H5N1

Italy orders seizure of migrant rescue ship over 'HIV-contaminated' clothes

The populist government of Italy is moving fast from mere anti-vaxxism to outright public health menace. Via The Guardian: Italy orders seizure of migrant rescue ship over 'HIV-contaminated' clothes. Excerpt:

Italian authorities have ordered the seizure of the migrant rescue ship Aquarius after claiming that discarded clothes worn by the migrants on their voyage from Libya to Italy could have been contaminated by HIV, meningitis and tuberculosis.  

Prosecutors from Catania, eastern Sicily, alleged that the waste was illegally labelled by the ship’s crew as “special waste” rather than “toxic waste”.

The Aquarius is currently docked in Marseilles, France, where so far it is beyond the reach of the Italian authorities.  

The ship is operated by the charity Médecins Sans Frontières (MSF) and SOS Méditerranée. Prosecutors in Catania said: “If Aquarius would disembark to Italy, it will be immediately put under seizure.” 

Nevertheless, the Italian authorities have placed 24 people under investigation for ‘‘trafficking and the illegal management of waste,” including the captain of the Aquarius, Evgenii Talanin, and Michele Trainiti, deputy head of the Italy mission of MSF Belgium. The Sicilian prosecutors also fined MSF a total of €460,000 (£409,000) and froze some of its bank accounts based in Italy.  

A total of 24 tonnes of discarded material – including leftover food and medical materials as well as clothes – was being investigated. 

Aids campaigners criticised the prosecutors’ claims that clothing could have been contaminated with HIV. “Clothing categorically is not, and has never been, an HIV transmission risk,” said Deborah Gold, chief executive of the National AIDS Trust. 

“This would have stood out as ridiculous even amongst the misinformation of the 1980s, never mind in 2018. Migrants and people seeking asylum have historically been attacked using myths about HIV and infectious conditions, and we condemn this both for its stigmatising of people living with HIV and of migrants fleeing hardship.” 

The Aquarius has been stuck in Marseilles since the Panamanian authorities revoked its flag, after “complaints by the Italian authorities”. But the ship seemed to have reached an agreement with a country that would offer the NGO its flag and was ready to leave the French port in few days to reach the waters of Libya. 

Matteo Salvini, Italy’s far-right deputy prime minister, hailed the seizure order for the Aquarius, tweeting: “It seems I did well to close the Italian ports to the NGOs.” 

NGO rescue boats have almost all disappeared from the central Mediterranean since Salvini announced soon after taking office that he was closing Italian ports to non-Italian rescue vessels.

Here is part of MSF's response:

Médecins Sans Frontières (MSF) strongly condemns the decision by Italian judicial authorities to request the seizure of the Aquarius for alleged anomalies in its disposal of on-board waste. It is a disproportionate and unfounded measure, purely aimed at further criminalising lifesaving medical-humanitarian action at sea.

"After two years of defamatory and unfounded allegations of collusion with human traffickers, judicial investigations, and bureaucratic obstacles against our humanitarian work, we are now accused of organised crime aimed at illicit waste trafficking,” says Karline Kleijer, MSF’s head of emergencies.

The request to seize the Aquarius, and the order to freeze some of our bank accounts, follows a longstanding investigation by the Prosecutor’s Office of Catania regarding the disposal of on-board waste, with particular reference to food leftovers, the clothes of rescued people, and waste from the ship’s medical activities.

The in-port operations, including waste management, of MSF’s search and rescue vessels have always followed standard procedures. Relevant authorities did not question these procedures, nor did they identify any hazard for public health since MSF began search and rescue operations in 2015.

MSF is fully willing to cooperate with Italian authorities but questions the Public Prosecutor's interpretation of the events and refutes accusations that it was involved in criminal activity aimed at illicit waste management of any kind.

Following an assessment of the seizure decree and an internal review, where the prosecutor’s allegations appear inaccurate or misleading, MSF has decided it will submit an appeal to Italian review courts.

