Doctors administer diphtheria and tetanus vaccinations provided by the World Health Organization (WHO) to children in Haiti displaced by the earthquake in 2010. Credit: Sophia Paris/UN Photo

By Naomi Myint Breuer
UNITED NATIONS, Jul 15 2025 (IPS)

The latest data highlights that the world is off track to meet the targets set by the Immunization Agenda 2030 (IA2030) to achieve 90 percent global immunization coverage for essential childhood vaccines and halve the number of unvaccinated children by 2030.

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) released the 2024 Estimates of National Immunization Coverage (WUENIC) on July 15, revealing both progress and challenges in global childhood immunization.

WUENIC, the world’s largest dataset on childhood immunization, reports on 16 antigens across 195 countries.

In 2024, 20 million children did not receive at least one dose of the diphtheria, tetanus and pertussis (DTP) vaccine, a global marker for childhood immunization coverage. Of those children, 14.3 million received no vaccines at all. This is 4 million more than the 2024 target and 1.4 million more than in 2019, the IA2030 baseline year.

“We’ve hit this very stubborn glass ceiling, and breaking through that glass to protect more children against vaccine-preventable diseases is becoming more difficult,” Dr. Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals at WHO, said at a July 14 press briefing.

Conflicts are much to blame for the difficulty in immunization. Children living in one of the 26 countries affected by fragility, conflict or humanitarian emergencies are three times more likely to be unvaccinated than those who live in stable countries. Half of unvaccinated children live in these 26 countries.

“These aren’t just numbers. They are real children in places like Sudan and Yemen, where instability makes vaccine delivery difficult,” Thanbani Maphosa, Managing Director of Country Programmes for Gavi, the Vaccine Alliance, said. “In these settings, reaching a charge can mean navigating danger, displacement and a fractured health system.”

However, the 14.3 zero-dose children is a reduction from the 2023 number of 14.4 zero-dose children, and 85 percent of infants in the world received three doses of the DTP in 2024, an increase of 1 million more from 2023.

“While that growth may sound modest, in each of these children, this means another child protected at the same time,” O’Brien said.

Through their Zero-Dose Immunization Program (ZIP), UNICEF and partners have vaccinated over 1 million children in conflict-affected regions of the Sahel and the Horn of Africa since 2023. In 2024, Gavi, the Vaccine Alliance, supported more children against more diseases than ever before.

“That is not just a statistic. It is a testament to the resilience and determination of countries,” Maphosa said.

Furthermore, two-thirds of countries have maintained at least 90 percent coverage of four key vaccines over the past five years.

WUENIC reports there is improving immunization against measles. First-dose coverage rose to 84 percent, with 1.7 million children vaccinated in 2024, while second-dose coverage increased from 74 percent in 2023 to 76 percent in 2024.

Still, 20 million children missed their first dose, and 12 million did not complete their second, leaving 30 million at risk for measles. 360,000 measles cases were confirmed globally in 2024, the highest number since 2019. The number of countries with large and disruptive measles outbreaks rose to 60, almost double the 2022 number.

The rise in cases is due to an accumulation of people who are unvaccinated since the COVID-19 pandemic began.

Dr. Ephrem T. Lemango, Associate Director for Health and Global Chief of Immunization at UNICEF, warned that the progress made in 2024 is not enough to prevent measles outbreaks.

Lemango warned that even where national coverage rates appear high, disparities among districts put many disproportionately at risk. Measles outbreaks can only be prevented with 95 percent coverage with two measles vaccine doses in every community in every county.

Immunization efforts are challenged by fewer health facilities, workforce shortages, vaccine stockouts, and difficulties reaching remote communities, especially in areas affected by conflict or displacement. In high-income countries, immunization is challenged by decreased acceptance and vaccine hesitancy due to misinformation and distrust in institutions. Funding cuts are further putting children at risk for vaccine-preventable diseases. Nearly 50 countries have been disrupted by funding cuts.

“Misinformation and any forms of vaccine hesitancy are a reflection of a broader lack of trust or mistrust in the systems that deliver the vaccines, in the health workers that provide the vaccines, in the manufacturing facilities or ecosystem that manufactures the vaccines,” Lemango said.

Social media and the COVID-19 pandemic are largely to blame for disinformation and misinformation surrounding vaccines.

Lemango and O’Brien emphasized the importance of training health workers to address the questions and concerns of parents in regard to vaccinating their children and the critical role community leaders play in influencing public trust. O’Brien noted that a family’s local medical practitioner is the most influential voice in their decision to vaccinate their children.

“Political leaders, community leaders, religious leaders, and family leaders have a powerful influence on the choices that families make around the health of their children, and the voices of leaders can either reinforce trust or erode trust,” O’Brien said.

However, O’Brien emphasized that lack of access remains the primary barrier to immunization, rather than misinformation. Lemango noted that 95 percent of parents want their children to be vaccinated.

An area of notable progress is HPV vaccination. 43 million girls were vaccinated against HPV in 2024, setting the world on track to reach 86 million adolescents by the end of 2025. 60 million girls are now protected against cervical cancer, more than in any previous decade.

He noted that many countries are committing record levels of domestic financing to immunization, but a funding gap persists. Of the USD 11.9 billion needed to achieve their goals, only USD 9 billion has been raised.

Maphosa noted that millions of children are still not being reached and there is no “one-size-fits-all” solution. Lemango called on governments, partners and communities to close funding gaps, serve fragile or conflict-affected communities and address misinformation.

Maphosa emphasized the urgency of the situation, given a global rise in conflict, fragility and population. “Vaccines have never been more important and urgent than they are now,” he said.

He added that countries and organizations must work together to close the immunization gap so that every child is protected.

“That’s the promise of immunization,” he said. “One of the best tools the world has to ensure health, security and prosperity. And with continued commitment and continued investment, it’s a promise we can keep.”

Follow @IPSNewsUNBureau
  

A child receives treatment at a cholera clinic in the DRC, where clean water is scarce and healthcare even scarcer. Credit: UNICEF

By Shreya Komar
UNITED NATIONS, Jul 14 2025 (IPS)

The Democratic Republic of Congo (DRC) is grappling with one of its worst cholera outbreaks in recent history, exposing deep systemic cracks in public health, water infrastructure, and humanitarian response, leaving its youngest citizens in peril.

On April 3, 2025, the United Nations released a stark warning: a fast-spreading cholera outbreak in the southern province of Tanganyika was placing thousands at grave risk. As of that date, 9 out of 11 health zones in the province were affected, with over 1,450 confirmed cases and 27 deaths, marking a six-fold increase compared to the previous year.

By early June, the outbreak had exploded far beyond Tanganyika. The World Health Organization (WHO) reported 29,392 suspected cholera cases and 620 deaths nationwide, making this the worst outbreak in the country in six years. Most alarmingly, children, especially those under five, are dying in disproportionate numbers due to weakened immune systems, chronic malnutrition, and an almost total collapse of access to clean water and sanitation in many areas.

A recent Instagram post from the WHO underscored the scale of response efforts: “To tackle the rise in #cholera cases & deaths in #DRCongo, WHO is mobilizing resources for the hardest-hit areas: emergency beds, free medical care, and deployment of over 7,000 community health workers.”

Cholera is an acute diarrheal infection caused by ingesting food or water contaminated with the Vibrio cholerae bacterium. It is entirely preventable and highly treatable. So why is it still killing hundreds in a single outbreak?

“The reason cholera has persisted is that we have not addressed poverty to the level that we should,” said Dr. Anita Zaidi, director of the Enteric and Diarrheal Diseases program at the Gates Foundation.

The answer lies not in the biology of the disease, but in the fragile reality of life in the eastern DRC. In provinces like Tanganyika, North Kivu, and South Kivu already scarred by decades of armed conflict, mass displacement, and collapsing infrastructure the cholera bacterium finds ideal conditions to spread.

A 2024 study on cholera risk in Goma found that the lack of water infrastructure forced communities to rely on unsafe sources like Lake Kivu, the small Lake Vert, and the Mubambiro River, which are often contaminated with human waste.

In the most affected areas, only 20 percent of residents have access to safe drinking water. Healthcare infrastructure is threadbare, with limited beds, medicine, or trained personnel to handle waves of acute cases. Years of humanitarian funding cuts have only made the situation worse especially for women and children.

Between July 2024 and June 2025, nearly 4.5 million children under five are expected to suffer from acute malnutrition in the DRC, 1.4 million of whom are experiencing severe acute malnutrition. Cholera, which causes rapid dehydration and can be fatal within hours, is especially deadly in malnourished children. With their immune systems already compromised, even the smallest lapse in hydration or care can become fatal.

Still, field efforts are outpaced by the scale of the emergency. In 2017, the Global Task Force on Cholera Control (GTFCC) launched the “Ending Cholera: A Global Roadmap to 2030”, which aimed to eliminate the disease from 20 countries, including the DRC.

The strategy emphasized early detection, integrated prevention (clean water, sanitation, vaccination), and international coordination. But with only five years left before 2030, the roadmap’s vision is faltering in the DRC. In 2023, the DRC recommitted to cholera elimination, as documented by the WHO, but outbreaks have only worsened.

A Doctors Without Borders emergency response in Lomera, South Kivu, highlights the impact of unmanaged gold rushes, poor sanitation, and overburdened clinics creating a perfect storm for cholera transmission.

Efforts by the UN and NGOs have ramped up in recent months. Oral Cholera Vaccines (OCVs) are being deployed in hotspots. Emergency treatment centers are being established. Supplies are arriving, albeit slowly. But a true resolution requires structural investments in safe water infrastructure, consistent access to healthcare, and conflict stabilization.

More importantly, child-focused solutions must be prioritized. In a recent peer-reviewed article, Congolese researcher Aymar Akilimali called for dedicated pediatric cholera wards in eastern DRC, noting that most children have no access to tailored emergency care even during active outbreaks.

He also stated that “a community-based and multisectoral response must be implemented, including an anti cholera vaccination campaign, a budgeted response plan with involved partners, as well as the development of national cholera control plans, epidemiological surveillance, risk communication on cholera, community awareness, and social mobilization.”

The cholera outbreak in the DRC is not just a public health crisis; it is a humanitarian failure. It is a warning signal of what happens when decades of conflict, poverty, and weak governance go unaddressed. As 2030 approaches, the question isn’t whether we can end cholera, it’s whether we’re willing to invest in the lives of those most at risk of it.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

Teacher U Aung San standing in the ruins of his classroom, which was destroyed by the March 28 earthquake that left millions across Myanmar in urgent need of humanitarian assistance. Credit: UNICEF/Minzayar Oo

By Naomi Myint Breuer
UNITED NATIONS, Jul 3 2025 (IPS)

“Myanmar cannot become a forgotten crisis,” Jorge Moreira da Silva, Executive Director of the United Nations Office for Project Services (UNOPS), has said. “This country has faced cyclones, war, conflict, violence, climate and now immense suffering.”

Three months after a 7.7 magnitude earthquake struck Myanmar, humanitarian groups warn that the international community is failing to respond. Despite the scale of need, only 36 percent of the USD 275 million requested for the earthquake response has been disbursed. Almost halfway through the year, the 2025 Humanitarian Needs and Response Plan (HNRP), which guides aid efforts throughout the country, is just 12 percent funded.

Da Silva was speaking at a press briefing on June 24 following his visit to Myanmar. His views reflect those of others involved in bringing humanitarian aid to the country.

“The dangerously low funding for response efforts in Myanmar remains our greatest challenge,” former UN Humanitarian Coordinator Marcoluigi Corsi said in his June 20 outgoing statement.

The ongoing armed conflict and political turmoil following the 2021 military coup are also making humanitarian assistance more difficult to achieve.

UN High Commissioner for Human Rights Volker Türk reported in a June 27 briefing to the Human Rights Council that the military’s attacks rose again, despite initial ceasefire announcements after the earthquake.

Since the earthquake, the military has launched more than 600 attacks, 94 percent of which were in areas where a ceasefire had been announced. Over 500 civilians were killed, and 1000 were injured. Türk said that attacks have restricted humanitarian access. WHO reports that 6 attacks have led to 48 health workers killed and 85 injured. The International Committee of the Red Cross (ICRC) has urged that groups in these areas respect international humanitarian law.

“Every day, we face barriers that prevent or delay assistance from reaching those who need it most,” former UN Humanitarian Coordinator Marcoluigi Corsi said in his outgoing statement on June 20. “I call on all parties to ensure unrestricted humanitarian access—without conditions, without delays.”

The March 28 earthquake killed 3,800 people and injured more than 5,000, according to UN estimates. Tens of thousands were newly displaced, adding to the 3.2 million displaced since the coup. The UN now estimates that 3.5 million people, 6 percent of the population, are displaced, and more than 6 million are in need of urgent assistance.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) Myanmar office estimates that 19.9 million people were in need of humanitarian assistance before the earthquake, and now 2 million more are.

“Myanmar is one of the countries most in need of humanitarian assistance in the Asia-Pacific region,” the ICRC reports.

So far, 61 percent of the target population in need of humanitarian health services have been reached, according to the World Health Organization (WHO). With the monsoon season underway and active fighting restricting humanitarian access, organizations are warning about the urgency of the situation.

“We have faced many crises, including armed conflict and flooding, and now we have again been hit by the earthquake,” Daw Khin Po, who was displaced by the earthquake, told the ICRC.

The ICRC has been working with the Myanmar Red Cross Society (MRCS) and local partners to assist over 111,000 people in Mandalay, Sagaing, Bago and Shan State. They have provided clean water, food, tarpaulins, solar streetlights, essential household items, cash and emergency health care, as well as training, agricultural and livestock materials, support for small businesses and risk awareness training. These organizations have also been supporting existing hospitals and community health centers.

“However, the scale of needs is beyond what any single organization can address,” the ICRC reported.

OCHA is currently working to respond to Myanmar’s humanitarian crisis through “coordination, advocacy, policy, information management and humanitarian financing tools and services.”

“Amid these shocks, the security environment continues to deteriorate, people are facing grave protection threats, and coping capacities are stretched to the limit,” the OCHA Myanmar office wrote.

Humanitarian partners assisted around 1.5 million people between January and March 2025, which is 27 percent of the annual target, according to the OCHA Myanmar office. These efforts have targeted internally displaced persons (IDPs), returnees, resettled and locally integrated IDPs, and non-displaced stateless people. The office said that local organizations are the “backbone” of the response to the humanitarian situation, especially in areas of conflict.

Without funding, though, Corsi said more people will be at risk as organizations are unable to provide necessary support.

“The world cannot look away. The international community must step up their support,” the ICRC’s head of delegation in Yangon, Arnaud de Baecque, said.

The monsoon season creates further threats to the population, who risk disease, flooding and displacement, and adds more urgency to the situation. WHO is currently working to improve access to clean and potable water, provide health services and prevent disease outbreaks. They are collaborating with the Red Cross, the United Nations Children’s Fund (UNICEF), and the World Food Programme (WFP) to improve water safety systems and disseminate health information.

But WHO reports that people living in makeshift structures due to the earthquake are subject to extreme health risks.

Türk emphasized that the situation in Myanmar must receive continuous attention.

“Amid the turmoil, planning for a future with human rights front and center offers people a sense of hope,” he said. “We owe it to the people of Myanmar to make that hope a reality.”

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

Wounded civilians at the Al Shifa Hospital in the Gaza Strip. Credit: WHO

By Naureen Hossain
UNITED NATIONS, Jan 19 2024 (IPS)

Gaza’s healthcare system is “on its knees” as ongoing hostilities force hospitals to operate beyond their capacity and displace their healthcare workers, according to a WHO expert.

On Wednesday, WHO Health Emergency Officer Sean Casey spoke with reporters in New York on the healthcare crisis in Gaza. Following a five-week visit to the region, Casey elaborated on the WHO team’s work during his visit and their findings on the hospitals that were still running amidst the outbreak of violence since October 7. During his visit, he visited six out of the 16 hospitals still operating in the Gaza Strip. He described them as either “minimally or partially functioning” with the limited medical supplies and personnel available to them. But without unfettered access to medical supplies or fuel to run generators in the facilities, the hospitals will not be able to stay open.

“Every time I went to a hospital, I saw again and again the simultaneous humanitarian catastrophe that’s unfolding—we see it every day in Gaza getting worse—and the collapse of the healthcare system,” he said.

The growing number of trauma patients impacted by the ongoing attacks is currently overwhelming the healthcare system. There are up to 60,000 injured people in the region that require urgent care. Yet, there is a backlog of patients in hospitals, which only increases with each passing day. This is causing hospitals in the field and in towns to essentially play catch-up with the previous days’ cases. Patients with specialized needs, such as mothers requiring maternal or natal care or patients undergoing dialysis treatments, have also been struggling to get the care they need.

Palestinian refugees flee the conflict. Credit: UNRWA/Ashraf Amra

There are not enough doctors or nurses in the hospitals to accommodate the ever-increasing number of patients. Nasser Medical Complex in Khan Younis is currently operating with only 30 percent of its staff, according to Casey. There are reportedly over 25,000 doctors and nurses in Gaza. However, a large number of them are no longer in their homes and are unable to travel to work. This includes specialists in other fields of treatment. Areas around hospitals have been evacuated, as it’s been observed that hospitals have been hit by gunfire and bombings, rendering them rubble.

Al-Shifa Hospital, one of the largest still open, has been operating beyond its 700-bed capacity. It now serves as a “trauma stabilization point,” according to Casey. Thousands of people, displaced by the loss of their homes, have taken refuge in the hospital, where there is nowhere else to go, filling up the operating rooms, corridors, and floors. For the patients, only five or six doctors and nurses are present.

