Tuesday November 10, 2009




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1105 Sexual violence prevention and re-integration funding "falls through cracks" [DRC]--While medical and psychological care are being provided to survivors of sexual violence in eastern Democratic Republic of Congo, where 7,000 women and girls have been raped this year alone, UN and aid workers on the ground say the funding response has been too narrow, leaving key issues inadequately addressed.

"Increased international attention to sexual violence in DRC has led to a substantial increase of funding, accompanied by a disproportionate lack of evaluations of the real needs on the ground and lack of understanding of the complexity of the issues," notes the Comprehensive Strategy on Combating Sexual Violence in the DRC, released in 2009 by the Office of the Senior Adviser and Coordinator for Sexual Violence in the DRC.

"Efforts are unevenly distributed [...] The programmatic focus is essentially on two sectors: medical and judicial support to sexual violence survivors, while the remaining sectors show very few interventions," according to the strategy.

The sectors receiving proportionally less funding and attention include prevention and reintegration.

"Just treating the results of sexual violence is a catastrophe. No one is really treating the root or the entirety of the situation. If you just care for the raped women, you will be caring for them up until infinity," said Butros Kalere of Women for Women.

Among those feeling the funding pinch is Heal Africa, a Goma-based NGO that provides medical and social care in the region.

"Sexual violence is not just a physical problem, but we often don't have enough funding and thus, we are limited to real work only for the immediate victims," the organization's community health coordinator, Jean Robert Likofata Esanga, told IRIN, adding that its programmes that focus on prevention, rehabilitation and re-integration continually suffer under-funding.

Effective prevention programming, according to Tasha Gill, child protection officer with the UN Children's Fund (UNICEF) in the DRC, "employs advocacy and awareness to mobilize the communities through community leaders, identifying the issues and working towards longer-term changes within local social norms, while alternately working towards protecting those who are most vulnerable".

Gill also noted that the UN planned over the next few years to better direct funding so that "funding for this sort of prevention programming no longer falls through the cracks".

Even organizations that specialize in protection are feeling the pinch. "We usually try to reduce vulnerability and protect 1,000 women in the communities on the outskirts of Goma by providing them with skills training, literacy and financing a portion of their activities," explained an employee of one such NGO. "Now that our donor wants us to work more in an 'emergency' setting and we are confined to working in the IDP camps, it is very difficult as the population is always in flux. It's hard to keep track of them and be consistent with the training."


The UN's goals for re-integration include "ensuring victims' satisfaction and guaranteeing non-recurrence of sexual violence" as well as ongoing psycho-social care. However, the services are fragmented due to minimal funding, complicated coordination and the distances to be covered for transportation and service provision. Even in Goma's Kibati I IDP camp in July, women were returning without access to further counselling, education or skills-building.

As Constance, a Heal Africa counsellor, said: "We would like to help each victim reintegrate smoothly and carry on with counselling sessions, but we are limited to having a clinic or a skill centre nearby. We do not have the funds to help every woman through her return."

The UN's ideal plan for re-integration also includes a "survivor-centred skill approach". While some NGOs have funding to provide women with the opportunity to learn skills during their hospital stays, their use of those skills upon their return can be restricted by location and availability of material. For example, women are restricted in practising their sewing skills by lack of access to a sewing machine, while literacy skills are restricted by the lack of schools.

"Medical, protection, and legal/justice services and psycho-social care are part of treating sexual violence, but these services also need to include enabling women to be able to provide for their families... for them to feel like they can move on and take care of their children," Mendy Marsh, an independent expert on sexual violence, told IRIN.

Until funding for programmes addressing sexual violence in the DRC makes this a priority, prevention and rehabilitation funding and programming will continue to have to make do with a small percentage of current funding.



1105 Turning to traditional medicine in fight against malaria [Africa]--Encouraging the use of traditional African herbal medicines could prevent some of the one million malarial deaths on the continent, according to specialists attending a conference in Nairobi. Many poor communities, especially in rural settings, cannot afford modern malarial drugs and many people die due to inaccessibility of treatment.

“Malaria kills many people in Africa, both children and adults, despite the availability of free treatment in certain African countries. While it is true many governments in Africa, with development partners, give free pediatric treatment for malaria, many still cannot access this facilities and resort to home treatment,” says Merlin Wilcox of the Research Initiative on Traditional Antimalarial Methods and the University of Oxford.

Some specialists at the ongoing 5th MIM Pan African Malaria Conference in Nairobi said medicines drawn from plants that abound in the continent could be utilized to save many people, especially those in poor settings, from malaria.

BN Prakash, a researcher with the Foundation for the Revitalization of Local Health Traditions, based in Bangalore, said Africa could draw on experiences in India where medicinal plants have been used with great success in the control of malaria-related deaths.

“Research in India has shown a 5-10 times reduction in malaria-related deaths among communities who use traditional medicinal plants like Guduchi [tinospore coeditdia], a local medicinal plant found in India,” said Prakash.

Preserving traditional knowledge

Another speaker, Gemma Burford of the Global Initiative for Traditional Systems of Health, said while there had been increased cases of loss of knowledge about traditional medicinal plants, student-led research could be used to preserve knowledge and create a database on these plants.

“When we carried out research involving school children in rural Tanzania about traditional Maasai medicines, we found out that 48 percent of these children already had knowledge about these plants. We used [this knowledge] to create a database for the purposes of preserving the knowledge and these plants too,” said Burford.

“It is important to note that many malarial drugs are still bought from commercial pharmaceutical shops and not many of them are that cheap. Costs also involve how easy or not it is to access these government facilities, especially in Africa where medical facilities are far-flung,” Burford said.

Educating the youth

Speakers at the conference called on African governments to introduce educational programmes that would teach the younger generations about the traditional methods of treating malaria and other diseases plaguing the continent.

“The biggest obstacle to use of traditional medicines is lack of interest from the youth and teaching them about these medicines would be the best way to let them appreciate their values. Evangelical churches and development agencies must also be persuaded to stop fighting traditional African medicine because modernity and tradition can be married to provide a formidable force against malaria,” added Burford.

Effectiveness and dangers

Doumbo Ogobara, director of the Mali Malaria Research and Training Centre, and a lecturer at the University of Bamako, said there should be more research to ensure the effectiveness of traditional medicinal plants in the treatment and management of malaria.

“More research must be directed towards finding out the effectiveness of these traditional medicinal plants and their safety and efficacy because initiatives on using them could be counter-productive if this is not done. More emphasis therefore must be laid on research for plant-based prophylactics for malaria,” said Ogobara.

Mahamadou Sissoko of the Centre called for caution in taking the traditional medicinal route, arguing that many malaria-related deaths have occurred even among communities that have relied heavily on traditional plants for treatment.

“People are dying even in places where there is still widespread use of traditional medicinal plants and unless the efficacy of a traditional plant on malarial treatment can be ascertained through vigorous research, we could have our backs against the wall. Many traditional healers will abuse this and give anything as medicine so long as it is a plant - we must urge caution,” said Sissoko.



1024 Mentors to boost breastfeeding [Mali]--Have you checked in with your breastfeeding support group? If you were a woman who gave birth in one of Mali’s 48 “baby-friendly hospitals”, you should have been assigned to one that checked up on you – often as soon as minutes after the delivery.

