This week UN Security Council considered the situation in Syria. Aid groups operating in northeastern Syria have been raising the alarm about civilian casualties and an impending humanitarian crisis this week, as Turkey began a military assault on the turbulent region’s Kurdish militants. Credit: UN Photo/Manuel Elias

By James Reinl
UNITED NATIONS, Oct 10 2019 (IPS)

Aid groups operating in northeastern Syria have been raising the alarm about civilian casualties and an impending humanitarian crisis this week, as Turkey began a military assault on the turbulent region’s Kurdish militants.

Doctors Without Borders (MSF), Human Rights Watch (HRW) and other groups warned about everything from massive new flows of refugees to conditions for detained Islamic State (IS) fighters from a previous phase in Syria’s chaotic civil war.

Turkish forces began an offensive in Syria’s northeast on Wednesday to clear out Kurdish militias and return Syrian refugees, within days of United States President Donald Trump’s controversial decision to withdraw U.S. troops from Syria’s turbulent north.

MSF teams “remain ready to provide medical care after the Turkish military launched operations” and “are preparing for a potential increase of patients linked to the conflict,” the group said in a statement Wednesday.

“We have seen people being displaced from locations along the border due to the conflict and are extremely worried that the military intervention will threaten the safety and wellbeing of the Syrian people,” the group said.

Military operations against Kurdish fighters began Wednesday with air strikes rocking the Syrian border town of Ras al Ain with large explosions, as Turkey moved tanks, artillery, and howitzers in preparation for a broader assault.

United Nations spokesman Farhan Haq said aid groups would have “scale-up at a time of crisis” and urged the region’s armed forces to keep the Turkey-Syria border open so that aid trucks could bring food, medicine and other gear to those affected by fighting.

Ankara seeks to create a “safe zone” to return millions of refugees to Syrian soil and end a “terror corridor” on Turkey’s southern border. Turkey says Kurdish YPG fighters in northeast Syria are terrorists due to their links to militants waging an insurgency inside Turkey.

Turkey had been preparing to advance into Syria’s northeast since U.S. troops started pulling out of the area in a policy shift by Trump that was widely condemned in Washington as a betrayal of America’s armed Kurdish allies.

Eric Schwartz, president of Refugees International, an aid group, blasted Trump’s policy shift and rounded on Turkish President Recep Tayyip Erdogan’s “shockingly irresponsible” assault, which “will put lives at grave risk.”

“Trump’s decision to give Turkey the green light to launch an incursion into northeast Syria could have major humanitarian consequences,” Schwartz, a former U.S. State Department official, said in a statement.

“It could open new fronts in the conflict and newly displace hundreds of thousands of civilians across an area already in the grip of a humanitarian crisis [and] likely force international relief groups to evacuate just when they are most needed.”

Doz, a youth aid organisation, said Ankara’s stated objective of resettling some 2 million Syrian refugees from Turkey back to their homeland was tantamount to “demographic engineering and ethnic cleansing”.

In a statement, Doz urged the European Union, the U.N. and the U.S. to try to “prevent this war”, which will have “dramatic consequences such as new mass forced migration and directly affect the life of 6 million civilians.”

Fighting in the struggling northeast could “revive” prospects for IS and “cause the release” of some 12,000 hardline militants who are detained by Kurdish forces at al-Hol and other camps in Syria’s northeast, said Doz.

HRW, a New York-based campaign group, said the detained militants across some seven lockups in the northeast included 4,000 foreign fighters who should be repatriated to their countries of origin.

“Thousands of people, including children, are stuck in what amounts to shockingly overcrowded prisons on suspicion of being IS, but no one is accepting responsibility for them,” said Letta Tayler, a crisis researcher for HRW. 

“Any authority that effectively controls these informal prisons is legally bound to urgently improve conditions and ensure that each and every detainee is held lawfully.”

Dr. Joanne Liu, President of MŽedecins Sans Frontires, and Mr. Peter Maurer, President of the International Committee of the Red Cross, speak following the adoption by the Security Council of a resolution on healthcare in armed conflict. Credit: UN Photo/Rick Bajornas.

By Tharanga Yakupitiyage
UNITED NATIONS, May 9 2016 (IPS)

Aid organisations have differing views about the upcoming World Humanitarian Summit, after Médecins Sans Frontières (MSF) pulled out last week some still hope the Summit will help bring about much needed change.

There is little doubt that the world’s humanitarian system is over-burdened as a result of the worst humanitarian crisis since World War II.

The ongoing crisis prompted UN Secretary-General Ban Ki-moon to convene the first-ever World Humanitarian Summit (WHS), which will take place in Istanbul on May 23-24.

Although MSF are concerned the summit will not adequately address weaknesses in humanitarian action, other aid organisations are more hopeful that the summit’s approach could help bring about a more coordinated approach to humanitarian and development assistance. Currently humanitarian aid, which focuses on disasters, is delivered by a largely separate system to development aid, which focuses on addressing systemic poverty.

MSF, which was significantly involved in preparations for the summit, announced last week that they “no longer have any hope” that the meeting will improve emergency response and reinforce the role of impartial humanitarian aid.

The summit’s focus on doing “aid differently” and “end(ing) need” threaten to “dissolve humanitarian assistance into wider development, peace-building and political agendas,” the organisation said in a statement.

MSF also stated that the WHS has become a “fig-leaf of good intentions” which does not make states accountable or responsible.

“By putting states on the same level as nongovernmental organisations and UN agencies, which have no such powers or obligations, the Summit will minimize the responsibility of states,” MSF said.

UN Secretary-General Spokesperson Stephane Dujarric expressed his disappointment in the move, noting that MSF is a “strong and influential voice” in the field.

MSF’s decision to withdraw announced last Thursday has contributed to an ongoing international debate over what is required to create “better aid.”

Care International’s Senior Humanitarian Policy and Advocacy Coordinator Gareth Price-Jones told IPS the WHS needs to ensure faster and more “principled” aid that is still based on the humanitarian doctrine of impartiality and neutrality.

Where Care International differs from MSF is the importance of addressing why there are such needs in the first place, he said.

“[MSF] feels that humanitarian aid should be strictly reactive…although having that reactive response is critical, what we also need is to address the demand side,” said Price-Jones.

He noted that a nexus between humanitarian and development aid would help to implement much needed measures for prevention and mitigation especially in cases of conflict, natural disasters and climate change.

“When the fire service was set up, the logic was to charge in and protect fires,” he said. “But if you look at what modern fire services do nowadays is mostly fire prevention because everyone knows it is obviously far better to prevent a fire than to put it out after it has happened.”

However focusing on prevention does not necessarily mean that humanitarian aid will become politicized, he added.

Similarly, Senior Research Fellow of the Overseas Development Institute’s (ODI) Humanitarian Policy Group  wrote in a report that the collaboration of humanitarian and development actors can contribute to making communities more resilient to future crises.

Bennett told IPS that addressing humanitarian and development aid together could more effectively address complex, long-term crises.

“Right now what you’re seeing is people using emergency funding for decades of aid which isn’t the right way to go about it,” she said.

Though Bennett acknowledges the important role of neutral and independent humanitarian assistance and stressed the need for caution, she said aid should not operate in such separate “silos” in some cases.

“Just call it need and combine forces to understand how we can address that need,” she told IPS. With a “larger pot of funding,” actors can address both short and long-term needs, she added.

She cited the refugee crisis in the Middle East as a case that requires a more long-term, comprehensive aid approach.

“The problem is not going to go away…its not that they are going to leave their home for nine months and then go back and rebuild their house and live there again, that’s not really what happens anymore,” she stated.

According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), the average length of displacement is now 17 years. Already, refugee-hosting countries such as Jordan have found their economic resources exhausted.

Norwegian Refugee Council’s (NRC) Country Director for Jordan Petr Kostohryz told IPS that the focus on immediate needs in the refugee crisis’ early stages created a degree of “aid dependency” instead of contributing to long-term solutions. This is partly due to the nature of humanitarian assistance, he added.

According to a UN and World Bank study, 90 percent of Syrian refugees in Jordan and Lebanon live under the national poverty line. Many families are unable to legally earn income and many children still lack access to education.

“We are at risk (of) losing a whole generation of Syrian refugee children,” he said.

Approximately 40 percent of all Syrian children in Jordan are out of school.

Though different stages of displacement calls for different needs, such protracted displacement often calls for early strategies beyond short-term immediate assistance in order to build resilience against future shocks, Kostohryz stated.

Bennett echoed similar sentiments to IPS, stating that a long-term view that combines short-term and long-term assistance is necessary to help provide education resources, create jobs, and give refugee families a more permanent living situation where “they feel they can actually start a life.”

When asked if he believes that the WHS will result in such tangible outcomes, Kostohryz told IPS that “we have no choice.”

“Although we may live in a time where agreeing on a common outcome or vision is the most difficult in decades, we need changes and new strategies that all key actors gather around and support,” he continued.

Kostohryz said that the solutions are ultimately political and that he hopes the WHS will lead to a confirmed commitment to the protection of civilians including education for all and a reaffirmation of principled humanitarian action.

Price-Jones also expressed similar optimistic hopes for the WHS, underscoring the need for states to make and strengthen such commitments to minimize humanitarian consequences.

“There are no humanitarian solutions to humanitarian problems. They are an outcome of a political failure either to plan for a natural disaster or to prevent and mitigate a conflict,” he told IPS.

Humanitarian reform is therefore in the hands of the world’s governments, a view that MSF shares.

Bennett added that along with governments, institutions such as the UN and large international non-governmental organisations (INGOs) must also address systemic issues in order to improve the humanitarian system including aid delivery and its outcomes.

More skeptical about the potential success of WHS, Bennett hopes that the meeting will at least provide a roadmap to “start” this conversation.

The WHS will bring together approximately 6,000 representatives from governments, businesses, aid organisations and affected communities. This includes 80 member states of the UN’s 193 members.

With the diversity in perspectives of what “humanitarian” means and should look like, it is still unclear what outcomes or actions the summit intends to produce, observers note.

The Tornado aircraft was developed and built by Panavia Aircraft GmbH, a tri-national consortium that includes British Aerospace (previously British Aircraft Corporation); it has played a small role in the war in Yemen. Credit: Geoff Moore/CC-BY-2.0

By Kanya D'Almeida
UNITED NATIONS, Aug 25 2015 (IPS)

Of the 402 children killed in Yemen since the escalation of hostilities in March 2015, 73 percent were victims of Saudi coalition-led airstrikes, a United Nations official said Monday.

In a statement released on Aug. 24, Leila Zerrougui, the special representative of the secretary-general (SRSG) for children and armed conflict, warned that children are paying a heavy price for continued fighting between Houthi rebels and a Gulf Arab coalition, led by Saudi Arabia, bent on reinstating deposed Yemeni President Abd-Rabbu Mansour Hadi.

Incidents documented by the U.N.’s Country Task Force on Monitoring and Reporting suggest that 606 kids have been severely wounded. Between Apr. 1 and Jun. 30, the number of children killed and injured more than tripled, compared to the first quarter of 2015.

Zerrougui said she was “appalled” by heavy civilian casualties in the southwestern Yemeni city of Taiz, where 34 children have died and 12 have been injured in the last three days alone.

