Aitor Zabalgogeazkoa during an interview with IPS in Bilbao (Spain). Recently returned from Gaza, this Basque aid worker has spent three decades in the field of humanitarian work. Credit: Andoni Lubaki/IPS

By Karlos Zurutuza
BILBAO, Spain, Aug 19 2025 (IPS)

It’s 8am when Nasser Hospital in Gaza opens its doors. Aitor Zabalgogeazkoa, Doctors Without Borders’ emergency coordinator in the besieged territory, has already been at work for more than three hours.

“The first thing is to check online where the explosions or gunfire I heard overnight actually took place. That’s when we start organising the day,” says the 61-year-old MSF staffer, during an interview with IPS in Bilbao —400 kilometres north of Madrid. He has just returned home after two months in Gaza.

“By half past eight, the hospital has already reached its daily capacity. Children, women, the wounded… many are left outside because the system is overwhelmed. It’s incredibly hard to manage,” Zabalgogeazkoa explains.

That has been the reality since October 2023, when Israel launched its military offensive on the Gaza Strip, a Palestinian enclave bordering Egypt but cut off from the West Bank, where most Palestinians live.

Gazans living in tents set up on the beach fetch water in jerrycans. Access to even the most basic supplies has become a daily ordeal during the war. Credit: MSF

According to Gaza’s health ministry, the campaign has so far left more than 60,000 dead and 145,000 injured. The vast majority are civilians, including thousands of women and children.

Israel argues its operation is aimed at destroying Hamas’s military capacity — the Palestinian militia and governing authority in Gaza — following the 7 October 2023 attack in which around 1,200 people were killed in Israel and more than 240 taken hostage. Fifty remain in captivity, though only about 20 are thought to be alive.

The UN has warned of an “unprecedented humanitarian crisis,” with more than 90% of the population displaced and swathes of the enclave reduced to rubble. Numerous governments, international organisations and UN human rights experts have called it “genocide.”

“It’s two million people trapped between bombs and hunger, in 365 square kilometres where conditions deteriorate by the day,” says Zabalgogeazkoa.

“Other than the war injuries, the most ordinary things can kill”: if you’re diabetic you’ll lose your foot because there’s no insulin; if you’re malnourished you can’t care for your children… Even being coeliac can kill you.”

A healthcare worker tends to a newborn in an incubator. The lack of fuel also affects hospitals, which rely on generators for electricity. Credit: MSF

“An orchestrated massacre”

The MSF coordinator notes that only two of the four food distribution points run by the Gaza Humanitarian Foundation (GHF) — an organisation backed by the US and Israel but heavily criticised — are still operating.

“Other than the war injuries, the most ordinary things can kill”: if you’re diabetic you’ll lose your foot because there’s no insulin; if you’re malnourished you can’t care for your children… Even being coeliac can kill you.”
“People have to cross war zones to get there, and then chaos breaks out. Many are injured in the stampedes of desperation. In the end, it’s thousands fighting for a few sacks of flour,” he recalls.

A Doctors Without Borders investigation published on 7 August, titled This is not aid, this is an orchestrated massacre, described the centres as “death traps”, called for the programme to be scrapped, demanded the reinstatement of the UN-coordinated mechanism, and urged governments and donors to cut support for GHF.

“Distributions start at nine, but two hours earlier you already hear the gunfire. Israel says there’s no other way to control the crowds, but we come across people with bullets in the head or chest,” explains Zabalgogeazkoa.

Since the offensive began, at least eight health facilities in Gaza have been targeted by the Israeli army, most of them bombed from the air.

“At Nasser Hospital they killed patients by firing a missile through a window on two occasions. Soldiers also stormed the building and we had to evacuate. We couldn’t return for weeks. It was one of the hospitals where babies were left in incubators, and nothing more was ever heard of them,” he laments.

Fuel shortages to power hospital generators have forced doctors in Gaza to take extreme measures, such as placing several babies in a single incubator. MSF staff have reported cases of up to six infants in one unit.

Even water supply is a major struggle. Zabalgogeazkoa notes that 70% of the urban network is destroyed, so much of the water never reaches its destination.

Israel maintains that Gaza’s hospitals often conceal military targets, including “Hamas command centres” and “tunnel networks.”

The MSF staffer rejects this outright: “They always use the same narrative, also when they kill journalists living in tents set up inside hospitals. For Israel, everyone is Hamas. Were all the journalists they killed Hamas too?”

Gaza residents in a district bombed by the Israeli army. After nearly two years of offensive, the territory has been reduced to rubble. Credit: MSF

“Inconvenient witnesses”

The UN reports that at least 242 journalists have been killed in Gaza since the offensive began — the highest number ever recorded in a conflict. The vast majority were Palestinian, as Israel has barred international press access. The few foreign correspondents who entered did so embedded with Israeli troops and were unable to work independently.

Nothing seems to stem the chain of attacks on local journalists, who bear the responsibility of documenting the horror.

On 30 June this year, an Israeli airstrike destroyed the al-Baqa café, killing at least 41 people, among them Palestinian photographer and filmmaker Ismail Abu Hatab. The café had been a popular meeting place for young people, journalists and artists, and one of the few places where residents could access the internet and charge their phones during the war.

On 11 August, four Al Jazeera reporters and a local fixer were killed when a bomb struck al-Shifa Hospital. The head of UNRWA accused Israel of “silencing the voices exposing atrocities in Gaza.”

“They’re killing journalists one by one. Now almost everything is left to 16-year-olds posting videos on social media with their phones,” says Zabalgogeazkoa, describing it as a “systematic elimination of inconvenient witnesses.”

With Hamas’s leadership decimated and no local government to manage resources or administer justice, the Strip is descending into chaos. “Israel is doing everything it can to bring about the complete breakdown of Gazan society,” he warns.

“Besides, medicines, food, fuel… they are manipulated in a cruel game. Just when supplies are about to run out, Israel allows enough for another three or four days. People are so consumed with survival that they cannot think about anything else,” adds the MSF staffer.

He is due to return to Gaza in mid-September, though he fears conditions will have worsened by then.

On 10 August, Israeli prime minister Benjamin Netanyahu announced the approval of a plan for a full takeover of Gaza as “the fastest way to end the war, eliminate Hamas and free the hostages.”

The announcement drew widespread international condemnation. Few doubt the already dire humanitarian situation will deteriorate even further.

BANGLADESH: Dose of Vigilance Helps Manage HIV, AIDS DHAKA, Nov 3, 2010 (IPS) - It is one of the poorest countries in the world, has a low literacy rate, and is next door to at least two countries that have a considerable portion of their respective populations with HIV and AIDS. Yet even having a large migrant population has not made Bangladesh a hot spot for HIV and AIDS. http://ipsnews.net/news.asp?idnews=53443

By James Reinl
UNITED NATIONS, Jul 24 2019 (IPS)

The global fight against Aids is floundering amid cash shortfalls and spikes in new HIV infections among marginalised groups in developing regions, Gunilla Carlsson, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said Tuesday.

