More than 200,000 affected by cholera epidemic in Yemen

Yemen is in the grip of a runaway cholera epidemic that is killing one person nearly every hour and if not contained will threaten the lives of thousands of people in the coming months, international agency Oxfam said in statement in June.

The UN says the country is facing the worst cholera outbreak in the world, with suspected cases exceeding 200,000 (as of 24 June) and the number increasing at an average of 5,000 a day.

In a joint statement, United Nations Children’s Fund (UNICEF) Executive Director Anthony Lake and World Health Organization (WHO) Director-General Margaret Chan said that in just two months, cholera has spread to almost every governorate of this war-torn country.

Already more than 1,300 people have died – one quarter of them children – and the death toll is expected to rise.

“UNICEF, WHO and our partners are racing to stop the acceleration of this deadly outbreak,” they said, also calling on authorities in Yemen to strengthen their internal efforts to stop the outbreak from spreading further.

Cholera has affected around 268 districts in 20 of Yemen’s 22 governorates. While cholera is endemic in Yemen, thecountry has experienced a surge in cholera cases since 27 April 2017.

Sajjad Mohammed Sajid Oxfam’s Yemen Country Director said: “Yemen is on the edge of an abyss. Lives hang in the balance. Two years of war has plunged thecountry into one of the world’s worst humanitarian crises and at the risk of famine. Now it is at the mercy of a deadly and rapidly spreading cholera epidemic. Cholera is simple to treat and prevent but while the fighting continues the task is made doubly difficult. A massive aid effort is needed now. Those backers of this war in Western and Middle Eastern capitals need to put pressure on parties to the fighting to agree a ceasefire to allow public health and aid workers to get on with the task.”

The more than two-year conflict in the country has devastated the country’s health facilities; less than half are fully functional and many public health professionals have not been paid in months. Key infrastructure, including water and sanitation facilities, are collapsing, contributing to the spread of diarrhoeal disease. The weather is also playing a role: the pathogens that cause cholera are more likely to spread in warmer weather and heavy rains in April / May washed piles of uncollected waste into water sources.

“We see that the numbers are going up,it’s really important to race against the spread and try to get treatment and water and sanitation measures to every corner, especially to those corners that are basically exporting the bacteria to other places,” Tarik Jasarevic a spokesperson for WHO said in June.

And although cholera can be treated quickly if caught early, WHO reiterated that getting help in a middle of a conflict “is not so easy.”

WHO and health partners are actively supporting the Ministry through a cholera task force to improve cholera response efforts at the national and local levels. As of 21 June, WHO has helped to set up 144 diarrhoea treatment centres and 206 oral rehydration points, along with more than 1,900 beds for cholera patients in 20 governorates.

The agency added that its health, water, sanitation and hygiene partners need $66.7 million to scale up the cholera response.

Meritxell Relaño, the UNICEF Representative in Yemen, said: “With no end in sight to the conflict, the cholera outbreak – and potentially other disease will continue to stalk the lives of children.”

Oxfam said that the outbreak is set to be one of the worst this century if there is not a massive and immediate effort to bring it under control. It is calling on rich countries and international agencies to generously deliver on promises of $1.2bn of aid they made last month.

On June 23, the European Commission issued a statement saying it was scaling up its response with an additional  Euro 5 million, bringing total EU support for efforts to tackle the disease to  Euro 8.8 million.

Christos Stylianides, European Commissioner for Humanitarian Aid and Crisis Management, said: “The cholera outbreak in Yemen continues to spread dramatically during the last weeks and warrants urgent action. Crucially, humanitarian organisations must be allowed full access to do their life-saving job. While we do all we can to help those in need, only a political solution will bring this catastrophe to an end.”

Aid groups unable to manage war zone risks – OCHA, NRC report

Humanitarian aid workers want to help people in some of the biggest war zones, but extreme risks and threats are paralyzing their operations, a United Nations-backed report concluded recently.

“‘Conflict parties’ lack of respect for the fundamental tenets of international humanitarian law and the brutality and volatility of today’s armed conflicts make it extremely difficult and dangerous for these brave aid workers to deliver humanitarian assistance and protection in complex emergencies,” said UN Emergency Relief Coordinator Stephen O’Brien, whose Office for the Coordination of Humanitarian Affairs (OCHA) co-produced the report.

Presence and Proximity: To Stay and Deliver, Five Years On , produced by OCHA, the Norwegian Refugee Council (NRC) and Jindal School of International Affairs in India, is based on interviews with more than 2,000 international and national aid workers, and includes case studies on humanitarian aid in Afghanistan, the Central African Republic (CAR), Syria and Yemen.

“It is our duty as aid workers to work where needs are greatest,” said Jan Egeland, Secretary General of NRC. “But our international humanitarian community is failing too many people in too many places, from Syria and Yemen to South Sudan and Nigeria. Extreme risks and threats are paralysing too many organizations and their ability to deliver aid and save lives.”