Gulf Coalition airstrikes on Aug. 21 resulted in a civilian death of 65; 17 of the victims were children. Houthi fighters also killed 17 kids and injured 12 more while repeatedly shelling residential areas.

In what the U.N. has described as wanton ‘disregard’ for the lives of civilians, the warring sides have also attacked schools, severely limiting education opportunities for children in the embattled Arab nation of 26 million people, 80 percent of whom now require emergency humanitarian assistance.

According to the United Nations Children’s Fund (UNICEF), 114 schools have been destroyed and 315 damaged since March, while 360 have been converted into shelters for the displaced who number upwards of 1.5 million.

On the eve of a new school year, UNICEF believes that the on-going violence will prevent 3,600 schools from re-opening on time, “interrupting access to education for an estimated 1.8 million children.”

With 4,000 people dead and 21 million in need of food, medicines or shelter, children also face a critical shortage of health services and supplies.

Doctors Without Borders (MSF) teams in Yemen say they have “witnessed pregnant women and children dying after arriving too late at the health centre because of petrol shortages or having to hole up for days on end while waiting for a lull in the fighting.”

MSF also faults the coalition-led bombings for civilian deaths and scores of casualties, adding that the Houthi advance on the southern city of Aden has been “equally belligerent”.

On Jul. 19, for instance, indiscriminate bombing by Houthi rebels in densely populated civilian areas resulted in 150 casualties including women, children and the elderly within just a few hours.

Of the many wounded who flooded an MSF hospital, 42 were “dead on arrival”, and several dozen bodies had to remain outside the clinic due to a lack of space, the humanitarian agency said in a Jul. 29 press release.

Appealing to all sides to spare civilians caught in the crossfire, Zerrougui said Yemen provides yet “another stark example of how conflict in the region risks creating a lost generation of children, who are physically and psychologically scarred by their experiences […].”

Ironically, despite the fact that Saudi-led airstrikes have been responsible for the vast majority of child deaths and casualties, the wealthy Gulf state pledged 274 million dollars to humanitarian relief operations in Yemen back in April, though it has yet to make good on this commitment.

Edited by Kitty Stapp

A child stands amid the rubble of what was once his home, after an aerial bombardment on the city of Idlib in northwestern Syria. Credit: Freedom House/CC-BY-2.0

By Kanya D'Almeida
UNITED NATIONS, Jul 9 2015 (IPS)

Barely 10 months ago, the United Nations Refugee Agency (UNHCR) said the refugee population from Syria had reached the three million mark. Today, the latest data from the field show that the number has passed four million.

“This is the biggest refugee population from a single conflict in a generation,” U.N. High Commissioner for Refugees António Guterres said in a statement on Jul. 9.

"I took [my son] to the field hospital in Tafas. They tried to help him but couldn't, since the appropriate equipment is not available in Syria. He needed to go to Jordan for treatment." -- Murad, the father of a 27-day-old baby injured in a barrel bomb attack in Syria
“It is a population that deserves the support of the world but is instead living in dire conditions and sinking deeper into abject poverty.”

Midway through its fifth year, the Syrian conflict that began in March 2011 has reached catastrophic heights, and yet shows no sign of abating.

What started out as mass demonstrations against long-time ruler Bashar al-Assad now involves multiple armed groups including fighters from the Islamic State in Iraq and Syria (ISIS).

A quarter of a million people are dead, according to estimates by the Syrian Observatory for Human Rights. A further 840,000 are injured, with many thousands maimed for life.

And as U.N. agencies struggle to cobble together the funds needed to heal, house and feed millions who have fled bullet-ridden towns and demolished cities, the exodus just keeps growing.

A UNHCR press release issued Thursday said Turkey is hosting 1.8 million Syrians, more than any other nation in the region. Over 250,000 of these refugees are living in 23 camps established and maintained by the Turkish government.

Other countries in the region that have opened their doors to scores of families fleeing the fighting include Lebanon (currently home to over 1.7 million Syrians), Jordan (hosting 629,000 refugees), Iraq (249,000) and Egypt (132,000).

In every single one of these countries, health and infrastructure facilities are quickly nearing breaking point as the hungry, sick and wounded arrive in droves.

On Jul. 9 Doctors Without Borders (MSF) warned that Jordanian hospitals are groaning under a huge patient burden, including numerous Syrians injured by barrel bombs.

In the last two weeks alone more than 65 war-wounded patients turned up at the emergency room of Al-Ramtha hospital in northern Jordan – less than three miles from the Syrian border – where MSF teams have been working with the Jordanian Ministry of Health to provide emergency care to refugees.

The medical humanitarian organisation has called repeatedly for an end to the use of these deadly, improvised weapons, which are typically constructed from oil drums, gas cylinders or water tanks filled with explosives and locally-sourced scrap metals dropped from high-altitude helicopters.

Due to the wide impact radius of barrel bomb attacks, victim often suffer wounds that are impossible to treat within Syria’s borders, where many health facilities have been reduced to rubble in the past five years.

“More than 70 percent of the wounded we receive suffer from blast injuries, and their multiple wounds tell their stories,” Renate Sinke, project coordinator of MSF’s emergency surgical programme in Ramtha, said in the statement released Thursday.

Dr. Muhammad Shoaib, MSF’s medical coordinator in Jordan, added, “A significant proportion of the patients we receive have suffered head injuries and other multiple injuries that cannot be treated inside southern Syria, as CT-scans and other treatment options are limited.”

One of the patients at Al-Ramtha Hospital, the father of a 27-day-old child who suffered head injuries as a result of shrapnel from a barrel bomb, recounted his family’s plight, which mirrors the experience of millions of civilians caught in the crossfire of the deadly conflict.

“At 9:00 a.m., a barrel bomb hit our house in Tafas […]. When I heard the news, I dropped what I was doing and I ran to the house as fast as I could […]. I saw my little boy. He was quiet and his head seemed to be injured. I took him to the field hospital in Tafas. They tried to help him but couldn’t, since the appropriate equipment is not available in Syria. He needed to go to Jordan for treatment,” Murad, the boy’s father, told MSF staff.

“It took us one-and-a-half hours from the time of injury until we arrived at the border, and some more before arriving in Ramtha. Now, all I want is for my baby to be better and go back to Syria.”

It is families like these that comprise the bulk of Syrian refugees, the highest recorded since 1992 when Afghan refugees reached an estimated 4.6 million, says the U.N. Refugee Agency.

Indeed, the figure from Syria could well be even higher than field reports suggest, and does not include the roughly 270,000 asylum applications by Syrians in Europe. A further 7.2 million people are displaced inside Syria itself, in remote or heavily embattled regions.

Worse, officials say, is the apparently inverse relationship between emergency needs and humanitarian funding: with the former constantly rising, while the latter shrinks.

UNHCR and its partners had requested 5.5 billion dollars for relief operations in 2015, but so far only a quarter of those funds have been received.

The World Food Programme (WFP), tasked with feeding about six million Syrians inside the country and in the surrounding region, is facing a massive shortfall, and warned last week that unless immediate funding became available, half a million people could starve.

There is also the very real possibility that over 1.7 million people will have to face the coming winter months without fuel or shelter.

As aid supplies dwindle, desperate and impoverished families are sending their children out to earn a living – according to a joint report released this week by the United Nations Children’s Fund (UNICEF) and Save the Children, three quarters of all refugee households surveyed reported that children have become breadwinners.

Against the backdrop of soaring poverty rates, these findings are perhaps not unexpected. An estimated 86 percent of refugees outside of camps in Jordan, for instance, live below the poverty line, while a further 55 percent of refugees in Lebanon are living in “sub-standard” shelters, according to the refugee agency.

While world leaders oscillate between political and military solutions to the crisis, Syrians are faced with a choice: death by shrapnel at home or death by starvation abroad?

Edited by Kitty Stapp

Patient and leading health organisations in South Africa have now joined a Fix the Patent Laws campaign launched in 2011 by Treatment Action Campaign (TAC) and Doctors Without Borders (MSF) to push for reform of the country’s current patent laws.

The campaign’s promoters say that these laws severely restrict access to affordable medicines for all people living in South Africa.

The organisations which have adhered to the campaign are: People Living With Cancer (PLWC), South African Depression and Anxiety Group (SADAG), DiabetesSA, CanSurvive, SA Federation for Mental Health (SAFMH), Stop Stock Outs, Cancer Association of Southern Africa (CANSA), Schizophrenia and Bipolar Disorder Alliance (SABDA), South African Non-Communicable Diseases Alliance (SANCD Alliance), Marie Stopes, Epilepsy South Africa and Cape Mental Health.

Together, they are calling on the South African government to finalise a National Policy on Intellectual Property that champions measures to reduce prices and increase access to a wide range of medicines for people in need across the country.

TAC and MSF reported Jun. 1 that the expanded coalition of organisations represents public and private sector patients in South Africa seeking treatment and care for a range of cancers, mental illnesses, diabetes and other non-communicable diseases – as well as tuberculosis, HIV and sexual and reproductive health diseases.

South Africa currently grants patents on almost every patent application it receives, allowing companies to maintain lengthy monopoly periods on medicines, argues the campaign. This keeps prices of many medicines higher in South Africa than in many other countries.

According to TAC and MSF, it is estimated that 80 percent of patents granted in South Africa do not meet the country’s patentability criteria. This is largely due to the fact that patents are granted without substantive examination of applications to ensure that patentability criteria are met.

“Some cancer patients would rather go to other countries, like India, for treatment – the combined cost of the flight, medical services and drugs is cheaper than buying the drugs alone in South Africa,” said Bernice Lass of cancer group, CanSurvive.

Linda Greeff of PLWC said that her organisation was supporting the campaign because “we want to ensure that there is proper scrutiny of patent applications before patents are granted. We want a patent granting process that is ethical and transparent, so that more people can access the medicines that they need.”

According to Cassey Chambers of SADAG, the group deals with “patients every day who cannot afford medication or treatment, and as a result become more depressed, helpless, hopeless and even suicidal in some cases.”

DiabetesSA’s Keegan Hall stressed that as health organisations, “we have an obligation to take steps to improve affordability and access to medicines. The cost of insulin and other diabetes management tools are far too expensive for many patients,” Hall added.

Health organisations joining the Fix the Patent Laws campaign say that they recognise the opportunity South Africa has to improve access to medicines for all diseases through reforming problematic patent laws.

South Africa’s Department of Trade and Industry (DTI) has already embarked on the process of legislative reform, releasing a Draft National Policy on Intellectual Property for public comment in 2013. The draft policy contained important commitments to reform the laws in order to restore the balance between public and private interest, in favour of people’s health.

The Fix the Patent Laws campaign coalition is calling for urgent approval of a finalised National Policy on Intellectual Property, as a critical first step toward reform of problematic patent laws and practices that deprive people living in South Africa of more affordable treatments for all conditions.

It notes that as a member of the World Trade Organisation (WTO), South Africa is required to uphold minimum standards of intellectual property protection as defined by the international Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS). This includes granting 20-year patents on medicines.

However, South Africa also has significant flexibility under TRIPS to amend national legislation in order to improve access to medicines. According to the health organisations, reforms could include the government taking measures to limit abusive patents being granted on medicines.

At the same time, it says, government could establish easier procedures for overcoming legitimate patent barriers when medicines are unaffordable, unavailable or not adapted for patient needs.