In San village, 380km north of the capital Bamako, dozens of mothers in 2005 formed the “Good Mothers” group – known in the local language as Denbanyuma –to tell new mothers about the all-milk rule; 660 mothers across the country are trained to do the same as part of a government child survival programme adopted in 2007, according to the Health Ministry.

“Before, women fed their newborns tea and water without knowing the consequences of this practice,” San mothers’ group leader Aïssa Tangara Traoré told IRIN. The UN has estimated that 300,000 babies could be saved every year in West Africa if they were fed only mother’s milk for the first six months rather than formula, tea, water or food as is generally the case.

Exclusive breastfeeding has been proven to boost a newborn’s defences against malnutrition and infections, yet according to the UN only 20 percent of mothers in West Africa and Central Africa report practicing it. Mali’s Sahelian neighbours have among the lowest numbers: 6 percent in Burkina Faso, 4 percent in Niger.

In a 2006 Mali government survey, 38 percent of women said they breastfed exclusively. The Health Ministry is conducting a new nutrition survey to be completed in 2010.

To date 48 maternity centres in Mali have been accredited – and 26 are in the review process – as baby-friendly hospitals, which is a UNICEF initiative launched in 1991 to encourage breastfeeding. One of the requirements for accreditation is to form breastfeeding support groups.

“As soon as the baby is washed, we ask the mother to start breastfeeding,” San mothers’ group member Oumou Dembélé, 35 and mother of four, told IRIN. “We visit the mothers every day until they leave the maternity ward.” She added that one Sunday of each month, the Good Mothers group organizes a talk at the San health centre to help convince mothers. “We still have the grandmothers who demand their daughters give babies tea or water,” said Dembélé.


Still perspiring from childbirth at the commune five health centre in Bamako, Diaminatou Cissé rested under her mosquito net with her newborn at her chest. She told IRIN the baby girl would not be fed the same things her older brother was. “My grandmother gave him cow’s milk and tap water. She is no longer alive, but my mother shares her views.” She said she has learned from the centre’s mother mentors that there is already water in milk.

The centre’s midwife, Djeneba Samaké, told IRIN that at baptisms a mothers’ support group talks about breastfeeding. She said economics helps promote breastfeeding: mother’s milk is free. “But even the richest women here who consider powdered milk as a status symbol and sign of progress are now choosing to breastfeed exclusively.”



1024 Death toll rises as cholera spreads [Tanzania]--An outbreak of cholera in northern Tanzania has continued to spread, claiming 59 lives over the past two months. Health ministry officials reported 60 new cases last week.

"We have recorded 3,454 cases of cholera in Tanga region during the last eight weeks," Nsachris Mwamaja, a spokesman for the health ministry, said.

He added that the most affected area was in Handeni District, where health officials have attributed the outbreak to ignorance of hygiene practices.

Mwamaja said the government was making efforts to check the spread of the disease to other regions such as Arusha, Kilimanjaro, Coast and the commercial capital, Dar es Salaam.

"Sufficient supplies of medicines and medical personnel have been sent to the affected areas," he said.

Seif Mpembenwe, Handeni district commissioner, said schools that had been closed because of the outbreak were expected to re-open in November.

"We will continue with sensitization campaigns until the situation improves," he said.

Mpembenwe said residents had been advised to dig and use toilets as well as boil drinking water to prevent cholera, an acute illness characterized by watery diarrhoea. The disease is caused by the bacterium Vibrio cholerae and is spread by eating food or drinking water contaminated with the bacteria.

Health officials fear that the long rains due now could lead to more cases of cholera if correct hygiene is not observed.

Meanwhile, the country continues its efforts to curb the spread of the H1N1 influenza. At least 1,000 suspected cases have been reported, mostly in the northern district of Mbulu.

Blandina Nyoni, the permanent secretary in the Ministry of Health and Social Welfare, said of the suspected cases, 339 had been confirmed from the 985 samples officially tested.

She said the disease had so far caused one death. The government had stepped up preventive measures, including screening centres at entry points and enhancing public education.

"People should not panic," Nyoni said. "Much as we don't have vaccines for swine flu in the country, there are adequate supplies of tamiflu antibiotics that are used in the treatment of swine flu."

The influenza is caused by a viral infection. Its symptoms are similar to those of influenza, such as fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort.



1024 Child disability, the forgotten crisis [DRC]--Looking at herself in the mirror, nine-year-old Helena squealed with delight at her reflection, standing upright with just the slightest support of her therapist. A year before, Helena was diagnosed with cerebral palsy and identified for therapy in Mugunga II IDP camp in Goma, eastern Democratic Republic of Congo. Helena, able only to crawl, had been confined to very specific spaces due to the lava in the IDP camp.

Helena was one of the lucky few to have received regular treatment. Robert Golden, a doctor, states in the 2008 UN Children’s Agency (UNICEF) report, Monitoring Child Disability in Developing Countries, that it is an “important but largely unaddressed issue”. This is especially true in DRC where child disability receives little attention among the myriad crises befalling the country.

According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), two million people are displaced in the eastern DRC. Combine this figure with World Health Organization (WHO) data that 10 percent of the world’s population suffer some form of disability, and that would mean 200,000 disabled people among the displaced, many of them children.

“Attention and funding for programmes addressing disability are largely under-funded worldwide, and particularly in Congo,” says Heal Africa’s Laura Keyser.

“The international community might not see disability as an emergency worth focusing on now, but it will become a full emergency if nothing is done,” said Loran Hollander of Heal Africa’s hospital in Goma.

Increasing Risk Factors

While funding for treatment remains minimal for agencies specializing in treating disabilities, the number of disabled children and those at risk continues to grow due to the increased risk factors brought on by the breakdown of the health infrastructure, ongoing violence and displacement in the eastern DRC.

Minimal access to healthcare, clean water, and overall poor nutrition during pregnancy lead to common congenital disabilities in children such as spina-bifida and limb deformities, and young children predisposed to early childhood diseases such as meningitis and polio, explained Keyser.

Access routes to health centres are often blocked for patients and medical teams. This lack of access leads frequently to birthing complications, child developmental delays and maternal mortality.

Furthermore, the prevalence of rape in the DRC is also linked to a probable increase in child disability. “Frequently women pregnant from rape do not seek pre- or peri-natal care, which can lead to the problems aforementioned, as well as birth trauma - either to the baby (ie lack of oxygen leading to cerebral palsy or some type of developmental delay) or to the woman (ie a fistula, which may or may not leave them incontinent),” said Keyser.


“Unfortunately, disabled children are more vulnerable to abuse, exploitation, neglect and discrimination. They face reduced social participation and have less access to education and other social services than children without disabilities,” states Golden.

In addition, according to Handicap International and Heal Africa, inside the camps as well as outside, children with a disability struggle daily with social stigma and discrimination.

Proper treatment, according to UNICEF, Handicap International and Heal Africa, provides the children with the physical ability to function more fully in society while also educating the community to break down stigma and social restrictions.

UNICEF notes that “early detection and intervention might confer benefits to children at risk for disability and prevent long-term functional limitations”.