Speaking with reporters in New York, Carlsson, head of U.N.-led efforts against the pandemic, warned that gains over recent years were under threat, particularly in parts of eastern Europe, central Asia, the Middle East and Africa.

“We are at a precarious point in the response to HIV. Some countries are making impressive gains, while others are experiencing rises in new HIV infections and even Aids-related deaths,” Carlsson said at U.N. headquarters.

“Annual gains are getting smaller and the pace of progress is slowing down.”

More than half of all new HIV infections in 2018 were among drug users, sex workers, men who have sex with men, transgender people, prisoners and the sexual partners of these groups, said Carlsson.

Many of those at-risk groups do not get the treatment they need, she added.

A UNAIDS report released Jul. 16 noted “worrying increases” in these new infections in eastern Europe and central Asia, where HIV cases rose by 29 percent, as well as in the Middle East, North Africa and Latin America.

Global funding for the fight against Aids dropped off markedly in 2018 — by nearly one billion dollars— as international pledges dried up and domestic investments did not grow fast enough to fill the gap.

Only around 19 billion dollars was available for the Aids response in 2018 — some 7.2 billion dollars short of the total 26.2 billion needed by 2020, said Carlsson, describing a “deeply concerning” development.

“Ending Aids will not be possible unless we are investing adequately and smartly, focussing on people first, not diseases, and creating roadmaps for people who are left behind,” said Carlsson.

Some 770,000 people died of Aids globally in 2018 and almost 38 million people were living with the human immunodeficiency virus (HIV) that causes it. The disease is transmitted via infected blood and other bodily fluids.

HIV cannot be cured but the infection can be kept in check by Aids drugs known as antiretrovirals. Around 23.3 million of the 37.9 million people with HIV globally currently get the Aids drugs they need.

Around 1.7 million people were newly infected in 2018, a 16 percent decline since 2010, driven mostly by steady gains in parts of eastern and southern Africa, according to the latest UNAIDS report.

South Africa, for example, has cut new HIV infections by more than 40 percent and Aids-related deaths by around the same proportion since 2010. But the report warns that the disease is still rife in other parts of eastern and southern Africa.

Earlier this month, the aid group Médecins Sans Frontières (MSF) warned that efforts to fight Aids were “stagnating” and that many of the disease-related deaths could be prevented if better care was available.

Dr. Gilles Van Cutsem, head of MSF’s team on HIV and Aids, said that many HIV sufferers turned up at clinics in Congo, Guinea, Malawi and elsewhere with advanced symptoms of a condition that their immune system was unable to fight.

“People arrive very ill, often with severe opportunistic infections such as tuberculosis, cryptococcal meningitis, or Kaposi’s sarcoma,” Van Cutsem said in a statement.

“When they arrive, sometimes it’s too late to save them. They might not have been diagnosed on time or they failed to get access to lifesaving treatment.”

The Agency Headquarters Hospital (AHH) in Bajaur Agency, shortly after a Taliban suicide bomb attack in 2013. Credit: Ashfaq Yusufzai/IPS

By Lyndal Rowlands
UNITED NATIONS, Apr 29 2016 (IPS)

Hospitals, health care workers and patients in war zones are supposed to be protected under international humanitarian law yet recent attacks from Syria to Afghanistan suggest that they have become targets.

The seeming lack of respect for the sanctity of health care in war zones has prompted UN Security Council members in New York to consider a new resolution designed to find new ways to halt these attacks.

The Security Council is expected to vote on the resolution on May 3, just days after Al Quds Hospital in Aleppo, Syria was bombed. Twenty seven staff and patients were killed in the airstrike on the hospital on Wednesday night, Dr Hatem, the director of the Children’s Hospital in Aleppo told The Syria Campaign.

Among the victims was Dr Muhammad Waseem Maaz, who Dr Hatem described as “the city’s most qualified paediatrician.”

Staffan de Mistura, UN Special Envoy for Syria told journalists in Geneva Wednesday that Dr Maaz was the last paediatric doctor left in Aleppo, although IPS understands there is another paediatrician in the Aleppo countryside.

Dr Hatem said that Dr Maaz used to work at the children’s hospital during the day and attend to emergencies at the Al Quds hospital at night time.

“Dr Maaz stayed in Aleppo, the most dangerous city in the world, because of his devotion to his patients,” said Dr Hatem.

Dr Hatem said that “hospitals are often targeted by government and Russian air forces.”

“When the bombing intensifies, the medical staff run down to the ground floor of the hospital carrying the babies’ incubators in order to protect them,” he said.

As a permanent member of the UN Security Council, Russia will be expected to vote on the proposed new resolution reinforcing the protection of hospitals, doctors and patients in war zones.

Another Security Council member accused of bombing a hospital, the United States, is expected to release its report Friday of its own investigation into the attack on the Médecins Sans Frontières (MSF) hospital in Kunduz, Afghanistan on October 3 2015.

MSF say that 42 people we killed in the sustained bombing of the hospital, including 24 patients and 18 staff.

Roman Oyarzun Marchesi, permanent representative of Spain to the UN said that the “the wake up call (for the Security Council resolution) came from organisations such as Médecins Sans Frontières who are forced to stay out of certain areas or countries due to the lack of protection on the ground.”

“Attacks against the provision of health care are becoming so frequent that humanitarian actors face serious limitations to do their jobs,” said Marchesi at an event held to discuss the proposed resolution at the International Peace Institute earlier this month.

The event brought together representatives from the medical community with the five Security Council members drafting the resolution: Egypt, Japan, New Zealand, Spain and Uruguay.

Speaking on behalf of Médecins Sans Frontières (MSF), whose hospitals have come under frequent attacks in recent months and years, Jason Cone, Executive Director of MSF America called for greater accountability:

“As of today suspected perpetrators get away with self-investigating and there’s no independent follow-up of attacks,” said Cone.

“It is a critical moment for member states to reaffirm the sanctity of the medical act in armed conflict,” he said.

The current situation does not reflect the respect given to health care in war from the earliest stages of the Geneva conventions, Stéphane Ojeda, Deputy Permanent Observer to the United Nations, International Committee of the Red Cross told the meeting.

“The protection of the wounded and sick has been at the heart of International Humanitarian Law since the start,” said Ojeda “Indeed the wounded and sick and the medical personnel taking care of them were the first categories of protected persons under international humanitarian law because of the 1864 first Geneva Convention,” he said.