Edited by Phil Harris   

In Papua New Guinea, most people live in rural areas with poor access to health services, increasing the challenges of fighting infectious diseases, such as tuberculosis. Credit: Catherine Wilson/IPS

By Catherine Wilson
CANBERRA, Australia, Mar 23 2015 (IPS)

Rising multi-drug resistance in patients suffering from tuberculosis, a debilitating infectious lung disease which mainly impacts the developing world, has led to a public health emergency in the southwest Pacific Island state of Papua New Guinea, according to state officials.

While efforts to combat the disease worldwide have produced results, with the global death rate dropping by 45 percent since 1990, the annual number of new cases in Papua New Guinea has risen from 16,000 to 30,000 over the past five years.

“The biggest barrier for the moment is cultural beliefs about the causes of diseases [...]. The first source of help [for many patients] is witchdoctors and local remedies." -- Louis Samiak, chairman of public health at the School of Medicine and Health Services at the University of Papua New Guinea
On World Tuberculosis (TB) Day, observed on Mar. 24, the country’s health experts spoke out about the challenges they face in tackling a disease that thrives in communities struggling against hardship and inadequate access to information and basic services.

“The biggest barrier for the moment is cultural beliefs about the causes of diseases. TB is a disease with long incubation and the first source of help [for many patients] is witchdoctors and local remedies. When patients present late [at health facilities] with advanced disease, it is difficult to treat,” Louis Samiak, chairman of public health at the School of Medicine and Health Services at the University of Papua New Guinea, told IPS.

Disease symptoms include fever, chest pains, fatigue, weight loss and cough, frequently with sputum and blood, which results in the airborne spread of bacteria.

The illness transmits quickly in overcrowded impoverished settlements and in Papua New Guinea, where sanitation coverage is only 19 percent and less than half the population have access to clean water, it is the leading cause of hospital deaths.

In rural villages of Kikori District in the southern Gulf Province the TB incidence rate is an alarming 1,290 per 100,000 people, according to the Papua New Guinea Institute of Medical Research. The national prevalence is 541 cases per 100,000 people, compared to the global average of 126.

The campaign to halt the epidemic in Gulf Province is supported by the international medical non-governmental organisation Doctors Without Borders (MSF). Operating from the main town of Kerema, MSF has since last year diagnosed an average of 50 new TB cases every month, inlcuding patients as young as 10 months.

Adults aged 15-54 years are mainly afflicted, but youth account for about 28 percent of cases in PNG, while pulmonary TB and TB meningitis contribute to malnutrition and mortality in children.

One mother took her ill six-year-old child to Kerema General Hospital in an arduous journey from her mountain village, which took three hours by boat and two by truck.

“In the beginning, the mother did not understand what TB is, why the child needs treatment every day for long periods and why she has to be away from her village. It took two months to gain her acceptance of the treatment and for her to prepare for living away from the village,” a spokesperson for MSF in Papua New Guinea recounted to IPS.

“But the child is now receiving treatment every day with signs of improvement.”

Threatening disease control efforts is increasing resistance in patients to the strong first-line drugs, isoniazid and rifampicin. Common practice of patients stopping medication as soon as they feel better and not fully completing treatment is the main cause of multi-drug resistant TB in the country, Suparat Phuanukoonnon of the Institute of Medical Research told IPS.

When treatment is interrupted, the lower level of medication consumed fails to eradicate all the bacteria, which then develop resistance in the patient’s body.

In 2013, 4.5 percent of diagnosed TB cases in the country were multi-drug resistant, a significant increase from 1.9 percent in 2010. Drug resistant TB is rising in the rural Western and Gulf Provinces and the capital, Port Moresby, where more than half the population live in squatter settlements.

The impact on development is acute, with 75 percent of people with TB worldwide of working age.

“TB can affect all or any part of the human body. It, therefore, affects the whole person and reduces their ability to be productive to society or their community,” University of Papua New Guinea’s Samiak said.

While sufferers face rising healthcare expenses, the inability to work reduces their incomes. Poverty is perpetuated in the next generation when the disease affects both parents, forcing children to withdraw from school in order to care and provide for the family.

Papua New Guinea is the most populous Pacific Island nation with a population of seven million. But there are immense logistical challenges to fighting infectious diseases in the country, with more than 85 percent living in rural areas with poor, if any, access to roads and readily available transport to urban centres and health facilities.

A further hindrance is insufficient healthcare professionals with less than one doctor and 5.3 nurses per 10,000 people and a decline in the country’s health services since 2002, according to a report last year by the National Research Institute.

It found the availability of basic drugs in health clinics has fallen by 10 percent and visits from doctors dropped by 42 percent in the past decade. Despite rapid population growth, the number of patients seeking medical help per day has decreased by 19 percent.

Resources also need to be directed toward public education following a medical research institute survey of 1,034 people in the Central, Madang and Eastern Highlands Provinces, which showed the majority to be unaware of TB, its causes, and treatment.

Phuanukoonnon explained, “Prior to the Global Fund grant for TB [eradication] in PNG in 2007, it was a neglected disease in terms of political commitment and proper funding for the control programme.”

Limited health services are stretched as it is and, while TB information is available at health centres, overworked staff members still have little time for advocacy.

Any educational approach should address “how people receive and process information and believe the information enough to take action”, which requires that “health communication should be relevant to local contexts,” she continued.

Resources to assail the epidemic have been boosted, with the Global Fund announcing last month a further 18 million dollars of funding to fight TB in Papua New Guinea over the next three years.

Samiak said that financial resources could be well spent developing in-country laboratory facilities and staff training, so that TB test results are processed more efficiently and patient follow up and treatment expedited.

Edited by Kanya D’Almeida

Every day, eleven Mozambican women die of cervical cancer. That is 4,000 every year. It is the most frequent cancer among women aged 15-44 and the biggest killer of women among all cancers. Credit: Mercedes Sayagues/IPS

By Mercedes Sayagues
MAPUTO, Oct 31 2014 (IPS)

Mozambique is reeling under the twin burden of HIV and cervical cancer. Eleven women die of cervical cancer every day, or 4,000 a year. Yet this cancer is preventable and treatable, if caught early.

Among African countries, Mozambique vies neck and neck with Malawi for the saddest statistics.

Mozambique has the highest cervical cancer cumulative risk and mortality – seven out of 100 newborn girls will develop this cancer and five will die from it.

Malawi is first in incidence (new cases per year), with Mozambique tailing second.

Cervical cancer is caused by the Human Papilloma Virus (HPV), a common virus with 40 types. Many people carry it dormant and often it goes away by itself. But two types of HPV cause cervical cancer.

HIV and HPV are deadly allies. HPV infection doubles the risk of acquiring HIV while HIV hastens progression of cervical cancer.

Some numbers will give an idea of Mozambique’s burden:

• 7.3 million women over age 15, who can potentially acquire HPV through sex.
• 820,000 women over age 15 living with HIV. Cervical cancer advances quickly with a weak immune system.
• 4,000 deaths of cervical cancer a year, not counting those who die at home, undiagnosed, untreated and unreported

Step by step, health authorities are tackling the problem with a three-pronged strategy: information for prevention, routine screening for detection, and better treatment.

There is even talk of bringing radio therapy equipment and training technicians. In terminal stages, radio therapy shrinks cancer and reducing excruciating pain.

Routine screening for this cancer is now offered with family planning services. Diagnosis and treatment via cryotherapy (freezing) can be done in one visit. The Ministry of Health hopes to cover all districts by 2017.

The mass media campaign had a tireless advocate in the former First Lady, Maria da Luz Guebuza. The Association for the Fight against Cancer, a volunteer group, has multiplied its outreach and helps patients at the oncology wards of main hospitals.

Information is dispelling the perception of cervical cancer as “the neighbour’s disease”, brought upon women by a neighbour’s curse or by witchcraft.

The situation is still dire; needs outpace resources, both human and financial. But it is a great improvement over just three years ago, when only a handful of clinics offered screening, and millions of women had never heard about HPV and cervical cancer at all.

First shipment of the ramped-up U.S. military response to Ebola arriving in Liberia. Credit: US Army Africa/CC-BY-2.0

By Joeva Rock
WASHINGTON, Sep 28 2014 (IPS)

Six months into West Africa’s Ebola crisis, the international community is finally heeding calls for substantial intervention in the region.

On Sep. 16, U.S. President Barack Obama announced a multimillion-dollar U.S. response to the spreading contagion. The crisis, which began in March 2014, has killed over 2,600 people, an alarming figure that experts say will rise quickly if the disease is not contained.

Obama’s announcement comes on the heels of growing international impatience with what critics have called the U.S. government’s “infuriatingly” slow response to the outbreak.

Assistance efforts have already stoked controversy, with a noticeable privilege of care being afforded to foreign healthcare workers over Africans.

The U.S. operation in Liberia warrants many questions. Will military contractors be used in the construction of facilities and execution of programmes? [...] Will the treatment centers double as research labs? [...] And perhaps most significantly for the long term, will the Liberian operation base serve as a staging ground for non-Ebola related military operations?
After two infected American missionaries were administered Zmapp, a life-saving experimental drug, controversy exploded when reports emerged that Doctors Without Borders (MSF) had previously decided not to administer it to the Sierra Leonean doctor Sheik Umar Khan, who succumbed to Ebola after helping to lead the country’s fight against the disease.

The World Health Organisation (WHO) similarly refused to evacuate the prominent Sierra Leonean doctor Olivet Buck, who later died of the disease as well. The Pentagon provoked its own controversy when it announced plans to deploy a 22-million-dollar, 25-bed U.S. military field hospital—reportedly for foreign health workers only.

One particular component of the latest assistance package promises to be controversial as well: namely, the deployment of 3,000 U.S. troops to Liberia, where the U.S. Africa Command (AFRICOM) will establish a joint command operations base to serve as a logistics and training center for medical responders.

According to the prominent political blog ‘Think Progress’, this number represents “nearly two-thirds of AFRICOM’s 4,800 assigned personnel” who will coordinate with civilian organisations to distribute supplies and construct up to 17 treatment centres.

It’s unclear whether any U.S. healthcare personnel will actually treat patients, but according to the White House, “the U.S. Government will help recruit and organise medical personnel to staff” the centres and “establish a site to train up to 500 health care providers per week.”

The latter begs the question of practicality: where would these would-be health workers be recruited from?

According to the Obama administration, the package was requested directly by Liberian President Ellen Johnson Sirleaf. (Notably, Liberia was the only African nation to offer to host AFRICOM’s headquarters in 2008, an offer AFRICOM declined and decided to set up in Germany instead).

But in a country still recovering from decades of civil war, this move was not welcomed by all. “Every Liberian I speak with is having acute anxiety attacks,” said Liberian writer Stephanie C. Horton. “We knew this was coming but the sense of mounting doom is emotional devastation.”

Few would oppose a robust U.S. response to the Ebola crisis, but the militarised nature of the White House plan comes in the context of a broader U.S.-led militarisation of the region.

The soldiers in Liberia, after all, will not be the only American troops on the African continent. In the six years of AFRICOM’s existence, the U.S. military has steadily and quietly been building its presence on the continent through drone bases and partnerships with local militaries.

This is what’s known as the “new normal”: drone strikes, partnerships to train and equip African troops (including those with troubled human rights records), reconnaissance missions, and multinational training operations.

