H5N1

Syria: MSF provides relief items and adapts response for coronavirus COVID-19

Via MSF.org: MSF provides relief items and adapts response for coronavirus COVID-19. Excerpt:

Deir Hassan camp in Idlib province, northwestern Syria, is one of the many camps to which hundreds of thousands of displaced families fled, to escape the military offensive by Syrian government forces with their Russian allies between December 2019 and early March 2020. Deir Hassan camp hosts more than 164,000 people in settlements scattered over the hills and, as is the case across northwest Syria, it lacks basic services. It is now also threatened by the potential spread of COVID-19. 

On 16 March, after assessing the needs in Deir Hassan camp, Médecins Sans Frontières (MSF) distributed essential items to 180 families in the Latamneh and Al-Habeet settlements, including family tents, mats, plastic sheeting, blankets, cooking sets and hygiene kits. 

“We witnessed people living in the open; we also saw two or three families sharing a tent which did not protect them from the cold or the rain,” says Ahmed, MSF project team leader. “There were too few tents to accommodate the new arrivals.” 

The next day, the MSF team distributed the same relief items to 115 families in Abo Obeidah, another settlement in Deir Hassan. 

“Thanks to MSF, we got tents,” says Manaf Shamma, a displaced mother living in Latamneh. “This camp was set up eight months ago, but it needs latrines, sewage, proper roads.” 

COVID-19 pandemic adds to health risks 

In Deir Hassan camp, the water and sanitation facilities are inadequate for such large numbers of people, raising the risk of water-borne diseases. So far, upper respiratory infections have been the main condition seen by the MSF mobile clinics. But now the coronavirus COVID-19 pandemic has become a huge challenge worldwide and in Syria. 

The Syrian government reported the first case of COVID-19 in Syria on 23 March. While no cases have been declared in Idlib province, the last rebel stronghold, the disease may spread very quickly through the region, especially in camps, where people live in large settlements, in overcrowded conditions with little sanitation.  

MSF has suspended our mobile clinics in Deir Hassan camp to allow our staff to attend training on infection prevention and control (IPC), and to make sure they won’t spread the virus. In the coming days, MSF community health workers will hold health education sessions on COVID-19 with displaced families in 10 settlements in Deir Hassan camp, and will distribute leaflets and specific hygiene kits.  

As our teams are now focusing their work on infection prevention and control measures, they are providing assistance for the triage and screening of patients in the two MSF-supported health centres, in Deir Hassan and Tal Karama.

MSF on COVID-19: Urgent help needed across European borders to protect medical staff

Via MSF.org: COVID-19: Urgent help needed across European borders to protect medical staff. Excerpt:

BRUSSELS – As the number of people with COVID-19 continues to rise rapidly across many countries in Europe - now the epicentre of the pandemic - Médecins Sans Frontières (MSF) urges European Member States to demonstrate solidarity beyond their national borders. Essential medical supplies, including personal protective equipment starting from face masks to protect healthcare staff, must be urgently channelled to where they are most critically needed.    

In Italy, where MSF began working in four hospitals in the country’s epicentre last week, shortages of personal protective equipment are increasingly commonplace, leaving healthcare workers on the frontline exposed. Protective equipment shortages are fuelling the epidemic and hampering the ability to save lives. 

Nearly 1,700 healthcare workers, or eight per cent of the total COVID-19 cases in Italy, have been infected whilst tirelessly caring for the rising number of severely ill patients who require long-term hospitalisation and specialised intensive care. 

“Even in high-level European hospitals we see health workers are overwhelmed, coping with up to 80 ambulances per day, with dramatic shortages of protective equipment that puts them at great risk,” says Dr Claudia Lodesani, President of MSF in Italy and lead of the MSF COVID-19 response in the country. “Some doctors are forced to wear the same face mask for 12 hours.”  

“Every day we are receiving new calls for help, for more staff, for more supplies,” Dr Lodesani says. “Without an influx of urgently needed protective equipment, more healthcare workers will fall ill, reducing the availability of care for patients, generating new clusters of cases, and dangerously weakening the fight against the disease.” 

At this moment of crisis, no country can cope or produce the supplies they need alone. European Member States need to urgently implement the solidarity mechanisms put in place by the European Union. Resources must be shared to fight the pandemic where it is currently raging.  

“Today it is Italy that urgently needs supplies of medical equipment to protect healthcare workers, but in a few weeks, it may also be the case elsewhere. Along with increased production, European governments must ensure that supplies can then be shipped easily to the virus hotspots,” says Brice de le Vingne, head of the MSF COVID-19 task force in Brussels. “Meanwhile, threats to close borders risk harming the flow of resources and staff to the most affected areas.”

