H5N1

Amid political and civil unrest in Myanmar, health services are inaccessible

A letter in The Lancet: Amid political and civil unrest in Myanmar, health services are inaccessible.

Myanmar is a democratic country in political crisis, and a suspension of health services is placing millions of patients with chronic illnesses in increasingly difficult situations. On Feb 1, 2021, the military initiated a coup and committed aggressive repression. In response, Myanmar's citizens engaged in massive protests and a civil disobedience movement in an attempt to end the coup and restore democracy. 

Our colleagues and friends in Myanmar, who ask for anonymity to protect themselves and their families from military reprisals, have relayed to us how political turmoil turned violent and continues to escalate. Numerous service sectors, including transportation and health care, have been disrupted. Public spaces have become unsafe due to increased violence, streets have been closed as a result of confrontations, and health services have either been suspended or operate on reduced hours because of a decrease in workforce and military police raids. 

We are particularly concerned for those patients with chronic illnesses who have multiple unmet needs. For example, essential HIV services (including HIV testing), delivery of antiretroviral therapy, viral load testing, and adherence counselling have been reduced or suspended because of closed facilities and the disappearance of providers in many towns throughout Myanmar. Within the health-care system, many medical facilities have closed or relocated to avoid military or police targeting. Health-care workers' security is under threat from state violence, resulting in additional barriers to accessing care. Most public hospitals with inpatient services have stopped providing services, leaving patients no choice but to use expensive private institutions. 

Moreover, because public transportation is unavailable and personal safety is increasingly threatened by violence on the streets, patients are reluctant to travel to refill life-sustaining medications. Given the far-reaching impacts of political instability on the health-care infrastructure, people with various illnesses in Myanmar are likely to experience serious service interruptions. 

Considering these dire conditions, we urgently call for humanitarian interventions from the international health-care community to ensure patients in Myanmar with chronic illnesses have access to necessary medical care for basic health maintenance and survival. Financial aid, human resources, and technical support are needed to create one-stop, wrap-around services for these patients, from screening to treatment. A continuous flow of medical supplies must be secured. Safe transportation is crucial for access to health care. 

Finally, research is needed to investigate how patients with chronic illnesses in Myanmar use health services because their physical and psychological health is negatively influenced by traumatic geopolitics. This research would allow the development of evidence-based interventions and serve populations who need support during these unstable political conditions.

Unknown men kill 5 polio vaccinators in eastern Afghanistan

Via Radio Killid: Unknown Men Kill 5 Vaccinators in E. Afghanistan.

Unknown gunmen on Tuesday morning gunned down five vaccination campaign workers in the provincial capital of Nangahar province, a security source told TKG. 

The polio vaccination workers were killed in separate attacks in the fourth and seventh districts of Jalalabad city, the provincial capital, the source spoke to TKG on condition of anonymity.  

The source put the toll of the dead to four women and a man who were polio vaccination workers.  Provincial officials confirmed the attack without disclosing details of casualties. 

There was no immediate claim of responsibility.

Health facilities targeted in Tigray region, Ethiopia

A news release from MSF.org: Health facilities targeted in Tigray region, Ethiopia. Excerpt:

ADDIS ABABA – Health facilities across Ethiopia’s Tigray region have been looted, vandalised and destroyed in a deliberate and widespread attack on healthcare, according to teams from Médecins Sans Frontières (MSF). Of 106 health facilities visited by MSF teams between mid-December 2020 and early March 2021, nearly 70% had been looted, and more than 30% had been damaged; just 13% were functioning normally. 

In some health facilities across Tigray, the looting of health facilities continues, according to MSF teams. While some looting may have been opportunistic, health facilities in most areas appear to have been deliberately vandalised to make them non-functional.  In many health centres, such as in Debre Abay and May Kuhli in North-West Tigray, teams found destroyed equipment, smashed doors and windows, and medicine and patient files scattered across floors. 

In Adwa hospital in central Tigray, medical equipment, including ultrasound machines and monitors, had been deliberately smashed. In the same region, the health facility in Semema was reportedly looted twice by soldiers before being set on fire, while the health centre in Sebeya was hit by rockets, destroying the delivery room. 

MSF teams recently visited 106 medical facilities across Tigray region, Ethiopia. Of the facilities visited: 30% had been damaged, 73% had been looted, and 87% were no longer functioning or fully functioning. 

Hospitals occupied by soldiers 

Every fifth health facility visited by MSF teams was occupied by soldiers. In some instances, this was temporary; in others the armed occupation continues. In Mugulat in east Tigray, Eritrean soldiers are still using the health facility as their base. The hospital in Abiy Addi in central Tigray, which serves a population of half a million, was occupied by Ethiopian forces until early March. 