Among its findings, the report found that as overall needs in the field have grown, so have the funding gaps, which necessitate cutting of projects and aid work.

Based on interviews with aid workers, the authors also concluded that abductions of workers are on the rise, criminality is seen as a rising threat, and the number of incidents against national aid workers has increased.

“Humanitarians expressed an increased sense of risk and vulnerability, even though most major security incidents affecting humanitarians occur in a very small number of countries and tend to reflect the increased level of humanitarian activity in proximity to ongoing conflict rather than expanded targeting of humanitarians around the world,” the authors wrote.

The report is a five-year follow-up to the 2011 document, ‘To Stay and Deliver’, which provided advice and recommendations to practitioners on critical issues, such as risk management, responsible partnerships, adherence to humanitarian principles, acceptance and negotiations with relevant actors.

Among the conclusions, the authors wrote that “not enough progress has been achieved since 2011, and many of the recommendations contained in the initial report remain particularly relevant today”.

Other trends noted that humanitarians are more focused on security analysis, and that remote programming – the concept of using local organizations to help implement aid activities – can generate risks and undermine the quality of protection and humanitarian programmes.

GE signs MoU with Saudi Arabia to support kingdom’s Vision 2030

GE has signed a range of Memorandums of Understanding [MoU] with the Kingdom of Saudi Arabia in an effort to support the delivery of Saudi Vision 2030. The MoUs cover multiple sectors and partners and aim to create a diverse and sustainable economic platform in the kingdom.

The initiatives touch upon the key pillars within Saudi Vision 2030, focusing on transforming the nation into a global investment leader and geographic hub and the upscaling of industrial skills and capabilities.

The agreements also place significant emphasis on human capital development and the digital transformation across multiple sectors, with the expanded application of GE’s Predix platform, which utilizes cloud-based data analytics to better ensure and enhance manufacturing efficiency.

The transformation of the healthcare industry is a main priority of the government, which is looking to offer services and research capabilities on par with leading nations in healthcare around the world. Through five different partnerships with King Faisal Specialist Hospital [KFSH], Dr. Sulaiman Al Habib Medical Group, the Saudi Telecom Company [STC], King Fahad Medical City [KFMC] and the Saudi Industrial Clusters Development Program [NICDP] respectively, GE is providing expertise, equipment and cutting-edge digital solutions to ramp-up national healthcare competencies.

King Fahad Specialist Hospital (KFSH) – Through their partnership, KFSH and GE are aiming to establish a long-term technology management partnership for both GE and non-GE equipment, and in so doing establishing KFSH as a Digital Hospital, making use of advanced analytics, information technology systems and infrastructure. Education is a crucial component of this agreement, which will see the development of clinical, technical medical and leadership educational programs.

Dr Sulaiman Al Habib Medical Group (HMG) – GE and HMG are collaborating to deploy and develop a Hospital Information Solution through GE’s Predix, with the goal to deploy it in Saudi Arabia and across the region.

STC, MoH – The landmark agreement between STC and GE, under the patronage of the Saudi Ministry of Health, is a vital element in the digitization of industry in the Kingdom. The three partners will introduce digital solutions through an Electronic Medical Records Predix Solution and a Centralized Appointment System, which together will serve to transform the centers into ‘digital hospitals.’

King Fahad Medical City (KFMC) – The partnership between KFMC and GE Healthcare focuses on the radiology privatization proof-of-concept for the medical imaging department at King Fahad Medical City and nearby hospitals, in addition to providing an operator to validate the government-wide operations over a 10-year period.

NICDP – This cooperation agreement will foster collaboration across multiple fronts in the development of biopharmaceutical capabilities in the Kingdom, stressing the importance of vaccine research and the development of local capabilities, eventually leading to the initiation of a bio-science park.

Report outlines changes required for improved healthcare in GCC

Dramatic economic growth fuelled by high oil prices since the early 2000s has brought rapid cultural change and resulted in a shift in lifestyle and dietary habits, leading to a rise in non-communicable diseases. In a new report, ‘Diagnosing healthcare in the GCC: A preventative approach’ <>, sponsored by Abbott, The Economist Intelligence Unit (EIU) reviews the health challenges facing the population in the six Gulf Co-operation Council (GCC) states – Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the UAE – and highlights the need for early diagnosis and preventative healthcare strategies.

The key sentiment among regional healthcare experts is that healthcare delivery should be the mandate of the private sector, while the public sector should be responsible for planning, oversight and clinical governance. Improved efficiency – in terms of better utilisation of resources and improved patient turnaround times – will drive the system towards faster and more effective diagnosis. Government oversight will be essential to ensure that the private sector is operating as it should.

