sub-saharan-africa http://www.ipsnews.net/2017/12/production-diversity-diet-diversity-nutrition-sub-saharan-africa/#respond Tue, 19 Dec 2017 14:13:20 +0000 Raghav Gaiha and Shantanu Mathur http://www.ipsnews.net/?p=153622 Raghav Gaiha is (Honorary) Professorial Research Fellow, Global Development Insitute, University of Manchester, England; & Shantanu Mathur is Lead Advisor, Programme Management Department, International Fund for Agricultural Development, Rome, Italy. The views are personal.

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Raghav Gaiha is (Honorary) Professorial Research Fellow, Global Development Insitute, University of Manchester, England; & Shantanu Mathur is Lead Advisor, Programme Management Department, International Fund for Agricultural Development, Rome, Italy. The views are personal.

By Raghav Gaiha and Shantanu Mathur
NEW DELHI, Dec 19 2017 (IPS)

Lack of diet diversity is viewed as the major cause of micronutrient malnutrition in Sub-Saharan Africa. Imbalanced diets resulting from consumption of mainly high carbohydrate based-diets also contribute to productivity losses and reduced educational attainment and income. Consequently, micronutrient malnutrition is currently the most critical for food and nutritional security problem as most diets are often deficient in essential vitamins and minerals. In Tanzania, for example, most rural and urban households consume mainly staples as their main food, which are high in carbohydrates, but low in micronutrients and vitamins. Staple food items increase energy availability but do not improve nutritional outcomes if not consumed together with micro-nutrient rich foods.

Raghav Gaiha

A positive relationship between farm production diversity and diet diversity is plausible, because much of what smallholder farmers produce is consumed at home. However, this is more plausible for a subsistence economy than one in which market transactions are prominent. Instead of producing everything at home, households can buy food diversity in the market when they earn sufficient income. Farm diversification may contribute to income growth and stability. Besides, as the majority of smallholder households in developing countries also have off-farm income sources, the link between production diversity and diet diversity is further undermined. Finally, when relying on markets, nutrition effects in farm households will also depend on how well the markets function and who decides how farm and off-farm incomes will be allocated to food. It is well-known that income in the hands of women frequently results in more nourishing food-especially for children.

A recent study analyzed the relationship between production and consumption diversity in smallholder farm households in four developing countries: Indonesia, Kenya, Ethiopia, and Malawi (Sibhatu et al. 2014). These four countries were selected mainly because of availability of recent household data. The results are classified under (i) association between production and diet diversity, (ii) role of market access, and (iii) role of selling and buying food. Farm production diversity is positively associated with diet diversity, but the effect is relatively small. In the pooled sample (of all four countries), producing one additional crop or livestock species leads to a 0.9% increase in the number of food groups consumed This effect, however, varies across the countries in question. In Kenya and Ethiopia, the estimates are very small and not (statistically) significant. In these two countries, average production diversity is quite high; further increasing farm diversity would hardly contribute to higher diet diversity. One indicator of market access is the geographic distance from the farm household to the closest market where food can be sold or bought. The estimated effects are negative, implying that households in remoter regions have lower dietary diversity. Better market access through reduced distances could therefore contribute to higher diet diversity. Reducing market distance by 10 km has the same effect on diet diversity as increasing farm production diversity by one additional crop or livestock species.

Shantanu Mathur

A more pertinent question is whether this also leads to more healthy diets. Depending on the type of food outlets available in a particular context, buying food may be associated with rather unhealthy diet diversification, for instance, through increased consumption of fats, sweets, or sugary beverages. This is examined by using alternative diet diversity scores, including only more healthy food groups. The finding that better market access tends to increase diet diversity also holds with this alternative measure. However, it is not self-evident that this measure is appropriate for two reasons: (i) one is the failure to distinguish between processed and unprocessed, say, vegetables (eg French fries and boiled potato) with vastly different nutritional implications; and (ii) at best, diet diversity (restricted or unrestricted) is an approximation to nutrients’ intake as there are substitutions both within and between food groups in response to income and price changes (a case in point is different grades of rice).

Another approach is to take into account what households sell and buy. This information is only available for Ethiopia and Malawi. If a household sells at least parts of its farm produce, it has a positive and significant effect on diet diversity. It is also much larger than the effect of production diversity. This comparison suggests that facilitating the commercialization of smallholder farms may be a better strategy to improve nutrition than promoting more diversified subsistence production. Furthermore, the negative and significant interaction effect confirms that market participation reduces the role of production diversity in dietary quality.

Better market access in terms of shorter distance and more off-farm income opportunities increase the level of purchased food diversity. If off-farm income opportunities are greater in rural areas with short distances to market, the market access effect can’t be disentangled from the income effect. The interaction between level of farm income and participation in off-farm activities is often complex as small farmers tend to work as labourers in the latter while relatively affluent dominate as owners in more remunerative enterprises. The two important inferences are: (i) increasing on-farm diversity among smallholders is not always the most effective way to improve diet diversity and should not be considered a goal in itself; and (ii) in many situations, facilitating market access through improved infrastructure and other policies to reduce transaction costs and price distortions seems to be more promising than promoting further production diversification. One major caveat, however, remains. Even the alternative measure of diet diversity/quality is merely a crude approximation to nutrition (Gaiha et al. 2014).

In brief, market access through buying/selling food is more closely associated with diet diversity than production diversity. Diet diversity, however, is a weak proxy for nutrition. Indeed, there is no shortcut to empirical validation of the link between diet diversity and nutritional outcomes-especially consumption of micronutrients.

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Water, Water Everywhere, Costs More Than You Might Thinkhttp://www.ipsnews.net/2017/12/water-water-everywhere-costs-might-think/?utm_source=rss&utm_medium=rss&utm_campaign=water-water-everywhere-costs-might-think http://www.ipsnews.net/2017/12/water-water-everywhere-costs-might-think/#respond Mon, 18 Dec 2017 17:46:01 +0000 Daniel Waldron and Zehra Shabbir http://www.ipsnews.net/?p=153601 Daniel Waldron & Zehra Shabbir of the Consultative Group to Assist the Poor (CGAP), housed at the World Bank, is a global partnership of more than 30 leading organizations.

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Credit: Water.org

By Daniel Waldron and Zehra Shabbir
WASHINTON DC, Dec 18 2017 (IPS)

Without reliable access to water, human beings cannot survive. Yet 3 out of 10 people do not have a safely managed water supply, and 6 out of 10 lack safely managed sanitation. Over 2 billion people drank water that was fecally contaminated in 2015, and the World Bank estimates that the annual cost of poor sanitation is in excess of $260 billion annually.

The technologies that can address these shortages are not complicated, but their upfront cost remains unaffordable to many low-income families. In Indonesia, for example, connection to piped water systems averages $150, while a flush toilet can cost around $250. For comparison, 11 percent of Indonesians live on less than $27 per month.

Microfinance offers an affordable, accessible remedy to these market barriers, but water and sanitation are not traditional targets for microcredit. Loans for water supply and sanitation (WSS) improvements require technical knowledge that many financial institutions lack, and the improved water or sanitation facilities do not usually generate cash flows that repay the loan.

WSS loans often produce economic impacts, but they are more diffuse, easier seen in aggregate: the child that does not fall ill, the hours not spent walking to a well. Yet as we have seen with the financing of solar products, there may be room for a broader role in financing assets that improve quality of life and alleviate human misery. By that standard, WSS loans are incredibly sound investments.

Early successes in water supply and sanitation credit

The nonprofit Water.org is one of the global leaders in facilitating WSS investments through its global WaterCredit program. WaterCredit programs are often set up as tri-parte arrangements. A prospective borrower applies for a loan to install a toilet, buy a water tank, or finance a piped water connection (among other uses).

If approved, the money either disburses directly from the financial institution to the contractor, generally a local artisan, or to the client, who then use it to buy or build the WSS product they need.
The ideal option for the financial institution is to deliver the loan capital straight to the vendor, which reduces the credit risk of funds being diverted to other uses.

This is more easily written than done, of course. As you might expect, most financial institutions lack technical expertise in the requirements of latrine construction or indoor piping. Management is often unaware of the benefits and needs assistance in structuring a loan product, staff require training on the features of WSS loans, and credit officers may need to deliver very different sales pitches.

In Tanzania, for example, a WSS program ran into difficulties when loan officers were embarrassed to discuss clients’ toilets. Financial institutions also benefit from established relationships with third parties who can offer capacity-building support for WSS lending.

This is where Water.org comes in. By partnering with financial institutions, Water.org offers technical and financial support, helping these institutions overcome barriers to WSS microfinance and demonstrating the impact that such loans can have.

This is not a limited engagement. A deep, long-term relationship is often needed to build financial institutions’ capacity, but the sustained effort can produce dividends.

Water.org has helped catalyze $602 million in WSS finance to 1.9 million borrowers in 11 markets. In India, Grameen Koota has been perhaps the most successful adopter, issuing almost 600,000 home improvement loans in the last four years, with upwards of $144 million lent in 2016 alone. In 2015, repayment rates across WaterCredit providers exceeded 99 percent.

Credit: Water.org

The case for digital finance in the water sector

Since WaterCredit loans are so small ($311 on average), there is an urgent need to bring costs down for long-term sustainability. In India, for example, Water.org provides a “smart subsidy” to partner financial institutions, with 78 percent reporting a profit on the WSS lending. But 50 percent of these institutions reported that their WSS lending would be unprofitable without the subsidy, highlighting the need to reduce costs.

Digitizing water credit will be crucial to overcoming this challenge. By lowering costs related to loan application processing, disbursement and repayment, WSS-specific digital credit can enable microfinance institutions and larger banks to finance important household improvements while still maintaining robust quality assurance.

Water.org has already experimented with digital loan repayment in Cambodia, where borrowers used the mobile transfer service WING. In Kenya, with more mature digital credit options already available, extensive work was done with Equity Bank to digitize their existing Maji loan, creating an easier-to-use, more profitable product that leveraged the existing Equitel platform and mobile app.