"We are more than ready to clarify the facts and stand accountable for the operational procedures we followed, but we strongly reaffirm the legitimacy and legality of our humanitarian work,” says Gabriele Eminente, general director of MSF in Italy.

MSF expands care as Ebola outbreak spreads in DRC

Via MSF.org: MSF expands care as Ebola outbreak spreads in DRC. Excerpt:

In response to the worst Ebola outbreak ever recorded in Democratic Republic of Congo (DRC), Doctors Without Borders (Médecins Sans Frontières) is stepping up efforts to contain the epidemic.  

Just over three months since the declaration of the latest Ebola epidemic centered in North Kivu, DRC, the intervention still faces serious challenges. To date, 341 suspected Ebola cases have been identified, of which 303 have been confirmed.  

The epicenter of the Ebola outbreak has moved from the small town of Mangina to the larger city of Beni, where the number of new suspected and confirmed Ebola patients has risen steadily for weeks. MSF teams are increasingly busy with tracing suspected cases, as the epidemic has reached a new level. As many as 30 new suspected cases are identified every day and admitted to the Ebola treatment center in Beni. 

MSF has opened a new transit center in Beni in response to the growing needs. “The objective of this transit center is to boost the overall capacity for patient care in Beni. Since the city became the new focus of the outbreak in October, new confirmed cases have been frequently appearing in several neighborhoods,” says Marie Burton, MSF project coordinator.  

The new MSF transit center was built very close to an existing Ebola treatment center (ETC) that was operating at capacity. The proximity of the two facilities is intended to bring the various components of the Ebola response in Beni closer together. The MSF facility was built on a former football field measuring 8,000 square meters and required a week’s worth of fast-paced construction work.  

Suspected Ebola patients will be admitted to the MSF transit center pending confirmation of their laboratory analyses. MSF medical staff will provide immediate care according to a person’s clinical status; once the diagnosis is confirmed, patients who test positive for Ebola will be transferred to the nearby ETC while those who test negative will be transferred to other health facilities where further care will be provided. Until recently, both confirmed and suspected cases were admitted to the ETC, although the two wards were isolated.  

In the new MSF transit center, individual rooms were constructed to improve patient isolation. Partitions were fitted with large plexiglass windows to enable medical staff to more closely monitor patients, as well as make it easier for patients to see visiting family members and loved ones. The center’s initial capacity of 16 beds can be increased to 32, or up to 48 if needed.  

Since August 1 the Ebola virus has killed 215 people in DRC. More than 100 patients have been able to recover so far. Active conflict and insecurity in the affected areas are making it difficult for health workers to reach the local community.  MSF is working alongside several organizations to help contain the epidemic.  

“Since the [epicenter] of the epidemic moved from Mangina to Beni, the outbreak has become harder to control. We now observe an increasing number of new cases further south, in the even bigger city of Butembo. We fear the situation might become even harder to manage, unless the response in this area is significantly strengthened,” says Gwenola Seroux, emergency cell manager for MSF.

MSF: HIV and TB treatment at risk as countries gradually lose Global Fund support

Via MSF.org: HIV and TB treatment at risk as countries gradually lose Global Fund support. Excerpt:

GENEVA — Médecins Sans Frontières (MSF) has called on the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria to make urgent changes to their policies and practices for countries transitioning away from, or gradually losing, donor support, which increase the risk of critical drug stock-outs and alarming drug quality issues in many countries. People receiving treatment for tuberculosis (TB) and HIV in transitioning countries have faced dangerous treatment interruptions and have been treated with drugs of unknown quality. The countries are also faced with paying much higher prices for drugs than they should be paying.  

Beyond the countries that are about to transition from Global Fund support, even low-income countries are being called upon by Global Fund to start paying for key medical commodities. This is often occurring in the absence of a rigorous assessment of procurement challenges and financial capacity, and often in the absence of the robust risk mitigation planning needed to safeguard people’s access to treatment.  