A central component of the healthcare system critical to early diagnosis is pathology, driving an estimated 70% of all healthcare decisions. Ensuring adherence to quality assurance protocols in laboratories will therefore be essential. In particular, ongoing training for laboratory technicians, provided by local educational facilities, will help to standardise testing procedures across the region.

Another component is insurance. To comply with the new insurance laws in the GCC, many companies are offering their employees a basic insurance package. In most cases, regular screenings and sophisticated testing are not covered. A framework must be developed to cover such tests if a genuine need can be identified.

The proliferation of insurance coverage has led to egregious doctor-incentivising practices. Enforcing regulation on incentivising of medical professionals will improve transparency and patient trust in the Gulf. Increased data capture and record-keeping, through systems such as Dubai’s “e-claim”, will shed more light on such practices, identifying instances where unnecessary tests are performed. In addition, individual health records will provide medical practitioners with detailed patient histories, which will lead to better diagnosis.

Melanie Noronha, the editor of the report, said: “Governments must develop a combined primary, secondary and tertiary prevention strategy to facilitate early diagnosis and preventative healthcare. A holistic strategy will entail educating the public about the need for regular screenings while improving access to these programmes, to create a system in which early diagnosis is possible.”

UAE MoH signs MoU with Sanofi to tackle non-communicable diseases

The UAE Ministry of Health & Prevention has signed a Memorandum of Understanding (MoU) with Sanofi to initiate comprehensive measures for the prevention of non-communicable diseases in the country.

The collaborative initiative aims to develop programs that will help enhance the skills of healthcare professionals for better disease management, implement national health awareness activities, and improve education and training on pharmaco-economics. The objective of the MoU is to reinforce support for all the key stakeholders involved in the healthcare sector including, regulators, health authorities, healthcare providers (HCPs) and, patients and caregivers.

The initiative involves customized outreach activities designed to effectively educate various stakeholders and target groups for different disease areas.

Dr Hussein Abdul Rahman Al Rand, Assistant Undersecretary for the Ministry’s Health Centers and Clinics Sector and Public Health, said: “The healthcare system in the UAE is taking every step to control the prevalence of preventable diseases among communities. Non-Communicable diseases such as diabetes and cardiovascular disease pose a threat to the health of the Emirati population and citizens. The incidence of these conditions can be greatly reduced if preventive and curative interventions are implemented effectively. Collaborative public-private partnerships are critical to achieving our healthcare goals and securing the future of the country. In line with this, we are happy to have Sanofi’s support in helping us strengthen the healthcare infrastructure in the UAE.”

To encourage two-way communication between patients, caregivers and the public, an integrated smart phone app will be developed to help maximize access to healthcare services.

The MoU also focuses on enhancing laboratory capabilities and genetic assay expertise by offering access to high-quality diagnostic testing for newborn babies, and free of cost testing for patients with high risk of LSDs (Lysosomal Storage Disorders). The long-term plan involves establishing disease registries, collecting epidemiological data, and driving awareness campaigns and screening programs on rare diseases.


WhatsApp enables monitoring of attacks on healthcare workers in Syria

The messaging service Whatsapp is being used in Syria to help monitor and collect data on attacks on healthcare workers and facilities, providing robust data in support of advocacy and accountability efforts.

The system, which enables teams to share data about attacks within 24 hours, identified 402 attacks against health care in Syria between November 2015 and December 2016, according to a new study in The Lancet. The study shows that during this year of the study, nearly half of hospitals in non-government controlled areas were attacked and a third of services were hit more than once.

Attacks on health care have reached unprecedented levels in Syria, now in its 7TH year of conflict. Collecting robust and reliable data is important to convince the international community to enforce legal protections, and to achieve accountability for widespread breaches of international law.

While reporting of attacks has improved, until now there has been no standardised method of collecting robust data. Collecting first-hand accounts from people on the ground can result in limited coverage, and using second-hand data such as media reports, satellite images and retrospective accounts can result in incomplete data, and collection is hampered by access constraints, security fears and concerns about confidentiality.

Following the 2010 UN General Assembly Resolution that threats to health care should be addressed, the WHO was tasked to develop a method of collecting more reliable data on attacks on health care.

The new tool was piloted by the Health Cluster in Gaziantep, Turkey, which coordinates humanitarian activities in Syria, including the UN and around 50 NGOs. The Health Cluster supports 352 health facilities in Syria, serving a population of approximately 5.5 million people.

The monitoring tool uses a 293-member WhatsApp group. When an incident occurs, a short message is posted to the group. All members with physically-verified information (i.e., who have visited the site or were present – not hearsay) are then asked to complete an anonymous and confidential online form to detail location, attack type (e.g. aerial bombardment, gunfire, arson), facility type, extent of damage, who was affected, injuries and deaths.