DR Congo: Red Cross volunteers attacked during Ebola burial

Via ReliefWeb, a report from the IFRC: DR Congo: Red Cross volunteers attacked during Ebola burial.

Goma/Nairobi/Geneva, 15 January 2020 – Two volunteers from the Democratic Republic of Congo (DR Congo) Red Cross were seriously injured following an attack during a safe and dignified burial of a suspected Ebola case near Mambasa, in eastern DR Congo on Monday, 13 January. The volunteers are now in hospital, receiving medical care and psychosocial support. 

DR Congo Red Cross teams have faced incidents of violence and aggression from communities resisting safe and dignified burial protocols since the start of the Ebola outbreak in North Kivu and Ituri. In this most recent attack, the family had consented to the burial but rumours and panic quickly spread among the community resulting in a violent assault against the Red Cross team. 

Grégoire Mateso Mbuta, President of the DR Congo Red Cross Society said: 

“This incident is a stark reminder of the serious risks our volunteers face when they carry out the dangerous task of safe and dignified burials. While we deplore any violence towards our volunteers or staff, we understand first hand, the fear and frustration that communities harbour and shall continue to render the needed services to the affected populations.” 

The current Ebola outbreak, which began on 1 August 2018, is unfolding in an area affected by a two decades-long conflict that has claimed countless lives and raised fear and hostility towards responders. 

Building community trust and acceptance has been at the core of the Red Cross’ Ebola response operations. This investment has paid off. Since the beginning of the outbreak nearly 20,000 successful safe and dignified burials have been conducted with a consistently high success rate. 

Red Cross volunteers continue to work within affected communities, listening to concerns and gathering feedback that is then analysed and used to provide improved support to people in need. As a result, community resistance for safe and dignified burials has drastically declined over the course of the operation.  

Nicole Fassina, Ebola Operations Manager for the International Federation of Red Cross and Red Crescent Societies (IFRC) said: 

“While we experienced an overall improvement in community’s acceptance of burials, this attack underscores why we cannot become complacent. The Red Cross will continue to engage and involve communities in the Ebola response if we want to bring this outbreak to end.”

At least 78 children died of dengue related illness in Yemen

Via ReliefWeb, a report from Save the Children: At least 78 children died of dengue related illness in Yemen. Excerpt:

Save the Children warns of an epidemic, as 52,000 suspected cases are recorded in the country.  

Seventy-eight children under 16 have already died in the outbreak of Dengue related illness in Yemen[i], with more than 52,000 suspected cases being recorded across the country. Save the Children warned this could signal the start of an epidemic. 

Heavy rainfall, coupled with the ongoing conflict, is disrupting clean water supplies. Because of the disruptions, people use water basins to collect rainwater and these uncovered water sources combined with the rain have contributed to the spread of mosquitoes in the affected areas, resulting in an upsurge in suspected dengue cases. 

If measures are not urgently put in place to strengthen the health care system so that cases can be detected early, the death total which reached 192 people by the end of 2019, could increase sharply. Cases have been recorded in almost all governorates in Yemen with the most affected being Hodeidah and Aden which recorded more than 60% of the deaths in the country.  

Save the Children Hodeidah Field Manager Mariam Aldogani, herself recovering from dengue fever, said: 

“Hodeidah has the second highest death rate in the country with 62 adult and children deaths in 2019. We have never seen anything like this before. More than 40 of our staff including their families have been affected by the fever. We are getting reports of deaths on a daily basis in remote areas of the governorate. Some of our health facilities are working 24 hours a day and last week one of our facilities recorded 30 cases in one day, most of which were children. 

“The economic situation in the country has not made it any better for people. Parents cannot afford to bring their children to the hospital or to buy the medication. Hospitals are full, and some patients are kept in hospitals having to lay on the floor because of a bed shortage. It’s really bad. Children as young as eight months have not been spared by the dengue fever. In some of the hospitals all you can hear are children crying in pain. We are currently supporting 48 health facilities in Hodeidah which recorded more than 6000 dengue fever suspected cases in 2019.”  

Save the Children's health centres have been receiving many cases of children suffering from dengue, and its teams on the ground are diagnosing and treating patients whilst referring the most severe cases.

WHO: Deaths from DR Congo measles outbreak top 6000

WHO AFRO has published Deaths from Democratic Republic of the Congo measles outbreak top 6000.