“I saw patients in hospitals every day with severe burns, open fractures, waiting hours or days for care, and they would often ask me for food or water,” he said. “In addition to their injuries and illnesses, they’re crying out for the basic necessities of life.”

Constraints on security and access, as well as limitations on movement, have at times even prevented the safe passage of medical supplies and fuel. “The last week that I was in Gaza, we tried every single day for seven days to deliver fuel and supplies to the north, to Gaza City. And every day, those requests for coordinated movement were denied,” Casey said. Without a guarantee, fewer supply trucks are crossing the Rafah border. Meanwhile, needs are not being met adequately.

Rafah is currently hosting a million people, yet it does not have the health infrastructure to host so many internally displaced people. In order to address some of the care demands resulting from the hostilities, WHO is working to mobilize medical personnel and set up field hospitals.

The “rapid deterioration” of the healthcare system in Gaza is happening concurrently with the “dramatic humanitarian catastrophe” affecting the communities, Casey said. Due to the attacks, over 1 million civilians are now homeless and struggle with widespread food insecurity and a lack of access to potable water. For children, this will be particularly dangerous. UNICEF has warned that 10,000 children are at risk of dealing with child wasting, the most life-threatening form of malnutrition.

Casey remarked that a ceasefire would “provide immediate relief to the people of Gaza” and would allow for the UN and its partners to mobilize medicines, medical supplies, and other emergency resources.

More than a hundred days have passed since the beginning of the current humanitarian crisis in Gaza. The death toll has exceeded 24,000, and more than 60,000 have been injured.

Major leaders in the UN and its agencies, including Secretary-General António Guterres, have called for a humanitarian ceasefire to come into effect immediately to allow unimpeded aid to go through and to “tamp down the flames of wider war” that is threatening the region. “I am deeply troubled by the clear violation of international humanitarian law that we are witnessing,” he said to reporters on Monday.

The heads of WHO, UNICEF, and the World Food Programme (WFP) released a joint statement urging for the delivery of emergency humanitarian aid to mitigate the risk of famine and deadly disease outbreaks. UNRWA Commissioner-General Philip Lazzarini, in his statement to mark the 100 days, remarked that the current conflict in Gaza was a “man-made disaster compounded by dehumanizing language and the use of food, water, and fuel as instruments of war.”

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

A child is vaccinated against the poliovirus. Malawi detected a single case and embarked on a mass vaccination programme against the disease which causes paralysis. Credit: Charles Mpaka/IPS

By Charles Mpaka
Blantyre, Malawi, Apr 18 2022 (IPS)

One polio case is one too many, global health experts say.

And when Malawi announced in February this year that it had detected a polio case in the country’s capital Lilongwe, the alarm was significant, and the response from both the government and global health partners was swift, if not frantic.

Detected on a 3-year-old child, the poliovirus is described by experts as a significant public health concern for several reasons.

According to the World Health Organisation (WHO), polio has no cure, and it is a highly infectious disease.

“It invades the nervous system and can cause total paralysis within hours,” said WHO in a statement released on February 17, 2022, upon the Malawi Government’s announcement of the outbreak.

Furthermore, Malawi has not registered any cases of polio in 30 years. The country last reported a case of poliovirus in 1992.

In 2005, Malawi obtained a polio-free status.

The WHO further says that the last case of wild poliovirus in Africa was detected in northern Nigeria in 2016. Globally, there were only five cases of wild poliovirus recorded in 2021.

In addition, according to the United Nations health body, Africa was declared free of indigenous wild polio in August 2020 after eliminating all forms of wild polio.

To date, says WHO, polio remains endemic in Afghanistan and Pakistan, and laboratory test results on the case in Malawi showed that the strain was linked to the one found in Pakistan’s Sindh Province.

“As long as wild polio exists anywhere in the world, all countries remain at risk of importation of the virus,” Dr Matshidiso Moeti, WHO Regional Director for Africa, said upon the announcement.

Immediately after the outbreak, the government declared a Public Health Emergency.

It also instituted risk assessment and surveillance measures to contain any potential spread of the virus – but it assured that there was no evidence that the poliovirus was circulating in the community. There are no reports of additional cases of polio thus far.

Within 72 hours, the Global Polio Eradication Initiative (GPEI) Rapid Response Team arrived in the country to support the outbreak response.

These efforts were followed by a mass vaccination campaign, the first of four rounds, targeting 2.9 million children under five.

UNICEF procured 6.9 million polio vaccine doses for exercise.

UNICEF had partnered with WHO and the Global Polio Eradication Initiative’s Gavi, Bill and Melinda Gates Foundation, Rotary and Centers for Disease Control and Prevention in supporting the Ministry of Health to vaccinate children in four mass campaigns.

The phase ran from March 21 to 26, 2022.

A Poliovirus Outbreak Response Situation Report released by the government on April 4 says 2.97 million children aged between 0 – and 59 months had been vaccinated in the campaign, representing 102 percent administrative coverage.

The Ministry of Health says it is delighted with the campaign’s success.

“We attribute this to the dedicated workforce, the door-to-door approach and low presence of misconceptions, misinformation and disinformation surrounding polio vaccine,” the ministry’s spokesperson, Adrian Chikumbe, told IPS.

But the campaign was affected by some challenges, the Ministry of Health acknowledges in the vaccination campaign review report.

Malawi is reeling from the impacts of cyclones Ana and Gome, which hit the country in January this year, leading to flooding in many parts of the country and displacement of close to a million people. According to the report, the dispersion of the communities due to flooding increased the workload for vaccination teams.

“Polio campaigns with house-to-house strategy have not been conducted in-country in more than ten years, resulting in house-to-house vaccination not being strictly being followed in some areas. Grassroot social mobilisation was also delayed in some communities,” adds the report.

The second phase of the polio vaccination campaign is slated for late April.

“We urge all of us to sustain the gains in the first round of the campaign by making sure no eligible child is left behind in the subsequent rounds of the campaign. That way, our children will be adequately protected against polio which leads to paralysis or even death,” says Chikumbe.

UNICEF says the re-emergence of the wild poliovirus in Malawi, three decades after it was last detected, is “cause for serious concern”.

“Vaccination is the only way to protect the children of Malawi from this crippling disease which is highly infectious,” says UNICEF representative in Malawi, Rudolf Schwenk.

According to UNICEF, as an epidemic-prone, highly contagious disease, polio can spread easily through the movement of people from endemic to polio-free areas.

This polio vaccination campaign comes nine months after Malawi also administered another polio vaccination drive in July last year when the country undertook a week-long catch-up campaign that targeted 1.8 million children who missed the vaccine earlier.

Ministry of Health says the vaccination campaign last year was intended to immunise all children born after the world had switched from the Trivalent Oral Polio Vaccine (tOPV) to the Bivalent Oral Polio Vaccine (bOPV). The bOPV is said to protect children against all three types of polioviruses.

Community health activist Maziko Matemba tells IPS that one case of polio is one too many because of the high rate of spread of the virus and the severity of its effects.

“You need a rapid response to forestall its spread. You may not manage it if it slips through, so immunisation is key,” says Matemba, also executive director for Health and Rights Education Programme (HREP), a local non-governmental organisation.

But he says the re-emergence of the case after 30 years in Malawi should remind the government of the need to ensure the health system’s resilience.

He says this resilience can be achieved through adequate funding to the health sector.

“As a country, we need to ensure that our health system is resilient and robust. One way we can make it such is by meeting the Abuja Declaration on Health to allocate at least 15 percent of the national budget to the health sector.

“Twenty-one years after that declaration, we still can’t go past 10 percent in budget allocation to the health sector. Without sufficient funding, outbreaks of this nature can spiral out of control, and we will struggle to contain other health shocks,” Matemba says.

Since the last case in 1992, Malawi has sustained its polio surveillance through an independent committee of experts that oversees and coordinates the country’s polio monitoring and reporting system.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

WHO Goodwill Ambassador for Leprosy Elimination, Yohei Sasakawa, would like to create a society where there is social inclusion. It is this philosophy that motivates his life-long campaign to end discrimination against people affected by leprosy. Credit: Sasakawa Leprosy Initiative

By Cecilia Russell
Johannesburg, Jan 30 2022 (IPS)

For the WHO Goodwill Ambassador for Leprosy Elimination, Yohei Sasakawa, ensuring affected peoples’ human rights is fundamental to the campaign to eradicate the disease.

In an exclusive interview with IPS on the eve of World Leprosy Day, he recalled his first encounter with people affected by leprosy, saying they were “without dreams or hopes and there was no light in their eyes.”

Sasakawa’s father, Ryoichi, hugged the patients in the newly opened hospital in Korea. He then realized that returning hope to people affected by leprosy could be his life’s work.

This work has continued for more than 40 years, but it is not over yet.

“People who should be part of society remain isolated in colonies facing hardships,” Sasakawa, who is also the chairman of the Nippon Foundation, says.

“Isn’t it strange that someone cured of a disease can’t take their place in society? I belatedly realized that if the human rights aspect wasn’t addressed, then elimination of leprosy in a true sense would not be possible,” explaining the rationale for approaching the United Nations in 2003.

As a result, a resolution on the elimination of discrimination against persons affected by leprosy and their family members was unanimously adopted by 192 countries voting in the UN General Assembly.

While Covid-19 has temporarily ended his travels, his work is far from complete. Once the pandemic is over, Sasakawa intends to continue his travels worldwide to bring onboard top officials and politicians – presidents and prime ministers – while spreading hope to affected people.

In the interim, the global ‘Don’t Forget Leprosy’ campaign by the Sasakawa Leprosy Initiative continues. The initiative strategically links the WHO Goodwill Ambassador for Leprosy Elimination, Sasakawa Health Foundation, and the Nippon Foundation towards achieving a leprosy-free world.

Sasakawa says his message is clear:  1) Leprosy is curable. 2) Medication is free. 3) Discrimination has no place.

“When people are still being discriminated against even after being cured, society has a disease. If we can cure society of this disease—discrimination—it would be truly epoch-making.”

Here are excerpts from the interview:

Yohei Sasakawa, Chairman of The Nippon Foundation, has served as WHO Goodwill Ambassador for Leprosy Elimination since 2001. He plays a leading role in the Sasakawa Leprosy (Hansen’s Disease) Initiative, which has organized the “Don’t Forget Leprosy” campaign.

Cecilia Russell: In your message to the world for World Leprosy Day, you expressed concern that the decrease in the number of cases detected was because the Covid-19 pandemic meant that less testing was done. How can leprosy-affected people get back on track?

Yohei Sasakawa: Many issues have been sidelined because of the Covid-19 pandemic, among them the challenges posed by leprosy, also known as Hansen’s disease. According to the Global Leprosy Update for 2020, there was a 37% year-on-year decrease in new cases due to disruptions to case-finding activities. There are concerns that hidden cases will lead to increased transmission and result in more cases with disabilities. On the other hand, while figures vary from country to country, the overall treatment completion rate remains at the same level as the previous year, indicating that stakeholders are working hard to maintain services, even in the midst of the global pandemic.

Even in normal times, health ministries have jurisdiction over all kinds of diseases. Compared to diseases such as TB, AIDS, or malaria, however, there are few cases of leprosy, so budgets and personnel are limited. Patients, meanwhile, might not visit a hospital because the long history of stigma attached to the disease makes it difficult, or because in its early stages, symptoms are painless. That’s why I feel it is necessary to meet with those at the top of the country and have them issue a call to eliminate leprosy. Once the COVID situation eases, I want to visit countries and encourage presidents and prime ministers to recognize the importance of this issue and seek their cooperation in helping activities against the disease to resume.

At the same time, I believe that the participation of people who have experienced the disease is also very important. There are so many things that people can do, such as active case-finding, mental support for people undergoing treatment, and awareness-raising. In 2011, the WHO issued guidelines on strengthening the participation of persons affected by leprosy in leprosy services in such areas as a way to improve the quality of leprosy services.

CR: You have chosen as a life’s work to raise awareness of both the disease and the impact of the stigma of leprosy. This is an age-old stigma and was considered a sign of impurity in Christian biblical times. How has an awareness of leprosy as a human rights issue changed perceptions about the disease? What more needs to be done?

YS: I started working on leprosy in the 1970s and have been the WHO Goodwill Ambassador for Leprosy Elimination since 2001. People who should be part of society remain isolated in colonies facing hardships. The more you look into it, the more you see the restrictions they live under, including legal restrictions in some cases. Isn’t it strange that someone cured of a disease can’t take their place in society? I belatedly realized that if the human rights aspect wasn’t addressed, then elimination of leprosy in a true sense would not be possible. That’s when I first approached the United Nations about this in 2003.

In 2007, the Japanese government appointed me as its Goodwill Ambassador for the Human Rights of Persons Affected by Leprosy. Collaboration with the Japanese government led in December 2010 to a UN General Assembly resolution on the elimination of discrimination against persons affected by leprosy and their family members to call on states to full consideration of Principles and Guidelines. The resolution was adopted unanimously by 192 countries.

Discrimination toward persons affected by leprosy and their families should never be tolerated. That’s why the Principles and Guidelines were approved.

Although they are not binding, given the reality that even treaties ratified by states, such as the Convention on the Rights of Persons with Disabilities, the Convention on the Rights of the Child, and the Framework Convention on Tobacco Control, are difficult to implement, we need to think of them as a tool to be used by stakeholders, including persons affected by leprosy, when advocating with governments to fix the problems.

When people are still being discriminated against even after they have been cured, then society has a disease. If we can cure society of this disease—discrimination—it would be truly epoch-making.

CR: Could you please tell our readers about your father and his role in influencing you to make this mission a life’s work?

YS: My father Ryoichi also served as a member of Parliament. He was a man who was especially compassionate toward the vulnerable and dedicated his life to them. Concerning leprosy, in particular, there was an incident where a young lady living in the neighborhood suddenly disappeared, and he later found out she had been segregated due to leprosy. He had a very strong sense of justice and took exception to the fact that something so unreasonable was permitted on the basis of a disease.

In 1962, my father established the Japan Shipbuilding Industry Foundation, the forerunner of The Nippon Foundation, and began social contribution activities. In 1967, he started work in earnest on realizing his long-held dream of eradicating leprosy with the construction of some new facilities for a leprosy center in Agra, India. With the establishment of the Sasakawa Memorial Health Foundation (now Sasakawa Health Foundation) in 1974, efforts to tackle the disease stepped up.

My father built leprosy hospitals, mainly in Southeast Asia. I was young and often accompanied him, but I didn’t go inside the hospitals. In the mid-1970s, he responded to a request to build a leprosy hospital in Korea. I went with him to the opening ceremony and entered a leprosy hospital for the first time. Everyone sat on the bed facing us, but they were completely expressionless. Their faces were ashen-colored; they were without dreams or hopes, and there was no light in their eyes.

I was really surprised to see my father go to every bed, hug each person, and encourage them in a very natural way, unconcerned by the pus oozing from their bandages. Discovering a world that I had not encountered before and seeing how naturally my father behaved, I wondered if this would be my life’s work. Since then, I have been active in leprosy.

CR: In some countries, people affected by leprosy are still confined to leprosy colonies. How do you see your role as WHO Goodwill ambassador and the Don’t Forget Leprosy campaign changing these perceptions around a treatable disease? What is needed to change the perception about leprosy and remove the stigma?

YS: Thinking strategically about how to make people aware of the importance of this problem and how to solve it is very important. You have to convince heads of state in each country. If a budget is allocated as a result of meeting with and explaining the situation to the head of state, if the president orders it—then the person in charge at the ministry of health or the leprosy program manager will be greatly encouraged in their work.

On the other hand, it is also very important to reach the many people without knowledge of leprosy and allay their fears explain that it’s not hereditary, it’s not divine punishment, it’s not highly contagious. Wherever I go, I always stress: 1) Leprosy is curable; 2) Medication is free; 3) Discrimination has no place. For that, the help of the media is necessary, so one of my very important tasks is to have a proper media strategy.

Also, as we now live in an era where every individual can publicize leprosy issues via social media, I think it is important that everyone concerned with these issues actively raises them, not as issues affecting someone else, but as personal issues.

CR: You have been involved in numerous other humanitarian endeavors, apart from your 40-year-old association with leprosy and your role as WHO Goodwill Ambassador for Leprosy Elimination. These include the Change for Blue campaign, and you acted as a special envoy of the Japanese government to try to bring peace to Myanmar. Do you have a philosophy about humanitarian work that guides you?

YS: One of my philosophies in life is the ‘on-site principle’: problems and their solutions are found in the field. Another is that social actions require that you keep your enthusiasm bubbling over, regardless of your age, and have the mental fortitude to withstand any difficulties. In addition, you have to keep going until you achieve results. I’ve acted on the basis of these three ideas.

CR: Is there anything else you would like to add?

YS: There are more than 1 billion people in the world living with disabilities, including persons affected by leprosy. We need to create an inclusive society where everyone can have an education, find work and get married if they want to. People have the passion and the motivation; often, all they lack is opportunity.

I would like to create a society where everyone feels fully engaged, able to express their opinions, and appreciated. The coming era must be one of diversity, and for that, we need social inclusion. There is such ability and potential in the world, and to have everyone participate in society will create a truly wonderful future.

That’s why it’s important for persons affected by leprosy to have confidence and speak out. To support them, Sasakawa Health Foundation and The Nippon Foundation are helping them to build up their organizational capacity. I’d like to see a society in which everyone is active, able to express their opinions to the authorities with confidence, and their contribution is valued.

Zimbabweans readily join the COVID-19 vaccine queues, but the rollout hasn’t been smooth. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Zimbabwe , Oct 8 2021 (IPS)

More than a month ago, she lost her parents, brother, and wife, to the coronavirus. Then her fiancé battled COVID-19, but 27-year-old Melinda Gavi said she had not contracted the disease.

