H5N1

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.

Beni: Free health care difficult to apply to Mabalako

Via Radio Okapi: Beni: free health care difficult to apply to Mabalako. The Google translation:

Beni's civil society complains of the non-respect of free health care in the Mabalako health zone affected by the Ebola virus disease. 

For nearly a month, patients who go to the health facilities of Mabalako, after free consultation with doctors, find themselves with prescriptions in hand. They have to fend for themselves to buy their medicines. 

According to health sources in Mabalako, the health zone no longer has drugs to take care of the patients free of charge. The first stock of medicines provided by the NGO ASTRAMES, which manages, among other things, the drug supply chain in North Kivu, is finished. So, say the same sources, it is difficult to apply the measure of the Ministry of Health, which is still in force in the health zones of Mabalako, Beni and Oicha.    

The leaders of the NGO ASTRAMES contacted by Radio Okapi, acknowledge the facts. They say they have received the order from the Ministry of Health and that the matter is being processed.

DR Congo: Armed attacks may worsen Ebola epidemic, Human Rights Watch warns

Via Actualite.cd: DR Congo: Armed attacks may worsen Ebola epidemic, Human Rights Watch warns. The Google translation:

Armed attacks attributed to ADF fighters are complicating efforts to stem the Ebola outbreak, Human Rights Watch warns in a statement released Thursday (October 4th). 

"The risk of this epidemic worsening is reinforced, while carers can not access certain areas because of insecurity, and the World Health Organization considers that  the threat is imminent for Uganda, neighboring country," said the NGO in a statement. 

"In four years, the Congolese government has been unable to stop the abuse and suffering in Beni," said Ida Sawyer, deputy Africa director at Human Rights Watch. "Beni needs more international action to protect civilians, bring perpetrators to justice, and help caregivers working to fight Ebola (...). The brutal killings of Beni residents will not stop until the commanders of the responsible forces are brought to justice," said Sawyer. 

"Since the Congolese authorities have not investigated or criminally prosecuted these atrocities, the International Criminal Court should investigate for future trials," she added. A total of 162 cases of haemorrhagic fever have been reported in the region, 130 confirmed and 32 probable.