The principle that health care personnel should not be punished for caring for the wounded and sick also needs to be respected, said Ojeda. “If you start questioning this, that’s a whole pillar of humanity starting to collapse,” he said.

Cone also added to Ojeda’s calls for the duties of doctors in caring for the wounded and sick to be respected: “We can not accept any criminalisation of the medical act, any resolution should reinforce and strengthen protection for medical ethics,” he said.

Doctors Without Borders/Médecins Sans Frontières  (MSF) is warning that the violence in Yemen “has radically increased” since March, with the humanitarian group seeing mass casualties from bombings and thousands of severely injured.

“Especially in Aden, the situation has been extremely difficult, where the population feels it’s almost impossible to go out of their houses,” said Teresa Sancristóval, the head of MSF’s emergency unit, who recently returned from the country.

“Snipers are shooting from the roofs of the hospitals. Ambulances are unable to cross front lines. Some days ago, 250 people were injured in Aden by a land attack and 80 people were injured in Sana’a through bombing.”

She noted that, “The impact of this conflict is much wider than only the bombing or the shooting. The situation is growing worse every week. The blockade is having an enormous impact on the population and you can see it on different levels. Yemen is predicted to be the first country in the world to have a capital without water, and water scarcity has an enormous impact.”

Sancristóval said that the price of water has doubled since the last month, and many families already spent one-third of their incomes on water.

Lack of sanitation services are also causing outbreaks of disease, with the charity Mercy Corps reporting 8,000 cases of dengue fever in Aden, as well as cases of typhoid and malaria.

Since the U.S.-backed Saudi-led coalition launched an aerial offensive against Shia Houthi rebels five months ago, some 4,000 people – at least half of them civilians – have been killed, 19,000 injured and 1.3 million displaced.

Nearly 13 million, of the population of 24.4 million, lack basic food items and 850,000 children face acute malnutrition.

“Aden has been devastated by over three months of intense violence and conflict,” U.N. Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Stephen O’Brien told reporters Wednesday.

“Hostilities on the ground, indiscriminate shelling of neighbourhoods and airstrikes have destroyed critical civilian infrastructure, including schools, hospitals and water treatment plants. Even a kindergarten was attacked, killing eleven people.”

Thus far, he said, over 200,000 people in Aden have been forced to flee from their homes in search of safety and basic services. Over 800,000 people in Aden – the total population of the Governorate – are in need of some form of humanitarian assistance like health services, water and sanitation, food or emergency shelter.

The armed conflict, which started earlier this year, is between two factions claiming to constitute the Yemeni government, along with their supporters and allies. Southern separatists and forces loyal to the government of Abd Rabbuh Mansur Hadi, based in Aden, have clashed with Houthi forces and forces loyal to the former president Ali Abdullah Saleh.

From April to July, almost seven million people received some form of assistance, O’Brien said.

However, he said the scaling up of assistance and the full-fledged return of U.N. staff to the capital has been hampered by the destruction and looting of the U.N. premises and assets.

“We cannot assist the people in Aden if we do not have offices, vehicles and the knowledge that our staff can work in safety and security,” O’Brien said, calling on the government to help retrieve all assets that are not destroyed.

He added that the overall aid effort in Yemen is also suffering from a lack of funding.

“Donors have not responded with the funding that is needed to cover the enormous humanitarian needs in the country. The Yemen Humanitarian Response Plan put forward by the humanitarian community is calling for 1.6 billion dollars. We have only received 18 per cent or 282 million dollars.”

Edited by Kanya D’Almeida

In the face of the growing number of crises taking place at the same time worldwide, humanitarian aid organisations – many of which have already reached their financial and logistic limits – are in desperate need of global coordination.

“We feel like we’ve hit the wall,” is how U.N. Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator Kyung-Wha Kang has described the dramatic situation.

This situation was the subject of the 3rd Vienna Humanitarian Congress held last week in the Austrian capital under the slogan ‘Humanitarian Aid Under Fire’.Humanitarian organisations are rethinking their strategies, especially in Syria and Iraq, and trying to include all stakeholders in a dialogue to obtain access to the people in need – Kyung-Wha Kang, U.N. Assistant Secretary-General for Humanitarian Affairs

Opening the congress, Annelies Vilim, Director of Global Responsibility, the Austrian platform for development and humanitarian aid, told participants: “Humanitarian aid is not an act of charity. It is a human right.“

In a world in which trouble spots and wars are on the rise, the question of how aid operations are carried out most successfully to meet the necessities of recipients is becoming increasingly relevant and, noted Vilim, at this moment millions of people are in desperate need of humanitarian aid.

Among others, the goal of the congress was to make humanitarian work more visible in these difficult times and to commit decision makers at all levels to value the importance of humanitarian assistance and cooperation.

Unfortunately, sufficient funding and clear structures are lacking and already inadequate contributions are under constant threats of budget cuts.

Host country Austria itself, for example, is no exception – an OECD study has shown that state spending in 2013 was only 1.3 euro per capita, 20 times less than the amount a country of similar wealth such as Sweden was paying.

“The world is facing drastic transformations and politics are not keeping up,” complained Yves Daccord, Director General of the International Committee of the Red Cross.

To address those challenges, U.N. Secretary-General Ban Ki-moon has launched an initiative, managed by the U.N. Office for the Coordination of Humanitarian Affairs (OCHA), to hold the first World Humanitarian Summit in May 2016 in Istanbul, Turkey.

It will bring together governments, humanitarian organisations, people affected by humanitarian crises and new partners, including from the private sector, to draw up solutions and set an agenda for the future of humanitarian action.

Logo of the 3rd Vienna Humanitarian Congress. In the face of the growing number of crises taking place at the same time worldwide, humanitarian aid organisations are in desperate need of global coordination.

One issue that is certain to be on the agenda is the safety of aid workers. With 1.5 billion people living in conflict-affected areas, “we will unfortunately have to face more stories in the media about aid workers killed in the line of duty, of atrocities committed against innocent civilians,” said Kang.

In 2013 alone, 474 humanitarian workers were attacked, injured or abducted and 155 lost their lives.

Due to the difficult circumstances, Kang explained that humanitarian organisations are rethinking their strategies, especially in Syria and Iraq, and trying to include all stakeholders in a dialogue to obtain access to the people in need.

Controversially, this also means that for the sake of civilians, parties that are considered “terroristic” should also be involved in the process. Humanitarian actors legitimate this by upholding the principles of humanity, neutrality, impartiality and non-discrimination in regard to beneficiaries, and independence.

It is estimated that today over 30 armed conflicts are taking place worldwide, 16 of which are considered as wars with more than 1,000 victims each year. According to the United Nations, Syria, Iraq, South Sudan and the Central African Republic are ranked at the highest level of emergency.