“The current pace of Global Fund country transitions, hastened by underfunding from donors, is creating a ticking time bomb where people’s HIV and TB treatment is jeopardised by unknown drug quality and drugs simply not being there,” said Dr Els Torreele, Executive Director of MSF’s Access Campaign. “Allowing countries to fall off a cliff without mitigating the risks for people who need treatment could reverse nearly two decades of progress against two of the world’s deadliest infectious diseases.” 

Over the last 16 years, the Global Fund’s central purchasing of HIV and TB treatment commodities has helped secure affordable prices through high-volume orders and attracting multiple competing suppliers. Crucially, the Global Fund has also been instrumental in ensuring people’s access to quality treatment by requiring all drugs purchased with its funding to have quality approval from either the WHO Prequalification of Medicines Programme or a stringent drug regulatory authority.  

The Global Drug Facility (GDF), which helps countries procure TB drugs, has documented a number of problems related to the Global Fund’s policies. In the past 18 months, 15 countries in Asia, Africa, and the Eastern Europe and Central Asia region have experienced stock-outs of TB drugs. Additionally, 29 countries in these regions, along with Latin America, have purchased TB drugs of unknown quality, and 21 countries have purchased TB drugs and tests at prices that far exceed the lowest global prices they should be paying.

As a case in point, see this report in Nature News & Comment, on the impact on TB in North Korea after the Global Fund withdrew from the country.

MSF in Yemen: Influx of war wounded as fighting intensifies in Hodeidah, Hajjah, Saada and Taiz

MSF.org has published Yemen: Influx of war wounded as fighting intensifies in Hodeidah, Hajjah, Saada and Taiz. Excerpt:

As conflict intensifies on several frontlines across Yemen, an influx of people with war-related injuries are being treated at facilities run by Médecins Sans Frontières (MSF) in Hodeidah, Hajjah, Aden, Saada and Taiz governorates. 

In Hodeidah, a major offensive was launched on 1 November by forces loyal to President Hadi, backed by the Saudi and Emirati-led coalition (SELC), against Ansar Allah troops. Heavy ground fighting and aerial bombardments are threatening the lives of thousands of civilians.  

Between 1 and 6 November, MSF teams in Hodeidah treated 24 war-wounded civilians at Al Salakhana hospital, including five women and nine children. Of these patients, 17 had blast injuries and one had a gunshot wound.    

In the same period, another 50 war-wounded were treated at MSF’s surgical field hospital in Mocha, 180 kilometres south of Hodeidah, mostly injured by blasts and gunshots. They included three women and eight children.  

This increase follows an intensification of ground fighting and aerial bombardments in Hodeidah since last Thursday.

“A stronger offensive by the Saudi and Emirati-led coalition-backed forces was launched with a deployment of troops on the ground. They have moved quickly around the city,” says Frederic Bertrand, MSF head of mission in Yemen. “This raises fears of a siege which could affect the tens of thousands of people still living inside Hodeidah.” 

“Every day we hear the sound of heavy airstrikes and shooting in the city,” says Bertrand. “On Monday afternoon [5 November], ground fighting occured near Al Salakhana hospital and the MSF house. Our teams had to stay inside the hospital for their own safety.” 

Movements of civilians leaving Hodeidah were reported last weekend, but it is difficult to assess how many have already left the city. “Other civilians are reportedly trapped inside the city because of the ongoing ground fighting and airstrikes,” Bertrand explains.

Bunia: Launch of the Ebola case analysis laboratory

Via Radio Okapi: Bunia: launch of the Ebola case analysis laboratory. The Google translation:

The activities of the Ebola Medical Test Laboratory and the Center for the Treatment of Suspected and Confirmed Cases in Ituri were launched on Tuesday, 6 November at the Bunia General Referral Hospital. It is the second laboratory of its kind in this province, after that of Tchomia.     

This center is equipped with patient reception units, eight patient rooms, latrines for men and women, a laundry room, a morgue and several other spaces reserved for various services. said Freddy Banza, doctor in charge of this program at WHO in Ituri.   

Traffic remains intense between Ituri and the neighboring province of North Kivu, where the disease first declared itself. This justifies the construction of this center and the opening of a laboratory.   