To build PR for its military exercises, AFRICOM relies on soft-power tactics: vibrant social media pages, academic symposia, and humanitarian programming. But such militarised humanitarianism—such as building schools and hospitals and responding to disease outbreaks—also plays more strategic, practical purpose: it allows military personnel to train in new environments, gather local experience and tactical data, and build diplomatic relations with host countries and communities.

TomDispatch’s Nick Turse, one of the foremost reporters on the militarisation of Africa, noted that a recent report from the U.S. Department of Defense “found failures in planning, executing, tracking, and documenting such projects,” leaving big questions about their efficacy.

Perhaps more importantly, experts have warned that the provision of humanitarian assistance by uniformed soldiers could have dangerous, destabilising effects, especially in countries with long histories of civil conflict, such as Liberia and Sierra Leone.

At the outset of the crisis, for example, efforts by Liberian troops to forcefully quarantine the residents of West Point, a community in the capital of Monrovia, led to deadly clashes. Some public health advocates worry that the presence of armed troops could provoke similar incidents.

The U.S. operation in Liberia warrants many questions. Will military contractors be used in the construction of facilities and execution of programmes? Will the U.S.-built treatment centers be temporary or permanent? Will the treatment centers double as research labs? What is the timeline for exiting the country? And perhaps most significantly for the long term, will the Liberian operation base serve as a staging ground for non-Ebola related military operations?

The use of the U.S. military in this operation should raise red flags for the American public as well. After all, if the military truly is the governmental institution best equipped to handle this outbreak, it speaks worlds about the neglect of civilian programmes at home as well as abroad.

This article first appeared on Foreign Policy in Focus. You can read the original version here.

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS-Inter Press Service.

Excerpt:

Sierra Leone and Liberia alone could have a total of more than 20,000 new cases of Ebola within six weeks and as many as 1.4 million by Jan. 20, 2015, if the virus continues spreading at its current rate. Credit: European Commission DG ECHO/CC-BY-ND-2.0

By Jim Lobe
WASHINGTON, Sep 26 2014 (IPS)

Despite mounting pledges of assistance, the continuing spread of the deadly Ebola virus in West Africa is outpacing regional and international efforts to stop it, according to world leaders and global health experts.

“We are not moving fast enough. We are not doing enough,” declared U.S. President Barack Obama at a special meeting on the Ebola crisis at the United Nations in New York Thursday. He warned that “hundreds of thousands” of people could be killed by the epidemic in the coming months unless the international community provided the necessary resources.

He was joined by World Bank President Jim Yong Kim who announced his institution would nearly double its financing to 400 million dollars to help the worst-affected countries – Guinea, Liberia, and Sierra Leone – cope with the crisis.

“We can – we must – all move more swiftly to contain the spread of Ebola and help these countries and their people,” according to Kim, much of whose professional career has been devoted to improving health services for people around the world.

“Generous pledges of aid and unprecedented U.N. resolutions are very welcome. But they will mean little, unless they are translated into immediate action. The reality on the ground today is this: the promised surge has not yet delivered." -- Joanne Liu, international president of Doctors Without Borders (MSF)
“Too many lives have been lost already, and the fate of thousands of others depends upon a response that can contain and then stop this epidemic,” he said.

Indeed, concern about the spread of the epidemic has increased sharply here in recent days, particularly in light of projections released earlier this week by the Atlanta-based U.S. Center for Disease Control and Prevention (CDC), which has sent scores of experts to the region. It found that Sierra Leone and Liberia alone could have a total of more than 20,000 new cases of Ebola within six weeks and as many as 1.4 million by Jan. 20, 2015, if the virus continues spreading at its current rate.

Moreover, global health officials have revised upwards – from 55 percent to 70 percent – the mortality rate of those infected with the virus whose latest outbreak appears to have begun in a remote village in Guinea before spreading southwards into two nations that have only relatively recently begun to recover from devastating civil wars.

Officially, almost 3,000 people have died from the latest outbreak, which began last spring. But most experts believe the official figures are far too conservative, because many cases have not been reported to the authorities, especially in remote regions of the three affected countries.

“Staff at the outbreak sites see evidence that the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak, according to the World Health Organisation (WHO), which is overseeing the global effort to combat the virus’s spread.

In addition to the staggering human costs, the economic toll is also proving dire, if not catastrophic, as the fear of contagion and the resort by governments to a variety of quarantine measures have seriously disrupted normal transport, trade, and commerce.

In a study released last week, the World Bank found that inflation and prices of basic staples that had been contained during the last few months are now rising rapidly upwards in response to shortages, panic buying, and speculation.

The study, which did not factor in the latest CDC estimates, projected potential economic losses for all three countries in 2014 at 359 million dollars – or an average of about a three-percent decline in what their economic output would otherwise have been.

The impact for 2015 could reach more than 800 million dollars, with the Liberian economy likely to be hardest hit among the three, which were already among the world’s poorest nations.

“This is a humanitarian catastrophe, first and foremost,” Kim said Thursday. “But the economic ramifications are very broad and could be long lasting. Our assessment shows a much more severe economic impact on affected countries than was previously estimated.”

Moreover, security analysts have warned that the epidemic could also provoke political crises and upheaval in any or all of the affected countries, effectively unravelling years of efforts to stabilise the region.

In a statement released Tuesday, the Brussels-based International Crisis Group (ICG) warned that the hardest hit countries already “face widespread chaos and, potentially, collapse,” in part due to the distrust between citizens and their governments, as shown by the sometimes violent resistance to often military-enforced quarantine and other official efforts to halt the virus’s spread. Food shortages could also provoke popular uprisings against local authorities.

“In all three countries, past civil conflicts fuelled by local and regional antagonisms could resurface,” according to the ICG statement which warned that the virus could also spread to Guinea-Bissau and Gambia, both of which, like the three core nations, lack health systems that can cope with the challenge.

Obama, who Friday will host 44 countries that have enlisted in his administration’s Global Health Security Agenda, himself echoed some of these concerns, stressing that containing Ebola “is as important a national security priority for my team as anything else that’s out there.”

Earlier this month, WHO estimated that it will cost a minimum of 600 million dollars – now generally considered too low a figure –to halt the disease’s spread of which somewhat more than 300 million dollars has materialised to date.

The U.S. has so far pledged more than 500 million dollars and 3,000 troops who are being deployed to the region, along with the CDC specialists. Even that contribution has been criticised as too little by some regional and health experts.

“…[T]he number of new Ebola cases each week far exceeds the number of hospital beds in Sierra Leone and Liberia,” according to John Campbell, a West Africa specialist at the Council on Foreign Relations (CFR), who cited a recent article in the ‘New England Journal of Medicine’.

“It is hard to see how President Obama’s promise to send 3,000 military personnel to Liberia to build hospitals with a total of 1,700 beds can be transformative,” he wrote on the CFR website. “The assistance by the United Kingdom to Sierra Leone and France to Guinea is even smaller,” he noted.

A number of foundations have also pledged help. The Bill and Melinda Gates Foundation, which has spent billions of dollars to improve health conditions in sub-Saharan Africa, has committed 50 million dollars, while Microsoft co-founder Paul Allen’s foundation has pledged 65 million dollars to the cause. The California-based William and Flora Hewlett Foundation announced Thursday it had committed five million dollars to be channelled through half a dozen non-governmental organisations.

But whether such contributions will be sufficient remains doubtful, particularly given the dearth of trained staff and adequate facilities in the most-affected countries and the speed at which the pledged support is being delivered – a message that was underlined here Thursday by Joanne Liu, international president of Doctors Without Borders (MSF), which has been deeply engaged in the battle against Ebola.

“Generous pledges of aid and unprecedented U.N. resolutions are very welcome,” she said. “But they will mean little, unless they are translated into immediate action. The reality on the ground today is this: the promised surge has not yet delivered,” she added.

“Our 150-bed facility in Monrovia opens for just thirty minutes each morning. Only a few people are admitted – to fill beds made empty by those who died overnight,” she said. “The sick continue to be turned away, only to return home and spread the virus among loved ones and neighbours.”

“Don’t cut corners. Massive, direct action is the only way,” she declared.

Obama himself repeatedly stressed the urgency, comparing the challenge to “a marathon, but you have to run it like a sprint.”

“And that’s only possible if everybody chips in, if every nation and every organisation takes this seriously. Everybody here has to do more,” he said.

Increasing levels of violence across India due to ethnic tensions and armed insurgencies are taking their toll on women and cutting off access to crucial reproductive health services. Credit: Stella Paul/IPS

By Stella Paul
BASTAR, India, Sep 26 2014 (IPS)

Twenty-five-year-old Khemwanti Pradhan is a ‘Mitanin’ – a trained and accredited community health worker – based in the Nagarbeda village of the Bastar region in the central Indian state of Chhattisgarh.

Since 2007, Pradhan has been informing local women about government health schemes and urging them to deliver their babies at a hospital instead of in their own homes.

Ironically, when Pradhan gave birth to her first child in 2012, she herself was unable to visit a hospital because government security forces chose that very day to conduct a raid on her village, which is believed to be a hub of armed communist insurgents.

“I have seen women trying to use home remedies like poultices to cure sepsis just because they don’t want to run into either an army man or a rebel." -- Daniel Mate, a youth activist from the town of Tengnoupal, on the India-Myanmar border
In the panic and chaos that ensued, the village all but shut down, leaving Pradhan to manage on her own.

“Security men were carrying out a door-to-door search for Maoist rebels. They arrested many young men from our village. My husband and my brother-in-law were scared and both fled to the nearby forest.

“When my labour pains began, there was nobody around. I boiled some water and delivered my own baby,” she said.

Thanks to her training as a Mitanin, which simply means ‘friend’ in the local language, Pradhan had a smooth and safe delivery.

But not everyone is so lucky. Increasing levels of violence across India due to ethnic tensions and armed insurgencies are taking their toll on women and cutting off access to crucial reproductive health services.

This past June, for instance, 22-year-old Anita Reang, a Bru tribal refugee woman in the conflict-ridden Mamit district of the northeastern state of Mizoram, began haemorrhaging while giving birth at home.

The young girl eventually bled to death, Anita’s mother Malati told IPS, adding that they couldn’t leave the house because they were surrounded by Mizo neighbours, who were hostile to the Bru family.

According to Doctors Without Borders (MSF), a global charity that provides healthcare in conflict situations and disaster zones across the world, gender-based violence, sexually transmitted infections including HIV, and maternal and neonatal mortality and morbidity all increase during times of conflict.

This could have huge repercussions in India, home to over 31 million women in the reproductive age group according to the United Nations Population Fund (UNFPA).

The country is a long way from achieving the Millennium Development Goal (MDG) target of 103 deaths per 100,000 live births by 2015, and is still nursing a maternal mortality rate of 230 deaths per 100,000 births.

There is a dearth of comprehensive nationwide data on the impact of conflict on maternal health but experts are agreed that it exacerbates the issue of access to clinics and facilities.

MSF’s country medical coordinator, Simon Jones, told IPS that in India the “most common causes of neonatal death are […] prematurity and low birth weight, neonatal infections and birth asphyxia and trauma.”

The government runs nationwide maternal and child health schemes such as Janani Suraksha Yojana and Janani Shishu Suraksha Karykram that provide free medicine, free healthcare, nutritional supplements and also monetary incentives to women who give birth at government facilities.