Kinshasa, 7 January 2020 – With the death toll from the world’s worst measles epidemic in the Democratic Republic of the Congo (DRC) surpassing 6000, the World Health Organization (WHO) is calling for more funding to stop the outbreak.  

Under the leadership of the DRC Ministry of Health, WHO, Gavi, the Vaccine Alliance, and other partner aid agencies vaccinated more than 18 million children under five across the country in 2019. However, in some areas, routine vaccination coverage remains low and 25% of the reported measles cases are in children over the age of five, who are the most vulnerable. 

“We are doing our utmost to bring this epidemic under control. Yet to be truly successful we must ensure that no child faces the unnecessary risk of death from a disease that is easily preventable by a vaccine. We urge our donor partners to urgently step up their assistance,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. 

Since the start of 2019, around 310 000 suspected measles cases have been reported. The epidemic has been aggravated by low vaccination coverage among vulnerable communities, malnutrition, weak public health systems, outbreaks of other epidemic-prone diseases, difficult access by vulnerable populations to health care and insecurity that has hampered response in some areas.  

Lack of funding remains a huge impediment to successfully curbing the outbreak. So far, US$ 27.6 million have been mobilized. However, a further US$ 40 million are required for a six-month plan to extend the vaccination to children between six and 14 years and to reinforce elements of the outbreak response beyond vaccination, including improving treatment, health education, community engagement, health system strengthening, epidemiological surveillance and response coordination.  

“We recognize the Government’s engagement in the efforts to end the outbreak and we are grateful for the generosity of our donors. But we still need to do more,” said Dr Amédée Prosper Djiguimdé, Officer in charge of WHO office in the DRC. “Thousands of Congolese families need our help to lift the burden of this prolonged epidemic from their backs. We cannot achieve this without adequate finances.” 

The European Civil Protection and Humanitarian Aid Operations, Gavi, the Vaccine Alliance, Médecins du Monde, Médecins Sans Frontières, United Nations Children’s Fund, WHO and other partners have been supporting the Government to bring the long-running epidemic under control. In December 2019, WHO trained 60 health professionals from the Ministry of Health to conduct a range of services, including community engagement, health education and surveillance. These health professionals are being deployed this week as part of the response.

Goma: Around 3,000 people vaccinated against Ebola

Via Radio Okapi: Goma: around 3,000 people vaccinated against Ebola. The Google translation:

About three thousand people have already been vaccinated against Ebola hemorrhagic fever with the new Johnson and Johnson vaccine in two health areas on the northern outskirts of the city of Goma, announced, Thursday, December 26, the technical secretariat of the national committee multi-sectoral response to the Ebola virus disease in its epidemiological report. 

A total of 2,938 people received this Johnson and Johnson vaccine between November 14 and December 20.  

According to MSF, which is implementing this project, this vaccination still faces enormous challenges in this very troubled area of ​​the city. 

MSF France's vaccination coordinator in Goma, Dr Véronique Urbaniak, believes that the recurrent manifestations of the population in the two targeted health areas, Majengo and Kahembe, during the first four weeks of this clinical study for this new vaccine, are among the main challenges:  

“We first had to find sufficiently large sites. Another challenge was the security situation in Goma. When we started we had to deal with demonstrations that blocked streets and prevented movement, therefore, prevented us from accessing the sites. But (they) also prevented participants, who wanted to get vaccinated, from freely coming to the sites." 

But overall, she said, vaccination is going well in six sites now. 

The clinical trial with this experimental vaccine from the American laboratories Johnson & Johnson should go until April 2020. According to the response secretariat, approximately 260,000 people have been vaccinated from August 8, 2018, to date, against this epidemic. This has already affected 3,371 people, including 2,228 deaths, in the two Kivus and in Ituri.

MSF: DRC Ebola outbreak crisis update, December 2019

MSF.org has published DRC Ebola outbreak crisis update. The summary: 

Democratic Republic of Congo (DRC) declared their tenth outbreak of Ebola in 40 years on 1 August 2018. The outbreak is centred in the northeast of the country, in North Kivu and Ituri provinces, with cases also now appearing in South Kivu. With the number of cases having surpassed 3,000, it is now by far the country's largest-ever Ebola outbreak. It is also the second-biggest Ebola epidemic ever recorded, behind the West Africa outbreak of 2014-2016.  