Unfortunately, the interest rate cap imposed in 2016 has — at least temporarily — scuttled those plans, although the loan remains available in-branch. Despite the lack of a fully digital WSS loan to date, the case for digitizing water credit remains strong, and in fact many digital loans are already being used for these purposes.

Water.org commissioned a loan utilization study in Kenya that focused on undifferentiated digital Equity Bank loans issued from October 2015 to March 2017. The study found that over 21,000 loans (3 percent of total), amounting to $2.2 million, were used on water and sanitation products and services, indicating a sizeable latent demand.

Digital water loans linked to vendors and products will hopefully lead to even better outcomes for the households, although it’s also possible that undifferentiated loans will allow consumers to allocate more efficiently. Either way, digital credit appears likely to take water and sanitation lending mainstream, helping millions to live cleaner, healthier lives.

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No Health Protection for Migrant-Women Healthcare Givershttp://www.ipsnews.net/2017/12/no-health-protection-migrant-women-healthcare-givers/?utm_source=rss&utm_medium=rss&utm_campaign=no-health-protection-migrant-women-healthcare-givers http://www.ipsnews.net/2017/12/no-health-protection-migrant-women-healthcare-givers/#respond Mon, 18 Dec 2017 14:51:47 +0000 Baher Kamal http://www.ipsnews.net/?p=153596 While the media may be attracted by images of migrants drowning or sold as slaves, another flagrant but lesser-known drama is that of care workers, who are overwhelmingly women, often migrants, and who make a very large contribution to global public health, but are exposed to great health risks themselves with little or no protection, […]

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Credit: UN

By Baher Kamal
ROME, Dec 18 2017 (IPS)

While the media may be attracted by images of migrants drowning or sold as slaves, another flagrant but lesser-known drama is that of care workers, who are overwhelmingly women, often migrants, and who make a very large contribution to global public health, but are exposed to great health risks themselves with little or no protection, let alone basic labour rights.

Migrant women care workers buttress health systems in countries where there are shortfalls in health-care provision, while their own rights to health and well-being can be eroded and their health-care needs unfulfilled, the UN leading health agency reminded on the occasion of the World Migrants Day on 18 December.

These migrant women care workers act as “a cushion for states lacking adequate public provision for long-term care, child care and care for the sick,” the World Health Organization (WHO) said.

Ageing in late industrial and middle-income economies, combined with rising demographic dependency ratios and female labour force participation, have led to emerging care deficits in many contexts in developed and developing countries, it explained.

“Around the world, more women are entering the labour force, taking them away from traditional unpaid caring roles in the home. Increasingly, immigrant women are being drawn into receiving country economies to care, often in informal settings, and frequently engaged by private households, without full access to social protection and labour rights.”

A striking fact is that fewer than 15 per cent of home-based long-term care workers are estimated to be formally employed.

For its part, the Organisation for Economic and Cooperation Development (OECD) International Migration Outlook 2015 reported on the percentage of foreign-born workers among the total home-based caregivers of long-term care in a number of industrialised countries.

These percentages amounted to nearly 90 per cent in Italy, around 75 per cent in Greece, over 65 per cent in Spain, and 50 per cent in Luxembourg.

WHO’s report deals with paid home-based care workers who attend to the varied needs of children, older people, people with disabilities and the disabled and the sick.

Shocking Facts

Here are some key facts provided by WHO:

— Those who are hired informally often lack the statutory labour rights accorded to them through a contract, including pensions and benefits, and may receive wages that are significantly lower than those paid for equivalent work in the formal health-care system,

— Migrant women care workers face particular challenges because of the vagaries of immigration laws in various destination countries, which often prevent them from entering the country legally or taking paid employment.

— This lack of legal status puts undocumented immigrants working in the care sector in many countries at risk of abuse by unscrupulous employers.

— The care sector itself is rendered unable to fully benefit from the work of immigrant workers who may want to provide in-home care but are unable to find a legal path to enter the country or obtain employment.

— Migrant care workers generally encounter harsher working conditions and have fewer rights and less adequate health coverage than do native workers. Because care work is frequently relegated to the informal sector, employees find that access to health care or insurance is not guaranteed but granted at the whim of employers.

In the United States in 2010, for example, almost one quarter of foreign-born workers employed in health care support jobs, such as nursing, psychiatric, or home health aides lacked health insurance themselves.

— Much has been written about the poor conditions that care workers, especially migrants, regularly face, including low wages, long hours, and inadequate housing and food for those who “live-in.” Many studies report that such work often entails lack of respect and status and even verbal, physical and sexual abuse,

— In the most extreme instances, when recruiters or employers confiscate workers’ passports and deduct travel costs and other expenses from their wages (or fail to pay them altogether), care work jobs become a modern form of indenture

— Many migrant women care workers experience poor reproductive and sexual health. There is also ample evidence that they are subject to physical violence, including sexual harassment/ assault and regular beatings.

For example, 44 per cent of Filipina migrants reported knowing another domestic worker who had experienced physical abuse, 27 per vent knew someone who had experienced sexual harassment, and 22.4 per vent knew someone who had been raped.

IOM marks International Migrants Day on 18 December with a series of worldwide events including a Geneva award ceremony for the Global Migration Film Festival. Credit: IOM

The Day

William Lacy Swing, director general of the UN International Organization for Migration (IOM), made an urgent call for “Safe Migration for a World on the Move” ahead of the International Migrants Day.

IOM plans to mark the Day with a series of worldwide events including a Geneva awards ceremony for the Global Migration Film Festival, which includes many public and private sector partners participating with IOM missions in over 100 countries.

In addition to film screenings in Geneva and New York, IOM also plans to participate in a UN leadership debate featuring UN secretary-general Antonio Guterres at Manhattan’s UNICEF House, touching on the global compact on migration, expected to be adopted by the end of 2018.

The UN leadership debate will explore the common ground on migration, rather than the divisions, said Swing. Despite often-sharp rhetoric, migration “is less a problem to be solved than a human reality to be managed.”

Planned UNICEF House events include the opening of the critically acclaimed art installation UNPACKED: Refugee Baggage (See: www.Together-in-NY.org), brining to life stories of refugees who have settled in the US by exploring past traumas through three-dimensional models of their homes mounted on suitcases they carried on their journeys.

Safe Migration, Not Leaky Boats

In an Op-Ed column penned for International Migrants Day: Our Right of Passage Should be Safe Migration, Not Leaky Boats), Swing wrote, “While we live at a time when a privileged elite considers global mobility virtually its birth-right, it is denied to countless others trapped in hopelessly bad economic or conflict circumstances.”

He warned that denial leads to “smuggling networks, human traffickers and modern-day enslavers who ply their trade these days with complete impunity.”

Hundreds of millions who are not part of the growing, truly global labour talent market find themselves outside looking in, and looking onto a world they can only dream of, Swing added. “They face enormous income disparities and hardships and no chance of getting a visa or a work permit.”

It comes as no surprise then that vast armies of hopeful young migrants want to climb aboard the “leaky boats” referred to by the UN secretary general, Swing continued, adding that driven by lack of economic opportunity, often exacerbated by climate change, they too are vulnerable to the siren song of social media.

“That’s where smuggling networks, human traffickers and modern day enslavers ply their trade these days with complete impunity. These cruel deceptions go unchecked, as the social media giants chase new markets in the global south.”

Just a quick reminder: a big power like the United States drew millions of migrants when it had an open-door policy in the late 19th and early 20th centuries.

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Rohingyas: Lurching from Crisis to Crisishttp://www.ipsnews.net/2017/12/rohingyas-lurching-crisis-crisis/?utm_source=rss&utm_medium=rss&utm_campaign=rohingyas-lurching-crisis-crisis http://www.ipsnews.net/2017/12/rohingyas-lurching-crisis-crisis/#respond Sat, 16 Dec 2017 15:00:33 +0000 Farid Ahmed http://www.ipsnews.net/?p=153586 In this special series of reports, IPS journalists travel to the border region between Bangladesh and Myanmar to speak with Rohingya refugees, humanitarian workers and officials about the still-unfolding human rights and health crises facing this long-marginalized and persecuted community.

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Newly arrived Rohingya people wait at an army camp in Sabrang in Teknaf on Nov. 29, 2017 before being shifted to a camp in Cox's Bazar. Credit: Farid Ahmed/IPS

Newly arrived Rohingya people wait at an army camp in Sabrang in Teknaf on Nov. 29, 2017 before being shifted to a camp in Cox's Bazar. Credit: Farid Ahmed/IPS

By Farid Ahmed
COX'S BAZAR, Bangladesh, Dec 16 2017 (IPS)

Ferdous Begum was cleaning her child after he had defecated in the open, using leaves she collected from a nearby tree at Bangladesh’s Teknaf Nature Park. The settlement is packed with Rohingya refugees who fled military persecution in Myanmar since August.

“Access to water is terrible here,” Begum said. “We’ve only a couple of hand-dug shallow wells and we don’t get enough water from the wells for so many people living in the camp.”“Initially we received patients with bullet, burn and stab injuries. Now we’re getting more patients with waterborne and cold-related diseases and the number is increasing.” --Dr. Dipongkor Binod Sharma

Other camps near Teknaf are also facing acute shortages of water, especially access to drinking and clean water, while aid workers face difficulties with hygiene management for the refugees crammed in squalid camps stretching from Teknaf to Ukhia in Cox’s Bazar.

The latest UN report shows an estimated 655,000 Rohingya have crossed into Bangladesh after fleeing violence in Myanmar’s Rakhine State, increasing the total Rohingya population in Cox’s Bazar to 867,000 since Aug. 25.

The report said new arrivals were living in spontaneous settlements with increasing demand for humanitarian assistance, including shelter, food, clean water, and sanitation.

Ferdous Begum said her son was unwell last night, with a stomach upset. “Misfortune follows us anywhere we go,” Begum said.

Aid workers said refugees, especially pregnant women, lactating mothers and children were exposed to the risk of health hazards because of water shortages that led to poor hygiene management.