According to the interim governor of Ituri, Pacific Keta, this new laboratory will now quickly diagnose suspected cases of Ebola and immediately take care of patients who have symptoms of this virus.   He believes that the creation of this unit aims to prevent any suspect or confirmed case that may arise.   

"We needed isolation structures. We now have the lab; since some time ago, it was necessary to wait two to three days before we could have the results [of analysis of the samples taken from the patients]," he said.   

The construction of an Ebola treatment center, run by the NGO MSF-Switzerland, lasted three weeks.

Uganda: Ebola Preparedness Emergency Plan of Action

Via ReliefWeb, the IFRC has published Uganda: Ebola Preparedness Emergency Plan of Action (EPoA) - DREF Operation n° MDRUG041 update n° 01. Excerpt:

Summary of major revisions made to emergency plan of action: 

Following the confirmation of Ebola cases in Kashenyi at the shores of lake albert in DRC, 40km from thee landing site in Uganda about 3 weeks ago; and the continued conflict in Beni which has hampered the Ebola control efforts, the WHO risk level of the outbreak spreading to Uganda has been increased from high to very high nationally and regionally, but still seen low globally. This calls for strengthening and scaling up of current interventions. 

At the national level in Uganda, it has been noted that it is a matter of when and not if the outbreak will occur, with WHO initiating preparations for safe and dignified burial (SDB) by training teams. However, it is not yet clear who will take a lead in managing SDB services in the country. 

Harnessing on the expertise and experiences of the Red Cross Movement in previous Ebola outbreaks in west Africa, URCS is positioning herself to lead SDB services in Uganda. There is therefore a need for additional surge capacity to support the development of a clear SDB strategy and plan that will guide interventions. 

An additional allocation of CHF 17,040 is being requested through this Operations Update to enable the deployment of an SDB expert and to support the ongoing mission of the CEA expert.  

In addition, a strategy and Planning expert will be deployed for 1 month, funded by the Norwegian Red Cross, to support the SDB strategy and plan.

MSF in Central African Republic: More than 10,000 seek refuge in Batangafo hospital

Via MSF.org: Central African Republic: More than 10,000 seek refuge in Batangafo hospital. Excerpt:

Following clashes between armed groups that took place on Wednesday, 31 October 2018 in the north and centre of the Central African Republic (CAR), more than 10,000 people fled to seek refuge in the compound of a hospital supported by Médecins Sans Frontières (MSF). 

In Batangafo, in northern Central African Republic, violent clashes between armed groups led to the burning of three camps for internally displaced people, numerous homes and a marketplace. More than 10,000 people sought refuge in the compound of the MSF-supported hospital, while several hundred others fled to the bush. 

In Bambari, in the centre of the country, MSF teams on the ground responded to treat 12 wounded following further violent clashes, while in Batangafo MSF received 20 patients, including ten requiring emergency surgery. Among these victims, two patients died as a result of severe burns.

To meet the initial needs of these displaced populations, and to fight against diseases such as diarrhoea and respiratory infections related to precarious living conditions, MSF has set up additional sanitary facilities such as latrines and showers at Batangafo hospital. A medical team continues to work to provide care to those in need. 

"The situation in Batangafo and Bambari remains very tense. The protection of the population and the medical mission remain our primary concerns," says Omar Ahmed Abenza, MSF head of mission in CAR. "We managed to treat the wounded who arrived, but the tensions in these two cities are still very much in evidence. We call for the continued cooperation of all parties to the conflict to provide assistance to all those who need it.  

"The humanitarian situation in the Central African Republic remains worrying and this latest outbreak of violence is likely to further threaten the already extremely precarious displaced communities that today lack food, shelter and other basic necessities,” Abenza adds.