Gavi joined crowds scrambling to get vaccinated at Parirenyatwa hospital in the Zimbabwean capital Harare even though she was previously sceptical about getting vaccinated against the dreaded disease.

Her parents, brother, and wife were equally sceptical of the COVID-19 vaccines before they were visited by the disease, which eventually claimed their lives.

In a country of about 15 million people, nearly 5.5 million have had at least had one dose of the vaccine the Reuters COVID-19 tracker, which assuming that each person needs two doses, represents 18.8% of the population.

The World Health Organisation (WHO) confirmed in October that Zimbabwe had received 943 200 COVID-19 vaccine doses from the global COVAX Facility in September and October for its ongoing vaccination campaign.

IPS has been following the rollout of the vaccines in various centres over the past few months, recording people’s personal experiences in the queues.

Gavi says it has taken her days to get vaccinated.

“This is my third day coming here at Parirenyatwa to try and get vaccinated,” Gavi told IPS as she stood in a long and meandering queue at Zimbabwe’s biggest hospital.

About 200 people gathered at the back of the hospital, some looking tired as they lingered in the queue. Some sat on the pavements and or flower beds, waiting for their turn to get vaccinated in the slow-moving queue.

“We have limited vaccines, and often on a day we are vaccinating just 80 people and everybody else often just goes back home without getting vaccinated,” a nurse who refused to be named as she was unauthorised to speak to the media, told IPS.

In February this year, Zimbabwe began vaccinating its citizens against coronavirus after receiving a donation of 200 000 doses of China’s Sinopharm vaccine.

But when the vaccine first arrived, it was met with growing scepticism from social media platforms like WhatsApp, Twitter, and Facebook, which fuelled the vaccine hesitancy.

This is no longer the case. Now healthcare workers have to battle hordes of people scrambling for the vaccine.

“With time, as more and more people got vaccinated without severe safety fears, the public became more assured, and demand for vaccines gradually started to rise,” said epidemiologist Dr Grant Murewanhema in Harare.

In Bulawayo, on July 8, in the presence of IPS, at the United Bulawayo Hospital, a nurse moved along the queue of people waiting to get vaccinated, counting up to 60 recipients. She told the rest to return the next day.

She told them she only had enough vaccines for 60 people.

At number 60 was 47-year-old Jimmy Dzingai, who said he was a truck driver.

“Oh, better, at least I am going to get vaccinated,” said Dzingai then as he heaved a sigh of relief, folding his hands across his chest.

Meanwhile, as they were told to leave, others did so but grumbled as they filed outside the hospital, some waving their face masks in anger, shouting at hospital authorities for turning them away.

“This is not the first time I am coming here to try and get vaccinated. I have been here four times, and this is my fifth day starting mid-June – only to get excuses,” 54-year-old Limukani Dlela, a man who said he lived in Matsheumhlope, a low-density suburb in Bulawayo, told IPS saying that at times the excuse was that there not enough vaccines available and at other times there were a limited number of vaccines.

Corruption and nepotism have characterised this Southern African country’s bitter war against COVID-19, and many people like Dzingai, the truck driver, have not been spared by the rot.

As Dzingai stood at the end of the queue, four middle-aged women strode past him and all others, going straight to the head of the queue and quickly got vaccinated and left.

According to one of the nurses who manned the queue, “the four were staff members and couldn’t wait in the queue like everybody else.”

The nurse said this even though the four women, after receiving doses, immediately left the premises just like any other ordinary person.

“I was talking to my bosses right now, and my truck has been loaded for me to take the delivery to Zambia. I have told my bosses I was getting my vaccine. Instead, you are telling me I’m not going to be vaccinated. You should get water to inject me and give me the vaccine certificate. I will not leave this place without the vaccine,” swore the truck driver.

But the nurse would have none of it.

“You won’t be vaccinated today. That won’t happen, unfortunately,” she said.

Dzingai vowed to stay put at the hospital until he was vaccinated, but because the four women who jumped the queue and got vaccinated before him, it meant he (Dzingai) and three others who had waited at the end of the queue had to leave without the jab.

With many Zimbabweans like Dzingai now eager to get vaccinated, the government has so far authorised the use of China’s Sinovac and Sinopharm, Russia’s Sputnik V, and India’s Covaxin and the U.S. Johnson and Johnson vaccines.

It has not, however, been easy for people to get the doses. Now bribery has become the order of the day at Zimbabwe’s hospitals like Sally Mugabe Referral hospital in the capital Harare.

Lydia Gono (24), from Southertorn middle-income suburb in Harare, said she had to ‘switch to her purse’, which is local parlance for a bribe, to get quickly vaccinated at Sally Mugabe hospital, the closest medical facility to her home.

“I spent close to a week trying to get vaccinated here without success, but today I just rolled a US 10 dollar note in my hand and shook the hand of a nurse who manned the queue, leaving the note in her hand. I was taken to the front and vaccinated without any delay,” Gono told IPS.

Tired of the corruption and nepotism and the delaying tactics characterising the vaccination process at public healthcare centres, many middle-income earners like 35-year-old Daiton Sununguro have opted for the private medical centres to get their vaccines parting with US 40 dollars for a single dose.

“Paying is better than having to wait for many hours before getting the vaccine at public healthcare facilities. I will still come back and pay the other US 40 dollars for my second dose,” Sununguro told IPS at a posh private medical facility in Harare’s Mount Pleasant low-density suburb.

Follow @IPSNewsUNBureau
  

Among the major drivers of the Antimicrobial Resistance crisis is the misuse and overuse of antibiotics in livestock and feed. Credit: Germán Miranda/IPS.

By Tharanga Yakupitiyage
UNITED NATIONS, May 21 2019 (IPS)

Antimicrobial resistance is quickly becoming a global crisis and risks reversing a century of progress in health. Some organisations have already geared up and are tackling the issue from its roots.

In a new report, the United Nations Interagency Coordination Group (IACG) on Antimicrobial Resistance estimates that antibiotic resistance could cause 10 million deaths each year by 2050.

Already, drug-resistant infections cause at least 700,000 deaths annually around the world.

“Antimicrobial resistance is one of the greatest threats we face as a global community,” said UN Deputy Secretary-General and Co-Chair of the IACG Amina Mohammed.

“[The report] rightly emphasises that there is no time to wait and I urge all stakeholders to act on its recommendations and work urgently to protect our people and planet and secure a sustainable future for all,” she added.

In 2017, the World Health Organization (WHO) reported that antibiotic resistance was a “global crisis that we cannot ignore” and that if ignored, “will take us back to a time where people feared common infections and risked their lives from minor surgery.”

According to the IACG report, approximately 35 percent of common human infections are already resistant to currently available medicines in some member countries of the Organization for Economic Cooperation and Development (OECD), while resistance rates are as high as 80 to 90 percent in some low- and middle-income countries (LMICs).

The economic impact of antimicrobial resistance would also be catastrophic as healthcare expenditures will rise and sustainable food and feed production will increasingly be at risk.

The World Bank estimates that up to 24 million people could be forced into extreme poverty particularly in low-income countries, and the economic damage could be comparable to the shocks experienced during the 2008-2009 global financial crisis.

“The world is already feeling the economic and health consequences as crucial medicines become ineffective. Without investment from countries in all income brackets, future generations will face the disastrous impacts of uncontrolled antimicrobial resistance,” WHO said.

Among the major drivers of the crisis is the misuse and overuse of antibiotics in livestock and feed.

Though WHO has recommended that the food industry stop using antibiotics to promote growth and prevent disease, nearly three-quarters of the total use of antibiotics worldwide is still used on animals, greatly impacting the health of consumers.

According to the Alliance to Save our Antibiotics, livestock raised for food in the United States are given five times more antibiotics as farm animals in the United Kingdom. In the case of cattle, the difference in dosage rates may be as high as 16 times the rate of dosage per cow in the UK.

As a result, Europe banned the import of American hormone-treated beef.

In Bangladesh, a study found a range of antibiotics in almost 50 percent of poultry feed samples across 14 brands from four districts. The Bangladesh Agricultural Research Council also noted that the levels of antibiotics were far above the levels acceptable to human health.

Among such antibiotics was Oxytetracycline, which is often used to treat chest infections such as bronchitis and pneumonia.

Another review found a high prevalence of antimicrobial resistance in Bangladesh, partially due to the misuse and overuse of antibiotics, including in the livestock sector.

As Bangladesh’s livestock sector is only expected to grow, with plans to export poultry in coming years, sustainable livestock management is necessary in managing growing antibiotic resistance regionally and globally.

One organisation hopes to do just that.

After graduating from Chittagong Veterinary and Animal Sciences University, Salma Sultana saw a shortage of trained veterinarians and farmers resorting to untrained doctors who are most often behind the widespread misuse of antibiotics and thus the frequent death of livestock and rise in antimicrobial resistance.

In 2015, she founded the Model Livestock Advancement Foundation (MLAF) near Dhaka whose vision includes “to have a livestock sector that is sustainable, commercial, and contributing to livelihood, employment, national income, and food security.”

This includes the training and provision of modern and evidence-based animal health services as well as the prevention of antimicrobial resistance.

MLAF is the only educational, research, and animal healthcare voluntary organisation in Bangladesh and has since produced 45 veterinary service providers and 500 livestock entrepreneurs while providing health support to over 5,000 livestock herders.

The organisation has been recognised for its work as it was most recently awarded with the International Arch of Europe Award for Quality and Technology in 2018 and the Joy Bangla Youth Award in 2017 for its contribution to youth training and development.

As the Lancet Planetary Health found that interventions that restrict antibiotic use in food-producing animals reduce antibiotic-resistant bacteria in such animals by up to 39 percent, the work of organisations like MLAF is therefore crucial in the fight to keep the planet and its populations healthy and safe.

Two health care workers clean their feet in a bucket of water containing bleach after they leave an Ebola isolation facility during an Ebola simulation at Biankouma Hospital in Côte d’Ivoire. Credit: Marc-André Boisvert/IPS

By Lyndal Rowlands
UNITED NATIONS, Dec 23 2016 (IPS)

A new Ebola vaccine may be the first to successfully protect against one of the world’s most lethal pathogens, according to a trial involving over 11,000 participants in Guinea.

The results of the trial – which was led by the World Health Organization together with Guinea’s Ministry of Health, Medecins sans Frontieres (MSF) and other international organisations – were published in British Medical Journal The Lancet Thursday evening.

“Ebola left a devastating legacy in our country,”said Dr KeÏta Sakoba, Coordinator of the Ebola Response and Director of the National Agency for Health Security in Guinea. “We are proud that we have been able to contribute to developing a vaccine that will prevent other nations from enduring what we endured.”

Alongside Liberia and Sierra Leone, Guinea was one of the three West African countries most affected by the Ebola outbreak of 2013 to 2016, which killed more than 11,000 people.

The vaccine was trialled in Basse-Guinée in Western Guinea beginning in 2015 when the disease was still occurring in the region. Of the over 5,800 people who received the vaccine, none were recorded as having Ebola 10 days or more after vaccination. By comparison, among those who did not receive the vaccine, 23 cases of Ebola were recorded.

Known as rVSV-ZEBOV – Vesicular Stomatitis Virus–Ebola Virus Vaccine – the vaccine was first developed by the Public Health Agency of Canada, an arm of the Canadian government.

Although rVSV-ZEBOV offers new hope that future Ebola outbreaks can be prevented, eradicating the disease will require much more than a successful vaccine trial.

For the three countries most affected by Ebola – Liberia, Sierra Leone and Guinea – a much broader response is required.

This response must include training – and retaining – a skilled health workforce.

Liberia, for example, with a population of 4.1 million people, has less than 50 physicians, or just one doctor per 100,000 people, according to data compiled by Afri-dev.info.

By contrast, one of the main reasons Nigeria is considered to have been able to prevent the disease from spreading widely, is because of that countries relatively high number of skilled health workers.

The possibility of using rVSV-ZEBOV to stop future outbreaks is still some distance in the future. The vaccine is yet to be submitted for regulatory review – although it has been granted special status by US and European drug administrations which will allow it to pass through this process faster.

Should the vaccine pass the regulatory process it will then need to be widely administered – another challenge.

Many diseases which are vaccine curable, such as yellow fever and polio, have persisted for decades despite the availability of an affordable vaccine. According to MSF Access, governments and pharmaceutical companies could be doing much more to ensure that existing vaccines reach those most in need.

Patient undergoing dialysis treatment at Mulago Hospital in Kampala. Credit: Rebecca Vassie

By Wambi Michael
KAMPALA, Jun 15 2015 (IPS)

Vincent Mugyenyi, a 65-year-old retired pilot from the Ugandan Air Force, has lost count of how many dialysis treatment slots he has had to attend in the eight years he has been fighting chronic kidney disease.

He spends eight hours a week on a dialysis machine in Mulago National Referral Hospital that filters toxins from his blood, performing the functions of healthy kidneys. The ultimate aim of dialysis is to bridge a gap until kidney functions recover or until a transplant is available for patients.

“I used to have a small farm with about one hundred animals. I sold all those animals for treatment because I still needed life. That is how this disease has affected me. It has depleted every resource of mine … land is very important but I have sold mine just to buy life,” Mugyenyi told IPS.

Mugyenyi is both luck and unfortunate. He is one of the minority of Ugandans with chronic kidney disease who has been able to receive dialysis treatment, but he does not qualify for a kidney transplant operation because of his advanced age.“We don’t have sufficient data on the disease. We understand more about HIV, malaria and tuberculosis, because these are diseases with lots of funding behind them. But funding for kidney disease isn’t there. Kidney disease deserves the same level of importance as HIV” – Dr Robert Kalyesubula, nephrologist at Mulago Hospital in Kampala

Chronic kidney disease (CKD) is a growing health burden in Uganda that is affecting the economic, social and physical livelihoods of patients and their family members.

Dr, Simon Peter Eyoku, a kidney disease specialist at Mulago Hospital’s renal unit, told IPS that CKD affects mainly Ugandan adults aged between 20 and 50, and that the commonest causes of kidney diseases in Uganda are HIV-related infections of the kidney, followed by hypertension and diabetes.

The World Health Organisation (WHO) says that with CKD being the 12^th leading cause of deaths worldwide and its incidence growing by around eight percent annually, it is a global public health concern.

Mulago National Referral Hospital is the only public hospital in Uganda treating patients with renal or kidney-related complications and, according to Eyoku, that often places a further burden on patients who have to travel long distances to the dialysis unit.

“I have seen patients migrate from far corners of the country to Kampala because that is where the dialysis machines are. That is how costly this disease can be to patients,” Eyoku told IPS.

A further problem is that the dialysis unit only has 33 haemodialysis machines for a total population of about 36 million people.

When the unit opened almost eight years ago with four dialysis machines, a patient had to pay the equivalent of 500 dollars for a week of dialysis treatment, making the cost of treatment prohibitive.

“Those who could afford it would fall out after selling land, houses, cars and then failing to continue. And at that time, the cost of a transplant was equal to the amount of money you paid in a year for dialysis,” said Eyoku.

In March 2014, the administration of Mulago Hospital decided to reallocate its budget in order to finance the renal unit and brought the cost of a week of treatment down to 40 dollars, but that is still out the reach of most Ugandans.

The hospital is now also offering two free sessions of dialysis, and Eyoku told IPS that this has led to an influx of patients with CKD, “so now we are struggling because we are getting many more patients on dialysis.”

Uganda’s health planners are accused of not giving priority to kidney-related diseases. “I wish we had more specialists managing kidney diseases,” Dr Robert Kalyesubula, one of the four consulting nephrologists at Mulago Hospital, told IPS.

“I wish we had more specialists managing kidney diseases, I wish we had more awareness programmes about kidney disease so that people know about it because it is devastating. I have seen big people break down on being diagnosed with kidney disease. And the pain, because it affects a whole family. If a father gets the disease then the children will not go to school.”

One of the difficulties with kidney disease is that in its early stages it has no specific symptoms so the patients who turn up for treatment are often in the final stages of the disease.

“Patients come in the dying stage,” said Kalyesubula. “You spend 90 percent of your time struggling to keep people alive rather than making them live.”

In addition, said the nephrologist, in Uganda as in the rest of sub-Saharan Africa, the magnitude of CKD is unknown and is not given sufficient importance.

“We don’t have sufficient data on the disease. We understand more about HIV, malaria and tuberculosis, because these are diseases with lots of funding behind them. But funding for kidney disease isn’t there. Kidney disease deserves the same level of importance as HIV. We are ignoring a disease which can be treated in its early stages.”

Patients who cannot afford to pay the 40 dollars a week for dialysis are treated in ward 4C, and the impression is that they are prisoners condemned to a death sentence with no possibility of appeal.

When IPS visits the ward on a busy afternoon, the scene was one of pathetic chaos, with the few doctors and nurses available rushing round, attending to both adult males and young girls in the same ward.

A male patient in his mid-forties had just died from kidney failure, and at the entrance to the ward, IPS met Rosemary Kyakuhaire, packing the bags of a brother who had died earlier in the day. She said that he had spent three weeks in the ward receiving palliative care because her family could not afford the expensive dialysis treatment.

In Uganda, Kalyesubula told IPS, a person would rather be diagnosed with HIV than kidney disease. “I say that mainly because HIV has a lot of support systems in Uganda. But for kidney disease, you are there on your own.  I have also seen people sell their houses to go for a kidney transplant but you don’t have to do that for HIV/AIDS.”

Provision of CKD treatment in Uganda depends primarily on whether the patient has health insurance or can otherwise afford treatment through taking out loans, selling property or financial support from relatives and friends. There are two private hospitals offering dialysis but only a lucky few can afford them.