Within 24 hours, the team in Turkey issues a flash update to key partners, the WHO, UN and donors. Every month, data is verified by checking health cluster alerts against external reports. Reports that remain unverified because of insufficient information are also recorded

From November 2015 to December 2016, 402 individual attacks were identified, of which 158 were verified. A total of 938 people were harmed, a quarter of whom were health workers. Nearly half (44%) of hospitals in non-government controlled areas were attacked and a third of services were hit more than once. Services providing trauma care were attacked more than other services. Aerial bombardment was the main weapon, and land operations to take over a specific location were associated with increased attacks.

Dr Alaa Abou Zeid, Emergency HealthCoordinator, WHO Health Cluster, Gaziantep (now Health Cluster Coordinator, WHO, Yemen) and lead author of the paper, says: “On a daily basis, we have witnessed the efforts that partners do to keep health facilities operational, including dividing facilities, such as operating theatres and post-operative care, among locations to try to reduce the risk that all services are affected, or moving entire services underground. Our challenge now is to convince our colleagues on the ground to continue collecting and verifying data, when they have still not seen a reduction in attacks. We urge the international community to mobilise and apply the Geneva Convention with conviction in order to effectively protect health care and similar civilian services in conflict.”

Need for improved evidence – The paper is part of a wider four-paper Series, led by researchers from the London School of Hygiene & Tropical Medicine, UK, assessing the evidence base for health interventions in humanitarian crises. Large-scale humanitarian crises are ongoing in Syria, Afghanistan, Central African Republic, DR Congo, Iraq, Libya, Nigeria, Somalia, South Sudan, and Yemen among others.

Worldwide, an estimated 172 million people are affected by armed conflict, including 59 million people displaced - the highest number since World War 2. In addition to these man-made crises, 175 million people are affected by natural disasters each year.

The four-paper Series reveals significant variations in the quantity and quality of evidence for health interventions in humanitarian crises, and brings together lessons learned from recent failures in humanitarian crises to provide recommendations to improve a broken system.

Professor Francesco Checchi, London School Hygiene & Tropical Medicine, and lead author for the Series, says: “Timely and robust public health information is essential to guide an effective response to crises, whether in armed conflicts or natural disasters. Yet insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. Far greater investment and collaboration across academic and operational agencies is needed to generate reliable evidence, and improve the response to humanitarian crises.”

Professor Paul Spiegel, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, and Series co-author adds: “The humanitarian system is broken. An unprecedented number of large-scale humanitarian emergencies are taking place, from Syria to South Sudan and Yemen, causing the largest number of people in a generation to be forcibly displaced. The existing humanitarian system was created for a different time and is no longer fit for purpose. Major changes are now needed to put the protection of humanitarian workers front and centre, to align humanitarian interventions with development programmes, to improve leadership and coordination and to make interventions more efficient, effective and sustainable.”

Polio outbreak in Syria

The Global Polio Eradication Initiative (GPEI) reports 8 June 2017 that a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed in the Deir-Ez-Zor Governorate of the Syrian Arab Republic. The virus strain was isolated from two cases of acute flaccid paralysis (AFP), with onset of paralysis on 5 March and 6 May, as well as from a healthy child in the same community.

Outbreak response plans are being finalized, in line with internationallyagreed outbreak response protocols, including plans for targeted vaccination campaigns to rapidly raise population immunity. An initial risk analysis has been conducted, finding low overall population immunity levels in the area but solid levels of disease surveillance. Active searches are being conducted for additional cases of acute flaccid paralysis. Surveillance and immunization activities are also being strengthened in neighbouring countries.

Although access to Deir-Ez-Zor is compromised due to insecurity, the Governorate has been partially reached by several vaccination campaigns against polio and other vaccine-preventable diseases since the beginning of 2016. Most recently, two campaigns have been conducted in March and April 2017 using bivalent oral polio vaccine (OPV). However, only limited coverage was possible through these campaigns. Syria also introduced two doses of inactivated polio vaccine in the infant routine immunization schedule in 2018.

The detection of the cases demonstrates that disease surveillance systems are functional in Syria. The polio programme is working with local authorities and organisations on the ground to respond immediately, using proven strategies. In 2013-2014, Deir-Ez- Zor was the epicentre of a wild poliovirus type 1 (WPV1) outbreak, resulting in 36 cases at the time. This outbreak was successfully stopped; the now-detected cVDPV2 strain is unrelated to the WPV1 outbreak.

Circulating VDPVs are extremely rare forms of poliovirus, mutated from strains in the oral polio vaccine (OPV) that can emerge in under-immunised populations. OPV has been a critical tool in eliminating 99.9% of polio cases worldwide, and while cVDPV is rare, the GPEI is actively working with countries to eradicate both vaccine-derived and wild polio. The same strategies that are eliminating wild poliovirus also stop cVDPV – it remains critical that all countries maintain strong disease surveillance and ensure all children are vaccinated.



Date of upload: 18th Jul 2017

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