Jusbeen, 4, came to the Heal Africa’s clinic with a serious infection, a noma, which had “scarred down” his mouth, making it difficult to eat or drink. Therapists discovered that Jusbeen also suffered from developmental delays. However, since his disability was caught early, he has undergone a significant transformation. With ongoing therapy and constant encouragement from his mother, Keyser notes, “he is now able to walk with hand-held assistance, smiles, laughs and engages in play activities which were impossible before”.

Due to minimal international attention to child disability amid the numerous crises afflicting the DRC, children like Jusbeen and Helena, who received treatment, remain among the minority. “These children need all the help they can get,” says UNICEF. At present, that help is limited.



1024 Humanitarian stockpile takes shape - on paper [West Africa]--When a storm hits in Togo, disaster relief items must be flown in from Brindisi, Italy, but that is just too far, according to the Economic Community of West African States (ECOWAS), which is formalizing the region’s first government-operated humanitarian stockpile in Mali’s capital Bamako.

The best-stocked depot that responds to West African requests for help during natural disasters is in Brindisi, Italy. Managed by the UN’s World Food Programme since 2000, the depot is one of five UN humanitarian response depots, with the others located in Panama, United Arab Emirates, Malaysia and Ghana.

ECOWAS’s Director of Humanitarian and Social Affairs, Dan Eklou, told IRIN that during 2009 flooding in West Africa, it took more than one week for some areas to receive materials from the Brindisi depot, which warehouses everything from tents to toilets, biscuits to blankets. “If the goods were in Bamako, it would not have taken that long to reach people who needed help.”

In Abuja, Nigeria in 2000 ECOWAS voted to create two permanent logistical bases in West Africa, one to store humanitarian supplies and the other peacekeeping materials to serve ECOWAS member states. Mali and Liberia were subsequently chosen as sites for the respective bases.

Nine years later, West African governments are preparing to sign the humanitarian stockpile into existence through an agreement with the government of Mali, which is making available 15 hectares at its airport in Bamako to house the planned depot.

Eklou said it will take time to conduct feasibility studies for construction. The organization is considering offers from the United Nations to build and stock the new warehouse.

The region’s stockpile capacity is currently inadequate, according to head of West Africa’s UN Office for the Coordination of Humanitarian Affairs (OCHA), Hervé Ludovic de Lys. “Given weather trends, climate change pressure and other indicators, it will become increasingly necessary to decrease the distance between depot and beneficiaries and to increase the stock of materials that can be deployed in times of catastrophe or crisis.”

As important as ease of access, is sovereignty added Eklou. “We do not want to depend on others from outside the region. There should be no constraints to disaster response.”

Pending signature of the agreement, all stockpile operations will be tax-free and free from import or export restrictions that govern the movement of goods in and out of Mali. Employees will have diplomatic immunity.

The depot is also intended to serve as a training facility for humanitarian rapid response exercises.



1024 Aid groups mobilize to help wounded [Guinea]--Aid agencies are mobilizing funds and relief supplies to help more than 1,000 Guineans injured in 28 September violence, as well as to brace for further unrest as the country remains “very volatile”, according to the UN.

UN agencies, donors and NGOs in the capital Conakry are providing meals for hospital patients, giving medical supplies to health centres and ordering in new supplies to ensure adequate emergency stocks, aid workers in Guinea told IRIN.

Three weeks after over 150 people were killed in a military crackdown on demonstrators in the capital Conakry, with women and girls raped, Guineans are coping with the aftermath, some still searching for disappeared relatives’ bodies. Uncertainty and tension reign.

“The situation is very volatile and it is feared that protests may continue with even more casualties in the next days or weeks,” said a World Health Organization (WHO) document on the situation in Guinea.

The number of wounded seeking treatment is rising as more people injured on 28 September visit health centres; aid workers and human rights activists say many people needing medical care have stayed home for fear of repression.

Immediately following the violence the Guinean Red Cross deployed scores of volunteers to assist the wounded, and other aid agencies including Médecins Sans Frontières provided emergency assistance to the health sector.

The UN on 14 October allocated US$417,205 from its Central Emergency Response Fund, CERF, for a WHO project to support health facilities in Conakry.

The funds will go toward medicines, trauma kits, rape treatment kits and blood transfusion supplies, as well as preparing health personnel to deal with trauma patients, according to the document.

More than 200 people are known to be in “a very serious” condition and need lengthy treatment, the document says.

Current emergency stocks of relief supplies are insufficient to deal with repeated shocks, according to the UN in Guinea.

“The main issue now is to determine the gaps in medical and relief supplies,” said Philippe Verstraeten, head of the Office for the Coordination of Humanitarian Affairs in Guinea. “We are working on defining those needs so we can mobilize for further funding.”

The NGO Terre des hommes (Tdh) is providing meals to patients in Donka Hospital, one of Conakry’s main public hospitals, according to Tdh’s Marie-Jeanne Hautbois. The Health Ministry’s crisis committee requested this assistance, as the ministry has said victims would receive free treatment including food, she said. The food is provided by the ministry, private donations and Tdh.

Guinea’s health system has long been in a dismal condition, with frequent ruptures in medicines and medical supplies. Since the junta took power in December 2008 government ministries, including the Health Ministry, have had no budget, according to a ministry official. In July the Health Ministry chaired an emergency meeting about a shortage of equipment for blood transfusions.



1024 Shift aid base to "safe" areas in-country, urges UN official [Somalia]--Humanitarian agencies should move from Nairobi to "relatively safe" areas of Somalia to be able to better serve more than 1.5 million internally displaced people (IDPs) caught up in a "deepening" humanitarian crisis, Walter Kälin, Representative of the UN Secretary-General on the Human Rights of IDPs, said on 21 October.

"It is essential to find ways to improve humanitarian access and security of humanitarian workers," Kälin told a news conference in Nairobi. "To the extent possible, humanitarian agencies must shift their operations from Nairobi to Puntland, Somaliland and other areas from where the affected regions can be serviced."

He said these agencies must be given the staff and resources necessary to effectively work in such a difficult and dangerous environment, and should receive respective support by donors.

Marcus Prior, a spokesman for the World Food Programme in Nairobi, told IRIN: “WFP retains several operational bases across Somalia and has international and national staff inside the country. We would like to have an even greater presence, but Somalia is probably the most dangerous place in the world for humanitarian workers to operate in."

Conflict in Somalia over the past 18 years has led to hundreds of deaths and the displacement of millions of others internally and externally. The UN Refugee Agency (UNHCR-Somalia) estimates that 1,550,000 Somalis are IDPs while there are some 312,800 Somali refugees in Kenya and another 146,000 in Yemen.

Since 1 July, the agency says, some 89,000 civilians have been displaced from Mogadishu due to fighting between government forces and Islamist militias opposed to the government.

Historical divisions

Since the ousting of President Siad Barre in 1991, Somalia has been largely controlled by warlords backed by different militias. At least 15 attempts have been made to re-establish a national government, the latest being the installation of President Sheik Sharif Ahmed in January 2009. However, Islamic militias opposed to Ahmed have continued attacks on government forces and civilians as well as African Union peacekeepers.