Twenty-seven-year old Benon Mulindwa is one of the lucky ones. His employer, the Uganda People’s Defence Force (UPDF), had medical insurance cover for his treatment and transplant costs. He told IPS that without that medical cover, he could not have afforded the 20,000 dollars or so a year for dialysis and another 20,000 dollars for his kidney transplant.

However, Mulindwa received the transplant not in Uganda but in India, with his employer’s medical insurance cover paying for the costs of transport to India and surgery there. He explained that most patients have to look for their own kidney donors at home.

Unlike developed countries which run public kidney donation registries, patients in Uganda have to find potential donors and that, said Kalyesubula, is where one of the difficulties for CKD patients lies.

Because of lack of awareness about the safety of kidney donations, many Ugandans are unwilling to donate a kidney to save the life of one of the growing number of patients on the kidney donation waiting lists.

But that is not the only difficulty, as Mulindwa explained. “It is very difficult because there those who come as thieves, there those who come expecting to be paid a lot of money. I know of one who promised to donate a kidney to one of the patients, but when the money was sent the ‘donor’ disappeared.”

Edited by Phil Harris   

G7-based companies and investors cheated Africa out of an estimated six billion dollars in a year through just one form of tax dodging, according to a new Oxfam report ‘Money talks: Africa at the G7’, released Jun. 2.

This is equivalent to three times the amount needed to plug the healthcare funding gap in the Ebola-affected countries of Sierra Leone, Liberia, Guinea and at-risk Guinea Bissau.

According to an Oxfam briefing paper release in April this year, an estimated 1.7 billion dollars is required to close the healthcare funding gap to improve dangerously inadequate health systems in these countries. This figure is based on raising spending to the recommendation of the World Health Organisation (WHO) that 86 dollars per capita is required to achieve the minimum package of essential services.“Multinational companies, many with headquarters in the United Kingdom and other G7 countries, are cheating African countries out of billions of dollars in vital tax revenues that could help vulnerable people get decent healthcare and send their children to school” – Nick Brye, Oxfam’s Head of U.K. Campaigns

The new Oxfam report comes as G7 leaders prepare to meet their African counterparts at the annual summit in Bavaria, Germany from Jun. 8 to 9. African leaders from Ethiopia (Prime Minister Hailemariam Desalegn), Liberia (President Ellen Johnson Sirleaf), Nigeria (President Muhammadu Buhari) and Senegal (President Macky Sall) are scheduled to join an outreach session on Jun. 8.

Oxfam is calling for the leaders of the G7 countries – Canada, France, Germany, Italy, Japan, United Kingdom and United States – to include action for ambitious tax reform in discussions about how the group can support economic growth and sustainable development on the continent.

In the United Kingdom, Oxfam is part of a coalition that has been calling on the recently elected new British government to show leadership by introducing a Tax Dodging Bill, which would make it harder for U.K. companies to avoid paying tax in the countries in which they operate – practices which currently cost some of the world’s poorest countries billions each year.

The coalition, which includes ActionAid and Christian Aid in addition to Oxfam, is currently running a Tax Dodging Bill campaign.

According to Oxfam, a well-crafted Tax Dodging Bill would also make it harder for big companies to avoid paying tax in the United Kingdom, and could bring in at least 3.6 billion pounds (5.4 billion dollars) a year to the U.K. Treasury, the equivalent of 600 pounds (910 dollars) for every household living below the poverty line.

“Multinational companies, many with headquarters in the United Kingdom and other G7 countries, are cheating African countries out of billions of dollars in vital tax revenues that could help vulnerable people get decent healthcare and send their children to school,” said Nick Brye, Oxfam’s Head of U.K. Campaigns.

“To fund the fight against poverty and to tackle worsening extreme inequality, we need action to ensure big companies pay their fair share, here and in the world’s poorest nations.”

Oxfam also notes that existing international efforts to tackle corporate tax dodging, such as the BEPS (Base Erosion and Profit Shifting) process, led by the Organisation for Economic Cooperation (OECD) for the G20 group of the world’s major economies, will leave gaping tax loopholes.

It warns that these loopholes can continue to be exploited by multinational companies across the developing world and that many African nations have been shut out of discussions on BEPS reform and will not benefit from them as a result.

Oxfam is also calling for British Chancellor of the Exchequer George Osbourne to attend July’s Financing for Development Conference in Ethiopia which will play host to heads of states and finance ministers from around the world.

The talks, which will focus on how the international community will fund development over the next two decades, are an opportunity for governments to work together to start shaping a more democratic and fairer global tax system.

In 2010, the last year for which data are available, Oxfam says that companies and investors based in G7 countries avoided paying tax on 20 billion dollars of income through a practice called trade mispricing – where a company artificially sets the prices for goods or services sold among its subsidiaries to avoid taxation.

With corporate tax rates in Africa averaging 28 percent, this equates to nearly six billion dollars in lost revenues. In addition, developing countries as a whole lose around 100 billion dollars a year through tax avoidance schemes involving tax havens, according to the U.N. Conference on Trade and Development (UNCTAD).

“Reforming global corporate tax rules so that African governments can claim the money owed to them is vital to tackle extreme poverty and inequality and boost economic growth, said Brye. “That’s why Oxfam has been calling for a U.K. Tax Dodging Bill that would ensure U.K. companies do their bit to help poor families at home and in developing countries.”

Edited by Phil Harris   

By José Graziano da Silva
ROME, May 5 2015 (IPS)

In the last half-century, people’s lifestyles have changed dramatically. Life expectancy has risen almost everywhere, but this has been accompanied by an increase of so-called non-communicable diseases (NCDs) – such as cardiovascular diseases, cancer, respiratory diseases, and diabetes – causing more and more deaths in all corners of the world.

José Graziano da Silva. Credit: FAO/Alessandra Benedetti

My distinguished colleague Dr Margaret Chan, Director-General of the World Health Organization (WHO), has called the worldwide rise of NCDs a “slow-motion catastrophe”. If NCDs were once considered the scourge of the developed world, this is no longer true; they now disproportionally affect low- and middle-income countries where nearly three-quarters of NCD deaths – 28 million per year – occur.

Much of the rise of NCDs can be attributed to unhealthy diets. WHO estimates that 2.7 million deaths every year are attributable to diets low in fruits and vegetables. Globally unhealthy diets are estimated to cause about 19 percent of gastrointestinal cancer, 31 percent of ischaemic heart disease, and 11 percent of strokes, thus making diet-related NCDs one of the leading preventable causes of death worldwide.

In other words, diet determines health – just as bad diets can lead to disease, healthy diets can contribute to good health.

But what exactly is a healthy diet? This is a difficult question. Generally, a healthy diet must provide the right nutrients in the right balance and with sufficient diversity, limiting the intake of free sugars to less than 10 percent of total energy requirements, and keeping salt intake to less than 5 grams per day.“There is no one-size-fits-all healthy diet. A healthy diet must be affordable, based on locally available foodstuffs, and meet cultural preferences”

However, there is no one-size-fits-all healthy diet. A healthy diet must be affordable, based on locally available foodstuffs, and meet cultural preferences. For over 20 years, FAO, together with WHO, has worked with governments on national Food-Based Dietary Guidelines: short, science-based, tips on healthy eating, in accordance with local values, customs and tradition.

Healthy meals do not always taste or look the same. Take, for example, the Mediterranean and Japanese diets: very healthy and completely different.

The Mediterranean diet revolves around the consumption of legumes, cereals, fruits and vegetables, olive oil, fish, and moderate consumption of dairy products (mostly cheese and yogurt). It emphasises unprocessed, plant-based foods, such as fruits and vegetables, in addition to the consumption of beans, nuts, cereals and other seeds; olive oil is the main source of (unsaturated) fat.

Japanese cuisine, on the other hand, is often associated with sushi (raw fish with rice), and sashimi (fresh raw seafood). The Japanese diet emphasises at least seven ingredients: fish as a major source of protein; vegetables including daikon radish and sea vegetables; rice; soya (tofu, miso, soya sauce); noodles; fruit; and tea (preferably green).

The Japanese and Mediterranean diets are examples of healthy diets. They use a great variety of ingredients; they are rich in plant foods including vegetables and fruit, legumes and fibres; they are modest in red meat; and they utilise many natural herbs and spices instead of salt to flavour food.

Both diets are linked to peoples and cultures as much as to their natural environment: it therefore comes as no surprise that both the Mediterranean diet and the Japanese diet have made it onto UNESCO’s World’s Intangible Cultural Heritage list.

The health benefits of the Japanese and Mediterranean diets are promising. Japanese enjoy one of the longest average life spans in the world – 87 years for women and 80 for men. In Mediterranean countries such as Italy and Spain, women have a life expectancy of 85 years. The figure for Italian men is 80 years, the same as their Japanese counterparts. All of them are above the average of high-income countries: 82 years for women and 76 years for men.

Medical research also indicate that that the Japanese diet leads to the lowest prevalence in the world of obesity – only 2.9% for Japanese women – and other chronic diseases like osteoporosis, heart ailments and some cancers. On the other hand, the Mediterranean diet, if followed for a number of years, is known to reduce the risk of developing heart disease, cancer, hypertension, Type 2 diabetes, Parkinson’s and Alzheimer’s disease.

In sum, adhering to a healthy diet helps you to not only to live longer, but also to have a better quality of life. Conversely, a bad diet causes malnutrition and can expose you to a range of NCDs.

A modern paradox is that many countries – including developing countries – suffer from undernourishment on the one hand, and obesity and diet-related diseases on the other. And while FAO’s chief concern is to eradicate hunger in this world, we cannot separate food security from nutrition. FAO – together with our U.N. agencies – considers food and nutrition security a basic human right.

In all cases, the cost of malnutrition goes beyond the health of the individual: it affects society as a whole in terms of public health costs and loss of productivity, and, therefore, is an issue that must be addressed through public and coordinated action.

Last year’s Second International Conference on Nutrition (ICN2), organised jointly by FAO and WHO, sent a clear message in that direction. The two outcome documents of ICN2, the Rome Declaration on Nutrition and the Framework for Action that commit world leaders to establishing national policies aimed at eradicating malnutrition and making nutritious diets available to all.

A key message from ICN2 is: governments have a central role to play in creating a healthy food environment to enable people to adopt healthy dietary practices. Yes, it is consumers who choose what to eat, but it is the government’s role to provide the enabling environment that encourages and makes healthy choices possible. (END/COLUMNIST SERVICE)

Edited by Phil Harris   

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:

She is just 14, but Janida avoids eye contact with others, preferring to look down at the ground and nodding her head if someone tries to engage her in conversation.

Janida (not her real name) was once a sociable and playful child, but that was before she was sexually abused by her stepfather and giving birth to a baby who is now four months old.

Her days marked by trauma and depression, Janida is just one of many girl children in Kenya who have been abused and robbed of their childhood, leaving them emotionally scarred.

“The little girl [Janida] underwent both physical and mental torture,” Teresa Omondi, Deputy Executive Director and Head of Programmes at the Federation of Women Lawyers (FIDA) Kenya, told IPS. ”Her best option was to terminate the pregnancy rather than suffer the mental and physical torture, but she could not afford the cost of a safe abortion.”Many of the induced abortions taking place continue to be unsafe and complications are common” – Teresa Omondi, Federation of Women Lawyers (FIDA) Kenya

Under Article 26 (4) of the Kenyan constitution, “abortion is not permitted unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.”

In September 2010, Kenya’s Ministry of Health released national guidelines on the medical management of rape or sexual violence – guidelines that allow for termination of pregnancy as an option in the case of conception, but require psychiatric evaluation and recommendation.

Then, in September 2012, the health ministry released standards and guidelines on the prevention and management of unsafe abortions to the extent allowed by Kenyan law, only to withdraw them three months later under unclear circumstances.

According to Omondi, “the law has not yet been fully put into operation and many providers have not been trained to provide safe abortion, meaning many of the induced abortions taking place continue to be unsafe and complications are common.”

The health ministry is responsible for doctors and nurses not being permitted to be trained on providing safe abortion, said Omondi, so “it is ridiculous that while Kenya’s Ministry of Health accepts that post-abortion care is a public health issue regarding numbers, practitioners have their hands tied.”

The issue of unsafe abortions in Kenya hit the headlines in September last year, when Jackson Namunya Tali, a 41-year-old nurse, was sentenced to death by the high court in Nairobi for murder, after the death of both Christine Atieno and her unborn baby in a botched illegal abortion.

Various inter-African meetings attended by Kenya have been held on reducing maternal mortality rates by providing safe abortions, with health ministers agreeing that statistics show that countries that do provide safe abortions have reduced their maternal mortality rates.

In a recent analysis, Saoyo Tabitha Griffith, Reproductive Health Rights Officer at FIDA and an advocate at the High Court of Kenya, said that despite Kenya having adopted a Constitution that affirms among others, women’s rights to reproductive health and access to safe abortion, Kenyan women continue to die from unsafe abortion – a preventable cause of maternal mortality.

For Dr Ong’ech John, a health specialist in Nairobi, perforated uteruses and intestines, heart and kidney failures, anaemia requiring blood transfusion as well as renal problems are just a few of the health complications arising from an abortion that goes wrong.

“Unsafe abortion complications are not just about removal of the products of conception that were not completely removed. One can evacuate but the perforated uterus has to be repaired, or you remove the uterus and it is rotten,” Dr Ong’ech told IPS.

“When the health ministry issued a directive in February this year instructing all health workers, whether from public, private or faith-based organisations, not to participate in any training on safe abortion practices and the use of the medication abortion, many questions were left unanswered,” said Omondi.

A highly respected Kenyan doctor, Dr John Nyamu, spent one year in prison in 2004 after his clinic was raided following the discovery of 15 foetuses on major roads together with planted documents from a hospital he had worked for but had since closed.

Speaking of his ordeal with Mary Fjerstand, a senior clinical advisor at Ipas, a global non-governmental organisation dedicated to ending preventable deaths and disabilities from unsafe abortion, Nyamu said that the publicity surrounding his imprisonment helped people to “realise the magnitude and consequences of unsafe abortion in Kenya; women were dying in great numbers. Before that, abortion was never spoken of in public.”

He went on to say that Kenya wants to achieve the Millennium Development Goal of a 75 percent reduction in maternal mortality, but that “it can’t be achieved if safe abortion is not available.”

A May 2014 World Health Organisation (WHO) updated fact sheet indicates that every day, approximately 800 women die worldwide from preventable causes related to pregnancy and childbirth, with 99 percent of all maternal deaths occurring in developing countries.

Edited by Phil Harris   

As part of Milan’s drive to promote a sustainable urban food policy, schoolchildren are being encouraged to take home leftovers of non-perishable food, armed with doggy bags bearing the slogan “I DON’T WASTE”. Credit: Municipality of Milan

By Maurizio Baruffi
MILAN, Apr 28 2015 (IPS)

How can we provide healthy food for everyone, without threatening the survival of our planet? This is the fundamental issue at the centre of Expo 2015 – which has ‘Feeding the Planet, Energy for Life’ as its central theme – and a huge challenge for cities. 

More than 50 percent of the world’s population currently lives in urban areas – a proportion that is projected to increase to 66 percent by 2050 – and ensuring the right to food for all citizens, especially the urban poor, is key to promoting sustainable and equitable development.

As the city hosting Expo 2015, Milan has great visibility and an extraordinary political opportunity for working to build more resilient urban food systems. This is a vision that the City of Milan has decided to fulfil by formulating its own Food Policy, and by bringing together as many cities as possible to subscribe to an Urban Food Policy Pact: a global engagement to “feed cities” in a more just and sustainable way.

How we can provide healthy food for everyone, without threatening the survival of our planet, is the fundamental issue at the centre of Expo 2015 and a huge challenge for cities
The food policy, which will be implemented by Milan’s city government over the next five years, is being drafted through a wide participatory process, starting with an assessment of the strengths and weaknesses of the city’s food system.

This is a complex picture with some bright spots and some shadows highlighting several thematic areas that the food policy should take into consideration: from access to food to the environmental and social impact of food production and distribution, from food waste to education.

Milan has more than 1.3 million inhabitants, but almost two million people come to the city every day for work, study, leisure or, health care.

Through its public catering company Milano Ristorazione, the City of Milan prepares and delivers more than 80,000 meals each day for schools, retirement homes and reception centres. Thus, there is a lot the City can do to enhance and spread good practices – for example, by tackling food waste and improving the sustainability of the food supply chain.

Many projects are already in place. More than one-third of the fruit and vegetables served by Milano Ristorazione is organic, 57 percent is supplied from short distance, and children at school are encouraged to take home a doggie bag with leftovers of non-perishable food.

Every year, families in Milan still waste the equivalent of one month of food consumption, but several non-profit organisations are saving the food surplus from supermarkets and cafeterias and delivering it to more than one hundred of the city’s charities.

Meanwhile, with poverty on the rise as a result of the prolonged economic crisis, civil society and public institutions are working actively to help those in need. Soup kitchens offer around two million meals each year and the City of Milan itself delivers almost 250,000 meals to the elderly and the disabled.

The Office of the Mayor is currently asking citizens, civil society organisations, scholars, innovative entrepreneurs and chefs, among others, to have their say on the issues that the city’s food policy should address. The purpose is to draw up a strategic document that will be discussed in a town meeting in May, when a number of planning panels (Food Malls) will be launched. Their task is to turn the guidelines into pilot projects.

The process will culminate in the adoption of the food policy by the City of Milan and the launch of a number of pilot projects that will address some of the issues outlined in the food policy over coming years.

In the meantime, progress on the Urban Food Policy Pact is proceeding swiftly. The idea of an international protocol on local food policies was launched in February 2014 by the mayor of Milan, Giuliano Pisapia, at the summit of the C40 (Cities Climate Leadership Group) in Johannesburg.