“The army used Abiy Addi hospital as a military base and to stabilise their injured soldiers,” says Kate Nolan, MSF emergency coordinator. “During that time, it was not accessible to the general population.” 

“They had to go to the town’s health centre, which was not equipped to provide secondary medical care – they can’t do blood transfusions, for example, or treat gunshot wounds,” says Nolan.  

"Health facilities and health staff need to be protected during a conflict, in accordance with international humanitarian law. This is clearly not happening in Tigray," said Oliver Behn, MSF General Director. 

Ambulances seized 

Few health facilities in Tigray now have ambulances, as most have been seized by armed groups. In and around the city of Adigrat in east Tigray, for example, some 20 ambulances were taken from the hospital and nearby health centres. 

Later, MSF teams saw some of these vehicles being used by soldiers near the Eritrean border, to transport goods. As a result, the referral system in Tigray for transporting sick patients is almost non-existent. Patients travel long distances, sometimes walking for days, to reach essential health services. 

Many health facilities have few – or no – remaining staff. Some have fled in fear; others no longer come to work because they have not been paid in months. 

Devastating impact on people 

The attacks on Tigray’s health facilities are having a devastating impact on people,” says Oliver Behn. “Health facilities and health staff need to be protected during a conflict, in accordance with international humanitarian law. This is clearly not happening in Tigray.”

The crisis of health care in Myanmar

A letter in The Lancet:The crisis of health care in Myanmar.

We are writing in solidarity with the health workers of Myanmar during the worsening crisis following a military coup on Feb 1, 2021. Many UK health research and care institutions have worked with clinical colleagues in Myanmar over many years, building both partnership and friendship. Together we have seen significant improvements in the country's health system, providing life-saving care to mothers, newborns, infants, and children. Those improvements are now at risk. 

Large numbers of Myanmar civilians, including health workers, are committed to the Civil Disobedience Movement, believing that peaceful protest is the best way to avoid a politically and economically disastrous slide back into military dictatorship, and to arrive at a way forward for Burmese democracy. Demonstrations have spread to all parts of the country. Through personal communication with colleagues in Myanmar and news reports, it is clear that many protesters are in hiding, sleeping in a different place each night in fear of their lives. Petrol is now scarce, banks are closed, and internet, electricity, and water supplies are all disrupted. Meanwhile, although government hospitals, schools, and universities are shut, groups of doctors are treating patients quietly and without charge in a variety of settings. 

UN Resolution 2286 prohibits harm against health workers in situations of conflict. They must be protected now, not least by the vigilance of the global community. Myanmar's doctors and nurses are a vital constituency in the country's social development. We urge all parties to respect their humanitarian role and to ensure their safety. We hope that by bearing witness alongside our Myanmar friends and colleagues, we may help to galvanise international support for Myanmar's recent democratic process, a resolution to the current crisis, and a resumption of the country's path to prosperity.

Ebola: The gendarme presumed author of the destruction of the vaccine kits in Gouecke remains untraceable

Via guineenews.org, a follow-up to an unusual story: Anti-Vaccine reluctance: the gendarme presumed author of the destruction of the kits in Gouecke remains untraceable. The person was originally said to be a soldier. The Google translation: 

The gendarme, accused of being the main actor of the destruction and the fire of the material serving as shelter for the vaccination of the people contacted in Gouecké, remains for the time being untraceable, we learned on the spot.  

Indeed, several days after the destruction and the fire of the tents and the hand washing kits, installed for the vaccination of the people contacted, the main actor indexed by the sub-prefect of Gouecké, remains for the moment untraceable despite all actions taken by the response committee. 

Joined by our reporter based in the N'Zérékoré region, Mr. Daniel Théa, relative of the gendarme, specifies “You know people are managing this Ebola case very badly. Our brother had every intention of surrendering. But he stayed with a woman from the WHO, who was convincing him to agree to come to N'Zérékoré, when a vehicle full of men in uniform came to stop him, and suddenly he fled. Imagine, all of Gouecké's cases of death are from his family. So psychologically, it's really hard to keep up. If to this is added more brutality, the situation can only become more complicated.” This is how our brother took refuge with certain young people, our interlocutor said. 

“You know, he was the one in front of the young people to destroy the equipment. On the pretext that her sister was sent to N'Zérékoré and that she died. For the moment he has not agreed to surrender," deplores Ibrahima Koné, the sub-prefect of Gouecké. 

Despite all the awareness campaigns carried out on the ground, reluctance remains relevant in Gouecké and Bangana in the urban commune of N'Zérékoré. 

Note that 302 contacts remain to be followed to date, 17 cases of alerts including 8 deaths have been recorded and 94 people contacted have been vaccinated, according to statistics provided by the response commission to date.