The country is divided into three regions: the self-declared republic of Somaliland in the northwest; the autonomous Puntland region in the northeast; and the south-central part of the country, housing most of the IDPs.

Security issues

Puntland welcomed Kälin’s call and said it was ready to cooperate with humanitarian agencies.

"We will welcome and ensure the security of any agency that wants to establish a base here," said Ali Mohamed Hayaan, director-general of Puntland’s ministry of security.

Hayaan said it made sense for aid agencies, wanting to access south-central Somalia, to operate out of Puntland, "since it would be cheaper and closer to those in need".

Ali Sheikh Yassin, deputy chairman of the Mogadishu-based Elman Human Rights Organization (EHRO), said while there were "massive violations of the rights of the displaced and, ideally, agencies should be close to them to monitor these violations, however it won’t be easy for aid agencies to move to Somalia.

"Unfortunately, the security situation is such that even Somalis like us are operating under the most extreme insecurity."

Deepening crisis

Kälin, who visited Somalia from 14 to 21 October, said the international community was failing the IDPs when the humanitarian crisis was deepening. He said there was a need for a stronger engagement of the international community in Somalia.

"I am shocked by the degree of violence facing the civilian population in central and south Somalia," he said. "Serious violations of international humanitarian and human rights law, in particular indiscriminate attacks and shelling of areas populated or frequented by civilians, are being perpetrated by all parties to the conflict with total impunity.

"Such acts are a major cause of displacement and may amount to war crimes and other crimes under international law."

Kälin urged all parties to the conflict - state actors and anti-government groups - to abide by their obligations under international humanitarian and human rights law.

Deplorable camp conditions

"I am deeply concerned about the unacceptable living conditions in some of the IDP settlements I have visited, including lack of proper shelter, food and drinking water; severe malnutrition of children, very poor sanitation, lack of education and health facilities and severe overcrowding," Kälin said.

Calling on donors to be prepared, Kälin added: "Torrential El Niño rains are expected to further aggravate an already dramatic situation."

He said lack of humanitarian access to those most in need, dangers for humanitarian workers, such as abductions, as well as a sharp decline in donor contributions, had exacerbated the "long-standing humanitarian crisis and risks bringing it to hitherto unknown levels".

Exploitation risk

Although he noted there was risk of aid being diverted, Kälin urged donors not to reduce humanitarian aid. "This would only mean punishing the most vulnerable among already destitute communities but also playing into the hands of radical elements who could easily exploit the situation," he said, urging all actors to grant humanitarian access and ensure safety of humanitarian workers.

Although he did not visit south and central Somalia, Kälin said he had received testimonies regarding violence and the appalling living conditions of IDPs in the Afgoye corridor, close to the Somali capital, which has one of the highest IDP densities worldwide.

"Existing humanitarian aid is pitifully insufficient compared to the needs of the displaced who often face severe protection risks and marginalization," he said. "Vulnerabilities are heightened by the fact that many IDPs have been displaced more than once."



1024 US troops help build disaster response capacity [East Africa]--Military contingents from five East African countries have begun field training in disaster and emergency response as well as anti-terrorism in the northern Ugandan district of Kitgum.

"The joint field training being conducted in northern Uganda is expected to develop further the capacity of the East African Community's armed forces in humanitarian assistance; disaster relief management; and, to some extent, peace support operations, counter-terrorism operations, disaster management and crisis response," Beatrice Kiraso, the deputy secretary-general of the East Africa Community (EAC) in charge of the community's political federation, told IRIN.

Supported by the US army, the 10-day training is codenamed "Natural Fire 10" because it is the 10th time such exercises have taken place since their inception in 1998. It began on 16 October with contingents from Burundi, Kenya, Rwanda, Tanzania and Uganda participating. At least 550 US marine personnel and 133 military personnel from each of the five countries are taking part.

An LRA connection?

US military officials have dismissed speculation that Natural Fire is being held in preparation for a new offensive against the Lord’s Resistance Army (LRA), whose rebellion has devastated northern Uganda, the Kitgum area in particular. In late 2008 the US was a partner with Ugandan troops in Operation Lightning Thunder, a botched attempt to capture LRA leader Joseph Kony in the Democratic Republic of Congo. Tens of thousands of civilians in the DRC, Southern Sudan and the Central African Republic have been displaced because of LRA activity.

According to long-time regional observer Peter Eichstaedt, author of First Kill Your Family - Child Soldiers in Uganda and the Lord’s Resistance Army, the joint exercises convey a clear, if tacit, message to Kony. “That message being, of course, that a multi-national force of 1,000 - an effective number for a fighting force anywhere in the world - can be assembled in this strategic location with relative ease,” Eichstaedt wrote on his blog.

“Such a force would be a huge problem for someone like Kony, should he think about a return to northern Uganda. It shows that Uganda has allies who are willing not only to donate moral support and money in the fight against Kony and his maniacal militia, but are willing to put boots on the ground.

“This is an acknowledgement that Kony is much more than Uganda's problem, and has become a regional nightmare,” he writes.

While it makes no mention of the LRA, the US Army's Africa website says of Natural Fire: “By building capacity within partner nations and increasing our ability to work together, US Army Africa will be better prepared for future engagements. In doing so, the US Army also solidifies military rapport with allies in East Africa, key to supporting stability in the region.”

Regional threats

Kiraso said the training was taking place while the EAC was embarking on a new phase of strengthening regional integration even as the region faces "real and potential complex emergencies", which could translate into threats to socio-economic, cultural and political wellbeing of East Africans.

These threats, she said, ranged from natural to man-made disasters; poverty and disease; porous borders and the proliferation of small arms and light weapons; internal strife; and insecurity in states neighbouring the EAC.

"It is very important to develop the East African Community’s capacity to handle such emergencies and threats to peace, security and stability," Kiraso said.

Maj-Gen William B. Garrett, the commanding general, US Army-Africa and US Army-Southern European Taskforce, said the training would help build the capacity of East African armies in combating terrorism and responding to humanitarian catastrophes.

Ugandan army commander, Gen Aronda Nyakarima, said the LRA was no longer a threat to Uganda’s peace as the group was now in the Democratic Republic of Congo and in the Central African Republic. Regional cooperation, he added, was therefore required to get rid of the LRA. 



1024 Humanitarian crisis now unfolding in Angola - DRC [Luanda-Kinshasa]--A burgeoning humanitarian crisis among the tens of thousands of people expelled by the Democratic Republic of Congo (DRC) to neighbouring Angola is beginning to unfold.

"The fears of a humanitarian emergency and the needs of the people have been confirmed," said the UN Refugee Agency (UNHCR) representative, Bohdan Nahajlo, after an assessment visit to the affected region in northern Angola.

The most urgent needs of the expelled are shelter, food, medicine and sanitation facilities.

Tit-for-tat expulsions since August 2009 by the governments of Angola and DRC have led to more than 32,000 Angolans being repatriated to Angola, and about 18,800 Congolese nationals being deported from Angola. Following talks on 13 October in the DRC capital, Kinshasa, both countries agreed to "immediately stop the expulsions of citizens of their respective states".