The Central African Republic occupied some of the limelight at the Vienna congress in a panel discussion on humanitarian space and life and work in war. Two of the country’s religious leaders – Archbishop Dieudonne Nzapalainga and Imam Layama Oumar Kobine – spoke out about their fight for peace and disarmament.

Both argued that the civil war in their country was not a religious war. “Neither the Bible nor the Koran say that people should kill,” said Nzapalainga, explaining that five days after the beginning of the crisis in December 2012, religious leaders had come together to work collectively on an interreligious platform.

The problem, said the religious leaders, is that 75 percent of the country’s population is illiterate and therefore open to exploitation and recruitment by militant groups. This affects young people in particular and, because the state and government have ceased to exist, it is humanitarian workers who often fulfil the duties of the authorities.

Karoline Kleijer, Emergency Coordinator of Médecins Sans Frontières (MSF), described her experience of how life has become incredibly difficult for humanitarian workers in the country.

She described how shortly after arriving in the country in April 2014, armed forces entered a meeting of MSF staff and local community leaders that she was attending, opened fire and killed 20 people, including three MSF workers.

The incident had a huge impact on the organisation, she said, but despite all the difficulties “it did not stop us from working in the country. Since then, we have performed more than 10,000 operations and treated more than 300,000 people for malaria. We have delivered more than 15,000 babies and we have been continuing activities up to today.”

Although the principle that civilians have to be protected in armed conflicts and war and have a right to humanitarian assistance is embedded in the Geneva Convention, humanitarian workers have to take great risks to obtain access to the population in distress and, contrary to their neutrality, are becoming targets themselves.

“We hope that humanitarian workers will continue to take those risks, because we continue to take those risks in order to help the population in need,” said Nzapalainga.

Edited by Phil Harris    

Concern is being raised by civil society and the public about how Sierra Leone’s government is handling the Ebola pandemic. Credit: Marc-André Boisvert/IPS

By Lansana Fofana
FREETOWN, Nov 6 2014 (IPS)

The fight against the deadly Ebola epidemic ravaging West Africa seems to be hanging in the balance as Sierra Leone’s Minister of Health and Sanitation Dr Abubakar Fofana told IPS that the government is overwhelmed by the outbreak.

“We were not prepared for this Ebola scourge. It took us by surprise and with our weak health system, we can only rely on support given to us by our international partners,” he told IPS.

According to a report published last week by British charity Save the Children, five people are infected every hour here and the situation is worrisome.

The government has, however, downplayed this, claiming the report is hugely exaggerated and that the situation is getting better in some parts of the country.

However, concern is being raised by civil society and the public about how the government is handling the outbreak.

Bernard Conteh, the director of the rights advocacy group Anti-Violence Movement, told IPS: “The authorities should be more pro-active. They should pay health workers, who are the frontline soldiers in this fight, reasonably well and ensure they are supplied adequate Personal Protective Equipments. This is not happening. Even the enforcement of the quarantine of Ebola suspects is not effectively done.”

On just one day, Nov. 2, 61 new cases were reported across the country bringing the nationwide toll to 4,059 people infected by the virus. This surpasses neighbouring Liberia which, until a month ago, was the worst-hit country. Liberia has recorded 2,515 cases while Guinea, where the epidemic first started, has 1,409 recorded cases of Ebola.

Since the outbreak of the epidemic in April, Sierra Leone has lost five medical doctors, more than 60 nurses and auxiliary health workers to Ebola. And the figure keeps going up.

The African Governance Initiative has also painted a grim picture of the outbreak here, saying that it is spreading nine times faster than it did two months ago. Of the 12 districts in the country and the capital Freetown, only Koinadugu in the north was Ebola-free — until recently. It now has at least six confirmed cases. Now, no part of Sierra Leone is unaffected but the virus.

The government has, however, been assisted by the international community. The United Kingdom has sent medical equipment and health workers, and has built test and treatment centres in parts of the capital. China has also sent medical aid, while Cuba has deployed dozens of medics on the ground.

But, there are still many challenges to be addressed. According to the medical charity MSF or Doctors Without Borders, the outbreak is far from over and more help is desperately needed.

“There is a huge gap in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilisation,” MSF says.

As the fight against the killer epidemic continues to prove difficult with the virus spreading fast, the government in Freetown has just implemented a year-long state of emergency. This comes just two days after an earlier 90-day state of emergency, implemented in July in response to the outbreak, ended.

Attorney-General and Minister of Justice Frank Kargbo told IPS the extension of the emergency period was necessary to help control the spread of the virus.

“No one knows when the Ebola epidemic will end. We believe that within this period and with our hard work, we will be able to contain the disease.”

Many attribute the rapid spread of the Ebola virus to people’s attitudes and, as MSF says, a lack of sufficient community education and mobilisation. Cultural practices and traditional beliefs are also greatly hampering the fight against Ebola.

“Our people still continue to touch, wash and bury their dead. This is an easy way to get infected, even though they have been told repeatedly not to do so,” the chairman of the National Ebola Response Committee, Alfred Palor Conteh, told IPS.

People also refuse to report to hospitals when they fall ill because of the fear of stigmatisation by their families and communities. Many believe that Ebola is fatal and that going to treatment centres will not help. Ebola survivors and discharged patients also face stigmatisation.

However, Health Health and Sanitation Minister Fofana said he was hopeful the situation would be brought under control soon with international help.

Edited by: Nalisha Adams

Children in the town of Gueckedou, the epicentre of the ebola outbreak in Guinea. Credit: ©afreecom/Idrissa Soumaré

By Carey L. Biron
WASHINGTON, Oct 17 2014 (IPS)

President Barack Obama is under significant pressure to impose a range of restrictions on travellers coming to the United States from West African countries affected by the current Ebola outbreak.

Yet public health experts and development advocates warn that such restrictions would harm the already reeling economies of Ebola-hit countries in the region, and squeeze the international community’s ability to get health workers and goods into these countries.“If we get this wrong and just hunker down and hide, we will make this problem worse both in West Africa and in the United States.” -- Charles Kenny of the Center for Global Development

“An accelerated mobilisation of personnel and resources is necessary to control the Ebola epidemic in West Africa and care for patients, through the establishment of new Ebola management centres,” Tim Shenk, a press officer with Medecins Sans Frontieres, the humanitarian group that has been at the core of the international response to the epidemic, told IPS.

“For this reason, it is crucial that airlines continue flying to the affected region.”

Calls for halting flights and imposing visa restrictions have been floating around Washington since the virus’s spread caught the world’s attention over the summer. Yet these have strengthened substantially in recent days, following the confirmation of three cases of Ebola in the United States.