But according to Waliullah Ahmed Laskar, an advocate in the Guwahati High Court in the northeastern state of Assam, who also leads a rights protection group called the Barak Human Rights Protection Committee, women wishing to access government programmes must travel to an official health centre – an arduous task for those who reside in conflict-prone regions.

In central and eastern India alone, this amounts to some 22 million women.

There is also a trust deficit between women in a conflict area and the health workers, Laskar told IPS. “Women are [often] scared of health workers, who they think hold a bias against them and might ill-treat them.”

For Jomila Bibi, a 31-year-old Muslim refugee woman from Assam’s Kokrajhar district, such fears were not unfounded; the young woman’s newborn daughter died last October after doctors belonging to a rival ethnic group allegedly declined to attend to her.

Bibi was on the run following ethnic clashes between Bengali Muslims and members of the Bodo tribal community in Assam that have left nearly half a million people displaced across the region.

Daniel Mate, a youth activist in the town of Tengnoupal, which lies on India’s conflicted border with Myanmar, recounted several cases of women refusing to seek professional help, despite having severe post-delivery complications, due to compromised security around them.

“When there is more than one armed group [as in the case of the armed insurgency in Tengnoupal and surrounding areas in northeast India’s Manipur state], it is difficult to know who is a friend and who is an enemy,” he told IPS.

“I have seen women trying to use home remedies like poultices to cure sepsis just because they don’t want to run into either an army man or a rebel,” added Mate, who campaigns for crowd-funded medical supplies for the remotest villages in the region, which are plagued by the presence of over a dozen militant groups.

The solution, according to MSF’s Jones, is an overall improvement in comprehensive maternal care including services like Caesarean sections and blood transfusions.

Equally important is the sensitisation of health workers and security personnel, who could persuade more women to seek healthcare, even in troubled times.

Other experts suggest regular mobile healthcare services and on-the-spot midwifery training to women in remote and sensitive regions.

According to Kaushalendra Kukku, a doctor in the Kanker government hospital in Bastar, “When violence erupts, all systems collapse. The best way to minimise the risk of maternal death in such a situation is to take the services to a woman, instead of expecting her to come to [the services].”

Pradhan, who has now resumed her duties as a community health worker, agrees. “I was able to deliver safely because I was trained. If other women receive the same training, they can also help themselves.”

Edited by Kanya D’Almeida

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Doctors Without Borders (MSF) says Afghanistan is “one of the riskiest places to be a pregnant woman or a young child”. Credit: DVIDSHUB/CC-BY-2.0

By Karlos Zurutuza
KABUL, Sep 16 2014 (IPS)

Nasrin Mohamadi, a mother of four, has promised herself never to set foot in an Afghan public hospital again. After her first experience in a maternity ward, she has lost all faith in the state’s healthcare system.

“The doctors said that I had not fully dilated yet so they told me to wait in the corridor. I had to sit on the floor with some others as there wasn’t a single chair,” Mohamadi tells IPS, recalling her experience at Mazar-e Sharif hospital, 425 km northwest of Kabul.

“They finally took me into the room where three other women were waiting with their legs wide open while people came in and out. They kept me like that for an hour until I delivered without [an] anaesthetic, and not even a single towel to clean my baby or myself,” adds the 32-year-old.

“Immediately afterwards the doctors told me to leave as there were more women queuing in the corridor.”

“Many rural health clinics are dysfunctional, as qualified health staff have left the insecure areas, and the supply of reliable drugs and medical materials is irregular or non-existent." -- Doctors Without Borders (MSF)
Even after she left the hospital, Mohamadi’s ordeal was far from over. The doctors told her not to wash herself for ten days after the delivery, and as a result her stitches got infected.

“I paid between 600 and 800 dollars to give birth to my other three children after that; it was money well invested,” she says.

This is a steep price to pay in a country where the average daily income is under three dollars, and 75 percent of the population live in rural areas without easy access to health facilities.

Many women have no other option than to rely on public services, and the result speaks volumes about Afghanistan’s commitment to maternal health: some 460 deaths per 100,000 live births give the country one of the four worst maternal mortality ratios (MMR) in the world outside of sub-Saharan Africa.

While this represents a significant decline from a peak of 1,600 deaths per 100,000 births in 2002, far too many women are still dying during pregnancy and childbirth, according to the United Nations.

In 2013 alone, 4,200 Afghan women lost their lives while giving birth.

The lack of specialised medical attention during pregnancy or delivery for a great bulk of Afghan women is partly responsible. Few have access to health centres because these are only reachable in urban areas. The lack of both security and proper roads forces many women to deliver at home.

This does not bode well for the 6.5 million women of reproductive age around the country, particularly since Afghanistan only has 3,500 midwives, according to the U.N. Population Fund (UNFPA)’s latest State of the World’s Midwifery report.

This means that the existing workforce of midwives meets only 23 percent of women’s needs. The situation is poised to worsen: UNFPA estimates that midwifery services in the country “will need to respond to 1.6 million pregnancies per annum by 2030, 73 percent of these in rural settings.”

Even women with access to top-level urban facilities, such as the Kabul-based Malalai Maternity Hospital, are not guaranteed safety and comfort.

For instance, Sultani*, a mother of four, tells IPS she is far from satisfied with her experience.

“I gave birth through caesarean section to my four children in this hospital but the doctors who attended to me were unskilled,” she remarks bluntly. “A majority of them had only completed three years of medical [school].

“On a scale of one to 10, I can only give Malalai a four,” she concludes.

Sultani’s opinion may be specific to her own experience, but it finds echo in various reports and studies of the country’s health system. A 2013 activity report by Doctors Without Borders (MSF) labeled Afghanistan “one of the riskiest places to be a pregnant woman or a young child” due to a lack of skilled female medical staff.

“Private clinics are unaffordable for most Afghans and many public hospitals are understaffed and overburdened,” reports the organisation, which runs four hospitals across the country.

“Many rural health clinics are dysfunctional, as qualified health staff have left the insecure areas, and the supply of reliable drugs and medical materials is irregular or non-existent,” continues the report.

This is a sobering analysis of a country that will need to configure its health system to cover “at least 117.8 million antenatal visits, 20.3 million births and 81.3 million post-partum/postnatal visits between 2012 and 2030”, according to UNFPA.

Given that contraceptive use is still scarce, reaching only 22 percent of reproductive-age women, large families continue to be the norm. Afghan women give birth to an average of six children, a practice fuelled by a cultural obsession with bearing at least one son, who will in turn care for his parents in their old age.

A lack of information about birth spacing means mothers seldom have time to fully recover between deliveries, causing a range of health issues for the mother and a lack of milk for the newborn child.

Findings from a 2013 survey conducted by the Afghan Ministry of Public Health indicate that only 58 percent of children below six months were exclusively breastfed.

Still, this is an improvement from a decade ago and represents small but hopeful changes in the arena of women and children’s health. The same government survey found, for instance, that “stunting among children has decreased by nearly 20 percent from 60.5 percent in 2004 to 40.9 percent in 2013.”

Dr. Nilofar Sultani, who practices at the Malalai Maternity Hospital, tells IPS that medical assistance in Afghanistan has improved “significantly” over the last ten years.

“There are more health centres, and [they are] far better equipped. The number of skilled doctors has also grown,” explains Sultani, a gynaecologist.

But the most important change, she says, has been in women’s attitude towards medical care. “Before, very few women would come to the hospitals but today, the majority of women come forward on their own. They’re slowly losing their fear [of] doctors,” notes Sultani, adding that health centres are among the very few places where Afghan women can feel at ease without the presence of a man.

Edited by Kanya D’Almeida

Even as aid workers are warning that children in South Sudan are falling victim to mass malnutrition, international agencies are said to be missing their fundraising goals to avert a looming famine in the country.

On Monday, Medecins Sans Frontieres (MSF), the international medical relief organisation, reported that nearly three-quarters of the more than 18,000 patients admitted to the agency’s feeding programmes in South Sudan have been children. South Sudan has experienced mounting civil violence in recent months, which humanitarian groups warn has directly impacted farmers’ ability to plant and grow crops.

A child snacks in her family’s new shelter, at Protection of Civilians (POC) camp III, near UN House, in Juba. Credit: UN Photo/JC McIlwaine

Yet even as South Sudan’s malnutrition epidemic intensifies, seven major international aid agencies, all of which prioritise food security in South Sudanese villages, may have to shut down their projects due to severe funding gaps.

Naming South Sudan to be “the most pressing humanitarian crisis in Africa,” CARE International, a U.S.-based relief agency, has stated that the United Nations’ most recent appeal for South Sudan is less than half funded.

The U.N. says some 1.8 billion dollars is urgently needed in the country, yet CARE says that seven implementing agencies are short by some 89 million dollars.

“We will be staring into the abyss and failing to avert a famine if funds do not start arriving soon,” Mark Goldring, chief executive of Oxfam, said in CARE’s report.

“This is a not a crisis caused by drought or flood. It is a political crisis turned violent. The people of South Sudan can only put their lives back together once the fighting ends. In the meantime… we are asking the public to help us with our urgent humanitarian work, but mainly we are calling on governments to fund the aid effort before it is too late.”

On Thursday, the U.S. Department of State announced it would provide another 22 million dollars in humanitarian assistance to facilitate “basic life support” in South Sudan. Yet the following day, three U.S. lawmakers wrote a letter to President Barack Obama, expressing “grave concern” over the growing conflict in South Sudan’s border region and urging “renewed diplomatic engagement” with the international community.

While solving the political problem at the root of South Sudan’s current violence is a significant priority, aid workers say the international community’s most dire concern should be for the nutritional needs of South Sudanese children.

“Many of these children have walked for days to receive medical care and food security, and these are only the ones we see,” Sandra Bulling, media coordinator for CARE International, told IPS from South Sudan. “We don’t even know about the ones hiding in the bush.”

Centrality of nutrition

The malnutrition crisis comes amidst tumultuous domestic politics in South Sudan, resulting in fighting that has raged since December. Some 1.5 million South Sudanese residents are now estimated to be displaced within the country, thereby decreasing their access to reliable food sources and requiring them to share already-limited supplies.

Dr. Jenny Bell, a medical worker and expert on South Sudan with the University of Calgary in Canada, acknowledges that “the nation’s health situation wasn’t brilliant before December,” but warns that the civil conflict has “compounded” the country’s medical issues.

South Sudan “already had the world’s highest maternal mortality rate, and it had been estimated that one in five South Sudanese children die before they reach age five,” she told IPS.

“But even though there had barely been enough food before, now there really won’t be enough, as [internally displaced] farmers were unable to grow crops [due to the violence], and cannot do so now because South Sudan is well into [its] rainy season.”

Adequate nutrition needs to be South Sudan’s top priority, Bell emphasises. The three leading causes of death in the country – malaria, diarrhoea and respiratory infections – are much more likely for a person to contract when he or she is malnourished, she notes.

Yet she adds that despite the “amazing agricultural potential” of South Sudan, funding for this purpose has been weak.

“The United States’ monetary aid to the region is complicated because they don’t trust the South Sudanese government,” she says. “Because of this, they’ve shifted everything to humanitarian aid, and all the development efforts have been wiped out.”

In addition to monetary aid for agricultural development, Bell says health-care facilities urgently need both supplies and personnel.