Nahajlo told IRIN that providing humanitarian assistance to the displaced was becoming a race against time, as the rainy season was closing in and would make the roads from the Angolan capital, Luanda, impassable, and the M'banza Congo airport in Angola's northern province of Zaire was not an option because it was closed for renovation.

"Sanitation [in the reception centres] is very bad," he said. Around 17,500 expelled Angolans were in the Mama Rosa settlement in the border-crossing town of Luvo.

Three settlements close to the town of Cuimba, near the DRC border in Zaire, were also hosting displaced people: there were about 5,000 in Lendi, about 2,500 in Casileha, and around 2,600 in Buela.

In Lendi more than 5,000 refugees had hastily erected very basic shelters. "Water is being given directly to the population in buckets - there are reports of people ill with diarrhoea and vomiting," Nahajlo said.

However, the exact number of people displaced to Angola is unclear, as people may have fled to Cabinda, the oil-rich Angolan province surrounded by DRC, or other areas bordering DRC, he told IRIN.

A recent UNHCR assessment of Angolan refugees in the DRC found that about 43,000 were willing to be repatriated voluntarily, but "in this atmosphere people will be encouraged to return," and the refugee agency was expecting a second wave of about 50,000 people, Nahajlo said.

"Besides addressing the immediate humanitarian and protection needs, we should also prepare for a continuous flow of Angolans into the country," who were crossing the border out of fear, and the hope of being reunited with their families in Angola, he warned.

The speed of the expulsions meant that some people had been driven from their places of work without being able to inform their families, people in mixed nationality marriages had been forbidden to accompany their spouses to Angola, and families had been split, with children divided among their parents.

"I met a man who told me he was given 24 hours to leave, but he could not reach his wife, who had travelled to another town to visit her sick mother. He ended up leaving the family behind," Yolanda Ditewig, a UNHCR Protection Officer who was part of the assessment team, told IRIN.

The Angolan government has estimated that about 10,000 tents, of which UNHCR is expected to provide about half, would be required to provide shelter for the expelled Angolans.

During Angola's almost three decades of civil war, which ended in 2002, the DRC hosted more than 100,000 Angolan refugees; since then, thousands of undocumented Congolese migrants - mostly thought to be illegal diamond diggers – have been working in Angola.

The ebb and flow of people expelled from both sides of the border has become a common spat between the neighbours. According to the UN Office for the Coordination of Humanitarian Affairs (OCHA) there have been six major waves of expulsions since 2003, in which a total of 140,000 Congolese were deported from Angola.

Back in the DRC

"There are no sites to host the expelled people [from Angola]," said Willy Iloma, who chairs a human rights organisation and coordinates NGOs in Muanda territory on the Angolan border, in the extreme west of the DRC's Bas-Congo Province. "They are now scattered in churches and among host families; some have gone to Kinshasa [capital of DRC] and other towns."

According to the UN Office for the Coordination of Humanitarian Affairs, there are two groups in Muanda and Tshela territories: "forced voluntary expulsees who left following threats, and those who were physically deported to the border. Most of them are small-businesspeople, as well as women and children. Although these expulsees have humanitarian needs, the situation is now under control and aid is not currently required [in DRC]."

Iloma said the expulsees "have gone through a hell that began in Angola when they were arrested and held in cells for three days. Women were raped and men molested, and their goods were taken away before they crossed the border. Some turn to begging; others sell what few possessions they have left in the market."

Some of the women who were raped were pregnant, said Marie Munzi, who was among the DRC citizens expelled from the Angolan enclave of Cabinda. "Some women gave birth during their journey."

Angolan "security agents searched us, even our private parts. They took everything. Women had to abandon their husbands and here we are, abandoned; nobody is looking out for us," she said.

Simon Mbatshi, the governor of Bas-Congo, said steps had been taken to meet humanitarian needs, such as making trucks available to send food to the affected areas, and "the government has decided to vaccinate all the children crossing the border."


1024 Cholera returns and kills five, so far [Zimbabwe]--Five people have died from cholera at two different locations in Zimbabwe, and 30 other people are undergoing treatment for the waterborne disease, raising the spectre of another epidemic.

The permanent secretary for health, Gerald Gwinji, told the state-run newspaper, The Herald, on 20 October that three people had died from cholera in Mashonaland West Province, in the northeast of the country, while two other deaths were recorded in Midlands Province, in central Zimbabwe.

Gwinji attributed the deaths in Gokwe North, Midlands, to "religious objectors who for a long time have been reluctant to seek medical attention. We are still trying to come up with ways of addressing this special group."

A cholera outbreak that began in August 2008 and lasted for a year before it was officially declared at an end in July 2009 caused the deaths of more than 4,000 people and infected nearly 100,000 others.

The cause of this epidemic was dilapidated and broken sanitation and water infrastructure, much of which is still in the same state as a year ago, so the coming rainy season is likely to facilitate the spread of the disease.

"We have received confirmation of the cholera cases from the government and this poses a new challenge, in the sense that there is need to educate and sensitise some communities which are resisting prevention and medication for cholera," said Tsitsi Singizi, a spokesperson for the UN Children's Fund (UNICEF).

"Our education teams are already out in full force, and we hope that this time the effect of cholera will not be as it was last time," she commented.

Samuel Sipepa Nkomo, the minister for water resources development and management, told IRIN that repairing the water and sanitation infrastructure in the capital, Harare, was the main priority, as this had been the epicentre of the previous cholera outbreak.

Depressed state of affairs

"I am currently touring water sources throughout the country to establish the state of collapse and dilapidation, and what I have seen so far is very depressing," he said.

"In some parts of the country, some settlements have stopped using some dams because too much raw sewage was discharged into them. We want to ensure that if Harare is rehabilitated we will not have other potential sources of cholera outbreaks."

Dams are the usual source of water for drinking and household use in towns as well as rural areas, but when many of these became too polluted, people resorted to digging shallow wells to obtain water. Pit latrines were often dug too near the wells, which became contaminated and not only helped spread cholera, but also made the disease difficult to combat.

The chairperson of the Combined Harare Residents Association, Simbarashe Moyo, told IRIN there was concern over the slow pace of infrastructure repairs, but acknowledged that "After many years of neglecting our water and sewer infrastructure by many administrators, it is only fair to acknowledge the good work that the current administration at the municipality is doing."

However, Mluleki Dube, who lives in Ashdown Park, a middle-class suburb in Harare, told IRIN that the area had been without water for the past 10 days. "The sanitation situation ... is a ticking health time bomb because some residents now resort to using secluded areas to relieve themselves, while others have sunk shallow and unprotected wells to provide water."



1024 Rains wash away IDP shelters in Mogadishu [Somalia]--Flash floods have rendered homeless thousands of internally displaced persons (IDPs) living in camps in and around Mogadishu, the Somali capital, locals say.

"The rains that fell on Friday and Saturday [16 and 17 October] destroyed many of the makeshift shelters," Jowahir Ilmi, head of the Somali Women Concern (SWC), a local NGO, said. "The resulting floods washed away many of the shelters."

Ilmi said many IDP families lost everything - "the floods took their utensils and anything that was not fixed to the ground”.