Diphtheria is rapidly spreading among Rohingya refugees in Cox’s Bazar, the World Health Organization (WHO) warned last week.

In one month, as of Dec. 12, a total of 804 suspected diphtheria cases, including 15 deaths, were reported among the displaced Rohingya population in Cox’s Bazar.

The first suspected case was reported on Nov. 10 by a clinic of Médecins Sans Frontières (MSF) in Cox’s Bazar, according to the WHO.

A number of aid workers working in the field said hygiene was very important to prevent disease outbreaks in these overcrowded camps.

Many of the latrines made initially were already overflowing and faecal sludge was seen in the open in almost every camp. And many of the tubewells or hand-pumps are broken, shortening the supply of safe water.

Dr. Dipongkor Binod Sharma of Dhaka Community Hospital Trust, who has been working with Rohingya refugees since the latest influx began in August, said, “Initially we received maximum patients with bullet, burn and stab injuries. Now we’re getting more patients with waterborne and cold-related diseases and the number is increasing.”

Dr. Sharma said a large number of his patients were women and children suffering from acute malnutrition and anaemia, as most of the pregnant and lactating women were very young – many still in their teens.

“Hygiene is very crucial for them, but it seems they are not aware,” he said.

A Rohingya girl proudly holds up her drawing at a UNICEF school at Balukhali camp, Bangladesh. Credit: Farid Ahmed/IPS

A Rohingya girl proudly holds up her drawing at a UNICEF school at Balukhali camp, Bangladesh. Credit: Farid Ahmed/IPS

A Rohingya refugee named Gul Nahar rushed to a BRAC aid centre with her six-month-old boy, Mohammad Haras, seeking help. “He’s been suffering from high fever along with diarrhoea for the last 10 days,” Nahar said.

Nahar said the seven members of her family were living together in a single shanty room.

WaterAid Bangladesh country director Dr. Md Khairul Islam told IPS he was aware of water shortages in the camps in Teknaf. “The situation might be exacerbated when local farmers start irrigation for their crops in the area soon,” he added.

Executive director of the government’s Institute of Water Modelling, Professor M Monowar Hossain, told IPS there were plans to initiate a survey to ascertain the level of ground water there.

“It’s a part of the national survey… It’s not particularly for the Rohingya issue. [But] Until we do the survey, we can’t say there is any scarcity of water,” said Prof Hossain, a former dean of Bangladesh University of Engineering and Technology (BUET).

Local people fear the presence of over half a million Rohingyas will put additional pressure on water sources and that would worsen the situation in the coming months.

They warned about a severe water crisis in the later part of winter, when the groundwater level naturally goes down.

Rohingyas in the Jadimora area said that they were trying to collect water from tubewells in local communities, but on many occasions they’d been barred.

In the absence of safe water, Rohingyas in makeshift camps in Damdamia Nature Park, Jadimora, Alikhali, and Unchiprang areas of Teknaf are collecting water from ponds, waterfalls and other untreated sources.

“Nobody is supplying drinking water for us. We collect water from a nearby pond,” said a Rohingya community leader in the Damdamia area, Rashid Ullah.

Many Rohingyas built makeshift shelters in forest preserves, felling trees and setting up shanties on hilly slopes. Other have taken refuge at overcrowded registered and unregistered camps.

The haphazard sprouting of camps makes it hard to supply safe drinking water to Rohingyas, aid workers said.

Department of Public Health Engineering officials said for the Rohingyas who took shelter in wild forests and hills, safe drinking water facilities like tube wells are nonexistent.

“We can’t say we have reached all Rohingyas with safe drinking water and other facilities as they are living scattered,” Refugee Relief and Repatriation commissioner Mohammad Abul Kalam of Cox’s Bazar told IPS.

“Particularly in Teknaf, we wanted to relocate those Rohingyas facing shortage of water to other camps, but they were not interested,” Kalam said.

Aid workers say the Rohingya influx has slowed down, but several hundred refugees still arrive every day, adding pressure on both the government and humanitarian relief groups.

The International Organization for Migration (IOM) has constructed more than 3,800 latrines and 159 wells in six host community locations – Whykong, Palonkhali, Jaliapalong, Kutupalong, Rajapalong and Baharchora.

“Access to clean water and safe sanitation services is a problem for the communities hosting refugees in Cox’s Bazar,” said Alessandro Petrone, WASH Programme Manager for IOM’s Rohingya Response, in a statement earlier this month.

“A global and up to date WASH assessment providing a proper gaps analysis and an activities plan is urgently needed. IOM is developing a rated assessment tool and will deploy teams to the field in the coming days to support this work,” said Petrone.

The Inter-Sector Coordination Group (ISCG), of which IOM is a part, reported this week that the humanitarian situation for Rohingya refugees in Bangladesh remained dire.

The inter-agency Humanitarian Response Plan (HRP) for 2017-18 identified the areas of WASH, health, nutrition and food security and shelter for immediate scale-up to save lives in both settlements and host communities, it said.

As per the HRP, the Rohingya population in Cox’s Bazar is highly vulnerable, many having experienced severe trauma, and are now living in extremely difficult conditions.

The limited WASH facilities in the refugee established settlements, put in place by WASH sector partners, including UNICEF, prior to the current influx, are over-stretched, with an average of 100 people per latrine, the report said.

New arrivals also have limited access to bathing facilities, especially women, and urgently require WASH supplies including soap and buckets.

Given the current population density and poor sanitation and hygiene conditions, any outbreak of cholera or Acute Watery Diarrhoea (AWD), which are endemic in Bangladesh, could kill thousands of people residing in temporary settlements, the report warned.

he series of reports from the border areas of Myanmar and Bangladesh is supported by UNESCO’s International Programme for the Development of Communication (IPDC)

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Rohingya Refugees Endure Lingering Traumahttp://www.ipsnews.net/2017/12/rohingya-refugees-endure-lingering-trauma/?utm_source=rss&utm_medium=rss&utm_campaign=rohingya-refugees-endure-lingering-trauma http://www.ipsnews.net/2017/12/rohingya-refugees-endure-lingering-trauma/#comments Thu, 14 Dec 2017 14:24:19 +0000 Farid Ahmed http://www.ipsnews.net/?p=153560 In this special series of reports, IPS journalists travel to the border region between Bangladesh and Myanmar to speak with Rohingya refugees, humanitarian workers and officials about the still-unfolding human rights and health crises facing this long-marginalized and persecuted community.

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Rubina (extreme left) along with her friend at the Islamic School at Kutupalong camp, home to Rohingya refugees from Myanmar. Credit: Farid Ahmed/IPS

Rubina (far left) along with her friend at the Islamic School at Kutupalong camp, home to Rohingya refugees from Myanmar. Credit: Farid Ahmed/IPS

By Farid Ahmed
COX'S BAZAR, Bangladesh, Dec 14 2017 (IPS)

Twelve-year-old Rubina still struggles with the horrors she witnessed in her homeland in Myanmar before fleeing to neighbouring Bangladesh three months ago.

Despite reaching the relative safety of a refugee camp at Kutupalong in Bangladesh’s southeast town of Cox’s Bazar – now home to nearly a million ethnic Rohingya people, mostly women and children, who fled military persecution in Myanmar – Rubina suffers from post-traumatic stress caused by the harrowing experiences back in her country.

Conservative estimates by Médecins Sans Frontières (MSF) state at least 6,700 of Rohingya deaths have been caused by violence, including at least 730 children under the age of five
“Barely a night passes without nightmares,” she told IPS at an Islamic school in the camp where she comes every day to learn the Quran.

“I’m fine as long as I’m with my friends, but sometimes I feel alone even amidst a crowd… I can’t forget anything that I have seen.”

Rubina was orphaned in the latest spate of violence in Myanmar’s Rakhine state. She fled to Bangladesh along with her grandparents and three siblings after her parents were hacked to death by local Buddhist people in the presence of the army.

Rubina is among thousands of others who endured similar ordeals.

Different NGOs and aid groups are now working in more than a dozen camps stretching from Teknaf to Ukhia in Cox’s Bazar. A 45-kilometre drive reveals settlement after settlement, with thousands of bamboo and tarpaulin shanties lining both sides of the hilly road.

Nur Mohammad, 12, witnessed soldiers killing his father. “My father, a fisherman, tried to escape by running away, but the military chased him and shot him to death,” said Mohammad, who was staying at his maternal grandparents’ house in Shahporir Dwip. Mohammad’s father was a Myanmar national and his mother was Bangladeshi.

“As soldiers chased my father, my mother and I ran for cover through a jungle… we ran and walked for several days until we reached Bangladesh,” he said. “Sometimes I wake up at night and I feel like soldiers are knocking on the door… In that moment, I forget I’m in Bangladesh.”

Twelve-year-old Rohingya boy Nur Mohammad holds up Myanmar currency in Shah Porir Dwip. Credit: Farid Ahmed/IPS

Twelve-year-old Rohingya boy Nur Mohammad holds up Myanmar currency in Shah Porir Dwip. Credit: Farid Ahmed/IPS

The latest figures by the International Organization for Migration (IOM) indicate that 647,000 Rohingyas have arrived in Bangladesh since the latest spate of violence in Rakhine that began in August. The Bangladesh government estimated 300,000 to 400,000 Rohingyas were already here before the current influx.

A Rohingya community leader, Dil Mohammad, now lives in a camp in the no-man’s-land between Bangladesh and Myanmar at Tambru of Naikhongchhari in Bangladesh’s Bandarban district. He told IPS that women and children were the worst victims of violence.

Dil Mohammad, who has a degree in psychology from Yangon University (1994), worries about the future of those children, and especially young women, who will carry emotional scars from their experiences.

Though the Myanmar military denies it, many rights groups and UN officials have confirmed deliberate and planned atrocities, including murders, gang rapes and arsons against the Rohingyas.