The first of those was unknowingly carried by a man from Liberia. He died last week after infecting two of the health workers attending to him, and the case has prompted an intense and at times vitriolic response.

“A temporary ban on travel to the United States from countries afflicted with the virus is something that the president should absolutely consider,” John Boehner, the leader of the U.S. House of Representatives and one of the most powerful figures in Washington, said Wednesday.

In fact there are no direct air connections between the United States and any of the three countries most affected by the current outbreak. Further, it would be extremely complex to impose such a ban in tertiary transit countries.

On the other hand, it would be possible to create additional hurdles for those applying for U.S. visas in West Africa. But this would do nothing to deal with, for instance, the many U.S. passport holders living in these countries, and would likewise be logistically complex.

Nonetheless, Boehner was echoing a clear tide of U.S. support for the imposition of travel restrictions. According to a poll released Tuesday, two-thirds of people in the United States would support “restricting entry” of incoming travellers from Ebola-afflicted countries.

The federal government’s response to Ebola has suddenly become a defining issue in the U.S. midterm elections, slated for next month.

Dangerous isolation

The current Ebola outbreak has now killed more than 4,000 people, almost all in Guinea, Liberia and Sierra Leone. On Thursday, United Nations Secretary-General Ban Ki-moon urged the international community to make available a billion dollars to allow those combating the disease to meet a target of reducing the virus’s transmission rates by the beginning of December.

In the United States, meanwhile, the public support for travel restrictions has risen by six percentage points since just last week. And lawmakers, many of whom are currently in the last stages of political campaigns, are responding.

Though Congress is currently on recess, lawmakers held a rare hearing on Ebola Thursday. By Thursday evening, members of Congress who supported some sort of travel restrictions outnumbered those who didn’t by 56 to 13, according to a list compiled by a Washington newspaper.

While those who do not support a travel ban were all Democratic, the support for such restrictions stretches across both parties.

“I’ve been struck by just how intense this political pressure has become, and the pressure is bipartisan,” J. Stephen Morrison, the director of the Global Health Policy Center at the Center for Strategic and International Studies (CSIS), a Washington think tank, told IPS.

“While the arguments made against travel bans have been solid, they don’t win the day with the public. Further, if the base population carrying the virus continues to grow, the threat won’t ease and neither will this pressure.”

Even as lawmakers increasingly funnel – and perhaps fuel – concern over Ebola in this country, the Obama administration remains adamant that it is not considering any travel restrictions beyond health scans and interviews at international airports.

“Shutting down travel to that area of the world would prevent the expeditious flow of personnel and equipment into the region,” Josh Earnest, the White House press secretary, told journalists Wednesday. “And the only way for us to stop this outbreak and to eliminate any risk from Ebola to the American public is to stop this outbreak at the source.”

Earnest did not reject the possibility completely, however, noting that a travel ban is “not on the table at this point.”

Yet many of those closest to the Ebola response warn that travel restrictions would be not only unfeasible but outright dangerous, exacerbating the outbreak.

“You don’t want to do something that inadvertently accelerates the economic collapse of these countries or impedes the flow of health workers and critically needed commodities,” CSIS’s Morrison says. “Our ability to get ahead of this crisis necessitates the flow, back and forth, of thousands of health-care workers and commodities.”

Indeed, such concerns have already been borne out. African Union aid workers, for instance, were recently delayed for a week getting into Liberia due to travel restrictions imposed in a number of African countries.

“It has been quite challenging over the last several months, because there have been a reduction in commercial flights … a reduction in shipping that comes into the country,” Debra Malac, the U.S. ambassador to Liberia, told journalists Thursday. “[That’s made it] very difficult to get things like food as well as supplies in that are critically needed in order to help address this epidemic.”

Devastating economies

U.S. travel restrictions could also pose significant economic risks, both to Ebola-hit countries and Africa as a whole.

“There’s a lot of air traffic between Africa and the U.S. that’s very important for trade and investment, the tourism industry, for the diaspora,” CSIS’s Morrison says. “All of that is reliant on air links, so how do you make sure you’re not kicking the pins out of those economic processes?”

Already there are widespread fears over the financial impacts of Ebola on Guinea, Liberia and Sierra Leone.

Earlier this week, the World Health Organisation warned that the virus now threatens “potential state failure” in these countries. Last week, the World Bank estimated that the epidemic could cost West African countries some 33 billion dollars in gross domestic product.

“If we get this wrong and just hunker down and hide, we will make this problem worse both in West Africa and in the United States,” Charles Kenny, a senior fellow at the Center for Global Development, a think tank here, told IPS.

“Imposing any kind of travel ban would tank the economy of these three countries, and that will have knock-on effects on dealing with the disease – increasing the suffering and the number of people with the disease.”

Edited by Kitty Stapp

The writer can be reached at cbiron@ips.org

As one of the Ebola epicentres, the district of Kailahun, in eastern Sierra Leone bordering Guinea, was put under quarantine at the beginning of August. Credit: ©EC/ECHO/Cyprien Fabre

By Carey L. Biron
WASHINGTON, Sep 8 2014 (IPS)

The U.S. military over the weekend formally began to support the international response to the Ebola outbreak in West Africa.

Advocates of the move, including prominent voices in global health, are lauding the Pentagon’s particularly robust logistical capacities, which nearly all observers say are desperately needed as the epidemic expands at an increasing rate.On Monday, the United Nations warned of an “exponential increase” in cases in coming weeks.

Yet already multiple concerns have arisen over the scope of the mission – including whether it is strong enough at the outset as well as whether it could become too broad in future.

President Barack Obama made the first public announcement on the issue on Sunday, contextualising the outbreak as a danger to U.S. national security.

“We’re going to have to get U.S. military assets just to set up, for example, isolation units and equipment there to provide security for public health workers surging from around the world,” the president said during a televised interview. “If we don’t make that effort now … it could be a serious danger to the United States.”

While the United States has spent more than 20 million dollars in West Africa this year to combat the disease, Washington has come under increased criticism in recent months for not doing enough. Obama is now expected to request additional funding from Congress later this month.

The military’s response, however, has already begun – albeit apparently on a very small scale for now, and in just a single Ebola-hit country.

A Defence Department spokesperson told IPS that, over the weekend, Secretary of Defence Chuck Hagel approved the deployment of a “25-bed deployable hospital facility, equipment, and the support necessary to establish the facility” in Liberia. For now, this is the extent of the approved response.

The spokesperson was quick to note that additional planning is underway, but emphasised that the Pentagon is responding only to requests made by other federal agencies and taking no lead role. Further, its commitment to the hospital in Liberia, the country most affected by the outbreak, is limited.

The Department of Defence “will not have a permanent presence at the facility and will not provide direct patient care, but will ensure that supplies are maintained at the hospital and provide periodic support required to keep the hospital facility functioning for up to 180 days,” the spokesperson said.