CARE’s Bulling agrees that training medical personnel is of key importance in South Sudan, adding that her focus is to work with local staff but fly in as many experts as possible.

“But it is mainly money that we need, so we can procure medicines and all of the necessary nutritional requirements,” she says.

When asked what it would take for the international community to react to the need for more funding in South Sudan, Bulling cited a technique that she says has historically been effective.

“We need to have photos of children starving and dying before the world reacts to such a disaster,” she says.

“This is what has worked for Somalia … you need these pictures to talk. For South Sudan we do all these press releases and calls to action, but as long as there is no big report with photos to show how bad the situation is, there is no response.”

IDPs in Jabal Al-Akrad, in Syria's Latakia region. Credit: Shelly Kittleson/IPS

By Shelly Kittleson
REYHANLI (TURKEY), May 19 2014 (IPS)

As once-eliminated diseases resurface and barrel bombs and alleged chlorine attacks target civilians, doctors in rebel-held areas and across the border struggle with issues of how best to serve their profession.

Up to 70 percent of Syria’s health workers had fled the country as June last year, according to the World Health Organization, and many of the country’s medical facilities have been destroyed or heavily damaged by regime air strikes.

‘’Even blood bags are controlled by the ministry of defense...You go to jail if they find you with one" -- Dr. Omar
Though regime and opposition fighters are often said to share the blame for obstructing access to medical care for civilians, Dr. Omar, who works with the Syrian Expatriate Medical Association (SEMA), said that his organisation has not experienced problems with any rebel groups while working in Syria. However, he stressed that his work ended when the patient – whether rebel fighter, regime soldier or civilian – had been treated.

“My work stops there. What they do with them afterwards is not my business,” he said, stressing the need for neutrality in order to continue operating in areas even when they change hands from one group to another.

Doctors Without Borders (MSF) has long been known for the same code of ethics, but nevertheless had five of its expatriate staff taken hostage in early January, most likely by the fundamentalist group Islamic State of Iraq and Al-Sham (ISIS). More moderate factions have pushed the extremist group out of much of rebel-held territory in the north in recent months but the medical workers’ whereabouts remain unknown.

MSF decided to pull all foreign staff from Syria after the incident but continues to operate several makeshift clinics and mobile facilities in the country using Syrian personnel. It also supports local hospitals.

The international NGO – which, Dr. Omar notes, was ‘’the first group to send us money and support in 2011’’ – has not been able to register with the Turkish government and is thus unable to establish official offices across the border.

He said that he had recently been in Kasab, part of a coastal area seized in late March by rebel fighters, to set up medical facilities for ‘’damage control and sending them elsewhere. That’s all we can do right now’’.

Save the Children recently reported cases of doctors forced to give children unnecessary amputations and patients choosing to be knocked out with metal bars rather than undergo surgery without anaesthesia, which is in short supply. There have been outbreaks of vaccine-preventable measles and polio that have begun to spread across the country’s borders.

Dr. Omar initially left regime territory in early 2012 to avoid arrest, after working as one of the first to coordinate clandestine treatment to those injured in protests across the country. The work involved considerable risk, because ‘’even blood bags are controlled by the ministry of defence, not by the health ministry.”

‘’You go to jail if they find you with one,’’ he said.

He was later one of four doctors working inside the country who met secretly with Syrian expatriate medical staff in the Turkish border town of Reyhanli in November 2011 to start working alongside the Union of Syrian Medical Relief Organizations (UOSSM).

Of the other three doctors, “one has been killed under torture, Mohammad Osama Baroudi, one has been in prison since 2012, and one is working at a field hospital inside.’’

At least 440 medical personnel have been killed in the ongoing conflict, reports Physicians for Human Rights, while many hundreds of others continue to be held in regime detention facilities.

The border town where Dr. Omar works when he is not inside Syria has changed dramatically since this IPS correspondent’s first visit in 2012. A few makeshift care facilities and injured fighters propped up on porches under ‘internet café’ signs or treated in disused hotels and homes have been replaced by a more organised system.

Several medical facilities cater to the masses of injured, amputees and patients with spinal cord injuries who have made it to this side of the border, and ragged-looking Syrian children begging in the streets are a common sight. A clinic specifically for prosthetics, the National Syrian Project for Prosthetic Limbs (NSSPL), has been set up on its outskirts, and short courses are held for would-be physical therapists, many of whom are medical students forced by the conflict to abandon their studies.

A 29-year-old physiotherapist working here told IPS that he had been arrested in early 2011 on terrorism charges and briefly joined a rebel group after being tortured in jail. He found, however, that he was unable to make himself kill anyone. He claims to be one of only a few fully trained and medically certified Syrian physiotherapists now in the town, as he graduated from the faculty set up in 2006 in Homs that closed only a few years later when war broke out.

He and his younger brother were taken from his house in the middle of the night, and he spent ‘’34 days, 6 hours and 28 minutes’’ in detention. His family eventually found a trusted contact to whom they paid 30,000 dollars to have him released. His brother, who worked with the Red Crescent, is still in prison. His family has meanwhile paid several thousand dollars to get him moved to detention facilities where they can occasionally visit him and refuse to leave the area unless his brother comes with them.

The physiotherapist feels he can be more useful here than inside, but admits: ‘’I am afraid of myself. If I go back inside I know I won’t come out again. My old friends would like me to work with them again. But I am still wanted by the regime and would put my family in even more danger than they already are.’’

A young boy looks through a monocle in the teaching hospital in Malakal, Upper Nile State, South Sudan. Fighting continues here despite a ceasefire agreement. Credit: Mackenzie Knowles-Coursin/IPS

By Andrew Green
JUBA, Feb 3 2014 (IPS)

South Sudan is taking the first steps in what promises to be a long process of healing the fractures that prompted more than five weeks of fighting, potentially leaving thousands of people dead and wounded and displacing 863,000 others.

But tensions remain high, following reports of continued fighting in some areas of the country and the government’s decision to move forward with treason charges against four remaining political detainees. And the longer the process stretches on, the worse the situation will become for the hundreds of thousands of displaced across the country.As the numbers of internally displaced continue to grow, the U.N. and humanitarian partners are struggling to provide enough food, clean drinking water and shelter for all of them.

Upper Nile State Information Minister Philip Jiben Ogal told IPS there was gunfire last week outside of Malakal, the state capital. The fighting is in contravention of an almost two-week-old ceasefire agreement between the government and rebels.

Martin Ojok Karial lives in Malakal, working in the Ministry of Finance’s taxation office. Malakal suffered two waves of fighting and was temporarily held by government forces. The town’s central market is destroyed and at least 27,000 people have sought refuge at the United Nations base on the outskirts of town. Karial is one of them.

The humanitarian medical group Doctors Without Borders (MSF) also announced Jan. 31 that ongoing insecurity had forced thousands of people to flee into the bush in Unity State.

Karial sees the fighting as a political feud that was allowed to get out of control.

“A lot of people were dying without any reason,” Karial told IPS. “Because the clashes are between two people. The president of South Sudan and the vice president. This is no reason for people to fight and kill themselves.”

The fighting here first broke out in a Juba military barracks on Dec.15 and spread quickly – first throughout the capital and then across central and eastern South Sudan. President Salva Kiir accused his political rival and former deputy Riek Machar of launching a coup against the government. Machar has repeatedly denied the charges, though he acknowledges he is now in open rebellion against the government.

Following weeks of negotiations in Addis Ababa, the two sides inked a cessation of hostilities agreement Jan. 23. Just hours after signing the document, they began accusing each other of violations.

Karial said people have now lost faith in their political leaders. Even if the two sides strike a peace deal, he said, they would be hard-pressed to convince people like him that it will last.

The government released seven of the 11 political prisoners it had held since mid-December, flying them to Nairobi, Kenya’s capital, late last week. And on Saturday Feb. 2, an advance wave of regional observers arrived to begin monitoring a ceasefire agreement signed between rebels and the government.

While acknowledging there was not enough evidence to charge seven of the detainees, Justice Minister Paulino Wanawilla announced treason charges against the remaining four.

Wanawilla accused them of helping Machar and two others – all of whom are still at large – orchestrate a coup against the government, prompting the outbreak of fighting.

“I think there is enough [of a] case to take them before the court,” Wanawilla said.

Despite the government’s latest refusal to accede to the rebel demand, neither side has backed out of peace talks, which are scheduled to resume this week in Ethiopia.

“The parties are committed and they are ready to resolve the conflict in a peaceful way,” Ethiopian major general Gebreegzabher Mebrahtu said after arriving in Juba. Mebrahtu heads the monitoring efforts organised by the Inter-Governmental Authority on Development, a regional bloc.

It is unclear whether the two sides can strike a bargain that will bring the divided country back together again.

In a pastoral exhortation released late last week, Cardinal Zubeir Wako called for “better governance across the nation and an end to the personalised political power.”

Until people feel safe and they have some control over their political leaders and the events in the country, they will not leave the U.N. bases, the churches and the mosques where they sought shelter from the fighting.

Valerie Amos, U.N. Humanitarian Affairs chief, visited Malakal last week and talked to a handful of the more than 64,000 people displaced in the county.

“Even when I said, ‘We need to work on reconciliation, we need all the communities to come together, the leadership to come together. We need to make sure that people’s safety and security is guaranteed.’ Even then, people were not convinced,” she said. Instead, they asked to be moved to other parts of the country or to leave entirely.

It is a tenuous situation. As the numbers of internally displaced continue to grow, the U.N. and humanitarian partners are struggling to provide enough food, clean drinking water and shelter for all of them. They are also contending with the risk of disease outbreaks.

Aid workers are also starting to draw attention to the long-term implications of the situation.

“We’re coming up to the hunger gap and it is very likely because people have been forced to move as a result of the insecurity, that they won’t have the same food reserves that they had before,” MSF general director Arjan Hehenkamp told IPS.

The U.N. has announced that while 3.2 million people are at risk of immediate food insecurity, more than seven million people may become food insecure this year.

And as the two sides continue discussions, the situation is only going to get worse.

Foreign aid workers are increasingly becoming targets of corrupt officials within the Somali government and the Islamist extremist group Al-Shabaab.

“The government is laden with corrupt officials and allied clan militias that are determined to use them [aid workers] for their own interests,” political analyst Hassan Abukar told IPS. “Kidnapping foreign aid workers has become a way to extract cash from NGOs. Al-Shabaab is mistrustful of the NGOs for fear of losing control in the way aid is administered and [mistakenly believes] that these relief agencies are spying on the terror group.”

Abukar’s comments come as international and independent aid organisation Médecins Sans Frontières, or Doctors Without Borders (MSF), announced this week that it was pulling out of Somalia after over two decades of delivering aid and healthcare there. The murder and harassment of their staff has made it increasingly impossible for the organisation to operate, Dr. Unni Karunakara, MSF’s international president, told reporters at a press briefing in Kenya on Aug. 14. “With the government unable to prevent attacks on themselves, attacks on aid organisations and their workers are not unsurprising.” -- Ahmed Soliman from Chatham House

MSF, which was one of the very few providers of essential healthcare in the Horn of Africa nation, has persevered to provide aid through a civil war, in-fighting among local clans, and piracy. But it will immediately stop all operations. MSF has been operating in the country since 1991, and treated approximately 50,000 people a month.