“In most cases, children saw the brutality and the wrath of military against the Rohingyas, but many women were also showing the signs of brutality as they were raped and abused by the military and others,” said a Rohingya man, Mohammad Faisal, at a settlement at Teknaf Nature Park and Wildlife Sanctuary.

Faisal’s teenage wife Hajera, who was expecting her second baby, said they were lucky to have escaped with other family members, and everybody was safe and alive.

“I saw a soldier killing a baby – just throwing it onto the ground. I can’t forget the scene. I have a one-year-old baby girl,” Hajera said. “It could be my daughter… I tried to erase it from my mind, but I can’t. When I close my eyes I see the military man killing the baby and hear the baby crying.”

In most cases, women were unable to share their experiences with others, she said. “They can’t tell people how they have been abused, so they will bear their trauma [in silence],” Hajera said.

A Rohingya couple, Mohammad Faisal and his wife Hajera, pose for a photo with their child at their camp at Teknaf Nature's Park, Bangladesh. Credit: Farid Ahmed/IPS

A Rohingya couple, Mohammad Faisal and his wife Hajera, pose for a photo with their child at their camp at Teknaf Nature’s Park, Bangladesh. Credit: Farid Ahmed/IPS

An aid worker at a centre of Save the Children, who asked not to be named, told IPS about the children she worked with. “They come here and spend the whole day making new friends and playing with them, but they need time to recover fully,” she said.

Professor Tasmeem Siddiqui of Dhaka University, the founder and chair of Refugee and Migratory Movements Research Unit in Dhaka, said, “Those who are coordinating there must build up leadership from the community, especially women’s leadership.”

“Trauma management is a big challenge after any genocide. People can’t easily forget what they have seen. It should be handled very carefully with the people who have expertise in those fields,” she told IPS, adding, “I don’t think there is a very systematic co-ordination among the groups working in the Rohingya settlements.”

As women and children were the primary victims, women and children from their community should be engaged, along with the experts, so that the victims can speak up without inhibition, she said.

For women, trauma and sexual assaults are not the only issues to be addressed. In this vast stretch of unprotected settlements, they face other risks, from hygiene, and sanitation to trafficking.

Rohingya people interviewed for this story didn’t fear the type of attacks they faced in Myanmar, but said there were still opportunists who would try to exploit the helplessness of the Rohingya women and children who were struggling to survive.

“Besides systematic aid work by groups with expertise, community participation is essential for the protection of women and children,” Professor Siddiqui stressed.

Bangladesh and Myanmar recently signed a deal regarding repatriation of Rohingya. Many see the step as a ray of hope, but others who have suffered from decades of poverty, underdevelopment and sectarian violence at home were more cynical.

Even 10-year-old Mohammad Arafat expressed doubts. “They killed my father in front of me. My mother and I escaped,” he said. “If we go back there, they will kill us.”

The series of reports from the border areas of Myanmar and Bangladesh is supported by UNESCO’s International Programme for the Development of Communication (IPDC)

 

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For Freedom from Poverty, Universal Health Coverage Is a Musthttp://www.ipsnews.net/2017/12/freedom-poverty-universal-health-coverage-must/?utm_source=rss&utm_medium=rss&utm_campaign=freedom-poverty-universal-health-coverage-must http://www.ipsnews.net/2017/12/freedom-poverty-universal-health-coverage-must/#respond Tue, 12 Dec 2017 07:29:14 +0000 Siddharth Chatterjee and Githinji Gitahi http://www.ipsnews.net/?p=153471 Siddharth Chatterjee is the United Nations Resident Coordinator in Kenya. Dr Githinji Gitahi is the Global CEO of Amref Health Africa.

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Nearly one million Kenyans are pushed below the poverty line and remain poor as a result of healthcare expenses. Credit: Paul Nevin

By Siddharth Chatterjee and Dr Githinji Gitahi
NAIROBI, Kenya, Dec 12 2017 (IPS)

Today is 12 December 2017 is an auspicious day, as it marks Kenya’s independence from colonial rule in 1963. Today is also Universal Health Coverage Day. It is the anniversary of the first unanimous United Nations resolution calling for countries to provide affordable, quality health care to every person, everywhere.

In Kenya illness can mean financial ruin.

Every day families are forced to sell their assets, rely on community support or see their modest life savings wiped out by medical bills.

Ill-health is a substantial burden not only on Kenyan families, but also on the country’s economic growth. Every year, nearly one million Kenyans are pushed below the poverty line and remain poor as a result of healthcare expenses.

Out-of-pocket expenses at point of treatment in Kenya make up a third of the country’s total health expenditure, far above the World Health Organization’s suggested 15 or 20%.

Universal health coverage should be [viewed] as a rights issue,” said Dr. Tedros Adhanom Ghebreyesus, the director general of the World Health Organization (WHO). “Many families are getting into poverty because they are spending their savings for health care services.”

Across the globe there is a strong correlation between high rates of out-of-pocket expenses and catastrophic and impoverishing health expenditure. It is a powerful factor in inequality of access to healthcare, often forcing the poor to forgo medical treatment. It also increases costs, because when poor people finally seek treatment it’s either too late or else complications caused by delay have worsened their condition.

Approximately four out of every five Kenyans have no access to medical insurance, so the cruel reality is that most are just an accident or illness away from destitution. Among the poorest quintile a mere 3% have health insurance, this provided by the government’s National Hospital Insurance Fund (NHIF). This rises to 42% of the wealthiest fifth where private cover is also more common. Additionally, there are stark disparities between rural and urban populations, where rates of coverage are an average of 12% and 27% respectively.

“Over the next 5 years, my Administration will target 100% Universal Healthcare coverage for all households”. Credit: State House

To its credit, the Kenyan government is taking steps towards reducing these inequalities. Payments for primary and maternal health services in public facilities have been abolished, resulting in increased utilization and improved outcomes, particularly among the poorest. President Uhuru Kenyatta at his inaugural speech emphasized, “Over the next 5 years, my Administration will target 100% Universal Healthcare coverage for all households”.

Devolution of health care provision to county governments should also ensure more efficient resource distribution, accountable health services and improvements in equity that will eventually help decongest the overstretched Referral Hospitals.

Recent initiatives by the NHIF–such as inclusion of outpatient care and introduction of health insurance subsidies for the poor–are helping to expand coverage beyond those in formal employment. As a result, roughly 88.4% of households with health insurance are covered through the NHIF.

But as long as 33.6% of Kenyans survive on less than US$1.90 per day, there are still millions who cannot access quality healthcare.

Affordability is not the only barrier. Lack of public awareness, high loss ratios due to fraud, and reluctance among insurers to underwrite cover for the poor are also important.

Health insurance contributes only about 13% to national health expenditure, with the balance made up of out-of-pocket expenses at point of treatment, government and tax revenues, and donor funding. Such statistics undermine Kenya’s ability to achieve universal health coverage, enshrined in Kenya’s Vision 2030 and Sustainable Development Goal 3.

There is a clear need to develop low-cost, innovative solutions for expanding insurance coverage and technology must form part of such solutions. Technology-backed automation can improve efficiency and enhance transparency, both key requirements.

Mobile money can perform faster, more transparent and targeted health payments through health e-vouchers. Technology can process claims and enable healthcare consumers and providers to interact more efficiently, while offering more customized products to people of all incomes.

Efficient storage and sharing of patient data could reduce the cost of care by, for instance, tracing false claims, preventing repeat tests, or avoiding misdiagnosis.

Technology can also offer substantial savings in administration costs, which currently swallow a staggering 40% of the NHIF’s revenue, far in excess of the industry norm of 3-4%. Effective IT systems would help to reduce this astonishing disparity, as would improved governance and transparency. A lack of analytical capacity hobbles the NHIF’s ability to forecast and respond to increasing costs, hindering strategic planning and development. Better technology can address this.

However, such innovation must be accompanied by increased efficiency in health spending, through partnerships with institutions working to improving access to healthcare for the poor, and through policy dialogue between government and other stakeholders.

First Lady Margaret Kenyatta holds a new born baby when she visited Makueni County Referral Hospital during the handing over of the 30th Beyond Zero mobile clinic. Credit: State House

Ultimately, sustainability demands increased investment in preventive care and primary health. Diverting cash away from the 60% of the health budget that currently goes to curative care will pay dividends. Better primary care reduces ill-health and catches disease at an earlier stage, when treatment is cheaper and more effective. It also frees up resources to expand insurance coverage for the poor.

Launching the country’s SDG Platform with the United Nations in New York during the UN General Assembly in 2017, Kenya’s Cabinet Secretary for Foreign Affairs Dr. Amina Mohamed remarked, “As a government we have clearly prioritized the Universal Health Coverage agenda because it is one of the ways to protect our people from the consequences of out-of-pocket health expenditure which in Kenya forms about a fifth of family spending”.

This Independence Day, let us join hands to free every Kenyan from the tyranny of poverty by achieving universal health coverage. It is the foundation for economic development and prosperity.

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Debate on Glyphosate Use Comes to a Head in Argentinahttp://www.ipsnews.net/2017/12/debate-glyphosate-use-comes-head-argentina/?utm_source=rss&utm_medium=rss&utm_campaign=debate-glyphosate-use-comes-head-argentina http://www.ipsnews.net/2017/12/debate-glyphosate-use-comes-head-argentina/#comments Fri, 08 Dec 2017 20:20:09 +0000 Daniel Gutman http://www.ipsnews.net/?p=153423 In and around the city of Rosario, where most of Argentina’s soybean processing plants are concentrated, a local law banned the use of glyphosate, the most widely-used herbicide in Argentina. But two weeks later, producers managed to exert enough pressure to obtain a promise that the ban would be overturned. This episode, which took place […]

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Academics discuss the impacts on health and the environment of the use of glyphosate in Argentine agriculture, during a Dec. 6 conference at the University of Buenos Aires. Concern about this topic is now on the country’s public agenda. Credit: Daniel Gutman / IPS

Academics discuss the impacts on health and the environment of the use of glyphosate in Argentine agriculture, during a Dec. 6 conference at the University of Buenos Aires. Concern about this topic is now on the country’s public agenda. Credit: Daniel Gutman / IPS

By Daniel Gutman
BUENOS AIRES, Dec 8 2017 (IPS)

In and around the city of Rosario, where most of Argentina’s soybean processing plants are concentrated, a local law banned the use of glyphosate, the most widely-used herbicide in Argentina. But two weeks later, producers managed to exert enough pressure to obtain a promise that the ban would be overturned.