“This approach provides for the establishment of the hospital facility in the shortest possible period of time … Once the deployable hospital facility is established, it will be transferred to the Government of Liberia.”

On Monday, Liberia’s defence minister, Brownie Samukai, said his government was “extremely pleased” by the announcement.

“We had discussions at the Department of Defence on the issues of utilising and requesting the full skill of United States capabilities, both on the soft side and on the side of providing logistics and technical expertise,” Samukai, who is currently here in Washington, told the media. “We look forward to that cooperation as expeditiously as we can.”

No security needed

The current Ebola outbreak has now killed some 2,100 people and infected more than 3,500 in five countries. On Monday, the United Nations warned of an “exponential increase” in cases in coming weeks.

Yet thus far the epidemic has resulted in an international response that is almost universally seen as dangerously inadequate. Obama’s statement Sunday nonetheless raised questions even among those supportive of the announcement.

Medecins Sans Frontieres (MSF), the French humanitarian group, remains the single most important international organisation in physically responding to the outbreak. While MSF has long opposed the use of military personnel in response to disease outbreaks, last week it broke with that tradition.

Warning that the global community is “failing” to address the epidemic, the group told a special U.N. briefing that countries with “civilian and military medical capability … must immediately dispatch assets and personnel to West Africa”.

Yet while MSF has welcomed Obama’s announcement, the group is also expressing strong concerns over the president’s reference to the U.S. military providing “security for public health workers”.

MSF “reiterates the need for this support to be of medical nature only,” Tim Shenk, a press officer with the group, told IPS. “Aid workers do not need additional security support in the affected region.”

Last week, MSF urged that any military personnel deployed to West Africa not be used for “quarantine, containment or crowd control measures”.

The Defence Department spokesperson told IPS that the U.S. military had not yet received a request to provide security for health workers.

Few guidelines

The United States is not the only country now turning to its military to bolster the flagging humanitarian response in West Africa.

The British government in recent days announced even more significant plans, aiming to set up 68 beds for Ebola patients at a centre, in Sierra Leone, that will be jointly operated by humanitarians and military personnel. The Canadian government had reportedly been contemplating a military plan as well, although this now appears to have been shelved.

Yet the concerns expressed by MSF over how the military deployment should go forward underscore the fact that there exists little formal guidance on the involvement of foreign military personnel in international health-related response.

The World Health Organisation (WHO), for instance, has no broad stance on the issue, a spokesperson told IPS. As the WHO is an intergovernmental agency, it is up to affected countries to make related decisions and request.

“Each country handles its own security situation,” Daniel Epstein, a WHO spokesperson, told IPS. “So if governments agree to military involvement from other countries, that’s their business.”

Another spokesperson with the agency, Margaret Harris, told IPS that the WHO appreciates “the skills that well-trained, disciplined and highly organised groups like the US military can bring to the campaign to end Ebola.”

Yet there is already concern that the U.S. military response could be shaping up to be far less robust than necessary.

MSF’s Shenk noted that any plan from the U.S. military would need to include both the construction and operation of Ebola centres. Thus far, the Pentagon says it will not be doing any operating.

While around 570 Ebola beds are currently available in West Africa, MSF estimates that at least 1,000 hospital spaces, capable of providing full isolation, are needed in the region.

In a series of tweets on Monday, Laurie Garrett, a prominent global health scholar with the Council on Foreign Relations, a Washington think tank, expressed alarm that the Defence Department’s Ebola response was shaping up to be “tiny” in comparison to what is needed.

Edited by Kitty Stapp

The writer can be reached at cbiron@ips.org

Syrian refugee schoolchildren being taught in the Shatila Palestinian refugee camp. Credit: Shelly Kittleson/IPS

By Shelly Kittleson
BEIRUT, Aug 1 2014 (IPS)

The Shatila Palestinian camp has no library, nor does adjacent Sabra or Ain El-Hilweh in the south. And, after recent statements by Lebanon’s foreign minister, some fear that the thousands of Syrian refugee children within them will soon have even slimmer chances of learning to read and write.

The United Nations stated earlier last month that Syrian refugees would total over one-third of Lebanon’s population by the end of 2014, and that at least 300,000 refugee children were not enrolled in school.

In early July, Foreign Minister Gebran Bassil said that no assistance should be given to Syrian refugees as “all this aid – be it food, shelter or health care – encourages Syrian refugees to stay in Lebanon, while what we want is to encourage their speedy exit.”“The overcrowded breezeblock camps are filled with school-age children from across the [Lebanese-Syrian] border, suffering from psychosocial disorders, nutritional problems and limited possibilities for enrolling in Lebanese educational institutes

During his time as energy minister in the previous government, Bassil had said that Syrians should be seen as a “threat to the safety, economy and identity of the country.”

Tangled electrical wires droop dangerously low and posters of Syrian president Bashar Al-Assad are prominent alongside those of Palestinian ‘resistance’ leaders and ‘martyrs’ in the Lebanese capital’s camps, where refugees are said to have initially been welcomed.

Lebanon’s security forces do not enter the 12 officially registered Palestinian camps in the country despite withdrawal from a 1969 agreement granting the Palestinian Liberation Organization (PLO) control over them.

Several Syrians told IPS they feel more comfortable there than they would in areas controlled by Hezbollah, which is fighting alongside the Syrian regime and whose political wing is part of the government.

With 10,000-20,000 having arrived since the conflict began, refugees from Syria now outnumber the original inhabitants of Beirut’s Shatila camp, set up in 1949 to shelter stateless Palestinians.

The overcrowded breezeblock camps are filled with school-age children from across the border, suffering from psychosocial disorders, nutritional problems and limited possibilities for enrolling in Lebanese educational institutes.

There than the capacity of the public school system capacity, the most obvious hurdle for refugee children, says Fadi Hallisso, co-founder and general manager of the Syrian-run NGO Basmeh & Zeitooneh which works in the camp, is that Syrian public schools teach in Arabic while their Lebanese counterparts use either French or English.

Destitute or missing parents leading to the need to work or beg to survive, transport costs and war-induced trauma are other factors at play, and the problem is compounded by nutritional deficiencies.

A UNICEF study found earlier this year that severe acute malnutrition had doubled in certain parts of the country between 2012 and 2013. It noted that almost 2,000 children under the age of five were at risk of dying if they did not receive immediate treatment, while even milder states of malnutrition stunt children’s physical and mental growth.

Basmeh & Zeitooneh has set up a school in Shatila for about 300 students using the Lebanese curriculum taught by Syrians and Palestinians, who are paid between 400 and 700 dollars a month, according to Hallisso, “which no Lebanese teacher would be willing to work for.”