A few months later, Milan and more than 30 cities around the world started to discuss the Pact, exchanging data, goals and best practices through webinars carried out under the Food Smart Cities for Development project financed by the EU Commission-DEAR (Development, Education, Awareness Raising) programme.

It is thrilling to see very different urban areas such as New York, São Paulo, Ghent, Daegu, Abidjan and Melbourne sharing projects, ideas, problems and solutions with a common goal: to build  a network of cities willing to work together to transform their future, placing the issue of food high on the political agenda.

A group of international experts is currently working on a draft of the Pact’s protocol that will be submitted to an advisory council and cities. The task of the advisory council – which is made up of international organisations, such as the Food and Agriculture Organisation (FAO), World Health Organisation (WHO), World Food Programme (WFP) and the European Commission – is to review the pact and ensure that it is consistent with other international initiatives on the similar subjects.

Many cities have expressed their interest in subscribing to the Urban Food Policy Pact – to be signed in October this year on the occasion of World Food Day – and its proponents expect it to be one of the most significant legacies of Expo 2015.

Looking forward, the Pact will also feature at the U.N. Climate Change Conference to be held in Paris in December.

Agriculture and food production are major contributors to greenhouse gas emissions, and our ability to produce food will be highly affected by climate change – building a more resilient world, where the right to food is ensured for everyone, is a process that need to start from cities, and from their ability to develop sustainable policies.

Edited by Phil Harris    

More information about Milan’s Food Policy and the Urban Food Policy Pact can be found at www.cibomilano.org/

Excerpt:

Distributing condoms in prisons and schools has set off a heated debate, rendering the fight against HIV/AIDS a challenge ahead of this year's U.N. deadline for nations to halt its spread. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Mar 28 2015 (IPS)

Tatenda Chivata, a 16-year old from Zimbabwe’s Mutoko rural district, was suspended from school for an entire three-month academic term after he was found with a used condom stashed in his schoolbag.

Regerai Chigodora, a 34-year-old prisoner at a jail in Harare, had his 36-year sentence stretched to 45 years after he was caught with used condoms in prison early this year.

With restrictions blocking the distribution of condoms in schools and prisons in Africa, health experts say the continent’s opportunity to halt the spread of HIV/AIDS in line with the U.N. Millennium Development Goals may be squandered,

“It will be hard for Africa to win the war against HIV/AIDS if certain groups of people like students and prisoners are being skipped from preventive measures,” Tamasha Nyerere, an independent HIV/AIDS counsellor based in Dar es Salaam, the Tanzanian capital, told IPS.

Human rights activists in Zimbabwe say more cases of youths like Chivata and prisoners like Chigodora may be going unreported in countries where condom use in jails and schools is anathema.With restrictions blocking the distribution of condoms in schools and prisons in Africa, health experts say the continent’s opportunity to halt the spread of HIV/AIDS in line with the U.N. Millennium Development Goals may be squandered.

“It’s indeed disturbing how hard we have worked as Africa to fight against the spread of HIV/AIDS yet we have not been so pragmatic in our bid to institute preventive measures in schools and jails, where most of our African governments have vehemently refused to allow condoms to be distributed with the common excuse that they promote homosexuality in jails and sexual immorality in schools,” Elvis Chuma, a gay activist in Zimbabwe’s capital Harare, told IPS.

Zimbabwean prisoner Chigodora agreed, telling IPS that “whether or not authorities here like it, homosexuality is rife in jails and even if we may smuggle in condoms to use secretly, if you get caught like in my case, you will be in for serious trouble.”

Schoolchildren in Africa like Zimbabwe’s Chivata have to contend with secret use of condoms in school. Their only crime is that they are underage, said Chivata.

“I’m serving a suspension from school because I was caught with a condom I used during sex with my girlfriend, but the same teachers teach us about use of protection if we get tempted to engage in sex. Now I’m wondering if I was wrong using a condom. Perhaps I could have gone undetected if I had opted to have unprotected sex,” he told IPS.

Under Zimbabwe’s Legal Age of Majority Act, any Zimbabwean under the age of 18 years is a minor, while a person between the age of 16 years and 18 years is defined as a young person under the Children’s Protection and Adoption Act.

Sodomy is also a punishable offence in Zimbabwe, which rights activists say, makes it difficult for this Southern African nation and other African nations to distribute condoms in prisons.

“African countries like Zimbabwe are being cornered by their own laws which bar them from dishing out condoms to prisoners and school children,” Tonderai Zivhu, chairperson of the Open Association of People Living with HIV/AIDS, a lobby group in Masvingo, Zimbabwe’s oldest town, told IPS.

South Africa and Namibia may be the only two out of Africa’s 54 countries that have adopted HIV/AIDS preventive measures in schools and jails.

In 2007, South Africa’s new Children’s Act came into effect, giving children 12 years and older the right to obtain contraceptives. The country’s Department of Correctional Services also provides condoms to inmates.

In Namibia, the country’s policy on HIV/AIDS states that all convicted prisoners awaiting trial and inmates are entitled to have access to the same HIV-related prevention information, education, voluntary counselling and testing, means of prevention, treatment, care and support as is available to the general population.

Other African countries, however, seem unclear about their position on condoms use in jails and schools.

Last year, the government of Rwanda confirmed the prevalence of homosexuality in prisons, but was non-committal on whether or not it would start distributing condoms in its correctional facilities.

This year, Zimbabwe’s Primary and Secondary Education Minister Lazarus Dokora told parliament that parents were free to pack condoms for their children in their schoolbags, but that the government would not allow them to be openly distributed at schools.

“We must say children are in school to learn and be initiated for certain life skills, and when it comes to condoms, you are the guardian of your child and you must have an intimate connection with your child so that when you pack their school luggage and prepare their books you can also pack condoms,” Dokora had said.

This laissez-faire approach has incensed certain African indigenous pro-culture activists who have been vocal in their calls against condom distribution in prisons and schools.

“Distributing condoms in prisons and in schools will render African governments accomplices to the commission of the crime of sodomy and sexual immorality among school-going children, which is against our cultural values and norms as Africans,” Bupe Mwansa, head of the Culture and Traditions Conservation Association in Zambia, an indigenous pro-culture lobby group, told IPS.

According to the World Health Organisation (WHO), an estimated 3.2 million children lived with HIV at the end of 2013, mostly in sub-Saharan Africa, with approximately 145,000 HIV-positive children from Zimbabwe.

The Zimbabwe National Statistics Agency (ZimStat) states that Zimbabwe has a total of 18,000 prisoners, with 28 percent of these living with HIV and AIDS.

In South Africa, an estimated 41.4 percent of that country’s 166,267 prisoners are also living with HIV/AIDS, based on statistics from the Ministry of Health there, despite the country being the only African nation that does not outlaw homosexuality.

Although other African governments admit there are sexual activities going on in schools and prisons, they remain hesitant to allow condom distribution in them.

“School children engage in premarital and often unprotected sex, yes we know, and prisoners also have unprotected anal sex, but presently there is nothing we can do as government to address these challenges because our laws do not allow underage children to engage in sex while homosexual, now rife in our jails, is also unlawful,” a top Zimbabwean government official speaking on the condition of anonymity told PS.

But for human rights doctors like Nomalanga Zwane in Johannesburg, fighting HIV/AIDS in schools and jails requires drastic measures.

“If school kids are left on their own with the belief that they are not engaging in sex because they are barred by being underage, we are fighting a losing battle against HIV/AIDS because the same school pupils will spread the disease even outside school while prison inmates with no access to condoms will also one day come out of jail and further spread the disease,” Zwane told IPS.

Zimbabwe’s ex-convicts like 37-year-old Jimson Gwatidzo, now an ardent campaigner for the distribution of condoms in jails after he contracted HIV in jail, sees no credible reason why some African governments forbid condoms in prisons “in the face of rampant rape-induced HIV/AIDS infections behind prison walls.”

“It is time for governments across Africa to scrap anti-sodomy laws to allow for the distribution of condoms in prisons and be able to fight HIV/AIDS spread in jails without legal barriers,” Gwatidzo told IPS.

Edited by Lisa Vives/Phil Harris    

Coal mining in India. Coal-fired plants contribute 60 percent of India’s energy capacity and are a large source of the air pollution that is taking a toll on people’s health and their livelihoods. Photo credit: The Hindu

By Chaitanya Kumar
NEW DELHI, Mar 19 2015 (IPS)

In November last year, India’s power minister Piyush Goyal announced that he plans to double coal production in India by the end of this decade and, in an effort to enhance production, the Indian government has started a process of auctioning coal blocks.

Coupled with the auctions is the disinvestment of Coal India Limited (CIL), the world’s largest coal mining company, and both actions can provide short-term reprieve to India’s energy and fiscal deficit woes.

However, there are four reasons why investors and the government should be wary of investing in coal for the long run (10-15 years).

The first stems from the fact that it is rapidly becoming clear to big business and governments around the world that a large proportion of coal and other fossil fuels should be left in the ground. The second is that coal consumption is declining in many parts of the world, with economics increasingly in favour of alternate sources of energy, such as wind and solar.“A systematic effort is now under way to dilute environmental, land and forest laws … The latest land ordinance passed by the [Indian] government has done away with two key pillars of the process of land acquisition: social impact assessment and community consent”

Reasons three and four have to do with growing resistance from tribal and grassroots communities, and the fact that India will be forced to take some form of action as air pollution becomes increasingly dangerous.

Despite its plans for coal production, the Indian government has been giving the right indicators on its pursuit of renewable energy, but this ambition – though welcome – is being counterbalanced by the country’s continued lust for more coal.

Call it an addiction that is hard to let go or sustained pressure from big corporations and their existing investments in coal, the Indian government has turned its eye on the vast domestic reserves in the country.

Growing resistance from tribal and grassroots communities

A systematic effort is now under way to dilute environmental, land and forest laws in the country. The latest land ordinance passed by the government has done away with two key pillars of the process of land acquisition: social impact assessment and community consent. The ordinance is facing stiff resistance from opposition parties and the general masses of India.

Any project, either private or under a public private partnership (PPP), previously required the consent of 80 percent of the community that the project impacted but no such consent is now required.

Social impact assessments that factors in effects on the environment and human health, among others, were mandatory for projects and while such assessments were shoddy in the past, doing away with them completely sets a poor precedent for industrial practices and gives even less of a reason for companies to clean up their acts.

A lack of social impact assessment also adds to the ambiguity that exists in offering the right compensation as part of the rehabilitation and resettlement plan embedded in the land ordinance.

In the context of coal, the efforts of the government to re-allocate 204 coal blocks and begin mining will be met by stiff resistance from impacted communities. “There is a fear that we will witness greater state violence on people as they begin resisting projects that have immediate impacts on their lives and livelihoods”, says Sreedhar, a former geologist who now runs a network of activists called Mines, Minerals & People.

The Mahan coal block, forcefully pursued by the Essar company, is a case in point where local communities have been resisting open cast mining for several years. The mine is located in what is one of the last remaining tracts of dense forests in central India. Mahan has subsequently been withdrawn from the auctions, a victory celebrated by the local communities.

Foreign investors are especially wary of pumping money into projects that can see resistance from local communities. The high profile cases bauxite mining plans by British resources giant Vedanta in ‘sacred’ hills in eastern India and the plans of South Korea’s POSCO steel-making multinational to open a plant in the eastern state of Odisha have become strong deterrents for big money to enter India.

While the government’s efforts at allaying fears may work, there is a difference in rhetoric and on-the-ground reality because it will not be easy to simply wish away people’s concerns.

Visible resistance has taken shape in the state of Chhattisgarh where twenty tribal gram sabhas in the Hasdeo Arand coal field area of the state passed a formal resolution under the forest rights act against coal mining in their traditional forest land.

“There has to be an assessment of India’s energy needs alongside an evaluation of the forests that we stand to lose from coal mining. Allocation of coal blocks in dense forests is imprudent,” says Alok Shukla, an activist from Chhattisgarh who is mobilising tribal communities to uphold their forest rights.

These struggles might only intensify as government efforts are aggressively under way to further dilute tribal rights and open up inviolate forests for coal mining.

Air pollution is becoming hazardous and India will be forced to act

As the pressure to act on air pollution builds, India will have to enforce strict emission norms on coal plants and their operators. Installing flue-gas desulphurisation scrubbers should be mandatory on any new plant that is set to operate in coming years. These devices are very effective in limiting dangerous pollutants from escaping into the atmosphere but come at a heavy cost for investors and coal power generators. 

But why would the government work towards increasing operational costs for power plants in the pipeline? Here’s why – air pollution is killing Indians every year and is now the fifth largest contributor of deaths in the country. The fact that 13 of the world’s 20 most polluted cities are in India is a cause for great alarm. A study has indicated that one in three children have shown a reduction in lung function in Delhi.

The World Health Organisation (WHO) report, which makes this claim, advises that fine particles of less than 2.5 micrometres in diameter (PM2.5) should not exceed 10 micrograms per cubic metre. Delhi tops the list at 153 micrograms of PM2.5 per cubic metre and it is only getting worse.

In Delhi, for instance, coal roughly contributes 30 percent of recorded air pollution (particulate matter) and the numbers are higher in the coal clusters of the country. Coal-fired plants contribute 60 percent of India’s energy capacity and are a large source of the air pollution that is taking a toll on people’s health and their livelihoods.

A recent report on coal pollution in India by Urban Emissions and Conservation Action Trust reveals a shocking statistic – in another 15 years between 186,500 and 229,500 people may die premature deaths annually as a result of a spike in air pollution caused by coal-fired power plants.

In dealing with air pollution, curbing the effects of harmful pollutants like nitrous and sulphur oxides from coal power plants is critical and there is growing pressure on the central government to introduce strict emission standards. India is the only major coal-powered nation that does not have any concentration standards for these pollutants, a requirement that should soon be in place.

Both domestic and international pressure can move India to clean up its air. The government cannot afford to have an ‘airpocalypse’ on its hands.

All is not well with the coal industry in India  

Undaunted, Narendra Taneja, energy cell convenor of India’s ruling Bharatiya Janata Party, has claimed that coal and gas will remain the mainstay of the country’s economy for the next 50-60 years.

The impossibility of this claim becomes apparent when we look at the actual reserves of extractable coal. Only one-fifth of the coal reserves of CIL are extractable and if the ambitious doubling of domestic production happens, the known reserves are expected to last for less than two decades.

Coal mines that expire before the lifetime of new coal plants scream for greater economic prudence from investors.

India’s ambitious renewable energy expansion plans need to be complemented by a phase-out plan of coal. The world needs stronger political leadership from India as it tries to tackle the twin challenges of poverty and climate change.

Edited by Phil Harris   

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:

A woman planting a shea tree in Ghana to protect riverbanks, and for her economic empowerment. Much still remains to be done to overcome the difficulties women – particularly rural women – face in terms of mobility and political participation. Credit: ©IFAD/Dela Sipitey

By Valentina Gasbarri
ROME, Mar 14 2015 (IPS)

Rural women make major contributions to rural economies by producing and processing food, feeding and caring for families, generating income and contributing to the overall well-being of their households – but, in many countries, they face discrimination in access to agricultural assets, education, healthcare and employment, among others, preventing them from fully enjoying their basic rights.

Gender equality is now widely recognised as an essential component for sustainable development goals in the post-2015 agenda, with empowerment of rural women vital to enabling poor people to improve their livelihoods and overcome poverty.“To improve women’s social and economic status, we need more recognition for the vital role they play in the rural economy. Let us all work together to empower women to achieve food and nutrition security – for their sake, and the sake of their families and communities” – IFAD President Kanayo F. Nwanze

This year’s International Women’s Day, celebrated worldwide on Mar. 8, marked the 20th anniversary of the landmark Fourth World Conference on Women in Beijing (1995), which called on governments, the international community and civil society from all over the world to empower women and girls by taking action in 12 critical areas: poverty, education and training, health, violence, armed conflict, the economy, power and decision-making, institutional mechanisms for the advancement of women, human rights, the media, the environment and the girl child.

Despite that call, much still remains to be done to overcome the difficulties women – particularly rural women – face in terms of mobility and political participation.

“Too often, rural women are doing the backbreaking work,” Kanayo F. Nwanze, President of the International Fund for Agricultural Development (IFAD), said on the occasion. “To improve women’s social and economic status, we need more recognition for the vital role they play in the rural economy. Let us all work together to empower women to achieve food and nutrition security – for their sake, and the sake of their families and communities.”

This year, the three Rome-based U.N. agencies – the Food and Agriculture Organisation (FAO), World Food Programme (WFP) and IFAD – along with journalists and students from Rome’s LUISS, John Cabot and La Sapienza universities met to share testimonials of innovative interventions aimed at empowering rural women in four key areas: nutrition, community mobilisation, livestock and land rights.

A large body of research indicates that putting more income into the hands of women translates into improved child nutrition health and education in all developing regions of the world.

Explaining why women and men need to be involved together to move forward on nutrition, Britta Schumacher, a WFP Programme Policy Officer, described how the Renewed Efforts Against Child Hunger and Undernutrition (REACH) programme had been able to tackle malnutrition and health problems using an approach based on positive gender-oriented objectives.

The REACH programme – a joint initiative of FAO, the U.N. Children’s Fund (UNICEF), WFP and the World Health Organisation (WHO) – is based on the human right to nutrition security and seeks to transform the way governments and donors approach investment in nutrition to leverage existing investments most effectively and systematically identify priorities for additional investments needed to scale up.

Noting that “the long girls stay at school, the better is their health” because “lack of awareness represents a concrete obstacle to good practices,” Schumacher said that in Bangladesh activities had been carried out under the REACH programme to transfer knowledge within and between members of communities and local authorities, boost rural women’s access to services and strengthen their self-esteem. 