This episode, which took place in November, reflects the strong economic interests at stake and the growing controversy surrounding the use of agrochemicals and their impact on people’s health and the environment.

“Agriculture in Argentine has undergone major changes in recent decades and consolidated its agroindustrial model, strongly based on soy, which displaced wheat and corn,” explained Emilio Satorre, professor and researcher at the University of Buenos Aires (UBA) department of agronomy.

“The sown area climbed from 15 to 36 million hectares, 60 to 65 percent of which are covered with genetically modified (GM) soy, while the use of phytosanitary products increased threefold. This system generated great wealth for the country, but of course it produces greater risks,” he told IPS.

For Satorre, “society is increasingly exacting… and the environment and health have become a central focus.”

Glyphosate accounts for over half of the agrochemicals used, since the government authorised in 1996 commercial sales of GM soybean resistant to that herbicide, which was then produced exclusively by Monsanto, the US biotech giant with a large subsidiary in this South American country.

Along with direct seeding or no-till systems, which avoid soil tillage and mitigate erosion, glyphosate and GM soy form the foundation on which the phenomenal expansion of agriculture has been based in this country of 44 million people, where the agro-livestock sector represents about 13 percent of GDP.

This growth took place at the expense of the loss of millions of hectares of natural pastures in La Pampa, one of the world’s most fertile regions in the centre of the country, and of native forests in the Chaco, the northern subtropical plain shared with Bolivia and Paraguay.

Large-scale soy production expanded so much that it reached the edge of many urban areas.

One of them is Córdoba, the second-biggest city in the country, located in the central region. There, a group of women have put Ituzaingó – a working-class neighborhood – on the national map since 2002.

It was when they mobilised to protest about a large number of cases of cancer and malformations, which they blamed on the spraying of soy crops that grew up to a few metres from their homes.

The Mothers of Ituzaingó, a neighbourhood on the outskirts of Córdoba, the second-biggest city in Argentina, have taken their fight against agrochemicals, because of its impact on the health of their community, to the emblematic Plaza de Mayo in Buenos Aires. Credit: Courtesy of Mothers of Ituzaingó

The Mothers of Ituzaingó, a neighbourhood on the outskirts of Córdoba, the second-biggest city in Argentina, have taken their fight against agrochemicals, because of its impact on the health of their community, to the emblematic Plaza de Mayo in Buenos Aires. Credit: Courtesy of Mothers of Ituzaingó

With their struggle, the Mothers of Ituzaingó obtained a judicial ruling that banned fumigations closer than 500 metres from their houses, as well as the criminal conviction of an agricultural producer and a fumigator.

They became a beacon of hope for many social movements in the country.

“I started when my daughter, who was three years old, was diagnosed with leukemia. Today thanks to God she is alive and they haven’t sprayed here anymore since 2008, but we were poisoned for years and people are still getting sick,” said Norma Herrera, a homemaker who has five children and two grandchildren.

“It was a very hard struggle at the beginning. Over the years the facts have proved us right, but we were never able to get professionals to scientifically establish the connection between the spraying and the health problems,” Herrera told IPS.

Thanks to the social movement of which the Mothers of Ituzaingó were pioneers, a decision was reached Nov. 16 by the city council in Rosario to ban glyphosate.

The provision placed emphasis on a study carried out by the International Agency for Research on Cancer (IARC), the specialised cancer agency of the World Health Organisation, which declared the herbicide a “probable carcinogen” two years ago.

The decision took agricultural producers by surprise. At the time they seemed more worried about the uncertainty over whether the European Union would or would not renew the licence for the use of glyphosate, which was to expire on Dec. 15.

A negative decision would cause a severe economic impact for Argentina, the sector’s business chambers warned.

But on Nov. 27 the EU agreed in Brussels to renew the licence for the herbicide for five years, with the votes of 18 countries against nine and one abstention.

In 2016, Argentina’s agricultural exports totaled 24 billion dollars, equivalent to 46 percent of the country’s total exports, while soy meal, cornmeal and soy oil accounted for the main sales abroad.

Three days after the EU’s decision, the heads of rural entities went to Rosario’s city hall and convinced the same city councilors who had banned glyphosate that there was no “scientific evidence” warranting such a decision.

A few hours later, several city councilors said they had not discussed the issue with the necessary depth.

As a result, although the provision is not yet in force because it was not signed by the city government, a new municipal bill was drafted, which authorises spraying with the herbicide with certain precautions, and is set to be discussed this month.

“We consider it deplorable that the councilors have reversed the commendable decision to protect the health and environment of the population of Rosario, yielding to pressure from the soy lobby and showing who truly governs” said a group of more than 10 environmental and social organisations.of the region in a press release.

For Lilian Correa, head of Health and Environment at the UBA school of medicine, “the next generation of Argentinians must put on the table the cost-benefit equation of the current productive model. Today, the impact on health and the environment is not measured.”

Correa warned about the prevailing apathy in Argentina regarding the regulation and handling of toxic agrochemicals, citing the case of endosulfan, an insecticide banned in 2011 by the Conference of the Parties to the Stockholm Convention on Persistent Organic Pollutants.

“When that happened, Argentina set a two-year deadline to sell off stocks of endosulfan. That was done to benefit a company, in an unethical and illegal manner,” Correa said during a Dec. 5 conference at the UBA agronomy department

In 2011, a four-year-old boy died in Corrientes, in the northeast of the country, poisoned when endosulfan was sprayed on tomato crops less than 50 metres from his house.

In December 2016, the owner of the tomato plantation in question became the first person tried in Argentina for homicide through the use of agrochemicals.

However, the court considered that no negligence could be proven in the use of the substance, which at that time was permitted, and acquitted him.

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Rohingya Refugees: The Woes of Women (Part Two)http://www.ipsnews.net/2017/12/rohingya-refugees-woes-women-part-two/?utm_source=rss&utm_medium=rss&utm_campaign=rohingya-refugees-woes-women-part-two http://www.ipsnews.net/2017/12/rohingya-refugees-woes-women-part-two/#respond Fri, 08 Dec 2017 13:00:43 +0000 Sohara Mehroze Shachi http://www.ipsnews.net/?p=153404 In this special series of reports, IPS journalists travel to the border region between Bangladesh and Myanmar to speak with Rohingya refugees, humanitarian workers and officials about the still-unfolding human rights and health crises facing this long-marginalized and persecuted community.

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A Rohingya woman and her child at a refugee camp in Bangladesh. Credit: Kamrul Hasan/IPS

A Rohingya woman and her child at a refugee camp in Bangladesh. Credit: Kamrul Hasan/IPS

By Sohara Mehroze Shachi
COX'S BAZAR, Bangladesh, Dec 8 2017 (IPS)

Under pouring rain, hundreds of young and expectant mothers stand in line. With her bare feet and the bottom of her dress covered in mud, Rashida is one of them, clutching her emaciated infant. She lost her husband on the treacherous trek from Myanmar to Bangladesh, and with nowhere to go and her resources exhausted, rain-drenched and standing in this long, muddy line for food and medicine for her child is her only hope.

Rohingya women line up for aid. Credit: Sohara Mehroze Shachi/IPS

Rohingya women line up for aid. Credit: Sohara Mehroze Shachi/IPS

Following the recent brutal campaign unleashed against the Rohingyas by the Myanmar military, over half a million refugees came to Bangladesh since August 2017, and more are arriving every day. The United Nations Population Fund (UNFPA) estimates that there are nearly 150,000 newly arrived women of reproductive age (15-49 years), and according to the Inter Sector Coordination Group’s September 2017 Situation Report on the crisis, there are over 50,000 pregnant and breastfeeding mothers among the new arrivals in Bangladesh who require targeted food and medical assistance.

“We collaborate with some groups and help refugees living in the camp areas where there is a shortage of medical supplies,” said Andrew Day, who has been advocating for refugees for the past two years in Bangladesh. “They don’t have the means to see a doctor.”

While small scale interventions are being taken by development organizations to supplement hospitals, such the placement of 35 midwives trained by UNFPA in two camps, hospitals are underfunded, overcrowded and struggling to provide care to the burgeoning pregnant refugee population and thousands of newborns.

Newborn children in the Rohingya refugee camps. Credit: Umer Aiman Khan/IPS

Newborn children in the Rohingya refugee camps. Credit: Umer Aiman Khan/IPS

Early marriage and high birth rates are prevalent among the Rohingya community. According to a flash report on mixed movements in South Asia by the Office of the UN High Commissioner for Human Rights (OHCHR), a majority of the refugees were married young (at 16 or 17) and gave birth at an average age of 18.

In a Rapid Gender Analysis assessment conducted by Care in Balukhali Makeshift Camp at Cox’s Bazar, it was found that many female respondents between the ages of 13 and 20 years had children and others are currently pregnant.
The assessment uncovered that knowledge and practice of birth control was nonexistent or very limited among the Rohingya refugees, and religious sentiment was a strong factor contributing to the emphasis placed on pregnancy and the aversion to contraceptives.

“It (pregnancy) is God’s wish” said Jainul whose wife was expecting their sixth child. “God will help me feed the children,” he added. His wife echoed this belief.

According to locals, many Bangladeshis are donating money to the refugee camps as they believe helping fellow Muslims will earn them God’s blessings, and the resources are being used to set up Madrasahs – religious education schools. The imams of these madrasahs advise against contraception, so while the government and relief agencies such as the International Organization for Migration (IOM) are trying to provide birth control options and information on family planning, Rohingya women refuse to comply.