The facilities have been newly renovated and are in a building with a Médecins Sans Frontières (MSF) clinic and dispensary on the second floor.

The organisation is trying to get funding for a small library where the children can come, read, consult reference works, use computers and find a space open to them with generator-powered electricity.

Maria Minkara, who works with Hallisso, told IPS that it would be open to both Palestinian and Syrian schoolchildren and that not a single library exists in the entire area housing tens of thousands of inhabitants.

Many of the children, she noted, live in dark, unhealthy environments, cut off from the power grid with no physical space in which to study. A walk through the crowded camps makes this obvious.

The Joint Christian Committee for Social Service in Lebanon, another organisation working with refugees, recently succeeded in obtaining permission for about 120 Syrian refugee children from its school in the Ain El-Hilweh camp near Sidon to return to Damascus for their 9^th grade and Baccalaureate exams, Executive Director Sylvia Haddad told IPS. Over 83 percent of them passed, she said.

Haddad admitted that several students’ families had refused to allow their children to go back to Syria out of fear of the regime, but said that “’they are regretting that decision very much now.”

Stressing that all politics and religion were kept out of the instruction of refugee children, Haddad said that questions on the curriculum being used by the group were referred to Abu Hassan, a Palestinian inhabitant of the camp who in the manner of militia fighters in the region uses an alias preceded by ‘Abu’ (‘father of’).

Abu Hassan said he had fought in the Palestinian ‘resistance’ in the past but declined to say with which faction, and denied that any pro-regime rhetoric was contained in the textbooks.

Abu Hassan was allowed to accompany the students to Damascus and back, but recent changes in Lebanese law make it harder for Palestinians fleeing Syria to enter Lebanon. Amnesty International published a report last month denouncing the restrictions, which require ‘pre-authorisation’ from the government or a residency permit.

Regulations regarding Syrian refugees also changed at the beginning of June, limiting entry to those coming from areas near the Lebanese border where fighting is under way and stipulating that refugees who cross back into Syria forfeit the right to return.

(Edited by Phil Harris)

Over 601,000 people have been uprooted from their homes throughout the country, with over 177,000 of them in Bangui alone. Credit: EU/ECHO Jean-Pierre Mustin/cc by 2.0

By Jonathan Rozen
UNITED NATIONS, Apr 4 2014 (IPS)

In a country suffering from what the U.N. has called “ethno-religious cleansing”, a “disappeared” state structure and “unacceptable sectarian brutality,” gaining access to the population of the Central African Republic has proven a difficult and sometimes deadly task for humanitarian workers.

“For everyone in this country, security is a challenge, because [the situation has] been very volatile and violent…Last year there were nine humanitarian workers who lost their lives,” Judith Léveillée, deputy representative for the U.N. children’s agency UNICEF in the CAR, told IPS from Bangui.“We don’t carry weapons and we never use armed escorts.” -- Benoit Matsha-Carpentier of IFRC

“I’ve never seen anything like it, and this is my seventh mission,” she said.

The conflict in the CAR began in 2012 when Muslim Séléka rebels launched attacks against the government. During the following two years, the conflict has grown along sectarian lines, with Christian anti-balaka (anti-machete) militias taking up arms against Séléka groups. While Muslim civilians represent a majority of the targeted population, Christians have also been threatened.

“There are situations where we physically cannot access the people we need to reach because the forces that are fighting are making it hard for us to get to them,” Steve Taravella, spokesperson for the U.N. World Food Programme (WFP), told IPS.

“Roads are blocked, convoys are redirected, food supplies are looted and people are being otherwise attacked,” he said.

In recent months, due to both the increase of international forces and the mass flight of the Muslim population, the U.N. has reported a calming of hostilities in the capital.

Nevertheless, the extreme and often random violence in the CAR poses a complex network of security challenges for aid workers trying to reach the approximately 2.2 million people in need to humanitarian assistance.

“At one point, the only road that goes from Cameroon to Bangui, the one we use as a corridor for food, was completely closed because the drivers from Cameroon, who were mainly Muslim, didn’t want to cross the border. [For weeks] they were too scared,” Fabienne Pompey, the regional communications officer for the WFP based in the CAR, told IPS.

“Now the road is open to transport the food from the border, but we use a military escort from [the African Union peacekeeping mission] MISCA.”

“Insecurity and banditry is on the rise, and this is of course a very big problem for humanitarian organisations…Its difficult to drive on the roads, and its complicated to have vehicles in your own compound because there is a risk that they will be stolen,” Marie-Servane Desjonqueres, spokesperson for the International Committee of the Red Cross in central and south Africa, told IPS.

The EU has been airlifting life-saving humanitarian cargo to the Central African Republic. Credit: EU/ECHO Jean-Pierre Mustin/cc by 2.0

International presence

The creation of a secure environment for the delivery of humanitarian aid in the CAR and an increase of international troops were both key elements of U.N. Secretary-General (UNSG) Ban Ki-moon’s six-point recommendation of Feb. 20.

Nevertheless, security remains an issue and aid workers continue to be targeted and attacked by armed groups, the U.N. reported Thursday.

Currently, the only international military forces in the CAR are roughly 2,000 French troops, under the Sangaris mission, and approximately 6,000 African Union peacekeepers, under the MISCA mission.

Following the UNSG’s request, the European Union pledged nearly 1,000 to lend further support, but this force has yet to materialise.

For UNICEF and the WFP, the use of armed escorts allows for access into areas of the country with serious security concerns.

“We do regularly act with [escorts from] the Sangaris or MISCA operations…but that is in the case of a last resort,” explained Léveillée. “It’s very important that we keep our neutrality. We don’t necessarily want to be associated with armed escorts.”

On Mar. 3, the UNSG proposed a 12,000-person U.N. peacekeeping mission in the CAR. The U.N. Security Council (UNSC), which must approve all peacekeeping missions before their implementation, is expected to vote on the resolution during the second week of April, with a perspective implementation in September, current UNSC president and Nigerian ambassador, Joy Ogwu, told reporters Wednesday.

Negotiating access

While some organisations, like Doctors Without Borders (MSF) and the International Federation of Red Cross and Red Crescent (IFRC) do not use armed escorts, negotiating with the parties to the conflict is a universally used tactic to gain access to people who would be otherwise inaccessible.

“We do not have armed personnel for security, we rely on the respect of the parties to the conflict,” Sylvain Groulx, head of the MSF mission based in Bangui, told IPS. “A lot of our operation includes outreach and dialogue.”

“We don’t carry weapons and we never use armed escorts,” Benoit Matsha-Carpentier, spokesperson for the IFRC, told IPS. “This is actually one of our principles.”