During the first eight months of the epidemic, until March 2019, more than 1,000 cases of Ebola were reported in the affected region. However, between April and June 2019, this number doubled, with a further 1,000 new cases reported in just those three months. Between early June and the beginning of August, the number of new cases notified per week was high, and averaged between 75 and 100 each week; since August, this rate has been slowly declining, with just 70 cases identified throughout all of October.

While there are positive signs that the number of cases is slowly reducing, the outbreak remains a serious public health concern, and it is unclear when it may end. 

Although the proportion of new Ebola cases previously identified and monitored as contacts has increased in the last three months, the rate is still hovering at around one-third. However, 40 per cent of new Ebola cases were never registered as contacts, showing that identifying and following up contacts of people diagnosed with Ebola remains difficult. Reasons include the movement of people (such as in the case of motorbike taxi drivers), to downright fear in some communities which hinders engagement. 

New Ebola patients are confirmed and isolated with an average delay of five days after showing symptoms, during which time they are both infectious to others and miss the benefit of receiving early treatments with a higher chance of survival.  

On 11 June 2019, Uganda announced that three people had been positively diagnosed with Ebola, the first cross-border cases since the outbreak began. After several weeks with no recorded cases, the Ugandan government announced a new case on 29 August; the patient, a young girl, sadly died. 

On 14 July 2019, the first case of Ebola was confirmed in Goma, the capital of North Kivu, and a city of one million people. The patient, who had travelled from Butembo to Goma, was admitted to the MSF-supported Ebola Treatment Centre in Goma. After confirmation of lab results, the Ministry of Health decided to transfer the patient to Butembo on 15 July, where the patient died the following day. On 30 July, a second person in Goma was diagnosed with Ebola; they died the next day and two more cases were announced.  

No new cases have since been recorded in either Uganda or in Goma.  

In reaction to the first case found in Goma, on 17 July 2019, the World Health Organization (WHO) announced that the current Ebola outbreak in DR Congo represents a public health emergency of international concern (PHEIC).  

In mid-August, the epidemic spread to neighbouring South Kivu province - becoming the third province in DRC to record cases in this outbreak - when a number of people became sick in Mwenga, 100 kilometres from Bukavu, the capital of the province. 

Given the ongoing challenges in responding to the outbreak, MSF believes that Ebola-related activities should be integrated into the existing healthcare system, in order to improve proximity of the services to the community and ensure that it remains functional during the outbreak.

Ebola in DRC: MSF stops activities in Biakato due to presence of armed forces in medical structures

Via Doctors Without Borders USA: Ebola in DRC: MSF stops activities in Biakato due to presence of armed forces in medical structures.

Biakato, DRC/New York, December 24, 2019—Doctors Without Borders/Médecins Sans Frontières (MSF) has ended its medical activities in Biakato, in the Ituri province of Democratic Republic of Congo (DRC), due to the presence of armed forces around and within health structures, the international medical humanitarian organization announced Tuesday. 

MSF has worked in Biakato since 2016 with the Ministry of Health to assist victims of sexual violence. Since the start of the Ebola epidemic, MSF has expanded its operations, not only managing suspected and confirmed cases of Ebola and implementing hygiene and infection control measures in several health facilities in the region but also by offering free primary health and pediatric hospital care.  

"We are no longer able to work in accordance with our principles of neutrality and impartiality," said Ewenn Chenard, MSF emergency coordinator. “We regret this decision, but the presence of armed forces around and within the health structures of Biakato goes against our principles."  

The security deployment in the Biakato region follows a series of attacks on November 27 and 28 during which three aid workers were murdered.  

“We are aware that a solution is needed to ensure the protection of the civilian population and the safety of medical personnel after the tragic events of November,” said Chennard.  “However, we firmly believe that military presence in health facilities undermines the neutrality and impartiality of medical aid. It is essential that health structures remain free of weapons so that communities feel safe to come and seek care.”  

MSF has worked in Ituri since 2003, providing lifesaving care to the most vulnerable populations. In support of the Ministry of Health, MSF is currently intervening in the context of the ongoing measles epidemic, with displaced persons from the territories of Djugu and Mahagi, for victims of sexual violence in the Mambasa region, as well as in the fight against the Ebola outbreak.

UNICEF: DR Congo Ebola Situation Report #49

Via ReliefWeb, UNICEF has published UNICEF DR Congo Ebola Situation Report #49 North Kivu, Ituri and South Kivu - Reporting Period: 25 November to 08 December 2019. Excerpt:

Highlights  

• A series of security incidents occurred in Beni since 19 November. Attacks on the World Health Organization (WHO)/Ministry of Health bases in Mangina and Biakato on 27 November resulted in the slow-down in Ebola response activities of all agencies. UNICEF maintained core staff in all three sub-offices to continue essential activities. 