Girls taking religious education lessons at a Madrasah in the camps. Credit: Kamrul Hasan/IPS

Girls taking religious education lessons at a Madrasah in the camps. Credit: Kamrul Hasan/IPS

Dr. Lailufar Yasmin, a lecturer in International Relations at the University of Dhaka, who is conducting research in the refugee camps, said at first when she went into the camps, she saw a lot of elderly and middle-aged females, but there were very few young women.

“But when I asked them about their age, I found out they were in their twenties,” she said. Repeated childbirth coupled with the trauma they experienced in Myanmar had taken such a toll on them that they all looked decades older than their true age, she explained.

“Many Rohingyas married their daughters off very young so that the military won’t come and rape them because their bodies become less attractive after childbirth,” she said.

“It is a community decision, not the girl’s decision, but the girls have internalized it that they need to have a lot of children because they need to save their race which is being persecuted,” Dr. Yasmin explained, adding that this philosophy contributed to the Rohingyas having very large families.

With thousands of Rohingya children soon to be born in Bangladesh, the need for ramped up medical care is acute. However, an IRC/RI assessment in October 2017 found that nearly 50 percent of all pregnant women have not received medical care and 41 percent of families with pregnant women do not know where to go for medical care for pregnant women. The report concludes, “These results point to a need for health messaging and services, as well as antenatal care and emergency obstetric care across the makeshift settlements.”

The series of reports from the border areas of Myanmar and Bangladesh is supported by UNESCO’s International Programme for the Development of Communication (IPDC)

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Rohingya Refugees: The Woes of Women – Part Onehttp://www.ipsnews.net/2017/12/rohingya-refugees-woes-women-part-one/?utm_source=rss&utm_medium=rss&utm_campaign=rohingya-refugees-woes-women-part-one http://www.ipsnews.net/2017/12/rohingya-refugees-woes-women-part-one/#respond Thu, 07 Dec 2017 13:58:48 +0000 Sohara Mehroze Shachi http://www.ipsnews.net/?p=153380 In this special series of reports, IPS journalists travel to the border region between Bangladesh and Myanmar to speak with Rohingya refugees, humanitarian workers and officials about the still-unfolding human rights and health crises facing this long-marginalized and persecuted community.

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Rohingya women of Balukhali camp embarking on the trek to the toilets. Credit: Umer Aiman Khan/IPS

Rohingya women of Balukhali camp embarking on the trek to the toilets. Credit: Umer Aiman Khan/IPS

By Sohara Mehroze Shachi
COX'S BAZAR, Bangladesh, Dec 7 2017 (IPS)

Afia* lines up her bucket every morning in the refugee camp for water delivery from humanitarian relief workers. On one particularly sweltering day, she kept four water pitchers in a row with gaps between them, hoping to insert another empty container in the space when the water arrived.

When another refugee saw this, she kicked away Afia’s pitchers, and a raging quarrel broke out. That night, the woman’s local boyfriend attacked Afia in her house, kicking her in the belly and hitting her mercilessly with a chair. Afia kept mum about the incident as her assailant threatened to kidnap and rape her in the jungle if she sought arbitration.

Afia is not one of the half a million Rohingyas who came into Bangladesh since this August from Myanmar. She is one of the thousands who have been living in the camps for years, and the water crisis has been exacerbated by the latest influx of refugees.

In the camps, men usually collect relief and water, with women going only when there are no males available. Since her husband left for Malaysia three years ago in search of work, she has not received any news from him and lives on her own in the camp, where scarcity of water is a heated issue and results in frequent altercations between the resident refugees.

While tubewells exist in the camps, many of them are dysfunctional as they are either too shallow and can no longer pump water, or have broken handles so no one can use them.

A dysfunctional tubewell in Kutupalong refugee camp in Bangladesh. Credit: Sohara Mehroze Shachi/IPS

A dysfunctional tubewell in Kutupalong refugee camp in Bangladesh. Credit: Sohara Mehroze Shachi/IPS

Toilets

Women’s tribulations in the refugee camps do not end with water. Access to toilets is also a major problem. And the speed and scale of the recent influx – 624,000 arrivals since August and counting – have put basic services that were available in the camps prior to the influx are under severe strain. Spontaneous settlements have also sprung up to accommodate the new arrivals and these lack many basic amenities.

“There are no separate latrines for the women; the ones that exist do not have any lighting, are not close to their shelters and there’s absolutely no privacy,” said Shouvik Das, External Relations Officer of The UN Refugee Agency UNHCR in Bangladesh. “When we go to distribute food, sometimes the female refugees don’t want to take it because they then will need to go to the toilets and they dread that,” he added.

While many foreign and local NGOs and relief workers had set up tube wells and latrines for the refugees living in the camps, a safe distance was often not maintained between the latrines and the tubewells.

“Recently, the World Health Organization (WHO) found that over 60 per cent of water sources tested in the settlements were contaminated with E.coli. Much of the contamination is a result of shallow wells located less than 30 feet away from latrines,” said Olivia Headon, Information Officer for Emergencies with the International Organization for Migration (IOM), which is providing vital WASH services to both the Rohingya and the communities hosting them.

“While IOM supports private WASH and sanitation areas to provide privacy and safety to women in the Bangladeshi community, similar areas are under development in the Rohingya settlements but are hindered by the lack of space,” she explained.

Cotton used for menstruation dried on roofs of shacks in Kutupalong Camp. Credit: Umer AIman Khan/IPS

Cotton used for menstruation dried on roofs of shacks in Kutupalong Camp. Credit: Umer AIman Khan/IPS

Risks of disease outbreak

Labeled as the world’s most persecuted minority by the UN, the Rohingya lacked access to many basic rights in Myanmar, including healthcare. A large number of the new surge of refugees had been suffering from various diseases before their arrival, including Hepatitis B, Hepatitis C and Polio, and are now staying in cramped camps.

Their squalid living conditions, combined with scarcity of safe water and sanitation facilities, have triggered fears among health experts of disease outbreaks. And women, with their limited mobility and resources, are particularly at risk.

“Women will have to bear a disproportionate risk of the public health burden, and will be at the receiving end of all the negative environmental fallouts,” says Sudipto Mukerjee, Country Director of United Nations Development Program, Bangladesh.

The female refugees suffer the worst during their menstrual cycles, with most of them reusing unsanitary rags or cotton for months. This is not only increasing their risks of infection and skin diseases, but also affecting their mobility. As a recently published report by the UN Refugee Agency UNHCR reads, “Women and girls are limiting their movement because of not only the fear of being harassed, kidnapped or trafficked but also because of their lack of appropriate clothing and sanitary napkins.”

However, while development organizations have been supplying sanitary products to the refugee women, many of them do not know how to use them because they have never had access to them.

“Some of them put the sanitary pads as masks on their faces because they simply didn’t know what to do with them,” said Dr. Lailufar Yasmin, Professor of Gender Studies at BRAC University who has been working with the refugees in the camps.

“If the people who you are working with do not know what to do with the help you are providing, it will not be effective,” she added, “You will only be wasting money.”

*Names have been changed to protect the refugees’ identities.

The series of reports from the border areas of Myanmar and Bangladesh is supported by UNESCO’s International Programme for the Development of Communication (IPDC)

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Resistance to Antibiotics: The Good, the Bad and the Uglyhttp://www.ipsnews.net/2017/12/resistance-antibiotics-good-bad-ugly/?utm_source=rss&utm_medium=rss&utm_campaign=resistance-antibiotics-good-bad-ugly http://www.ipsnews.net/2017/12/resistance-antibiotics-good-bad-ugly/#respond Wed, 06 Dec 2017 16:08:18 +0000 Baher Kamal http://www.ipsnews.net/?p=153352 The growing resistance to antibiotics and other antimicrobials due to their overuse and misuse both in humans and animals has become an alarming global threat to public health, food safety and security, causing the deaths of 700,000 people each year. This is a fact. The good news is that now more and more countries have […]

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Antimicrobial drugs play a critical role in the treatment of diseases, their use is essential to protect both human and animal health. However, antimicrobials are often misused for treatment and prevention of diseases in livestock sector, aquaculture as well as crop production. Credit: FAO

By Baher Kamal
ROME, Dec 6 2017 (IPS)

The growing resistance to antibiotics and other antimicrobials due to their overuse and misuse both in humans and animals has become an alarming global threat to public health, food safety and security, causing the deaths of 700,000 people each year. This is a fact.

The good news is that now more and more countries have adopted measures to prevent the excessive and wrong use of antimicrobials. The bad ones are that these drugs continue to be intensively utilised to accelerate the growth of animals, often for the sake of obtaining greater commercial benefits.

According to the first annual survey conducted by the Food and Agriculture Organization of the UN (FAO), the World Health Organization (WHO), and a global intergovernmental body on animal health—the World Organisation for Animal Health (OIE), more than 6.5 billion people – over 90 per cent of the world’s population – now live in country that has in place, or is developing, a national action plan on antimicrobial resistance (AMR).

“Nearly all of these plans cover both human and animal health in line with the recommended ‘one health‘ multi-sectoral approach,” FAO said on 17 November.

The survey’s release came at the end of the World Antibiotic Awareness Week, which kicked off on 13 November, announcing that more countries have unveiled plans to tackle AMR.

So far so good.

Ferocious Superbugs

The bad news is that careless disposal of antibiotics could produce ‘ferocious superbugs,’ warns the United Nations.

In fact, growing antimicrobial resistance linked to the discharge of drugs and some chemicals into the environment is one of the most worrying health threats today, according to new research from the United Nations that highlights emerging challenges and solutions in environment.

“The warning here is truly frightening: we could be spurring the development of ferocious superbugs through ignorance and carelessness,” on 5 December said Erik Solheim, chief of the UN Environment Programme (UNEP).

The Frontiers Report, launched on the second day of the UN Environment Assembly (UNEA), running through 6 December in Nairobi, looks at the environmental dimension of antimicrobial resistance in nanomaterials; marine protected areas; sand and dust storms; off-grid solar solutions; and environmental displacement – finding the role of the environment in the emergence and spread of resistance to antimicrobials particularly concerning.