Bilmo Nur, who is looking after four grandchildren, told IRIN she sought shelter with another family after the rains destroyed her makeshift home. “My grandson [18 months old] was almost swept away by the water.”

Nur said the children were weak and she was worried the cold weather would make matters worse.

"We don’t have food but we need shelter more urgently,” she said, adding that there had been a break in the rains but it was not expected to last long. “I hope we will get some tents and plastic sheeting before the next [flood].”

Khadra Ali, a community activist in the camps, told IRIN that many in the Ali Somali displaced camp, home to 350 families (2,100 people), were sleeping in the open. “If, as expected, we get another downpour today or tomorrow, we don’t have any place to shelter.”

Ilmi said the rains were also making the sanitary conditions of the camps worse. “The conditions were bad to begin with but the rains are making them worse.”

At the mercy of mosquitoes

Meanwhile, in the southern coastal city of Kismayo, 500km south of Mogadishu, heavy rains are adding to the misery of the displaced who fled the city during the recent fighting between two Islamist groups, a local activist told IRIN.

The source said thousands of IDP families who had not returned to city were at the "mercy of the rains and mosquitoes".

"Around 6,000 families [36,000 people] are living in the open or in very poor conditions," the source said, adding that most of those who fled the city [on 30 September and 1 October] had not returned.

Some 900,000 people who fled the fighting in Mogadishu between the government and Islamist insurgents have settled in the Mogadishu and Afgoye corridor, according to aid agencies.

Conflict, drought and hyperinflation have combined to create a humanitarian crisis in Somalia, with some 3.6 million needing food aid, according to the UN.



1017 Cholera kills at least 51 in north [Cameroon]--Cholera has killed at least 51 people in the past few weeks in northern Cameroon, where health experts say safe water and proper sanitation are sorely lacking.

“[The fight against cholera] here will be difficult because the hygiene conditions are awful,” said a health official who was not authorized to be quoted. He noted that most people defecate in open areas.

The regions affected are Cameroon’s North and Extreme North, with the first infections reported in September, according to the Health Ministry.

As of 14 October 23 people had died in Extreme North, of 144 infected, according to a Health Ministry document that is updated regularly, while in neighbouring North region 28 people had died of 152 infected.

This area of Cameroon is on the southern fringe of the Sahel and water is scarce; existing boreholes and wells are insufficient to meet the needs of the population, according to UN Children’s Fund (UNICEF) in Cameroon.

In rural Cameroon only 30 percent of inhabitants have access to safe water and 15 percent to sanitation systems, according to UNICEF.

In the cholera-hit areas local authorities have begun disinfecting wells and other water points, according to Albert Friki, prefect in one affected department of Extreme North region. Authorities are also urging communities to practice proper hygiene.

“We are urging people to be careful with the food and water they consume, and with how they handle the remains of people who died of cholera,” he said.

Cholera epidemics are frequent in northern Cameroon but the current outbreak is particularly severe, the health ministry official told IRIN. The highest number of cholera deaths in recent years was in the commercial capital Douala in 2004 when cholera killed 100 people.

Some 75 percent of people infected with cholera develop no symptoms but can pass on the infection, according to the World Health Organization; the disease is extremely virulent and can kill healthy adults within hours, WHO says.



1017 Stopping cholera emergencies [West Africa]--Cholera outbreaks in West Africa generally trigger extra hand-washings in households and panic-buying of bleach for treating water. But beating the deadly – but easily preventable – illness requires that such hygiene practices become routine, health experts say.

Researchers with the London School of Hygiene and Tropical Medicine (LSHTM) say knowing the drivers behind behaviour and tying hygiene messages to those impulses is crucial for preventing cholera, which has become a recurring health emergency in West Africa.

“If we want sustainable change we need to make sure people practice things so they become habits,” Jeroen Ensink of LSHTM’s environmental health group told IRIN.

One way for aid agencies to do so, he said, is to dissociate hygiene messages from cholera – which is seasonal – and link them instead to general diarrhoeal disease.

Ensink also said it might be time to “re-brand” hygiene and health messages, as knowledge of cholera’s causes does not always translate into new habits. “Hand-washing messages need not be just about health; they can be about: if you want to be modern, to smell nice, to be attractive to the opposite sex, use soap.” The use of proper latrines can be linked to privacy instead of just proper hygiene, he added.

LSHTM has studied the impact of government and aid agency prevention and preparedness measures in Guinea and Guinea-Bissau as part of a project funded by the European Commission humanitarian aid department (ECHO).


The ECHO project aims to build a more coherent approach to cholera control with sound preparedness and early response. And ECHO says ‘quick impact’ actions in vulnerable communities should be accompanied by longer-term prevention measures.

To date, emergency and development strategies fail to address the disease properly, lacking common objectives and complementary actions, ECHO says.

ECHO is focusing on Guinea and Guinea-Bissau, where cholera has become endemic; during 2007 and 2008 over 23,000 people were infected and 560 died in the two countries.

But all of West Africa is highly vulnerable to cholera and a regional approach is needed; ECHO and its partners will study lessons from Guinea and Guinea-Bissau to see what might be applied more widely.

As part of the ECHO-funded project UN Children’s Fund and NGOs are training local health workers in responding to cholera, boosting communications strategies and developing emergency kits, which include sanitation and water purification materials, to keep outbreaks in check.

“We know that the solution to cholera is an overall improvement in water, sanitation and environmental conditions,” said ECHO water and sanitation expert Francisco Gonzalez. But he said before such significant and permanent changes can be made, proper preparedness and response can save a lot of lives.

But to be effective anti-cholera actions must not be merely reactive, health experts say. LSTHM researchers observed in Guinea-Bissau that while most people could recite verbatim hand-washing and other hygiene messages, they apply them consistently only when cholera strikes. Changing such behaviour takes years, not months, said LSHTM’s Ensink.

The World Health Organization calls cholera a principal indicator of social development. Overcrowding in poor-sanitation urban areas is a main driver of cholera. And the disease hits the poorest of the poor most heavily. With factors like poverty, rapid and unregulated urbanization and poor infrastructure all favouring cholera outbreaks, substantial socio-economic fixes are necessary to eliminate cholera as a cyclical health disaster.


1017 Driving home the cholera message [Guinea-Bissau]--In Bafata, Guinea-Bissau, children go door-to-door counting mosquito nets, monitoring hand-washing and checking the distance between kitchens and latrines. The activities are among efforts by health NGOs and authorities to fill the gap between cholera-prevention messages and behaviour, after a 2008 epidemic killed some 220 people and infected at least 13,000.

The national flag is hoisted in front of the cleanest house, and the family is feted in schools and on local radio, Ingrid Kuhfeldt, head of NGO Plan International in Bissau, told IRIN. Plan International, which has been working in Bafata for 15 years, launched the scheme to prevent future cholera outbreaks.

“There is much more competition now on who has the best hygiene materials and the cleanest house – we hadn’t seen this kind of rivalry before,” Kuhfeldt said.

Children also try to dispel hygiene “myths” with families – for example that lemon juice can disinfect water – and show people how much chlorine to drop into a well to clean the water, Kuhfeldt said.