“The final straw was the realisation that authorities, armed actors and community leaders were actively supporting or tacitly approving the attacks, the abductions, the killings against our staff,” Karunakara said.

Karunakara explained that in some cases, the actors MSF had negotiated safe passage with had played a role in the abuse of MSF staff, either through direct involvement or tacit approval. “Because of their actions, hundreds of thousands of Somalis will now be effectively cut off from medical humanitarian aid,” said Karunakara.

In total, 16 MSF members have been killed, and MSF says they have experienced dozens of attacks on their staff, ambulances, and medical facilities since 1991.

MSF’s departure from Somalia comes at a time when Somalia’s Transitional Federal Government is trying to change the country’s image after years of civil war and famine. Many analysts believe MSF’s departure will be a huge blow to recent efforts to bring foreign aid and investment to the country.

“The departure of MSF shows the incapacity of the new government to manage local security,” Jabril Ibrahim Abdulle, head of the Centre for Research and Dialogue in Mogadishu, told IPS.

“The MSF withdrawal also comes at a time when the Somali government is trying to change the image of the country from a transitional to permanent government and on the eve of Somalia’s new deal conference to be held in Brussels mid-September where world leaders are expected to pledge millions of dollars to the new government.”

MSF’s departure shows that although the African Union Mission in Somalia and an independent Ethiopian force have driven Al-Shabaab out of the country’s main cities, the extremist group is still able to perpetrate wide-scale violence.

Analysts say there has been a notable change in Al-Shabaab’s tactics as they renew their assault on the capital. Several government institutions and airports have been attacked or bombed and government officials, district commissioners and civil servants have been assassinated.

Recently, the extremist group attacked the Turkish embassy in Mogadishu on Jul. 27, killing three people. And on Jun. 17, the United Nations compound in the city was also attacked. Fifteen were killed in the attack.

“In this context, with the government unable to prevent attacks on themselves, attacks on aid organisations and their workers are not unsurprising,” Ahmed Soliman from Chatham House, an independent policy institute based in London told IPS. “MSF would like civilian authorities to take the conviction of those who perpetrate such acts of violence more seriously. The government can certainly reinforce this message and work towards this goal.”

MSF is not the only organisation to withdraw staff. In recent weeks, owing to the increase in violence, most international organisations have withdrawn their non-essential staff from Somalia. While violence is known to increase during Ramadan and abate afterwards, Abukar believes that it is unlikely to reduce “because of the new dynamics of Al-Shabaab factions that are killing each other for control of territories.”

Evidence of Al-Shabaab’s infighting and the defection of Al-Shabaab’s veteran militant Islamist, Sheikh Hassan Dahir Aweys in July, could be a signal that more violence could be on the way.

Previously revered as a statesman for the group, Aweys was forced to hand himself over to government forces, giving power over to Afghan-trained leader Ahmed Abdi Godane.

Analysts expect that this will fuel more fighting, as this faction is more hardline and determined to achieve an Islamic state. The faction will also want to prove it remains a formidable force in light of the defections.

“The emergence of tribal militias loyal to the federal government, which are vying for power, the widespread of political assassinations that are never prosecuted, and the increasing inability of the government to expand its will and control beyond Mogadishu [means that violence will not abate],” Abukar said.

“As the latest U.N. Monitoring Group report on Somalia has pointed out, the Somali government cannot control a territory without international support.”

While Al-Shabaab fights within its ranks and MSF departs, with fears that more NGO’s may follow, the biggest concerns will be for the Somali people who are now cut off from much-needed medical care.

“Unfortunately the Somali people will pay the highest cost. Much of the Somali population has never known the country without war or famine. Already receiving far less help than is needed, many will no longer find the healthcare they require,” said Karunakara. “In several places, MSF has been effectively the only organisation providing quality medical care.”

WFP has launched an operation including the use of helicopters to bring urgently-needed food assistance to tens of thousands of people who have fled to hard-to-reach areas to escape violence in Pibor County, Jonglei State. Credit: UN Photo/Martine Perret

By Roger Hamilton-Martin
UNITED NATIONS, Jul 26 2013 (IPS)

Following fighting in the South Sudan state of Jonglei , the United Nations is trying to coordinate a humanitarian effort to help tens of thousands of people who have fled to the bush. The World Food Programme (WFP) has launched an operation to provide food for those who have escaped the conflict.

“We believe these people need food now and cannot wait for much longer after hiding in the bush for weeks,” said Chris Nikoi, WFP South Sudan country director, in a statement on Tuesday.

The agency is requesting 20 million dollars to fund emergency assistance for 60,000 people through December.

“The Lou Nuer have a longstanding grudge against the Murle, which of course is a two-way street,” Sudan expert Eric Reeves told IPS. “But over the past years these tensions have come to a boil and mutual retaliations are extremely violent.” Retaliation is often in response to cattle looting by neighbouring communities, he said.

It has proven difficult for humanitarian groups to gain access to the large number of people who have been affected by the conflict in the state, South Sudan’s largest, in part because of the fighting and in part due to the lack of passable roads.

The international medical humanitarian organisation Médecins Sans Frontières says it has “treated scores of people and is attempting to reach thousands more who are hiding in the bush… [an] MSF emergency team is attempting to reach tens of thousands of people hiding in unsafe, malaria-infested swamps, without access to safe drinking water, food, or medical care.”

John Tzanos, who heads the MSF team in Pibor County, said in a statement, “They [civilians] are afraid to seek medical care in towns so it is essential for us to intervene where they are so that all those in need can access treatment.” With the latest wave of violence over, there is still no word on the number of casualties.

“We don’t have any figures [on fatalities] at all,” the acting humanitarian coordinator of the U.N. Office for the Coordination of Humanitarian Affairs (OCHA) in Jonglei, Dr. Yasmin Haque, told IPS.

“The challenge has been access, and now we have been able to secure additional funding which has improved our air transport capacity. We have also had a strengthening and better communication in getting security clearances and information in getting our flights to those areas.

“The biggest need is going to be food, and getting the amounts required into the areas is going to be many trips over many days,” she said. Haque said U.N. agencies were working with the government, especially the Relief and Rehabilitation Commission, and were also coordinating aircraft with the army, the SPLA.

“People have been afraid to return to the more populated areas where they have been [living],” she said. “Fear of insecurity and fighting is keeping people away from the main county locations.”

Another spokesperson for OCHA told IPS, “We have already begun to register the people displaced, and have begun to distribute household items and emergency shelter to people who have been living in the bush, exposed to the elements.”

OCHA has appealed for more resources from the international community, and noted that during the rainy season, which lasts from May to October, up to 90 percent of roads in Jonglei state are inaccessible, so aid must be delivered by air.

There are also allegations that the Sudanese government in Khartoum has been exacerbating the conflict by supplying rebel Murle leader David Yauyau with weapons.

The difficulty in tracking Yauyau’s rebels has made it hard for U.N. agencies to keep the peace and supply civilians with necessary aid. Yauyau’s current rebellion has been running since April 2012, for what he claims to be the rights of the Murle.

In an interview last year, Yauyau said, “This time around, we are fighting for the people of South Sudan, the minority communities like the Murle and the others…They don’t have a voice… they don’t have rights to live on the land. We don’t have a voice in the government. We are struggling together with them and we’ve lost some of our sons.”

There are also allegations of human rights abuses perpetrated by the government.

In an open letter to the government written in June, Reeves and three other signatories said that “over the past several years – but the last six months in particular – South Sudan government security forces have engaged in a campaign of violence against civilians simply because they belonged to a different ethnic group or they were viewed as opponents of the current government.”

The U.N. has also condemned the government for what it calls “serious human rights violations” allegedly committed by elements within the South Sudanese Army in Pibor County.

Intellectual property provisions proposed by the United States would extend monopoly powers derived from patents to pharmaceutical companies that sell their medicines abroad. Credit: Bigstock

By Jared Metzker
WASHINGTON, Jul 16 2013 (IPS)

As a new round of talks behind a major proposed free trade area, the Trans-Pacific Partnership (TPP), get underway this week, the United States is pushing several developing countries to accept provisions that critics say would make it more difficult for their citizens to access medicine.

“The concern about access to medicine, and that the TPP deal will lead to high health-care costs, is huge,” Arthur Stamoulis, executive director of Citizens Trade Campaign, a fair trade advocacy group based here, told IPS.“TPP is certainly not being written in the interest of small business owners or working people.” -- Arthur Stamoulis of the Citizens Trade Campaign

On Monday, as negotiations for the TPP enter their 18th round, Medecins Sans Frontieres (MSF), a humanitarian organisation, reflected this concern, urged negotiating countries “to remove terms that could block people from accessing affordable medicines, choke off production of generic medicines, and constrain the ability of governments to pass laws in the interest of public health.”

Negotiations for the TPP, which officially started in 2010, are currently being held in Malaysia, and the countries participating include the United States, Australia, New Zealand, Chile, Peru, Brunei, Singapore, Malaysia, Vietnam, Canada and Mexico.

Japan is expected to join at the end of this round, while others have expressed interest in signing on, as well.

The Office of the United States Trade Representative has explained that the purpose of the deal is to “enhance trade and investment among the TPP partner countries, promote innovation, economic growth and development, and support the creation and retention of jobs.”

Yet critics have long warned that the United States appeared to be setting onerous conditions for any agreement, while complaining that the talks have been held in near secrecy, lacking oversight even from the U.S. Congress.

While intellectual property provisions proposed by the United States may be intended to promote innovation, MSF notes that they would extend monopoly powers derived from patents to pharmaceutical companies that sell their medicines abroad.

This means that it would take longer for cheaper generic drugs to come to market in low-income countries, where citizens often struggle to afford basic necessities.

Further, by hamstringing Asian suppliers of generic drugs, the effect of TTP’s restrictive intellectual property provisions could ultimately reverberate beyond the countries involved in the agreement.

“The critically important role that many Asian countries have in supplying both generic medicines and the active pharmaceutical ingredients needed to produce drugs is in jeopardy because of new restrictions proposed in the TPP,” says Judit Rius Sanjuan, U.S. manager of MSF’s Access Campaign.

“The TPP threatens to put a stranglehold on the world’s supply of affordable treatments, with dire consequences for patients, treatment providers, and pharmaceutical producers in developing countries.”

The proposed agreement could facilitate “evergreening” by patent-holding pharmaceutical companies, a term that refers to legal manoeuvres that, when successful, lead to monopoly powers being maintained longer than the 20 years typically allotted by patents.

Imposing these types of new restrictions would run counter to previous international agreements and national legislation under which Washington has pledged to expand access to generic medicines.

Any restriction in access to such medicines would also affect the United States’ own global health goals. Generics are said to make up some 98 percent of the medicines used by PEPFAR, the United States’ flagship anti-HIV/AIDS programme and the world’s largest.

MSF calls the practice of evergreening “abusive”. Further, under a free trade agreement all adhering countries would conform their laws, and the standard promoted by the United States would, the group is warning, do so in a way that would make evergreening more feasible abroad.

Sense of urgency

For the administration of President Barack Obama, there has been a sense of urgency to finish the TPP negotiations by the fall. Some observers have suggested that this could lead countries that would otherwise reject the clauses affecting access to medicine to allow them to remain.