The other bad news is that while antimicrobial medicines – antibiotics, antifungals, antivirals or antiparasitics – are widely used in livestock, poultry and aquaculture operations to treat or prevent diseases, the survey alerts that their over-use and misuse –such as for “promoting growth”– is leading to the emergence of microbes resistant to these drugs, making the diseases they cause difficult or in cases, impossible, to treat.

Epic Proportions

“Humans exposed to these antimicrobial resistant pathogens are also affected in the same way.”

And here comes the recurrent alert: despite progress, the global push to address this problem – which is taking on “epic proportions” – is still in its early stages.

There are weak points that still need to be shored up – particularly in the food and agriculture sectors of low- and middle-income countries, key battlegrounds against ‘superbugs’ resistant to conventional medicines, FAO cautions.

“In particular, there are major gaps in data regarding where, how and to what extent antimicrobials are being used in agriculture; also systems and facilities for tracking the occurrence of AMR in food systems and the surrounding environment need to be strengthened.”

“The goal is to help them develop the tools and capacity to implement best practices in animal and crop production, reduce the need for antimicrobials in food systems, develop surveillance capacity to assess the scale of AMR and efforts to control it, and strengthen regulatory frameworks to minimise the misuse of antibiotics while simultaneously ensuring access to drugs for treating sick animals,” said Ren Wang, FAO Assistant Director-General for Agriculture and Consumer Protection.

What Is the Problem?

The UN food and agriculture specialised agency provides the following sound explanation:
Since the introduction of penicillin in the middle of the 20th century, antimicrobial treatments have been used not only in human medicine but in veterinary care as well.

At first, they were utilized to treat sick animals and to introduce new surgical techniques, making it possible, for example, to perform caesarean sections in cattle on farms. With the intensification of farming, however, the use of antimicrobials was expanded to include disease prevention and use as growth promoters.

The use of antimicrobials in healthy animals to prevent diseases has now become common in husbandry systems where large numbers are housed under moderate to poor hygienic conditions without appropriate biosafety measures in place. Similarly, when a few members of a flock have a disease, sometimes all animals are treated to prevent its spread.

Besides such uses for treatment (therapeutic) and prevention (prophylactic uses), antimicrobials have been added — in low dosages– to animal feed to promote faster growth, FAO warns, adding that “although more and more countries prohibit the use of antimicrobials as growth promoters, it remains common in many parts of the world.”

A row of cattle waiting to be fed at the National Livestock Development Board Farm in Mahaberiyathenna, Sri Lanka. Credit: FAO

Although the UN agency does not say explicitly why this happens, it could be easily deduced that it is due to the voracious appetite for greater profits.

FAO goes on to warns that in the coming decades, the use of antimicrobials in animal production and health will likely rise as a result of economic expansion, a growing global population, and higher demand for animal-sourced foods. Indeed, their use in livestock is expected to double within 20 years.

“It is likely that the excessive use of antimicrobials in livestock (and aquaculture) will contaminate the environment and contribute to a rise of resistant microorganisms. This poses a threat not only to human health, but also to animal health, animal welfare, and sustainable livestock production — and this has implications for food security and people’s livelihoods.”

And the more antimicrobials are misused, the less effective they are as medicines in both veterinary and human healthcare, as the misuse drives AMR to evolve and emerge in disease-causing microorganisms, t adds.

Another major specialised UN agency, WHO, explains that antimicrobial resistance describes a natural phenomenon where microorganisms such as bacteria, viruses, parasites and fungi lose sensitivity to the effects of antimicrobial medicines, like antibiotics, that were previously effective in treating infections.

“Any use of antimicrobials can result in the development of AMR. The more antimicrobials are used, the more likely microorganisms will develop resistance, and the misuse and excessive use of antimicrobials speeds up this process.”

Examples of misuse include using an incorrect dose or administering an antimicrobial at the wrong frequency or for an insufficient or excessive duration, according to WHO.

The Dangers

AMR causes a reduction in the effectiveness of medicines, making infections and diseases difficult or impossible to treat, the UN health agency warns, adding that “AMR is associated with increased mortality, prolonged illnesses in people and animals, production losses in agriculture, livestock and aquaculture.

“This threatens global health, livelihoods and food security. AMR also increases the cost of treatments and care.”

Should all this not be enough, the WHO chief, Tedros Adhanom Ghebreyesus, says, “Antibiotic resistance is a global crisis that we cannot ignore… If we don’t tackle this threat with strong, coordinated action, antimicrobial resistance will take us back to a time when people feared common infections and risked their lives from minor surgery.”

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Rohingya Exodus Is a “Major Global Humanitarian Emergency”http://www.ipsnews.net/2017/12/rohingya-exodus-major-global-humanitarian-emergency/?utm_source=rss&utm_medium=rss&utm_campaign=rohingya-exodus-major-global-humanitarian-emergency http://www.ipsnews.net/2017/12/rohingya-exodus-major-global-humanitarian-emergency/#comments Tue, 05 Dec 2017 23:33:33 +0000 Naimul Haq http://www.ipsnews.net/?p=153339 IPS Correspondent Naimul Haq interviews WILLIAM LACY SWING, Director General of the International Organization for Migration (IOM)

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IOM Director General William Lacy Swing (right) visits Rohingya refugee camps in Bangladesh. Photo courtesy of IOM

IOM Director General William Lacy Swing (right) visits Rohingya refugee camps in Bangladesh. Photo courtesy of IOM

By Naimul Haq
DHAKA, Bangladesh, Dec 5 2017 (IPS)

In less than four months, over 600,000 Rohingya refugees have fled brutal persecution in Myanmar to seek safety across the border in Bangladesh. They are now crowded into camps across a stretch of 30 kms in Cox’s Bazar, a southeastern coastal region of the small South Asian nation.

The UN migration agency, International Organisation for Migration (IOM), has appealed to the international community for urgent funds. Over 344 million dollars was pledged recently at an international meeting to ramp up the delivery of critical humanitarian assistance. IOM stressed that the international community must work together to help to bring about a political resolution to the Rohingya crisis.We all need to work to create the conditions that will allow the refugees to eventually return voluntarily to Myanmar in safety and dignity.

IOM, at the request of the government of Bangladesh, has been leading the Inter Sector Coordination Group (ISCG), which is coordinating the humanitarian response to the influx of Rohingya refugees.

This appeal outlines IOM’s funding requirement from September 2017 to February 2018 as a part of the wider UN Humanitarian Response Plan.

William Lacy Swing, IOM’s Director General, told IPS Correspondent Naimul Haq that any durable solution must be a political one agreed between Bangladesh and Myanmar and supported by the international community.

Swing said that all stakeholders need to work to create the conditions that will allow the Rohingya refugees to eventually return voluntarily to Myanmar in safety and dignity.

He praised the Bangladesh government’s mobilization of its own resources, as well as the local community’s support to help the refugees. Swing went on a four-day visit in mid- October to several camps in Cox’s Bazar.

Following are the excerpts from the interview.

Q. During your visit to various camps, you witnessed the horror, heard the victims and saw the difficult situation prevailing in the camps. How do you compare the Rohingya exodus with the recent similar refugee crisis like in Syria?

A. The Rohingya refugee crisis, although much smaller than the exodus of five million people from Syria since 2011, is equally severe in many ways. It has unfolded at extraordinary speed with over 600,000 people arriving in a single, relatively small district – Cox’s Bazar – since August 25th. By contrast the Syrian civil war has resulted in Syria’s neighbors, notably Turkey, Jordan, Lebanon, and Iraq, all hosting large numbers of Syrian refugees. But the speed, scale and complexity of what is now happening in Cox’s Bazar has created a major global humanitarian emergency. The needs on the ground for shelter, food, clean water, sanitation and healthcare are enormous. When this happened, none of us – neither humanitarian agencies nor the government of Bangladesh – were fully prepared to cope with an influx of this magnitude in such a short space of time.

Q. In a joint statement about relief for the Rohingyas, you said, “Much more is urgently needed. The efforts must be scaled up and expanded to receive and protect refugees and ensure they are provided with basic shelter and acceptable living conditions. They [Rohingyas] are fully dependent on humanitarian assistance for food, water, health and other essential needs. Basic services are under severe strain. In some sites, there is no access to potable water and sanitation facilities, raising health risks for both the refugees and the communities hosting them.” How do you plan to expand the distribution and what is the estimated cost of the additional relief?

A. IOM has been providing assistance to Rohingya refugees in Cox’s Bazar, in partnership with the government, UN agencies, international and local NGOs, since September 2013. Now more international and local agencies are coming in to work with us in a well-coordinated effort to help an estimated 1.2 million people – including nearly 900,000 refugees and 300,000 people living in host communities already living since 1992.

But there are still gaps in the response and more resources are needed to ensure adequate, lifesaving assistance for everyone who needs it. Even now, three months after the start of the crisis, hundreds more people are still coming across the border from Myanmar every day. The Joint Response Plan, launched by the UN and partners in September, appealed for USD 434 million to support 1.2 million people through February 2018. Only USD 149.1 million has been received so far, of which IOM has received USD 52 million.

Q. The need [relief] assessment is taking place almost on a daily basis as the influx continues with more Rohingyas arriving in the camps for safety. It appears that the refugees would need to stay in Bangladesh for quite a while before a diplomatic solution is reached for their safe return. Having said this, a sustainable approach is needed on the ground. How do you or the international community, including the UN, plan to pursue both the governments [Bangladesh & Myanmar] to come to terms and find a peaceful return and settlement?

A. Any durable solution must be a political one agreed between Bangladesh and Myanmar and supported by the international community. We all need to work to create the conditions that will allow the refugees to eventually return voluntarily to Myanmar in safety and dignity. The agreement on return signed by the two countries last week is an important first step. But this is going to take time. As the UN Secretary-General has highlighted, UN agencies need to first resume their humanitarian work in Rakhine State, to promote reconciliation between the communities, and to help the government of Myanmar to implement the recommendations of the Rakhine Advisory Commission – the agreed roadmap to peaceful co-existence.