MSF: DRC 2018 Ebola outbreak crisis update October 2018

MSF.org has published DRC 2018 Ebola outbreak crisis update October 2018. This is an excellent summary of the start of the outbreak, current conditions, and MSF's role. Excerpt:

Current situation

More than ten weeks after the declaration of the epidemic, we seem to be facing a second peak of the outbreak: the epicentre has now moved from the small village of Mangina to the much bigger city of Beni, where the number of confirmed cases has shown a clear increase throughout October. Ten health zones in North Kivu and Ituri provinces (Mandima, Mabalako, Beni, Oicha, Butembo, Kalunguta, Komanda, Masareka, Musienene and Tchomia) have so far reported confirmed or probable cases of Ebola. The epidemiological situation in North Kivu is more of a concern now than it was in September, when the number of cases appeared to be decreasing.  

On 20 September, a new case emerged in Tchomia, 60 km south of Bunia in Ituri province. The infected patient died in Tchomia hospital, but was probably infected in Beni and travelled all the way up north. The epidemic is now getting very close to the Ugandan border, increasing the risk of a spill-over into the country. 

Epidemiological teams are still working on identifying all active chains of transmission. This is not simple given that the local communities in the affected areas are highly mobile and move from village to village for work and family reasons, as well as to seek health care.  Sick people have been known to visit more than one health centre before being identified as suspect cases and referred to an Ebola Treatment Centre. 

Since the beginning of the outbreak more than 8,000 contacts have been identified and more than 2,732 are currently being followed up by the Congolese Ministry of Health. The contact tracing and follow-up is done by the Ministry of Health with a team of epidemiologists.    

Area 

Mangina, a town of 40,000 people, is in Beni Territory, North Kivu province, northeastern DR Congo. Beni, the administrative centre of the territory, is about 30 kilometres away and is home to about 420,000 people. The area borders Uganda to the east; the North Kivu capital Goma, and the Rwandan border are further south. 

This area sees a lot of trade, but also traffic, including “illegal” crossings. Some communities live on both sides of the border meaning that it is quite common for people to cross the border to visit relatives or trade goods at the market on the other side. The region is densely populated, and the Ugandan border is a sensitive area and is crucial in terms of developments of the outbreak spreading in the region. 

The territory is characterised by high levels of insecurity – it is considered an area of conflict, with over 100 armed groups estimated to be active in North Kivu. Kidnappings and carjacking are very common. It is an area of heavy ongoing military operations – the city of Beni is subject to military rule and military justice, and moving around some areas in the region is quite difficult and sometimes impossible. Two attacks in Beni - the most recent on 20 October - have left a number of people dead, and have forced Ebola outbreak response activities to temporarily stop for a number of days before resuming.  

The outbreak has spilled in to the neighbouring province of Ituri, but the majority of cases still occurs in North Kivu.

MSF slams decision that ends critically-needed mental healthcare on Nauru

MSF.org has published MSF slams decision that ends critically-needed mental healthcare on Nauru.

NAURU/SYDNEY: Médecins Sans Frontières (MSF) strongly condemns the government of Nauru’s sudden decision to cease MSF’s provision of desperately-needed mental health care to asylum seekers, refugees and the local community on Nauru. 

MSF describes the mental health situation of refugees on the island as “beyond desperate” and calls for the immediate evacuation of all asylum seekers and refugees from the island, and for an end to the Australian offshore detention policy. 

“It is absolutely disgraceful to say that MSF’s mental health care is no longer required; the mental health situation of the refugees indefinitely held on Nauru is devastating”, said Dr Beth O’Connor, MSF psychiatrist. “Over the past 11 months on Nauru, I have seen an alarming number of suicide attempts and incidents of self-harm among the refugee and asylum-seeker men, women and children we treat.”  

“We were particularly shocked by the many children suffering from traumatic withdrawal syndrome, where their status deteriorated to the extent they were unable to eat, drink, or even walk to the toilet”, Dr O’Connor said. 

For the last 11 months, MSF’s psychologists and psychiatrists have been providing critical mental health care to stabilise and manage the symptoms of dozens of patients. Nevertheless, no therapeutic solution can be considered possible for people indefinitely held on Nauru.  