“We are hearing from other negotiating teams that the pressure to finalise this agreement by October is rising,” Sanjuan told IPS during a previous round of negotiations, “and they fear that if there is not more time for substantive discussion, this chapter could stand.”

She also notes that negotiations are being carried out in secret and without input from civil society. Her office became aware of the clauses related to intellectual property and access to medicine only after text of a chapter was leaked to them.

In fact, concerned groups and the media have had extremely limited opportunities to speak with negotiators. Much of the communication has occurred at so-called “stakeholder meetings”, wherein groups are allowed to make brief presentations to certain negotiators and given controlled access to speak face-to-face with them.

IPS recently attended a stakeholder meeting related to another major proposed U.S.-led free trade agreement and was told by multiple delegates that the information they could divulge was very limited.

That lack of transparency is being interpreted by some as a clear indication that the TPP agreement is not being negotiated in the interest of the general public. Indeed, the vast majority of those who have had access to the TPP talks have been representatives of major corporations.

“TPP is certainly not being written in the interest of small business owners or working people,” the Citizens Trade Campaign’s Stamoulis says. Instead, he suggests it will serve the interest of “a small handful of very powerful corporations”.

Stamoulis, too, notes mounting pressure on negotiators to finish the deal by the end of the year.

“They’re definitely going full steam ahead to get this thing done as fast as possible, there’s no doubt about that,” he says.

For her part, Sanjuan recommends that the urgency of those looking to push the agreement through be met by urgency on the part of those who want to avoid restricting medicinal access to poor people.

“The time for negotiators to fix the TPP is now, in this round of talks, before political pressure escalates and a deal that is bad for public health is sealed in the interest of time.”

Syrian refugee children learn to survive at a camp in north Lebanon. Credit: Zak Brophy/IPS.

By Katelyn Fossett
WASHINGTON, May 14 2013 (IPS)

Humanitarian assistance groups in Washington are warning that the health care system has become a deliberate target in the increasingly brutal civil war in Syria, presenting major challenges to addressing the humanitarian and refugee crises spurred by the conflict.

In a meeting with U.S. President Barack Obama on Monday, UK Prime Minister David Cameron stressed the centrality of the unfolding health crisis, emphasising the need in Syria to “care for trauma injuries, help torture victims to recover, [and get] Syrian families clean drinking water”.

Health aid is meeting significant obstacles, though, as the public health system in Syria reportedly has been largely dismantled after being targeted by Bashar al-Assad’s regime, which has wiped out a third of the hospitals in the country.

“The systematisation of the attacks [in Syria]…certainly served its purpose,” Stephen Cornish, executive director at Médecins Sans Frontières (MSF) in Canada, said recently at a panel discussion in Washington. “It created a flight of many medical personnel and destroyed large numbers of hospitals and interrupted public healthcare in a significant way.”

According to the Violations Documentation Centre, a Syrian human rights organisation based in Damascus, 469 health workers are currently imprisoned in Syria. Tom Bollyky, a senior fellow at the Council on Foreign Relations, a Washington think tank, estimates that around 15,000 doctors have been driven out of the country.

Bollyky noted that these attacks are one conflict’s manifestation of a disturbing global trend in which medical facilities and personnel become more frequent combat targets in conflict zones. In a March report, the Independent International Commission of Inquiry on the Syrian Arab Republic accused the Assad regime and opposition groups of strategically targeting medical facilities and personnel."Attacking medical personnel is a way of depriving a population of the humanitarian support they need."
-- Tom Bollyky

“Attacking medical personnel is a way of terrorising a population and depriving them of the humanitarian support they need,” Bollyky told IPS.

He pointed to similar instances in the Middle East and Asia, particularly coordinated attacks by the Taliban on polio immunisation volunteers in Afghanistan and Pakistan. On Monday, the Taliban announced it was halting its years-long effort to sabotage the campaign to eradicate polio among children in these two countries.

Such attacks are specifically outlawed in the Geneva Conventions, which entitle hospitals and medical staff to protection from hostile fire.

“Medical personnel are absolutely protected under international law,” Bollyky noted. “There is no circumstance where it is okay to attack medical personnel or facilities, and it is certainly happening on both sides.”

Silent casualties

The targeting of the Syrian health care system has not only left those wounded by combat without urgently needed care but has also exacerbated a public health crisis brought on by the poor living conditions of refugee camps outside of Syria.

Refugees from the conflict currently number more than one million, and the United Nations is warning that figure could swell to 1.5 million by the end of this year. That number is dwarfed by the more than 4.2 million Syrians who are displaced within Syria.

In addition to the systematic targeting, Syrian medical facilities are reportedly being “cannibalised” to serve military ends.

Zahir Sahloul, a doctor with the Syrian American Medical Society, told an audience on Friday about the looting of the two main hospitals in Aleppo – an eye hospital and a children’s hospital – that now serve as bases of operations for military battalions.

“Besides the destruction of the public health system, there is no sewer system,” Sahloul said “[There is a] lack of hygiene because of lack of electricity and sometimes water…and lack of diesel fuel. And because of that, you have a resurgence of some of the epidemics that weren’t there before.”

Chronic illnesses that were relatively easily treatable before the outbreak of the conflict – diabetes, or high blood pressure, for example – are now deadlier than ever, leading to what MSF’s Cornish called “silent casualties”.

These patients can’t be referred outside of the country because they aren’t considered emergency cases. But they also can’t be treated inside Syria because the necessary facilities and healthcare providers simply don’t exist anymore.

“Folks who have cancer and had their chemotherapy interrupted, all they can have is palliative medicine,” Cornish said. “And slowly, day by day, they die.”

Health workers are increasingly ill-equipped to deal with these growing problems, expert say, as their capacities are being undercut by suspicions over loyalty.

“In Syria, if you are a physician who is…’treating people from the other side’, you put your life at risk,” Sahloul said.

As humanitarian groups try to find solutions to the challenges to health and humanitarian assistance, observers appear united in their calls to the international community to ramp up pressure on both sides to stop hospital and medical staff attacks and to have more respect for international humanitarian standards.

Geneva Call, a non-governmental organisation in Geneva that focuses on engaging non-state actors in international humanitarian law, released several short video spots promoting respect for international humanitarian standards. One of the videos’ titles was “Respect and Protect Medical Personnel and Objects”.

Tom Bollyky suggested that treating these violations with more seriousness in the International Criminal Court– and recognising the international community’s responsibilities in combating them – would be a step in the right direction.

“You have seen a surge in these attacks, but you have not seen a surge in the indictments being brought against the people behind them,” he said. “The international legal system is not known for being expeditious, but it would be a form of real condemnation.”

The Agency Headquarters Hospital (AHH) in Bajaur Agency, shortly after a Taliban suicide bomb attack. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, May 1 2013 (IPS)

Akbar Shah was sitting with his sick wife in the gynaecology ward of the Agency Headquarters Hospital in Bajaur Agency, a division of northern Pakistan’s Federally Administered Tribal Areas (FATA), when a bomb ripped through the facility, scattering patients, doctors and medical supplies.

“We immediately rushed my wife to Peshawar (capital of the neighbouring Khyber Pakhtunkhwa province) because the doctors, paramedics and nurses were panicked and unable to look after patients,” Shah told IPS.

Hours later, the Taliban claimed responsibility for the Apr. 20 suicide mission.

"The Taliban are just inviting the wrath of God Almighty by targeting healthcare facilities...The patients should be shown mercy."
Shah’s wife is now being treated in a hospital in Peshawar and though her condition is showing signs of improvement, Shah still curses the Taliban for its ruthless campaign against health facilities in the region.

The entire medical community, along with a large majority of the general public, has slammed this latest attack, which killed four people, as a plot to deprive FATA’s population of six million people of adequate healthcare.

According to Dr. Shaukat Ali at the FATA Health Directorate, the 200-bed Agency Headquarters Hospital (AHH) had provided treatment to over 100,000 patients annually, with the help of 120 doctors and 100 paramedics.

“It is the only specialised hospital in FATA,” he told IPS, but it is now devoid of both patients and doctors, who have fled to Peshawar.

With 26 hospitals, 10 rural health centres and 419 community health centres, FATA is well equipped to deal with all of its residents’ medical needs. But if the attacks do not stop immediately, Shaukat Ali warned, the entire health system here will be rendered ineffective.

Meanwhile, medical facilities in Peshawar are struggling to keep pace with the influx of patients from tribal areas on the Afghanistan border, who say they are “too afraid” to visit hospitals that might be targeted by militants.

Dr Ahmad Sher at the Khyber Teaching Hospital in Peshawar told IPS his facility received about 20,000 patients from FATA in 2012 alone.

“The Taliban are just inviting the wrath of God Almighty by targeting healthcare facilities where patients are treated for different ailments. The patients should be shown mercy,” he said.

So far the Taliban have destroyed about 400 health facilities in FATA and the Khyber Pakhtunkwa (KP) province.

“Since 2008, the Taliban militants have damaged 128 health facilities in FATA,” Secretary of the Provincial Doctors Association (PDA) Dr. Muhammad Irfan told IPS, while the adjacent KP lost 55 health facilities between 2007 and 2009, during the Taliban’s illegal rule over the Swat district.

Militants have been particularly unforgiving of those who defy the so-called “ban” on polio immunisation, which they have labeled “un-Islamic”. The group also claims the oral polio vaccine (OPV) was designed to render the recipients impotent and infertile in order to “curb” population growth of Muslims.

In the past three months the Taliban have claimed responsibility for the deaths of 17 policemen, female vaccinators and volunteers in polio-related violence.

Last year, out of a total of 58 cases of polio in the country, 27 were recorded in the KP and 20 in FATA, which experts believe is likely the result of the Taliban’s interference with immunisation drives.

Fathema Murtaza, Pakistan spokeswoman for Doctors Without Borders (known by its French acronym MSF) told IPS it is crucial that medical structures and patients be spared from violence.

“MSF…calls for respect for the safety and security of patients, health facilities, and medical staff,” the group said in a press release last week. “All actors in the area must ensure that medical activities can take place unhindered and not be targeted.”

Since March, MSF medical teams have been running mobile clinics in Bajaur, providing services in three Basic Healthcare Units (BHUs) where about 200 patients are treated every week, Murtaza said.

“The safety and security of healthcare is essential for MSF to continue to expand its medical intervention in Bajaur,” she added.

The PDA’s Dr. Muhammad Irfan condemned the Taliban and asked the government to tighten security on hospitals so patients can receive necessary treatment undisturbed.

“We will hire private security guards and will impart training to our watchmen and other staff on how to foil terror (plots),” FATA’s director of health, Dr. Fawad Khan, informed IPS.

In that same vein, the female staff of government-run hospitals will be trained on how to conduct body searches of female visitors and take appropriate measures if they encounter anything suspicious.

The health directorate has also sought the services of the KP police in the training of health personnel.

Like other experts and medical professionals here, Khan believes the targeting of health facilities is particularly egregious in a region that is already lagging behind global health indicators, particularly with regards to maternal mortality.

“About 365 women (per 100,000 live births) die every year in Pakistan’s four provinces, while in FATA the number is closer to 400 due to pregnancy-related complications,” he said.

Similarly, FATA only has a 40 percent immunisation rate, compared to a nationwide rate of 67 percent.

A majority of FATA’s 400 qualified doctors are too afraid to go to work because of the dangers that loom over them every day, he added.

(END)