Stressing the need for community mobilisation, Andrea Sanchez Enciso, Gender and Participatory Communication Specialist with FAO, illustrated one of the achievements of FAO’s Dimitra project, a participatory information and communication project which contributes to improving the visibility of rural populations, women in particular.

In Niger, she said, “the Dimitra project encouraged the inclusion of a gender perspective in communication for development initiatives in rural areas … taking greater account of the specificities, needs and aspirations of men and women” and “creating participatory spaces for discussion between men and women, access to information and collective actions in their communities.”

Leading a two-year small livestock project in Afghanistan during the Taliban period, Antonio Riota, Lead Technical Specialist in IFAD’s Livestock, Policy and Technical Advisory Division, said that the project was developed and implemented in a context in which 90 percent of village chickens were managed by women and poultry was the only source of income for the entire community.

According to Riota, the project showed how small livestock can make a difference in rural women’s lives because one of its major results has been that “now women can walk all together” whereas previously they were accused of prostitution if they did so. “Some 75,000 women benefitted from the project and profitability increased by 91 percent,” he added.

Meanwhile, Mino Ramaroson, Africa Regional Coordinator at the International Land Coalition, described two African experiences of women’s networks – the National Federation of Rural Women in Madagascar and the Kilimanjaro Initiative – advocating for their rights to land and natural resources.

In Madagascar, the National Federation of Rural Women, which aims to promote rural women’s rights, improve members’ livelihoods and increase their resilience to external and internal shocks, has been joined by more than 450 rural women’s groups from the country’s six provinces.

The Kilimanjaro Initiative, initiated by rural women in 2012 and supported by the International Land Coalition, uses women’s rights to land and productive resources as an entry point for the mobilisation of rural women from across Africa to define the future they want, claim lives of dignity they deserve and identify and overcome the challenges that hold them back.

Edited by Phil Harris   

By Laurent Huber
GENEVA, Feb 18 2015 (IPS)

February 27 will mark the 10th anniversary of the World Health Organisation Framework Convention on Tobacco Control (FCTC), the first global public health treaty.

Today the FCTC has 180 Parties, making it among the most widely-adopted international instruments. About 90 percent of the world’s population falls under the FCTC’s protections.

The creators of the Convention were bold in their intentions – “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption.”

An anniversary is an opportunity to look back and reflect, and to look forward and plan. Has the FCTC lived up to its lofty goals? Are we on track to end the tobacco epidemic? Is it too soon to judge?

1 billion deaths ahead?

It is no accident that the first global, legally-binding public health effort targeted tobacco. In the absence of action, the world gloomily looked ahead to one billion deaths from tobacco consumption in the 21st century.

In addition to that depressing figure, tobacco has profoundly negative consequences for the wealth of nations and individuals, for human rights, for development and for the environment. In 10 years, have we made a dent?

Yes. The FCTC came into being at a critical time in the history of the tobacco epidemic. Consumption was moving swiftly from the developed to the developing world, and growing overall.

Everywhere, tobacco addiction was becoming a burden on the poorest, most marginalised populations.

Tobacco industry profits were staggering, dwarfing the gross domestic products of most of the countries in which they operated.

This wealth was poured back into marketing, litigation and public influence to ensure the addiction of future generations.

In 2005, when the FCTC came into force, the tobacco industry was put on notice that the world had united against it.

Numerous victories

The public health community can point to specific victories. In 2004, Ireland became the first country to ban smoking in all public and work places. They have been followed by dozens more.

Several countries have struck at the core of the industry’s business model by banning marketing – including the display of products in stores – and corporate social responsibility schemes (Mauritius), and by requiring plain packaging (Australia).

Scores of countries have introduced graphic warning labels on packaging, and there have been large tobacco tax increases in countries not previously known for their strong tobacco control policies, such as Chile and the Philippines, to name just two.

There is a protocol to address the massive problem (often perpetrated by the industry itself) of illicit trade. An increasing number of governments are using litigation to hold the industry accountable for the consequences of its products.

Mainly health ministries

But – and you knew there was going to be a “but” – sober reflection is also called for. The number of tobacco users and deaths continues to rise. The tobacco industry, the vector of the epidemic, is not on its heels: the profit of the four biggest firms was over US$36 billion in 2013.

While we have succeeded in convincing health ministries of the importance of tobacco, other government sectors lag far behind.

The implementation of the all-important FCTC Article 5.3, calling for governments to refuse to cooperate with the tobacco industry in formulating health policy, is failing miserably in all but a few countries.

And when governments bravely move forward with cutting-edge tobacco control measures, they can expect an avalanche of tobacco industry lawsuits, both domestically and through international trade agreements, chilling the political will of other governments.

Mixed results, to be certain. Should we celebrate? Absolutely! No one expected the FCTC to be an instant cure. At the outset, the curve of the epidemic was simply too steep to believe that, in 10 years’ time, it could be reversed.

We’ve made great strides.

On 27 Feb, if you have been involved in this historic endeavour, take a moment to congratulate yourself and a colleague. And then on the 28th, let’s move forward with purpose to fill in the gaps. The FCTC is the beginning, not the end, of a long and purposeful journey.

Edited by Roger Hamilton-Martin

Excerpt:

Many specialist doctors and nurses in Africa are migrating to greener pastures, leaving cancer patients with few options. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Feb 13 2015 (IPS)

Hidden by the struggles to defeat Ebola, malaria and drug-resistant tuberculosis, a silent killer has been moving across the African continent, superseding infections of HIV and AIDS.

World Cancer Day commemorated on Feb. 4 may have come and gone, but the spread of cancer in Africa has been worrying global health organisations and experts year round. The continent, they fear, is ill-prepared for another health crisis of enormous proportions.

By 2020, according to the World Health Organisation (WHO), approximately 16 million new cases of cancer are anticipated worldwide, with 70 percent of them in developing countries. Africa and Asia are not spared.“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, private oncologist in South Africa’s Eastern Cape Province

“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, a private oncologist in South Africa’s Eastern Cape Province, told IPS.

“Africa and its leaders have failed to recognise cancer as a high-priority health problem despite millions of people succumbing to the disease,” added Thabane.

Most of Africa’s 2,000 plus languages have no word for cancer. The common perception in both developing and developed countries is that it is a disease of the wealthy world, where high-fat, processed-food diets, alcohol, smoking and sedentary lifestyles fuel tumour growth.

While many cancers are linked to unhealthy diets and smoking, a large number – particularly in Africa – are caused by infections like hepatitis B and C which can lead to liver cancer and the human papillomavirus (HPV) that causes almost all cervical cancers.

An HPV vaccine treatment costs 350 dollars for three doses over six months in most sub-Saharan African countries, whereas in Zimbabwe radiotherapy costs between 3,000 and 4,000 dollars for a whole session.

A study published in 2011 found that since 1980 new cervical cancer case numbers and deaths dropped substantially in rich countries, but increased dramatically in Africa and other poor regions. Overall, 76 percent of new cervical cancer cases are in developing regions, and sub-Saharan Africa already has 22 percent of all cervical cancer cases worldwide.

According to Zimbabwe’s Ministry of Health and Child Care, the country only has four oncologists catering to over 7,000 cancer patients nationwide. “The shortage of cancer doctors stands as an impediment to comprehensive treatment and care for cancer patients here,” Dr Prosper Chonzi, director of Health Services in the Zimbabwean capital, Harare, told IPS.

The shortage of cancer specialists is also seen in West Africa.

Last year, The Vanguard, a Nigerian newspaper, reported that there were an estimated 60 oncologists serving over 300 million people in the West African sub-region with fewer than 20 oncologists serving 160 million Nigerians. Ghana has only seven for 24 million people, Burkina Faso two and Cote D’Ivoire just one. Sierra Leone has more than six million people and no cancer doctors.

Across the continent in Kenya, cancer accounts for approximately 18,000 deaths annually, with up to 60 percent of fatalities occurring among people who are in the most productive years of their life. Men are most commonly diagnosed with prostate or oesophageal cancer, and women are most frequently affected by breast and cervical cancer.

Zimbabwe’s health activists blame the absence of cancer education for the upsurge of fatal cases in the African nation. “Very few people, including government, consider cancer a real threat to the health delivery system,” Agnes Matutu, director of the Zimbabwe Cancer Alliance, an anti-cancer lobby group here, told IPS.

Melody Hamandishe, a retired government nutritionist, told IPS she blamed imported genetically modified foods. This contributes to cancer, she said, as does the abuse of alcohol, often causing liver cancer.

In Zambia, anti-cancer activists accuse the government of not prioritising the fight against the disease. “People are perishing in huge numbers because of cancer here in Zambia while government is seized with fighting HIV/AIDS,” Kitana Phiri, a cervical cancer survivor, now a devoted anti-cancer activist based in the Zambian capital, Lusaka, told IPS.

In Tanzania, cancer is also wreaking havoc. A January 2014 report by the Ocean Road Cancer Institute (ORCI), the only specialised facility for cancer treatment in this east African nation, said there are 100 new patients in every 100,000 population out of the country’s population of 45 million.

Finally, in Namibia, uranium workers were reported to have elevated rates of cancers and other illnesses after working in one of Africa’s largest mines.

Rio Tinto’s Rössing uranium mine extracts millions of tonnes of rock a year for the mineral. “Most workers stated that they are not informed about their health conditions and do not know if they have been exposed to radiation or not. Some workers said they consulted a private doctor to get a second opinion,” say researchers at Earthlife Namibia and the Labour Resource and Research Institute who collaborated in a study.

“The older workers all said they know miners dying of cancers and other illnesses. Many of these are now retired and many have already died of cancers,” says the study report.

Cancer is not beyond us in terms of cancer control and reducing the impact of the disease, declared the Cancer Association of South Africa (CANSA) on World Cancer Day this year.

“The global cancer epidemic is huge and set to rise,” said Elize Jourbert, head of CANSA. “In South Africa, more than 100 000 are diagnosed annually. This day helps us spread the word and raise the profile of cancer”.

Under the tagline ‘Not beyond us’, World Cancer Day in South Africa focused on taking a positive and proactive approach to the fight against cancer, highlighting that solutions do exist regarding cancer care and early detection and that they are within reach.

Meanwhile, Ellen Awuah-Darko, the 75-year-old founder of the Accra-based Jead Foundation for breast cancer, says it was her personal experience of finding a breast lump and ending up paying tens of thousands of dollars to be treated in the United States that made her start to push for change.

“In America I had to put down 70,000 dollars before they’d even talk to me,” she said in an interview with Reuters. “I was lucky, I could afford it after my husband died and left me money, but I thought ‘why should I get treatment when others can’t’.”

Now, every Wednesday, Awuah-Darko goes with healthcare workers into communities in the Eastern Region of Ghana to offer women a simple breast examination and show them how to check themselves.

“Early detection can save your life,” she said. “I want everybody to know that. It’s not something people should be ashamed of or embarrassed about.”

Edited by Lisa Vives/Phil Harris    

Social worker in the flat of a drug addict in Donetsk doing outreach work. Drug addicts, like other marginalised groups, including Roma, are victims of the collapse of the health system in East Ukraine. Credit: Natalia Kravchuk/International HIV/AIDS Alliance Ukraine©

By Pavol Stracansky
KIEV, Jan 28 2015 (IPS)

With international organisations warning that East Ukraine is on the brink of a humanitarian catastrophe as its health system collapses, marginalised groups are among those facing the greatest struggle to access even basic health care in the war-torn region.

The conflict between pro-Russian separatists and Ukrainian forces has affected more than five million people, with 1.4 million classified by the World Health Organisation (WHO) and human rights bodies as “highly vulnerable” because of displacement, lack of income and a breakdown of essential services, including health care.

Fighting and accompanying measures imposed by both sides have led to medical supplies being severely interrupted or cut off entirely, hospitals destroyed or battling constant water and power cuts, and crippling staff shortages at health facilities as medical staff flee the fighting.

A complete lack of vaccines is threatening outbreaks of diseases such as polio and measles, while there are concerns for HIV/AIDS and TB sufferers as supplies of vital medicines dry up and disease monitoring becomes almost impossible.Fighting and accompanying measures imposed by both sides have led to medical supplies being severely interrupted or cut off entirely, hospitals destroyed or battling constant water and power cuts, and crippling staff shortages at health facilities as medical staff flee the fighting.

Massive internal displacement because of the conflict – latest U.N. estimates are of 700,000 internally displaced persons (IDPs) with the figure rising by as much as 100,000 per week – has also left hundreds of thousands living in sometimes desperate and unhygienic conditions, creating a further health risk and the chance that infectious diseases, such as TB, will spread.

But while there is a threat to healthcare provision from collapsing resources, some in the region are facing extra barriers to accessing health care.

Ukraine has one of the worst HIV/AIDS epidemics in the world and the spread of the disease has been fuelled mainly by injection drug use. But, unlike in many Eastern European states, the country has been running for more than a decade an internationally lauded range of harm reduction programmes which have been credited with checking the disease’s spread.

These have included opioid substitution therapy (OST) programmes available to drug users across the country. These are particularly important in East Ukraine because the majority of Ukraine’s injection drug users come from the Luhansk and Donetsk regions.

But local and international organisations working with drug users say that addicts’ access to life-saving treatment in those areas has come under increasing pressure since the start of the conflict and that it could be cut off entirely within weeks as supplies of methadone and buprenorphine used in the treatment run out and cannot be replaced.

The International HIV/AIDS Alliance Ukraine which runs many OST centres as well as other harm reduction programmes, has said that stocks of antiretroviral drugs, OST and other life-saving treatments will have run out by  February.  More than 300 OST patients in Donetsk and Luhansk have lost access to treatment since the conflict began, while a further 550 patients on methadone will run out of drugs soon if emergency supplies cannot be delivered.

U.N. officials in close contact with international organisations helping drug users as well as doctors in Donetsk have confirmed to IPS that clinics have only a few weeks’ worth of stocks of methadone left.

One doctor in Donetsk working on an OST programme, who asked not to be named, told IPS:  “There are serious problems with medicine supplies. The last shipments came in September last year and some patients have already had to finish their treatments. Many had been on it for a decade and in that time had forged new lives, put their, sometimes criminal, past behind them and had families. It was absolutely tragic for them when they stopped.”

It is unclear what will happen to all those no longer able to access OST treatment. Doctors say some have gone into detoxification, while others have moved to other cities in safer areas of Ukraine in the hope of continuing OST.

But with 60 percent of those receiving OST also being HIV positive, according to the Donetsk doctor, and reports that many are now turning to illicit drugs and needle-sharing again as access to OST is cut off, there are concerns that the disease, along with Hepatitis C which is rife among injection drug users, and tuberculosis, could be spread, and that the lives of many drug users will again be at risk.

OST patient Andriy Klinemko, who was forced to flee Donetsk with his wife when their house was destroyed in bombing last summer and who is now in Dnipropetrovsk in central Ukraine, told IPS: “OST patients in East Ukraine are being forced to move, but not all of them can and even those that make it to other regions may not be able to continue OST because there is no money left to run such programmes. It’s a bad situation and at the moment I really can’t see any way it’s going to get better.”

But drug users are not the only marginalised community struggling to access health care.

Historically, the estimated 400,000-strong Roma community in Ukraine has, like Roma in many other Eastern European states, faced widespread discrimination in society, including in employment and education.

They have also always had limited access to healthcare because many Roma lack official ID documentation which makes it difficult for many to obtain official health care, while widespread poverty also means services and medicines which require any payment are also inaccessible to most. Meanwhile, many Roma settlements are in remote locations, far away from the nearest health centres.

Dr Dorit Nitzan, head of the WHO’s Ukraine Office, told IPS: “Even before the conflict, Roma in Ukraine had limited access to curative and preventive health service. As a result, Roma children have extremely low vaccination coverage. Moreover, rates of tuberculosis and other communicable and non-communicable diseases are higher among Roma than in the general population.”

Discrimination is also a problem. Zola Kondur of the Chiricli Roma rights group in Ukraine, told IPS: “In terms of healthcare, Roma are among the most vulnerable in the country. They are treated badly because of their ethnicity.”

However, the problems for Roma have dramatically worsened since the conflict began. Some human rights groups have said that since the separatist regimes took power in the region, Roma have faced systematic violent and sometimes fatal repression.

According to a report this month of an international mission to monitor human rights

by the Kharkiv Human Rights Protection Group, Roma living in separatist-controlled areas have been “subjected to open aggression from militants ….[who] have carried out real ethnic cleansing” against them. Many have fled and become IDPs, subsequently facing health struggles.

Dr Nitzan said: “As in every crisis, if not given special attention, marginalised and vulnerable groups are at higher risk. In Ukraine, many Roma lack civil documentation, and thus cannot be registered as internally displaced persons and are not included in the provision of any health services.

“Moreover, their inability to pay ‘out-of-pocket’ limits their ability to procure medication and/or services. Compounding this is that many Roma IDPs are residing at the margins of society, in remote geographical locations, where no services are available. All of these factors make health services inaccessible to Roma.”

Local rights groups say that Roma who have managed to flee to safe areas have often ended up homeless and starving after facing problems accessing aid because of a dismissive attitude from volunteers and staff at social institutions, while their lack of identification documents also prevented them from accessing any official help.

However, even those who have managed to find treatment have sometimes faced further problems.

Kondur told IPS: “In one case a Roma family moved from Kramatorsk to Kharkiv. A little boy had a heart problem brought on by the stress of the fighting and he was taken to hospital. One night, a group of young people broke the window of the boy’s hospital room, shouting ‘Gypsies get out’. The boy had a heart attack.”