Q. During your visit you met with the Prime Minister of Bangladesh Sheikh Hasina who was quoted as saying, “They [Rohingya] have to go back to their homeland, create international pressure on Myanmar so that they take steps to bring their citizens back.” We just had the UN General Assembly expressing concern for the Rohingya refugees while many heads of government have already sent messages to Myanmar to take back their citizens. The Bangladesh PM and the world leaders are expressing concerns in the same tone. What could be the role of IOM in finding a lasting solution and how?

A. The Prime Minister is correct in saying that there has to be a political solution supported by the international community. Much of this solution lies with Myanmar. IOM, as the UN Migration Agency, is a humanitarian agency and as such does not have the political weight of the UN Secretary General or the UN Security Council. But we can support the Secretary-General in advocating for dialogue between the parties in the hope that it will eventually allow the Rohingya to leave the terrible conditions in which they are living in Cox’s Bazar and return home safely to resume their lives.

Q. Do you have plans to visit Myanmar and meet the leaders there? If yes, what are you hoping to discuss and also see on the ground in Rakhine state where the Rohingyas are coming from?

A. I have no plans to visit Myanmar this year, but I look forward to returning next year to reaffirm IOM’s commitment to promoting peace and stability in Rakhine State, and, of course, to review the many other excellent projects that we implement in the rest of the country.

Q. A Critical Pledging Conference was held in Geneva on October 23, 2017 organized by OCHA, IOM and UNHCR and co-hosted by the European Union and Kuwait. Apart from pledges for international funds, what was the main message at the conference to the Rohingya crisis?

A. The conference was organized to provide governments from around the world an opportunity to show their solidarity and share the financial burden and responsibility for the Rohingya refugees. Over USD 344 million was pledged to urgently ramp up the delivery of critical humanitarian assistance. But countries represented at the conference also stressed that the international community must work together to help to bring about a political resolution of the Rohingya issue.

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Action Needed to Avoid the End of Modern Medicinehttp://www.ipsnews.net/2017/12/action-needed-avoid-end-modern-medicine/?utm_source=rss&utm_medium=rss&utm_campaign=action-needed-avoid-end-modern-medicine http://www.ipsnews.net/2017/12/action-needed-avoid-end-modern-medicine/#respond Tue, 05 Dec 2017 18:19:25 +0000 Martin Khor http://www.ipsnews.net/?p=153332 Martin Khor is Executive Director of the South Centre, a think tank for developing countries, based in Geneva.

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Antibiotic resistance is rising to dangerously high levels in all parts of the world, threatening our ability to treat common infectious diseases

Unregulated sales of antibiotics are contributing to growing resistance. Credit: Adil Siddiqi/IPS

By Martin Khor
PENANG, Malaysia, Dec 5 2017 (IPS)

The next time you have a bad cold and reach for the antibiotics left over from your last visit to the doctor, think again.

Firstly, the antibiotics won’t work as they only act against bacteria while the cold is caused by a virus.

Secondly, you will be contributing to the arguably the world’s gravest health threat – antibiotic resistance.

The wrong use and over-use of antibiotics is one of the main causes why they are becoming increasingly ineffective against many diseases, including pneumonia, tuberculosis, blood disorders, gonorrhoea and foodborne diseases.

While an effective antibiotic kills most of the targeted germs, a few may survive and develop resistance which can spread to other bacteria that cause the same infection or different infections.  The rate of resistance and its spread can increase if antibiotics are wrongly or over used, and they then become increasingly ineffective to treat bacterial infections.

When a new global financial crisis strikes, the developing countries will be more damaged than in the last crisis as they have become less resilient and more vulnerable. They thus need to prepare from being overwhelmed, says Martin Khor

Martin Khor, Executive Director of the South Centre

Global health leaders are now ringing the alarm bell.  “Antimicrobial resistance is a global health emergency,” warned the World Health Organisation’s Director-General Tedros Adhanom Ghebreyesus.   “The world is facing an antibiotic apocalypse,” said the United Kingdom’s Chief Medical Officer Dame Sally Davies.  “It may spell the end of modern medicine.”

Warns the WHO:  “Antibiotic resistance is rising to dangerously high levels in all parts of the world.  New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases…Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.”  (WHO Fact Sheet on antibiotic resistance, Nov. 2017).

These warnings were highlighted on World Antibiotics Awareness Week on 13-19 November when activities were held in many countries.

Antibiotic resistance is part of the wider phenomenon of anti-microbial resistance (AMR), which includes resistance of bacteria, fungi, viruses and parasites to medicines.

About 700,000 people die annually due to antimicrobial resistant infections, and this is estimated to rise to 10 million deaths a year by 2050 if action is not taken, with a cumulative economic cost of US $100 trillion, according to a 2016 review on AMR sponsored by the UK government.

A key tipping point was reached recently when it was found that some bacteria had evolved to be resistant to colistin, the antibiotic of last resort which is used on a patient when all other antibiotics are found ineffective.

Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases…Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.

WHO Fact Sheet on antibiotic resistance, Nov. 2017
In 2016, researchers in China found colistin-resistant E. coli bacteria in 20 per cent of animals, 15 per cent of raw meat and 1 per cent of hospital patients that were sampled.  The colistin resitance gene (mcr-1) could easily be transferred among different bacteria.

Malaysia was also one of the first countries where scientists found colistin-resistant bacteria.  “Since the publication of our findings, mcr-1 gene has been found in many other countries,” said Associate Professor Dr Chan Kok Gan of University Malaya.  “This is a frightening scenario and the whole world should sit up and take action to prevent further abuse of antibiotics.”

If this resistance continues to spread, colistin will become less and less effective and we will eventually lose the “antibiotic of last resort.”

The colistin story also carries another lesson.  It is widely thought that resistance is due to over-use of antibiotics by consumers or the spread of infections caused by resistant bacteria to patients in hospitals.

However resistance is also spread through the agriculture sector and the food chain, as shown in the study on colistin in China.

In many countries, much of the antibiotics used (80 per cent in the case of the United States) are fed in farms to animals as growth promoters, to make them grow fatter and faster, as well as to prevent or treat diseases.

Resistant bacteria build up in the animals and are present in raw meat.  Some of these bacteria are passed on to humans when they eat the meat.

In Malaysia, the Department of Veterinary Services in 2012  found that half of the domestic chickens tested had bacteria that were resistant to three types of antibiotics (ampicillin, sulphonamide, tetracycline), as cited in a memorandum by the Consumers’ Association of Penang.

The environment is another source of the spread of resistance.  Residues and wastes containing resistant bacteria flow from farms and hospitals and contaminate soils, drainage systems, rivers and seas.  Some of these bacteria find their way to humans.

The European Union banned the use of antibiotics as growth promoters in animal feed in January 2006 while the US started action to phase them out in December 2013.

In most developing countries, little action has so far been taken. Hopefully that will start to change.  In November 2017, the World Health Organisation issued its first ever guidelines on the use of antibiotics in food-producing animals.

“Scientific evidence demonstrates that overuse of antibiotics in animals can contribute to the emergence of antibiotic resistance,” said WHO’s Food Safety Director, Dr Kazuaki Miyagishima.

 

Antibiotic resistance is rising to dangerously high levels in all parts of the world, threatening our ability to treat common infectious diseases

Misuse of antibiotics and risks. Credit: WHO

 

A WHO-sponsored study published in The Lancet Planetary Health in November 2017 found that interventions that restrict antibiotic use in food-producing animals reduced antibiotic-resistant bacteria in these animals by up to 39%, according to a WHO press release.

The research paper (authored by William Ghali and 10 other scientists), reviewed thousands of studies, and selected 179 relevant ones, to find if there is an association between interventions that restrict antibiotic use and reduction in the prevalence of antibiotic-resistant bacteria in animals and in humans.

The key findings are that:

  • “Overall, reducing antibiotic use decreased prevalence of antibiotic-resistant bacteria in animals by about 15% and multidrug-resistant bacteria by 24-32%.”
  • The evidence of effect on human beings was more limited but showed similar results, “with a 24% absolute reduction in the prevalence of antibiotic-resistant bacteria in humans with interventions that reduce antibiotic use in animals.”

This study influenced the development of the WHO’s new  guidelines, which are aimed at influencing policy makers in the agriculture and health sectors.   According to a WHO press release, the guidelines include:

  • An overall reduction in the use of all classes of medically important antibiotics in food-producing animals.
  • Complete restriction of these antibiotics for growth promotion and for disease prevention without diagnosis.
  • Healthy animals should only receive antibiotics to prevent disease if it has been diagnosed in other animals in the same flock or herd or fish population.
  • Antibiotics used in animals should be from the WHO list as “least important” to human health and not from “highest priority critically important.”

In 2015, Health Ministers attending the World Health Assembly adopted a Global Plan of Action on anti-microbial resistance, and they agreed that each country should prepare national action plans by 2017.

Since there are many sources of antibiotic resistance, the national effort must include not only the health authorities but also those responsible for agriculture and the environment.

The health authorities should take action to control the spread of infections (including in hospitals), carry out surveillance of antibiotic resistance, introduce and implement regulations and guidelines on proper prescriptions, ethical marketing of drugs and rational drug use.

The agriculture authorities should phase out inappropriate use of antibiotics for animals, especially for growth promotion, while the environment authorities should prevent resistant bacteria and genes from contaminating soils, drainage systems, rivers and seas.

There should be campaigns to make the public aware of the dangers of wrongly using antibiotics and that they should not demand that doctors give them antibiotics unnecessarily.

The medical profession should adhere to guidelines on the proper use of antibiotics, while drug companies should not push for maximum sales but instead advocate prudent use of their antibiotics in both the health or animal sectors.

These are the more obvious actions that need to be taken and urgently if we are to succeed in slowing down the alarming rate of antibiotic resistance.   If we fail, it may well be “the end of modern medicine”, as the health leaders and the scientists have warned us.

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