“There are ongoing discussions, whether at high level with the government or at the volunteer level…with whoever is in front of them, to make sure [aid workers] have safe access to those who are in need.”

Beyond the larger international organisation, the IFRC has a network of national, country-specific societies, which help facilitate support on a more local level. This IFRC national society in the CAR has had a major impact in helping both the IFRC and other humanitarian organisations that may be experiencing restrictions get aid to the Central African population.

“If it’s too dangerous to have us on the ground, then we [distribute] using a local partner,” Desjonqueres explained. “Our main partner in CAR is the Central African Republic Red Cross. They have a very strong network all over the country, a lot of volunteers all over the place.”

Changing the perspective

Broadening respect for humanitarian access is an important factor in the ability for aid workers to support the suffering population in the CAR.

“One of our mandates is to disseminate the respect for international humanitarian law,” Desjonqueres continued. “For many years, we have been conducting sessions…to talk about those basic rules of humanity that need to be respected during times of war, and that includes safe passage for humanitarian workers.

“We are distributing food to the people in need, our criteria is people in need,” stressed Pompey. “It is very important to repeat this every time so that the parties involved in the conflict let us go.”

For the crisis in the CAR, which has killed thousands and displaced more than 600,000 people, getting aid to those in need is an immediate objective, but it is not a long-term solution.

“The best option would be a political settlement [to the conflict],” Pompey told IPS, “something inside the country to help make peace.”

South Africa is battling to reduce its cases of multidrug-resistant TB (MDR-TB) with the success rate for those on treatment at about 40 percent. Miriam Mannak/IPS

By Brendon Bosworth
CAPE TOWN, Mar 12 2014 (IPS)

Despite an increase in diagnosis times, South Africa is facing a growing drug-resistant tuberculosis (TB) burden as nationally there remains a large gap between the number of patients diagnosed with multidrug-resistant TB (MDR-TB) and those who start treatment.

Between 2007 and 2012, recorded cases of MDR-TB, which is resistant to at least two of the primary drugs used to combat standard TB, almost doubled.

South Africa has improved its ability to test for drug-resistant TB by introducing GeneXpert, a rapid testing machine that can diagnose TB in sputum samples in less than two hours.“We have in South Africa one of the only rising epidemics of drug-sensitive TB and drug-resistant TB. And we are not doing very well at detecting it and treating it.” -- Gilles van Cutsem, Médecins Sans Frontières (MSF)

But in 2012, just 42 percent of patients diagnosed with MDR-TB began treatment, according to government figures. The success rate for those on treatment is about 40 percent.

“If we don’t do something about it now, MDR-TB is going to become XDR-TB [extensively drug-resistant TB],” Dr. Jennifer Hughes, a drug-resistant TB doctor with Médecins Sans Frontières (MSF), told IPS. XDR-TB is a strain of TB resistant to at least four of the main TB drugs.

“If we don’t start focusing on how we treat XDR-TB properly as well, we’re just going to drive further and further resistance as we go.”

Treatment Gap

Most of South Africa’s provinces have increased their treatment capacity for MDR-TB patients after the government introduced a 2011 framework for decentralising MDR-TB care. This allows patients to start treatment at sites closer to their homes instead of the country’s few specialised TB hospitals, where a typical stay is six months.

But provision of treatment at primary healthcare level needs to increase, Dr. Norbert Ndjeke, director of the Department of Health’s DR-TB, TB and HIV division, told IPS.

“[Decentralisation] is not moving at the speed we want it to,” admitted Ndjeke. There is no special budget for decentralisation and provincial governments choose how to prioritise their spending, he said.

The number of sites MDR-TB patients can start treatment in the Western Cape, Gauteng, Eastern Cape, and the Free State provinces has quadrupled due to decentralisation. The number of sites in the Western Cape, for instance, went from four to 17, while Gauteng now has five treatment sites instead of one.

Limpopo Province has not added new facilities, while North West and the Northern Cape provinces have doubled available treatment initiation sites, going from one to two, and two to four, respectively.

When properly implemented, decentralisation can cut the treatment gap.

In Khayelitsha, a large semi-informal township on the fringes of Cape Town, a combination of quicker testing and decentralisation has led to the time between diagnosis and treatment for drug-resistant TB dropping from 73 days to just seven days between 2007 and 2013, according to data by MSF. Ninety-one percent of patients diagnosed with MDR-TB in Khayelitsha in 2013 began treatment.

Ndjeke noted that provisional national data for 2013 indicates that 10,095 MDR-TB patients began treatment. Figures are not yet available for the number of patients diagnosed during that period, but in the first nine months of the year 7,271 patients were diagnosed with MDR-TB, possibly indicating a shrinking gap between treatment and diagnosis.

Accurate recording and reporting of patient numbers and outcomes remains a challenge, and the government is working to improve its systems, he said.

Large Burden

South Africa has the world’s third-largest TB burden, after India and China, according to the World Health Organisation. It also reports the world’s most cases of XDR-TB, a virulent form of the disease that is resistant to at least four of the main TB drugs and has a treatment success rate of less than 20 percent. An estimated one percent of the population of about 51 million develops TB every year.

“We have in South Africa one of the only rising epidemics of drug-sensitive TB and drug-resistant TB. And we are not doing very well at detecting it and treating it,” said Gilles van Cutsem, MSF’s medical coordinator for South Africa and Lesotho, at a media briefing.

Doctors are concerned about the rise in transmission of drug-resistant TB.

When drug-resistant TB started emerging it was mainly due to patients not being able to complete their full course of treatment for standard TB, said MSF’s Hughes. But now most drug-resistant TB transmission happens through people breathing it in from others, she said.

New Drugs Offer Hope 

One of the main challenges for treating drug-resistant TB is that the available drugs come with side effects including nausea, vomiting and permanent deafness, which often deters patients from finishing their treatment course.

“The drugs are horrendous – it’s a terrible regime but it’s the best they’ve got,” Hughes told IPS. On average, patients need to take between 12 and 15 tablets daily for two years, she explained.

South Africa is running a clinical access programme for up to 200 XDR-TB – and pre-XDR-TB patients with limited treatment options for a new drug called Bedaquiline, the first drug designed specifically to treat TB in over 50 years.

One of the features of the drug, which is taken along with other drugs, is that patients get better a lot quicker, said Dr. Francesca Conradie, clinical advisor to Sizwe Hospital, a MDR-TB hospital in Gauteng.

“It’s the first in a pipeline of maybe four or five drugs that will revolutionise the way we treat MDR-TB,” said Conradie.

Based on the outcomes of this initial programme, South Africa’s Medicines Control Council will decide whether or not to register Bedaquiline for use for more patients.

A new regime of drugs for drug-resistant TB patients could be ready by 2022 based on the outcomes of existing trials, said van Cutsem.