Edited by Phil Harris

By Mario Lubetkin
ROME, Dec 10 2014 (IPS)

The vast international and national media impact of the Second International Conference on Nutrition (ICN2), held in Rome from Nov. 19 to 21, demonstrated the growing interest that nutritional problems are arousing worldwide, primarily because the media themselves are increasingly reporting issues related to poverty and exclusion.

Thousands of articles in leading newspapers from different countries of the world, numerous television reports and substantial social media activity focused on ICN2, jointly held by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO), 22 years after the first international nutrition conference, also in Rome.

Global representation was ensured through participation by more than 100 ministers and deputy ministers as the leading actors responsible for nutrition-related matters in their respective countries.

Mario Lubetkin

With a policy document and a framework for action containing over 60 points, adopted by consensus and applicable at national and international levels, this conference completed one phase and launched another whose results will be seen in the years to come.

Unlike other international meetings of this nature, this time the media highlighted the interventions of keynote speakers and the final documents, but more importantly continued to publish information and thought pieces on nutrition for some weeks following the conference.

Nutrition has achieved visibility as an issue on the global news agenda, primarily because of its serious social ramifications in developing and developed countries alike.

Countless experts brought to the fore the inherent existing contradiction of having 800 million people suffering from hunger (albeit 200 million fewer than 20 years ago), while 500 million adults are suffering from obesity. The seriousness of the situation is compounded by the fact that the number of the latter is still rising and is resulting in serious health risks for the population at large.“Nutrition has achieved visibility as an issue on the global news agenda, primarily because of its serious social ramifications in developing and developed countries alike”

Suffice it to say that 42 million children are overweight, while malnutrition is the underlying cause of 45 percent of infant mortality.

Statistics indicate that unhealthy diets and lack of exercise are the cause of 10 percent of deaths and permanent disability cases.

Over two billion people, or approximately one-third of all humanity, suffer from micro-nutrient deficiencies.

The problem among children under five years of age is particularly distressing because 51 million suffer from wasting, or low weight for height, which in turn results in higher mortality from infectious diseases. Moreover, 161 million children in that particular age group also suffer from growth retardation.

Malnutrition also has high economic costs. Recent studies have indicated that malnutrition hunger, micro-nutrient deficiency and obesity result in annual costs of between 2.8 and 3.5 trillion dollars, or 4-5 percent of world gross domestic product (GDP). The per capita cost is estimated to be 400-500 dollars per year.

In his speech during the International Conference on Nutrition, Pope Francis said that “when solidarity is lacking in one country, it is felt around the world.”

Despite there being enough food for everyone, food issues are subject to manipulated information, corruption, claims regarding national security, or “teary-eyed evocations of economic crisis”, the Pontiff said. “That is the first challenge we need to overcome”, he asserted as he called for the rights of all human beings to be uppermost in all development assistance programmes.

The Pope also stressed the need to respect the environment and protect the planet. “Humans may forgive, but nature does not”, he argued, adding that “we must take care of Mother Nature, so that she does not respond with destruction”. In this way, he linked the debates on nutrition with the ongoing International Conference on Climate Change in Lima, Peru (Dec. 1-12).

However, despite the breadth of international coverage, it is noteworthy that the leading media did not fully analyse the conference’s Framework for Action, which essentially sets the course for gradual resolution of nutrition’s major challenges.

The Framework for Action proposes the enhancement of political commitments, promotion of national nutrition plans incorporating the different food security and nutrition stakeholders, an increase in responsible investment, the fostering of inter-country collaboration, whether it be North-South or South-South, and the strengthening of nutrition governance.

The Framework also recommends measures to achieve sustainable food systems, revise national policies and investments, promote crop diversification, upgrade technology, develop and adopt international guidelines on healthy diets, and encourage gradual reductions in consumption of saturated fats, sugar, salt or sodium.

The chapter on communications suggests the conduct of social marketing campaigns and lifestyle-change communication programmes promoting physical activity, dietary diversification, consumption of micronutrient-rich food products to include traditional local foods, and taking account of cultural factors.

Although the principal responsibility for implementing the Framework for Action rests with governments and parliaments, non-State actors such as civil society and the private sector have an important role to play by joining forces in ensuring that the proposals are put into action.

Throughout this process, the media have a crucial oversight role in ensuring that the challenges and proposed solutions identified by the Second International Conference on Nutrition become reality in the short and medium terms. (END/IPS COLUMNIST SERVICE)

(Edited by Phil Harris)

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:

These Haitian schoolchildren are being supported by a WFP school feeding programme designed to end malnutrition which, for many countries, can be a double burden where overweight and obesity exist side by side with under-nutrition. Credit: UN Photo/Albert González Farran

By Gloria Schiavi
ROME, Nov 23 2014 (IPS)

Not only do 805 million people go to bed hungry every day, with one-third of global food production (1.3 billion tons each year) being wasted, there is another scenario that reflects the nutrition paradox even more starkly: two billion people are affected by micronutrients deficiencies while 500 million individuals suffer from obesity.

The first-ever Global Nutrition Report, a peer-reviewed publication released this month, and figures from the Rome-based U.N. Food and Agriculture Organisation (FAO) highlight a multifaceted and complex phenomenon behind malnutrition.

“The double burden of malnutrition [is] a situation where overweight and obesity exist side by side with under-nutrition in the same country”, according to Anna Lartey, FAO’s Nutrition Director. “And we are seeing it in lots of the countries that are developing economically. These are the countries that are going through the nutrition transition”."The double burden of malnutrition [is] a situation where overweight and obesity exist side by side with under-nutrition in the same country. And we are seeing it in lots of the countries that are developing economically. These are the countries that are going through the nutrition transition” – Anna Lartey, FAO’s Nutrition Director

Beside hunger then, governments and development organisations have also been forced to start tackling over-nutrition.

“While under-nutrition still kills almost 1.5 million women and children every year, growing rates of overweight and obesity worldwide are driving rising diseases like cancer, heart disease, stroke and diabetes”, Francesco Branca, Director of Nutrition for Health and Development at the World Health Organisation (WHO), explained in a statement.

The solution does not lie in the realm of science, health or agriculture alone. It requires a cross sectorial and multi dimensional approach that includes education, women’s empowerment, market regulation, technological research and, above all, political commitment.

For this reason, representatives of governments, multilateral institutions, civil society and the private sector met in Rome for the Second International Conference on Nutrition (ICN2) that took place at FAO headquarters on Nov. 19-21. Jointly organised by FAO and WHO, the conference came 22 years after its first edition and, unfortunately, addressed the same unsolved problem.

Malnutrition, in all its forms, has repercussions on the capability of people to live a full life, work, care for their children, be productive, generate a positive cycle and improve their living conditions. Figures from the Global Nutrition Report estimate that the cost of malnutrition is around four to five percent of national GDP, suggesting that prevention would be more cost-effective.

With the goal of improving nutrition through the implementation of evidence-based policies and effective international cooperation, ICN2 produced two documents to help governments and stakeholders head in the right direction: the Rome Declaration on Nutrition and a Framework for Action.

The conference also heard a strong call for accountability and for the strengthening of nutrition in the post-2015 development agenda.

Flavio Valente, who represented civil society organisations at ICN2, remarked that “the current hegemonic food system and agro-industrial production model are not only unable to respond to the existing malnutrition problems but have contributed to the creation of different forms of malnutrition and the decrease of the diversity and quality of our diets.”

This position was shared by many speakers, who stressed the negative impact that advertising of unhealthy food has, mainly on children.

According to a participant from Chile, calling obesity a non-communicable disease is misleading, because it spreads through the media system very effectively. He added that Chile currently risks being brought before the World Trade Organisation (WTO) by multinational food companies for its commitment to protect public health by regulating the advertising of certain food.

This happens in a country where 60 percent of people suffer from over-nutrition and one obese person dies every hour, according to the permanent representative of Chile at FAO, Luis Fernando Ayala Gonzalez.

In an address to the conference, Queen Letizia of Spain also acknowledged the responsibility of the private sector: “It is necessary to help the economic interests converging towards public health. It is worth remembering that no country in the world has been able to reverse the epidemic of obesity in all age groups. None.”

The outcome of ICN2 brought consensus around a plan of action and some key targets.

Educating children about healthy habits and women who are in charge of feeding the family was recognised as crucial, as was breastfeeding, which should be encouraged (through paid maternity leave and breastfeeding facilities in the workplace), and the need to empower women working in agriculture.

Supporting small and family farming would also give people better opportunities to eat local, fresh and seasonal produce as well as fruit and vegetables, reducing the consumption of packaged, processed food that is often low in nutrients, vitamins and fibres and high in calories, sugar, salt and fats.

However, teaching people how to eat is not enough, if they cannot easily access quality food – hence the need for relevant policies targeting the food chain and distribution.

Initiatives like the Fruit in Schools programme proposed by New Zealand go in the right direction, especially when implemented within a coordinated policy that promotes physical activity and a healthy lifestyle that fights consumption of alcohol and tobacco.

(Edited by Phil Harris)

To meet the challenge of feeding the world’s 805 million hungry people, this year’s State of Food Insecurity report calls for the creation of an ‘enabling environment’. Credit: FAO/Giulio Napolitano

By Phil Harris
ROME, Sep 17 2014 (IPS)

The number of hungry people in the world has declined by over 100 million in the last decade and over 200 million since 1990-92, but 805 million people around the world still go hungry every day, according to the latest UN estimates.

Presenting their annual joint report on the State of Food Insecurity in the World, the Food and Agriculture Organization (FAO), international Fund for Agricultural Development (IFAD) and World Food Programme (WFP) said that while the latest hunger figures indicate that the Millennium Development Goal (MDG) of halving the proportion of undernourished people by 2015 is within reach, this will only be possible “if appropriate and immediate efforts are stepped up.”

These efforts include the necessary “political commitment … well informed by sound understanding of national challenges, relevant policy options, broad participation and lessons from other experiences.”"We cannot celebrate yet because we must still reach 805 million people without enough food for a healthy and productive life" – WFP Executive Director Ertharin Cousin

Introducing this year’s report, FAO Director-General Jose Graziano da Silva said that the figures indicate that a “world without hunger is possible in our lifetime.”

The three Rome-based UN agencies noted that while there has been significant progress overall, some regions are still lagging behind: sub-Saharan Africa, where more than one in four people remain chronically undernourished, and Asia, where the majority of the world’s hungry – 520 million people – live.

In Oceania there has been a modest improvement in percentage terms (down 1.7 percent from 14 percent two years ago) but an increase in the number of hungry people. Latin America and the Caribbean have made most progress in increasing food security.

However, WFP Executive Director Ertharin Cousin warned that “we cannot celebrate yet because we must still reach 805 million people without enough food for a healthy and productive life.”

Calling for what they called an ‘enabling environment’, the agencies stressed that “food insecurity and malnutrition are complex problems that cannot be solved by one sector or stakeholder alone, but need to be tackled in a coordinated way.” In this regard, they called on governments to work closely with the private sector and civil society.

According to the report, the ‘enabling environment’ should be based on an integrated approach that includes public and private investments to increase agricultural productivity; access to land, services, technologies and markets; and measures to promote rural development and social protection for the most vulnerable, including strengthening their resilience to conflicts and natural disasters.

Speaking at the presentation of the report, the WFP Executive Director referred in particular to the current outbreak of Ebola in the West African countries of Sierra Leone, Liberia and Guinea which, she said, “is an unprecedented health emergency which is rapidly becoming a major food crisis.”

“You cannot isolate people without addressing the food and nutrition challenges of those who need assistance,” she added, noting that the populations in these countries are not harvesting or planting according to their regular seasonal requirements while the crisis rages.

“This is rapidly becoming a food crisis that is potentially affecting 1.3 million people today, with an unknown number of how many will be affected in the future.”

“We cannot let the unprecedented level of humanitarian crisis undermine our efforts to progress even further, to reach our planet’s most vulnerable people and to end hunger in our lifetimes.”

The State of Food Insecurity report will be part of discussions at the Second International Conference on Nutrition to be held in Rome from 19-21 November, jointly organised by FAO and the World Health Organization (WHO).

This high-level intergovernmental meeting will seek a renewed political commitment at global level to combat malnutrition with the overall goal of improving diets and raising nutrition levels.

Chifundo ART Clinic in Lusaka. Credit: AHF

By Chisha Mutale
Lusaka, Jul 28 2014 (IPS)

Chisha Mutale reports from Lusaka that substantial progress has been made against the transmission of HIV from mother to child by the the Zambian government and its cooperating partners.

[podcast]http://traffic.libsyn.com/ipslatamradio07/zambia_PMTCT.mp3[/podcast]

Permaculture enthusiasts with their harvested produce. Credit: Graham Bell/IPS

By Justin Hyatt
BUDAPEST, Jul 28 2014 (IPS)

Food security is often thought of as a question of diversifying supply and being able to move food through areas plagued by local scarcity, relying on the global economic system – including trade and transport – as the basis for operations.

But there is a growing current of opinion that the answer lies much closer to home, by creating locally resilient food supplies which are less dependent on global systems and therefore on the political and economic crises that afflict these systems.

While both approaches have their place, one issue that they have in common is the goal of improving diets and raising levels of nutrition.

At the global level, this goal will take centre stage at the international conference on nutrition that the Food and Agriculture Organization (FAO) of the United Nations and the World Health Organization (WHO) are jointly organising in Rome from November 19 to 21 this year.“Farmers and nutritionists rarely discuss the nutritional quality of a carrot and how it could be improved through farming practices. Farmers are more concerned with yield and appearance while nutritionists typically assume that all carrots are created equal” – Bruce Darrel, food security expert

The organisers will be seeking political commitment for funding improved nutrition programmes as well as including nutrition-enhancing food systems in national development policies. They are also likely to attempt to give the Zero Hunger Challenge in the post-2015 United Nations development agenda fresh momentum.

In the meantime, one task that many say still remains is how to address nutrition in a holistic way, ranging from soil health to plant and animal health as well as to education about food storage and preparation methods that maximise nutrition.

Canadian food security expert Bruce Darrell believes that there are currently few examples of holistic approaches to nutrient management that incorporate strategies for nutrient levels and develop efficient nutrient cycling. “Perhaps this is not surprising when dealing with something that is essentially invisible and which has no generally recognised name as a concept,” he argues.

In his daily work, Darrell examines the role of mineral nutrients in soil, how they are depleted by farming practices, and their implications for healthy food.

According to Darrell’s accumulated knowledge, a single carrot can be more than twice as high in nutrients as that of another carrot grown in poor quality soil, which contains less than half the amount of sugars, vitamins and minerals.

A lack of knowledge about these things needs to be overcome, says Darrell: “Farmers and nutritionists rarely discuss the nutritional quality of a carrot and how it could be improved through farming practices. Farmers are more concerned with yield and appearance while nutritionists typically assume that all carrots are created equal.”

While the carrot is only one example of a whole range of food and nutrition issues, it is becoming clearer that the knowledge gap can be and is gradually being overcome.

Increasingly, individuals and small grassroots organisations are getting together to develop whole-systems approaches to nutrition. There are also more and more networks emerging globally to understand food.

“Not all of us have the luxury to decide exactly how we feed ourselves,” Ágnes Repka, a raw food expert from Hungary and one of the coordinators of the Future of Food European Learning Partnership, told IPS. “But many of us can make a choice on how to prepare the ingredients we have. Keeping as much of our food in their natural, raw form is one of the best ways to maintain its nutrients.”

The Partnership aims to bring sustainable food initiatives from different parts of Europe to one place and learn from each other, bringing the insights regarding sustainable agriculture and healthy food to a new level of understanding.

Repka stressed that when the members of the Partnership think about the healthiest possible food, “we mean what is healthy for our body, for our mind, for our communities and our planet.”

In order to communicate the new-found gains in the world of nutrition and to promote awareness in food education, Ireland’s Truefood Academy comes just at the right time.

Colette McMahon and Casandra Cosgrove of the Academy explain their reasons for putting an educational component in their nutrition-related work: “As nutritional therapists we have found that the practical skills and understanding of basic nutrition is poor and so began to develop and implement an outreach programme in a workshop format.”

The approach has proved successful and beneficial, deepening the understanding of the nutritional impact of traditional food preparation skills, which has demonstrated positive measurable results in the quality of life of the participants.

Meanwhile, across the Irish Sea in southern Scotland, Graham Bell grows over a metric ton of food on less than a 0.1 hectare garden and envisions permaculture as an apt and wise approach to sustainable and nutritious food harvesting.

“The great opportunity is for people to grow as much of their own food as possible,” says Bell. “The first need is to ensure access to land but a lot can be done on very little as we are proving. The next step is to ensure people have the skills to grow what they need.”

“Good change takes time,” adds Bell. “It is incremental. Permaculture is not a missionary activity. It is about modelling better ways of behaving. Better for ourselves, our families, our friends and neighbours – and better for people we don’t know.”

Building durable, sustainable systems is a “one day at a time” approach, according to Bell – not an overnight solution. It involves a lot of sweat, toil and trial, but it is worthwhile, he and other practitioners say.

This summer, a permaculture gathering is taking place in Bulgaria, with the next gathering already scheduled at the Sieben Linden eco-village in Germany. Repka is an avid fan of such meetings and enjoys visiting and learning new things as well as sharing her knowledge.

“Learning how to get the most out of our food is a simple way that we can improve our health,” explained Repka. Uncooked plant based foods, such as vegetables, fruits, nuts and seeds in their raw form give our body more vitality, energy and health is Repka’s message.

“These are the simple choices we can make every day,” she added.

A medical centre at the Bandama checkpoint in Kenema to test people in transit for symptoms of Ebola. Credit: Mohamed Fofanah/IPS

By Mohamed Fofanah
KENEMA, Sierra Leone, Jul 12 2014 (IPS)

Adikali Kamara is a 36-year-old student nurse working in the government hospital in Kenema, a sprawling town on the fringe of the Sierra Leone’s Gola tropical rain forest.