Rather than resenting the children, adults listen, partly because of children’s rising status in society over recent years, according to Kuhfeldt. “[People] have a growing respect for their children having seen them make speeches in front of audiences in schools, heard them on the radio and seen them set up committees,” she said. “They’re starting to realize they can learn from [the children].”

In Guinea, with the support of aid agencies and the local health services, a local radio station in Kindia helps spread hygiene messages through radio spots and village contests. A team from the radio station organizes public games in remote communities, quizzing people on hygiene and cholera prevention and asking people to make up songs on a hygiene-related theme, according to Aboubacar Sylla, head of programming at the station. Prizes include radios, water buckets or farming tools.

"Hundreds of people come out for these activities; people really like it," Sylla said. "And it is quite interactive; we encourage everyone to talk about the subject at hand."

Bafata and Kindia recorded no cholera in 2008, despite infections in neighbouring regions.

Jeroen Ensink of the London School of Hygiene and Tropical Medicine – which recently studied prevention and preparedness efforts in Guinea and Guinea-Bissau – said it is not enough to simply impart knowledge; people must have incentives to begin forming new habits. He noted that research at LSHTM showed just 60 percent of the university’s staff clean their hands after defecating, despite “knowing better”.

Plan International's Kuhfeldt said programmes such as Plan's in Bafata work well because of the long-term trust the NGO has already built up among inhabitants and local authorities in the small community. The NGO has been engaged in education, clean water, children’s rights and health in Bafata for 15 years. “In Bafata we know everyone – the governor, the ministers of education and health and the communities."

But not all at-risk communities have the long-term presence of an international NGO. The European Commission humanitarian aid department (ECHO) says in a paper on cholera in West Africa: “The reported lethality rates in most of the countries show weak response mechanisms to the [cholera] outbreaks, mainly in those [countries] where no external assistance has been provided; and the low lethality rates of some countries are due to an external assistance.”

Health experts say it is essential that locals apply and perpetuate long-term education and prevention measures.



1013 Fifty quarantined as first H1N1 death reported [Tanzania]--At least 50 people have been quarantined in Tanzania's northern district of Mbulu to curb the spread of influenza H1N1, a highly contagious viral disease that killed one person last week, say health officials.

The death is the first in East Africa.

"We are struggling to control [the] further spread of the disease. Until late yesterday [11 October], the number of people suspected to have been infected had reached 158," said Anael Pallangyo, Mbulu District Medical Officer.

Pallangyo said a 40-year-old primary school teacher died of H1N1 at the local district hospital where she was admitted for treatment two days earlier. All 18 dispensaries in the district were now on alert and about 50 patients placed in isolation wards.

Tanzanian health authorities have stepped up surveillance at all the country's entry points, where people with flu-related symptoms such as coughing, fever and sneezing are taken to hospital for screening and treatment.

The ministry of health recently announced 172 confirmed cases of H1N1 at the end of September.

As of 9 October, 24 countries in Africa had officially reported 12,456 laboratory-confirmed human cases of H1N1, including 70 deaths, according to the UN World Health Organization (WHO). South Africa has reported most of the cases at 11,545 and 59 deaths.

WHO, however, notes that the reported number of cases understates the real number as countries are no longer required to test and report individual cases.



1013 How To: Rescue people trapped in a collapsed building [Kenya]--When an earthquake strikes a town, or a building is levelled by an explosion, news footage invariably shows search and rescue teams trawling through the rubble looking for survivors. But what does it take to rescue people trapped under tons of concrete?

Step one - coordination

The first thing is to activate search and rescue teams, often highly trained volunteers.

"Most of our members are doctors, ambulance operators, engineers or fire fighters," said John Holland, operations director of Rapid UK, a charitable search and rescue group.

They go through a rigorous two-year training process before they are allowed to assist in disasters.

"We try to deploy within 24 hours because the earlier we are on the ground, the better the chances of rescuing survivors," Holland said. "During the Pakistan earthquake [in 2005], we were able to deploy in 21 hours."

The International Search and Rescue Advisory Group (INSARAG) - a global network of more than 80 countries and disaster response organizations under the UN umbrella - has standardized guidelines for rescue missions.

"Once a government has made that call for international assistance, we alert our members, who begin mobilizing to travel to the area," said INSARAG's Winston Chang, a Singapore Civil Defence Force veteran who coordinated the search and rescue efforts following the recent earthquake in Padang, Indonesia. "We run a portal where once a disaster occurs, we pool information and our various teams can input data on their movements - whether they are on standby, mobilizing or have reached the ground."

INSARAG will usually set up an “on site operations coordination centre” where all search and rescue teams get instructions - depending on their area of specialty - on where to go and how to operate; the desk holds regular meetings to update itself and the teams on the progress being made on the ground.

"These operations can be quite large; just now in Padang, there were a total of 21 teams with 668 personnel and 67 search dogs," Chang said. "They need bases of operation where they will fuel their heavy equipment, coordinate their internal logistics and sleep."

"We also ensure that they follow specific standards of operation and remain culturally sensitive, especially since the teams are from such diverse backgrounds," he added.


Step two - analysis

Once in the disaster area, the first step is to analyze the task at hand, said Julie Ryan, a volunteer with the British NGO, the International Rescue Corps.

In a collapsed building, "you need to analyze the building, assess its history and try to establish where in the building people are most likely to be", she told IRIN. "You also need to determine how badly a building has been damaged and whether it is likely to collapse any further, causing damage to [survivors] and rescue teams."

The assessment also involves checking for hazards such as downed power lines, gas leaks, flooding and hazardous materials. Protective gear includes special suits, gloves, masks, and oxygen and carbon monitoring systems for air quality.

Step three - search mode

At its most basic, this involves trying to spot limbs in the rubble, and calling out to survivors to identify their locations.

Rescuers look for "voids", or pockets where people may be trapped when walls collapse or where survivors may have hidden, such as under desks, in bath tubs or stairwells.

"We feed a camera on the end of a flexible pole into the collapsed building - this shows where people are and how much of the building's structure is left," Ryan said.

"Rescuers also use sound location devices connected to a microphone system; the device bangs on the rubble three times and if people tap back or call out for help, they can be tracked and assisted," she added.

Listening is a crucial part of the operation, and search teams will often stop for several minutes to try to hear any calls, scratches or taps.

Other search tools include a thermal image camera system, which shows areas of body heat, and trained sniffer dogs. "We also use a carbon dioxide analyzer, which helps us detect people who might be unconscious but still breathing," Ryan said.

Buildings that have been searched are marked with INSARAG-recognized signs to avoid duplication of searches.

As survivors are found, rescuers try to get them to keep talking to determine their exact location, and dig towards them - the least dangerous way to do this is by hand.


Step four - the rescue operation

If survivors are trapped under rubble, it may need to be stabilized first; a process called cribbing - the construction of a rectangular wooden framework, a box crib, underneath the debris - may be used.

Survivors who are not able to move usually need to be lifted, dragged or carried out of the rubble using special equipment.

"If people cannot be manually dug out, then we can cut them out - there are specialized tools that can cut through concrete, metal and wood to reach survivors," Ryan said. "There is also a process known as 'slabbing', where heavy slabs of concrete are removed in order to free survivors - this is always a very difficult judgment call, because it risks further collapse, which could injure or kill more people."