• Following security incidents that affected the Ebola response UNICEF DRC Country Representative came on mission to Goma and visited Beni, Mangina, Biakato and Butembo with the Ebola Coordinator to support the teams and review plans to ensure the delivery of essential interventions in this heightened new context of insecurity. 

• Following insecurity and the increasing number of community deaths in Lwemba, 74 high-risk contacts including 26 women and 30 children arrived in Bunzi health area in Beni. UNICEF provided them with two tents, WASH kits and non-food items (NFI). An additional 30 people from Lwemba, Biakato and Alima arrived in Mambasa where they are staying with relatives - 18 of them are contacts who are supported by UNICEF.  

• Daily activities of the sub-coordination teams have resumed in Beni and Mangina. 

Key epidemic numbers 

3,206 confirmed cases (WHO, 08 December 2019) 

896 children <18 among confirmed cases (WHO, 08 December 2019) 

2,091 deaths among confirmed cases (WHO, 08 December 2019) 

Key figures 

36 implementing partners, including 17 national actors 

2,775 community workers and mobilizers 

140 community radio partners 

1,112 psychosocial agents, including caregivers, in UNICEF-run nurseries 

90 IPC/WASH supervisors and 433 hygienists for decontaminations 

34 nutritionists and 4 supervisors in Ebola Treatment Centers (ETC) 

Ebola Response Appeal (Pillars I and III) 

US$ 125.6 million 

Epidemiological overview  

With an additional 21 new confirmed cases in the last two weeks, a total of 3,324 Ebola Virus Disease (EVD) cases were reported as of 08 December 2019, among which 3,206 confirmed and 118 probable cases. Two thirds (2,209) of EVD cases died (global case fatality rate is 66 per cent). Of the total confirmed and probable cases, 56 per cent (1,873) were female and 28 per cent (939) were children.

DR Congo: MSF urges humanitarian organisations to return to southern North Kivu

Via MSF.org, a sobering account of the other problems North Kivu is dealing with: DR Congo: MSF urges humanitarian organisations to return to southern North Kivu. Excerpt:

KINSHASA – For years, the territories of Masisi, Walikale and Rutshuru, in the southern part of North Kivu, Democratic Republic of Congo, have been plagued with armed violence and banditry. In the past months, these armed clashes have intensified, further aggravating the dire humanitarian situation, leading to significant numbers of displaced people and worrying signs of malnutrition, sexual violence and gunshot wounds among them. 

“Since the start of the year, the number of victims of sexual violence treated by MSF in Masisi has doubled compared to last year, and we have seen an increase in malnutrition cases”, says Ewald Stals, MSF field coordinator in Masisi health zone. “The escalation of armed clashes has also led to more people being treated for bullet wounds, and to a surge of displaced families arriving in already overcrowded camps where access to water and sanitation is scarce. Unsurprisingly, cholera cases have been reported and we’ve had to rapidly set up a cholera treatment centre.” 

“Where are the humanitarians?” 

From January to September 2019, MSF teams working in the territories of Masisi, Rutshuru and Walikale treated more than 11,220 malnourished children, 2,310 victims of sexual violence and 1,980 people with weapons injuries. Despite this critical situation, these territories – often referred to as the ‘Little North’ of North Kivu in the aid sector – suffer from a glaring lack of assistance from humanitarian organisations.   

“In recent years, several NGOs have left the ‘Little North’ because of insecurity, difficulties in movement around the region, and a lack of funding,” says Karel Janssens, MSF Head of Mission in DRC. “Given this reduction in the number of organisations, we have been responding to an increasing number of medical, but also non-medical, needs, especially in camps. Now we’re running at maximum capacity, and other emergency organisations must urgently come back and help respond to the massive humanitarian needs on the ground.” 

According to recent estimates, more than 687,000 people are living in camps for internally displaced people or are being hosted by local families in the territories of Masisi, Rutshuru and Walikale. For months, MSF has been advocating for the on-the-ground return of other humanitarian organisations. These efforts resulted in the arrival of a handful of organisations with temporary funding from the DRC Humanitarian Fund in mid-November.  

“This support is temporary and far from enough to meet the needs,” says Janssens. “Given the scale of the crisis, a much larger humanitarian response is needed in southern North Kivu, with organisations being present on the ground and benefitting from longer-term funding. The Humanitarian Response Plan 2020 for DRC must clearly take this into account in its upcoming revision.”