“Our patients often describe their situation as far worse than prison, because in prison you know when you can get out,” continues Dr O’Connor. “Whilst in my professional opinion there is no therapeutic solution for these patients as long as they are trapped on the island, I fear the withdrawal of MSF’s psychiatric and psychological health care from Nauru will claim lives.” 

Although many of the refugees on Nauru have experienced trauma in their countries of origin or during their refugee journey, it is the Australian government’s policy of indefinite offshore detention that has destroyed their resilience and shattered all hope that they will one day lead safe, meaningful lives. 

“Separating families and forcibly holding men, women and children on a remote island indefinitely with no hope or protection, except in the case of a medical emergency is cruel, inhumane and degrading,” said Paul McPhun, MSF Australia’s Executive Director. “While the Australian government describes offshore detention as a humanitarian policy, our experience proves that there is nothing humanitarian about saving people from sea only to leave them in an open air prison on Nauru.”  

“This policy should be stopped immediately and should not be replicated by any government”, Mr McPhun said. “It’s not MSF’s psychiatrists and psychologists that should be leaving Nauru; it’s the hundreds of asylum seekers and refugees that Australia has trapped on the island for the past five years that should be leaving.” 

MSF started providing free psychological and psychiatric services in the Republic of Nauru in November 2017, to refugees, asylum seekers and the Nauruan people. These services were put on hold on 5 October 2018 when the government of Nauru informed MSF that our services were “no longer required” and requested that MSF end activities within 24 hours. 

Almost all 900 asylum seekers and refugees on Nauru, including 115 children, have been on the island for more than five years, with no clear process or prospect of permanent resettlement.

Sulawesi: Girl scout among 34 dead found in Indonesian quake quagmire

Via Thomson Reuters: Girl scout among 34 dead found in Indonesian quake quagmire. Excerpt:

PALU, Indonesia, Oct 6 (Reuters) - More than a week after a major earthquake hit the west coast of Indonesia's Sulawesi island, rescuers workers were focusing on Saturday on what looks sure to be a long, difficult search for bodies, many buried in appalling morasses of debris and mud. 

President Joko Widodo has said all of the victims of the 7.5 magnitude earthquake and tsunami that struck on Sept. 28 must be found.  

The official death toll from the quake and the tsunami it triggered has risen to 1,649, but will certainly increase.  

Most of the dead have been found in the region's main urban centre, the small city of Palu. Figures for more remote areas, some just re-connected to the outside world by road, are trickling in.  

No one knows how many people were dragged to their deaths when the quake triggered soil liquefaction, a phenomenon that turns the ground into a roiling quagmire. Communities in the south of Palu were particularly hard hit.  

The national disaster agency says 1,700 homes in one neighbourhood alone were swallowed up. Many hundreds of people are now entombed in slowly drying mud churned with heaps of debris and vehicles. 

In the Balaroa neighbourhood of Palu, rescuers found 34 bodies on Saturday, and laid them out in a row of blue and orange bags, among them 10-year-old Dede Aulianisa.  

Her parents recognised her from the clothes she was wearing when the quake struck.  

"I'm certain it's her. She was wearing the exact scout uniform, with a sweater with the words 'Geng 97'," her father, Anwar, who like many Indonesians goes by only one name, told Reuters.  

"When the land split, she happened to be on the side that collapsed," he said. "She was such a happy child. Very intelligent. Her teachers loved her and she had many friends."  

The most intact structure in the area was a battered two-storey house, pitched over at nearly 45 degrees with one side buried and a blue vehicle in the car port.  

In the Petobo neighbourhood nearby, a team of French rescue experts began hunting through an expanse of debris, looking for hands, feet or any body parts of victims sticking out of the mud. 

Arnaud Allibert and four other members of the group Pompiers Humanitaires Francais were the first rescuers to venture into that area. 

The team will scour the debris and find and retrieve bodies at the surface, to clear the way for excavators to dig deeper. 

"If we see body parts sticking out, we're going to dig to get the body out ... It's a long-term job, but after that, they'll come with the heavy machinery," Allibert told Reuters.