Concrete saws, jackhammers, chainsaws, bolt cutters, cranes and bulldozers are all part of the tool kit; chains, cables, anchors and rope-hauling systems are used to remove large pieces of masonry. Other equipment may include flat bags that are inserted under heavy objects and inflated with an air pump, and “shoring” equipment, which ensures passageways are stable and safe.

As survivors are removed, their medical condition is determined; patients are prioritized according to triage - based on the severity of their condition.

Search and rescue teams usually start the most urgent medical procedures on site; the most experienced teams may have defibrillators and endo-tracheal equipment to shock people back to life or perform emergency tracheotomies.

Step five - closure

Deciding when to end a rescue operation is always difficult.

"Obviously, the more time passes the less likely you are to find people alive," said Ryan. "But sometimes - especially if they have water available - people can remain alive for many days. In Pakistan, our team rescued two boys five days after the earthquake; they had survived on trickles of rainwater through the rubble."

According to Ryan, finding bodies - cadaver rescue - after the search for survivors is over is a very important part of any operation.

"Even when people haven't survived the collapse of a building, families find that having a body to bury is an important part of getting closure," she said.

According to INSARAG's Chang, the high octane operations can take their toll on rescuers, especially when they have to pull hundreds of dead people out of buildings.

"Most of them are used to dealing with blood and death in their daily professions, but from time to time it can become very difficult," he said. "Many teams are equipped to deal with trauma - the Swiss government's team, for instance, has a psychologist on hand, while doctors in the Singapore team have been trained to search for signs of trauma in team members."

Once the host government officially calls off the search, INSARAG starts the process of withdrawing the teams. A few remain and become part of the humanitarian relief effort, rebuilding hospitals and schools or shelter for families, but most will head back to their day jobs and await the next call to action.



1013 Cholera kills 29 as water shortage bites [Kenya]--At least 29 people have died of cholera and hundreds more are being treated for cholera-related symptoms such as acute watery diarrhoea (AWD) in the larger Turkana District in the northwest and in the eastern regions of Garbatulla and Laisamis, say health officials.

"Two people have died in Garbatulla, five in Laisamis, three in Turkana North, one in Turkana South and 18 in Turkana Central," said an official in Kenya's Ministry of Public Health and Sanitation.

The regions are not only facing an acute water shortage, due to a prolonged drought, but also have poor latrine coverage.

In the past week, he said, a total of 246 AWD cases have been reported and are being treated as cholera due to confirmation of the disease. Some 42 cases of cholera have been confirmed in the region.

Laisamis is in the larger Marsabit District, a vast region stretching about 66,000 sqkm. Residents are forced to trek long distances to health centres.

David Kasanga, Laisamis medical officer, told IRIN that three of the deceased had "died at home before they could reach [the] nearest health facilities".

Kasanga said health workers had been deployed to the affected areas, and the local Elmolo health centre has been reopened to deal with the new outbreak.

He said tents had been set up to serve as temporary wards. "We have managed to get drugs but we need more assistance as [the drugs] might not be enough to handle the rising number of new cases," he said.

Mark Ekale, a local leader, told IRIN that families had been forced to spend more on healthcare. "People are selling relief food... so that they can afford to pay for transport to the nearest health facilities."

According to residents, the number of dead may be higher due to a lack of access to medical services.

Laisamis Member of Parliament, Joseph Lekuton, said mobile clinics should be set up and additional health personnel sent to the area. Regions around Laisamis have experienced recurrent cholera outbreaks in the past six months. At least 834 cholera cases were reported in a previous outbreak there in June.

According to Lekuton, disease is just one of many challenges affecting local residents. "This is the worst year for Laisamis residents. Many have died as a result of hunger and disease[s] like cholera and malaria," he said, calling for more control initiatives. "...We must [prevent] more deaths and [the] burying of people every day," he said.

Like most of northern Kenya, Marsabit is facing an acute water shortage due to a prolonged drought and last saw rain in May 2008. The water scarcity has been blamed for the outbreak as residents are being forced to use water from sources that are believed to have been contaminated.

"The cholera outbreaks move from one locality to another but have similar causes - water problems, poor hygiene and a low latrine coverage," said the health ministry official, adding that the government was trucking in water and providing hygiene education. "We are encouraging affected residents to build and use latrines."


1013 Rains, poor roads hamper mystery disease response [Sudan]--Efforts to identify a haemorrhagic disease that has killed four people in a remote corner of Southern Sudan have been thwarted by bad roads made impassable by heavy rainfall, according to officials.

The deaths took place in Kitkit, a military outpost in Western Bahr al-Ghazal state. On 23 September, the state's director-general of health, Martin Mayen Wol, had written to Southern Sudan's health ministry in Juba to report the deaths and that six soldiers were complaining of nose bleeds and vomiting blood.

"As there is no means to verify the situation and confirm the condition due to the bad roads attributed to the rainy season, we ask your esteemed office for direct intervention through the international and UN bodies," wrote Wol. "The situation is urgent, Sir."

A team from Southern Sudan's health ministry, the UN World Health Organization and the Sudan People’s Liberation Army (SPLA) could only get as far as Timsah, 70km away.

"... Not even a vehicle could move," Nathan Atem, the Director-General of Preventive Medicine, said. "They had to come back."

Without a landing strip, Kitkit is inaccessible even to aircraft. A doctor sent to the region on a flight with the UN Mission in Sudan, following an appeal for help issued in late September, had to turn back.

Blood samples of those infected have been sent to the US Centers for Disease Control labs in Atlanta for analysis.

Ministry of Health Under-Secretary Majok Yak Majok played down fears that Ebola might be to blame for the deaths: "It could be any other disease that can cause bleeding," said Majok. "For a serious outbreak, it could have not remained [as] contained since 23 September."

He noted that if it was a viral infection it would have engulfed the entire region in the three weeks.












Headlines link directly

to the articles:


1105 Sexual violence prevention and re-integration funding "falls through cracks" [DRC]


1105 Turning to traditional medicine in fight against malaria [Africa]


1024 Mentors to boost breastfeeding [Mali]


1024 Death toll rises as cholera spreads [Tanzania]


1024 Child disability, the forgotten crisis [DRC]


1024 Humanitarian stockpile takes shape - on paper [West Africa]


1024 Aid groups mobilize to help wounded [Guinea]


1024 Shift aid base to "safe" areas in-country, urges UN official [Somalia]


1024 US troops help build disaster response capacity [East Africa]


1024 Humanitarian crisis now unfolding in Angola - DRC [Luanda-Kinshasa]


1024 Cholera returns and kills five, so far [Zimbabwe]


1024 Rains wash away IDP shelters in Mogadishu [Somalia]


1017 Cholera kills at least 51 in north [Cameroon]


1017 Stopping cholera emergencies [West Africa]


1017 Driving home the cholera message [Guinea-Bissau]


1013 Fifty quarantined as first H1N1 death reported [Tanzania]


1013 How To: Rescue people trapped in a collapsed building [Kenya]


1013 Cholera kills 29 as water shortage bites [Kenya]


1013 Rains, poor roads hamper mystery disease response [Sudan]















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