On June 19, he began feeling unwell, complaining of fever and a headache, and went to a chemist near where he lived to buy anti-malaria drugs and antibiotics to treat typhoid fever. “I thought that my symptoms indicated either malaria or typhoid because these are the most common ailments suffered by everybody here,” said Kamara.

However his condition did not change and two days later he decided to seek proper treatment at the hospital. That was when the doctors discovered he was suffering from Ebola, a disease that causes fever, vomiting, bleeding and diarrhoea and kills up to 90 percent of those infected.

Kamara was admitted immediately and just seven days later he was discharged after receiving supportive treatment.“People are vehemently denying that Ebola exists despite the massive awareness raising that is going on, and those that do believe the illness exists are so afraid that they do not come to the hospital or bring their relatives when they are sick. That is how Ebola spreads in the community” – Michael Vandi, Public Health Education Officer for Sierra Leone’s Eastern Province

Kamara is one the fortunate 51 persons in Sierra Leone who have survived the current Ebola scourge that is also ravaging two other West African neighbours – Guinea and Liberia. So far, 99 have died in Sierra Leone and a further 315 men, women and children have tested positive.

The Public Health Education Officer for Sierra Leone’s Eastern Province, Michael Vandi, who is based in the Kenema hospital which houses the country’s only Supportive Treatment Centre and testing laboratory for Ebola, said that the country is far from winning the fight against the disease, blaming people’s fear and denial of the disease.

Vandi said that “people are vehemently denying that Ebola exists despite the massive awareness raising that is going on, and those that do believe the illness exists are so afraid that they do not come to the hospital or bring their relatives when they are sick. That is how Ebola spreads in the community before we are aware of cases.”

According to Vandi, people are accusing doctors of administering lethal injections to the Ebola patients or removing vital organs for sale in European markets. He said that some even claim that people are being deliberately infected with the virus to reduce the population.

As a result, doctors and nurses in the hospitals have been attacked and many nurses are not wearing their uniforms on the way to work for fear of being attacked in the streets.

“Patients who were admitted – both male and female – are abandoning the hospitals,” said Vandi. “They are now going to pharmacies or being treated by quack doctors or nurses in their homes. This is worrisome because the signs and symptoms of Ebola mimic the prevalent malaria and typhoid fever in the country and, before they know what they are dealing with, it will be too late.”

The Senior Human Rights Officer who heads the Human Rights Commission’s Office in the Eastern Province, Hassan Yarjah, blames the government’s Ebola awareness raising strategy for fanning mistrust and disbelief among people.

He pointed out that the eastern part of the country, in which almost all cases of Ebola have so far been identified, is an opposition stronghold. “What the central government is doing, which I think is wrong, is sending people to these communities that the people cannot identify with; they are parliamentarians, they are ministers, they are executives from the ruling All People’s Congress party and this is a country where everything is polarised,” he said.

According to Yarjah, people in the country’s Eastern Province are saying that “because a census is scheduled for September, the politicians want to scare people away from this part of the country so that their number will dwindle; then, when they delimit the boundaries for constituency seats, this will mean less representatives for the opposition in parliament in the next election.”

“I think government should use the local structures, like the paramount chiefs, the medical personnel on the ground, and the local councils,” Yarjah told IPS.

Meanwhile, the government has announced a ban on regular trade fairs in Kailahun, one of the districts in Eastern Province worst hit by Ebola. There has also been an executive order for placing medical personnel at a number of checkpoints on roads from the Eastern Province to check people for Ebola-related symptoms.

“This has affected our agriculture,” complained Lamin Musa, a farmer from Kailahun. “We cannot sell our produce now at the trade fairs and this had heaped more hardship on our poor people. Even bush meat, which had been a lucrative trade for us, has been banned. It is difficult for us to understand all the suffering we have to undergo because of Ebola.”

Whatever the misgivings, misconceptions and accusations, the virus is thriving, in part due to dysfunctional medical systems and weak disaster management structures in Sierra Leone and its neighbours.

At the beginning of July, the World Health Organization (WHO) held an emergency meeting in Accra, Ghana, with health ministers from 12 West African countries to discuss and propose suggestions to combat the outbreak of Ebola virus that has hit the three West African countries.

The ministers adopted a common inter-country strategy calling for accelerated response to the Ebola outbreak in West Africa. The strategy stressed the need for regional, sub-regional and national leadership, coordinated actions by all stakeholders, enhanced cross border collaboration and the involvement of communities.

For his part, Kamara is optimistic. “I was able to beat this disease and any of you out there can,” he said. “You have to believe that Ebola is real, set aside prejudice and go to the hospital early if you experience the symptoms.”

The problem is that while Ebola may be a killer, a potentially greater threat to Sierra Leoneans and West Africans in general lies in less spectacular diseases. During the current outbreak of Ebola, other diseases are quietly taking their toll. Malaria is still rampant, and there is concern that cholera, which usually attacks during this period of the rains, will resurface to claim more lives.

Nadezdha Tolokonnikova and Maria Alyokhina (fourth and fifth from the right) with activists from the Andrei Rylkov Foundation for Health and Social Justice in Moscow marking the United Nations International Day Against Drug Abuse and Illicit Trafficking with calls for reform of Russia's hard-line drug policies. Credit: Andrei Rylkov Foundation

By Pavol Stracansky
MOSCOW, Jun 26 2014 (IPS)

A protest in Moscow Thursday marking the U.N. International Day Against Drug Abuse and Illicit Trafficking has highlighted the ‘torture’ drug users are put through in the Russian criminal justice system.

Nadezhda Tolokonnikova and Maria Alyokhina, members of the Pussy Riot Group who were controversially jailed for performing in a Moscow cathedral in 2012, spoke in the Russian capital to highlight the plight of drug users in Russia.

Joining protestors in more than 80 cities around the world demanding drug policy reforms, they attacked what they said was their country’s “cruel and inhuman” treatment of drug users.

Describing a litany of rights abuses against drug users, including torture and beatings by police and prison warders, they said Russian authorities viewed imprisonment as a “cure for drug dependency”.“Similar to xenophobia and homophobia, narcophobia has become a protective cloak for the authorities .... Creating an image of the enemy, the subhuman, the zombie, and reinforcing that image in the public consciousness justifies the inhuman treatment of drug dependent people in our country” – Nadezhda Tolokonnikova and Maria Alyokhina, members of the Pussy Riot punk rock group

“People who use drugs are outcasts – they are despised, hated, accused of all problems, and criminalised. Similar to xenophobia and homophobia, narcophobia has become a protective cloak for the authorities…. Creating an image of the enemy, the subhuman, the zombie, and reinforcing that image in the public consciousness justifies the inhuman treatment of drug dependent people in our country,” they said.

“Russia’s drug policy is built on torture. Humiliation and violation of human dignity – thisis what drug dependent people face everywhere, from hospitals to prisons and other state facilities,” they added.

Russia takes a hard-line approach to drug use, implementing repressive drugs legislation, including lengthy jail terms for possession of even tiny amounts of hard drugs.

Drug users say they are also targeted by police: official figures show that one in six of the Russian prison population is a drug user and, according to other surveys, just under 30 percent of drug users have been arrested at some point since they started using drugs.

They say they also regularly have confessions extracted from them or are coerced into helping officers as they go into withdrawal in detention – a charge police deny.

There is a complete lack of relevant medical services for drug users in temporary holding facilities and pre-trial detention centres and even painkillers are rarely given to addicts going into withdrawal.

Drug users in prison face particular hardship. Conditions for all prisoners are poor with hygiene often bad, cells massively overcrowded and brutality and disease rife. But drug users are especially vulnerable.

Anya Sarang, head of the Moscow-based Andrei Rylkov Foundation for Health and Social Justice, which works to raise awareness of drug problems, told IPS: “Russian prison is torture in itself with prisoners not given basic medical infection control, nutrition etc., and general human rights violations. But drug users are more vulnerable than other prisoners.

“For instance many are HIV positive, but not only are there problems getting their medicine or starting them on treatment because they are not given necessary immune system checks in some cases, but their diet is poor and there is always the risk of infections, such as tuberculosis.”

Tuberculosis (TB) is a major problem in Russian prisons, according to the World Health Organisation (WHO) and other bodies. Studies have shown that a person with HIV is 25 times more likely to contract TB in a Russian prison than outside one.

But the risk of potentially deadly infections is only one problem facing drug users in prisons. As in many jails across the world, drugs are smuggled in and traded between inmates, giving users, some of whom may never have tried hard drugs, access to substances like heroin and experience of dangerous drug-taking methods.

Campaigners say that this is further evidence of how the criminalisation of drug use only perpetuates and worsens drug problems.

Michel Kazatchkine, UN Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, told IPS: “We know from studies that contact with the criminal justice system is associated with increased injection drug use and other similar behaviour, among other problems. Putting drug users in prisons …. is making things worse not just in prisons but also for communities when they are released from prison.”

Activists point to how opioid substituition therapy (OST) for people in custody or prison has been successfully implemented in some Western states.

But the practice is completely banned in Russia, despite being widely implemented in many countries around the world, recommended by the World Health Organisation (WHO), and having been proved to be successful in helping halt the spread of HIV/AIDS.

Russia has one of the world’s fastest growing HIV/AIDS epidemics – there were 78,000 new HIV cases registered last year, up from 69,000 in 2012 and 62,000 in 2011 – which the Joint United Nations Programme on HIV and AIDS (UNAIDS) and other bodies say has been historically driven by injection drug use.

Drug use in the country is growing equally rapidly. According to figures from the country’s Federal Drug Control Service (FSKN) there were an estimated 8.5 million drug addicts in 2013 – up from 2.5 million since 2010. The service says up to 100,000 people die each year in Russia from drug abuse. It is also the world’s largest heroin consumer.

Tolokonnikova and Alyokhina said only a reform of drug policy including decriminalisation would improve the situation in prisons.

But Russian authorities show no sign of lifting the OST ban nor improving the very limited harm reduction services which exist in the country and FSKN officials have made a number of public statements in recent months reaffirming their commitment to hard-line drugs policies.

Kazatchine told IPS: “I don’t see any sign of Russia’s approach to drugs softening. What I am seeing is a toughening of the way Russian society looks at marginalised groups, such as drug users, men who have sex with men, LGBT people, etc. The climate has toughened and Russia is de facto criminalising drug use and recession.”

This, critics say, has left Russian drug users in a terrible position in society. Sergey Votyagov Executive Director of the Eurasian HRM Reduction Network (EHRN), told IPS that they were “one of the most stigmatised and under-served populations” in the country.

Meanwhile, the devastation wrought by Russia’s drugs policies has been seen clearly in its newest territory. Just days before Thursday’s protest in Moscow, campaigners in Ukraine had raised the alarm over the fate of drug users in Crimea following its recent annexation.

OST is available in Ukraine and had been provided to 800 people in Crimea. But as part of Russia, Moscow ordered OST programmes there shut down at the start of May.

A mission by the Council of Europe to Crimea which ended last month reported that at least 20 people had died following the cessation of the programmes and at least 50 more had migrated to the Ukrainian mainland, while a few had gone to Russia for detoxification and rehabilitation treatment.

Those who remained spoke of having to deal with intimidation by new authorities and, in some cases, losing their jobs because of either worsening health or their status as former OST patients being made public.

Some who have fled the peninsula described the fear and desperation among drug users still there.

Speaking at an event organised by the International HIV/AIDS Alliance in Ukraine in Kiev earlier this month, one woman, Oksana, who left the day after her OST treatment had stopped, said:  “I might have died if I had stayed in Crimea.

“I am disabled, I have had a stroke and I know very well how it feels to be left without therapy and help. Those who could not leave Crimea are in terrible conditions. Some of them are already dead, others have chosen suicide.”

There is little hope that things in Crimea will change any time in the foreseeable future. Earlier this month, Sergei Donich, deputy prime minister in the Crimean government, told local media that OST was ineffective and was being pushed by pharmaceutical firms who stood to gain from it.

Kazatchine described the situation on the peninsula as a “tragedy”, adding that it was unlikely there would not be more deaths among drug users.

He told IPS: “Evidence shows that OST reduces mortality, it prevents overdoses among drug users. I think it is inevitable that [with no more OST] more drug users will die.”

Cigarettes are a popular buy from vendors selling imported goods here in Port Moresby in Papua New Guinea. Credit: Catherine Wilson/IPS

By Catherine Wilson
SYDNEY, Aug 19 2013 (IPS)

Governments in the Western Pacific Islands, believed to be home to a third of the world’s smokers, have begun a long battle with the growing crisis of non-communicable diseases. Such diseases currently account for 75 percent of the region’s fatalities.

Kiribati and the Marshall Islands have the highest rates of diabetes in the world at 25.7 percent and 22.2 percent respectively. Fiji carries the greatest burden of non-communicable diseases (NCD)-related deaths in the region at 501 per 100,000 in the population.

Major factors include heavy tobacco and alcohol consumption, physical inactivity, and poor nutrition. These are exacerbated by rapid urbanisation, and spreading consumerism.
In 2011 Pacific Island leaders declared NCDs to be at the centre of a health and development exigency with long-term impacts including lower economic productivity, loss of household income and unsustainable health costs.

The limited capacity of health services to cope with escalating financial and service delivery demands is of growing concern. Most national health expenditure, up to 90 percent in Vanuatu and 87 percent in Samoa, is already met by governments, and there is limited potential to increase budgets further.

“I don’t think any country can cope with the burden of NCDs, not even high-income countries,” Dr Wendy Snowdon of the Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases at the Fiji School of Medicine told IPS.

“NCDs are expensive to treat, and while countries in the region are increasing their investment in treating NCDs, the only viable solution is effective promotion [of prevention] which could reduce the burden.”

Challenging entrenched lifestyle habits and controlling access to tobacco are imperative to reducing the prevalence of hypertension, diabetes and cancer, and addressing cardiovascular disease, which is the greatest killer of all.

The World Health Organisation (WHO) cites tobacco as the second highest risk factor in NCD-related deaths, 80 percent of which occur in low- and middle-income countries.

The prevalence of smoking in men ranges from 74 percent in Kiribati and 60 percent in Papua New Guinea to 55 percent in Tuvalu and 47 percent in the Cook Islands. Female smoking rates, while on the increase, are lower at 43 percent in Kiribati, 41 percent in the Cook Islands and 27 percent in Papua New Guinea.

Stephanie Erick of Tala Pasifika, a New Zealand heart service aimed at empowering Pacific peoples in tobacco control, told IPS: “Smoking practices over the years have embedded themselves in [Pacific] cultural practices, for example, with kava drinking. Socially it has become a part of gift giving [of duty free cigarette packs] from overseas travellers coming into Pacific Island countries.”

A report last year by the United States-based health foundation Legacy and the Pacific Partnership for Tobacco Free Islands (PPFTI) highlighted the very young age at which dependence starts. Twenty-five percent of high school students in the Northern Mariana Islands are smokers. In the Marshall Islands, almost 90 percent of smokers start in adolescence, and two-thirds are daily consumers by18 years.

The socio-economic repercussions for this generation as it ages will be serious in a region striving, with mixed progress, to achieve the Millennium Development Goals.

The connection between NCDs and disability, such as stroke paralysis, amputations and blindness, is already taking its toll. In Fiji, diabetes is the main cause of amputations and the second main factor in adult blindness.

A report by the University of Sydney, Australia, blames smoking for the burden of lung cancer in 39-47 percent of men in the Pacific Islands and predicts this will increase to 70-84 percent within the next two decades.

Pacific Island leaders, fully cognizant of the implications for the region’s future, developed crisis response strategies during an NCD Forum last year focussed on tobacco control and building capacity in primary health care services. Their goal is 25 percent reduction in NCD-related fatalities in people aged 30-70 years by 2025.

However, there are significant challenges to implementation, with many health service providers constrained by low funding and resources.

Prevention through ‘whole of society’ and ‘whole of government’ approaches is being advocated by health ministers as the most likely to reverse the present scenario.

A critical step has been ratification of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) by all Pacific Island member states and territories. The framework is supported by the MPOWER strategy which promotes tobacco price and tax increases, tobacco advertising bans, regulation of tobacco use in public spaces and cessation services.

Jeanie McKenzie, NCD adviser on tobacco and alcohol at the Secretariat of the Pacific Community (SPC) in Noumea, New Caledonia, told IPS that the FCTC was an important catalyst to the emergence of tobacco policies in the region.

“SPC has been undertaking tobacco enforcement workshops in Vanuatu, Solomon Islands, Cook Islands and Palau, and these reflect the fact that there is legislation in place in these countries,” she said. “Countries in the Pacific are also increasing the tax on tobacco, with many increases at or above 20 percent.”

This year the sale of single cigarettes and smoking in public places became illegal in the Solomon Islands. Fiji also introduced new requirements that graphic health warnings cover 60 percent of cigarette packages.

“Increasing the price of tobacco affects price-sensitive [social groups], usually youth and women, and acts as a disincentive,” McKenzie explained. “Laws that prevent the sale of small cigarette packs and the illegal breaking open of a pack and selling of single cigarettes also assist in dealing with the problem of young people being able to access cigarettes for a smaller financial outlay.”

WHO claims that every 10 percent increase in the retail price of tobacco induces a drop in consumption in low- and medium-income countries by up to 8 percent.

The coral atoll nation of Niue, located northeast of New Zealand, with a population of 1,611, has emerged as an early success story. Last month it announced that sustained tobacco control and health support measures had led to a massive drop in the smoking rate in men from approximately 58 percent in recent decades to 15.8 percent, and in women from 17 percent to 7.6 percent. This places the island state well ahead of its 2021 objective of less than 25 percent for men and 13 percent for women.