Paraguayans take to the streets in indignation over pandemic management

It's been striking to see how tolerant people have been of their governments' mismanagement of the pandemic. Apparently Paraguay is an exception. Via Deutsche Welle Brazil: Paraguayans take to the streets in indignation over pandemic. Excerpt from the Google translation and then an update:

The anger of Paraguayans against what they see as the government's deficient management of the covid-19 pandemic has hit the streets. The protests, which peaked on Friday with clashes with the police, have already led to the fall of the health minister. Protesters now call for the removal of the president, conservative Mario Abdo Benítez. 

This Saturday (03/06), Abdo Benítez asked for the resignation of all the ministers of his government, during a meeting with his closest collaborators in the presidential residence of Mburuvicha Roga, to "assess the situations of yesterday" and prepare a public statement, as informed the Minister of Information and Communication Technologies, Juan Manuel Brunetti. 

"The concrete message is this: the president listened to the citizens, summoned his office and asked them to make their positions available," said Brunetti. 

The spokesman insisted that Abdo Benítez had received "the message from the citizens", although the protesters demanded the departure of the entire Executive, starting with the President himself, and not changes of ministers. 

Brunetti also added that it will be the head of state who will announce the ministerial exits at the moment when "he has concrete facts to communicate to the citizens". 

With a record of infections, crowded ICU beds and a health system on the verge of collapse, Paraguay, which was praised for its crisis management, also faces a lack of drugs to treat patients with covid-19. Vaccination, moreover, is advancing slowly: it is estimated that only 0.1% of the population has been immunized. 

Pitched battle in Asunción 

On Friday, the protests started peacefully, but soon turned the historic center of the capital Asunción into a battleground. At least one person died and 18 others were injured.

Security forces fired rubber bullets and tear gas around Congress, while protesters tried to break through barricades and throw stones at the police. 

Images displayed by the local press showed several people injured by rubber bullets fired by police, and security forces agents hit by stones thrown by some protesters.  

The core of the disturbances was an area that includes the headquarters of the National Police, the headquarters of Congress and the Government Palace. After the confrontation, the crowd dispersed through several streets in the center, shouting slogans against the government of Abdo Benítez. 

Interior Minister Arnaldo Giuzzio told reporters that the incidents were caused by people who infiltrated the demonstration to generate turmoil. 

A group of protesters, estimated at around 100 by the Paraguayan press, intends to hold a vigil before Congress to demand the resignation of Abdo Benítez. 

Shortage of medicines and vaccines 

The call for the protest this Friday was made after the union of nurses and family members of patients held this week other demonstrations to denounce the lack of medical supplies and materials in public hospitals, especially among those most affected by the coronavirus.

On Friday morning, Health Minister Julio Mazzoleni resigned after meeting with Abdo Benítez, but that did not appease the anger of the protesters.

The Ministry of Public Health and Social Welfare issued a news release today announcing that Dr. Julio César Borba is now the interim minister of health.

Fire in an Ebola vaccination center: 'It was a soldier who instigated it'

Via Guineematin.com: Fire in an Ebola vaccination center: "it was a soldier who instigated it" (Gouécké SP). This is a confusing report: the soldier has a woman's name, but the translation mostly uses male pronouns (which I've changed for the sake of consistency). I hope future reports will clarify the matter. The Google translation and then a comment:

We know a little more about the fire of the Ebola vaccination facilities that occurred yesterday, Friday March 5, 2021, in the sub-prefecture of Gouécké (N'Zérékoré), the epicenter of the disease. Reached by phone by the correspondent of Guineematin.com in N'Zérékoré, the sub-prefect of Gouécké, Ibrahima Koné, gave details of this situation. According to him, it is an angry soldier who is the instigator of this violence. 

“It is a soldier named Alice Haba, in service at Dabola, who is at the origin of this act. Her sister, who was sick with Ebola, died this morning in N'Zérékoré. Now she says that she was not officially informed of her sister's death, and that it was the hospital and the sub-prefect who caused her sister's death. That is why she decided to come and burn down the premises of the sub-prefecture and the installations that are here. She mobilized children and took gasoline to come to the sub-prefecture. When they arrived, I was arrested in front of the sub-prefecture with a friend. They put gasoline on the tent (where the Ebola vaccination is done) and set it on fire. When we came to them, they fled to return to the neighborhoods,” explained Mr. Ibrahima Koné. 

For the time being, there have been no arrests following the fire at these facilities which house the vaccination against the Ebola epidemic. According to the sub-prefect of Gouécké, the soldier who is identified is a contact subject. It would therefore be necessary to wait until the security agents were vaccinated so that they could proceed to her arrest.

Alice Haba appears to be the sister of Lucie Haba, who died on February 12. Several other members of her family also contracted Ebola, and two of her brothers died.

Violence against health care: Attacks during a pandemic

An interactive report from the UC Berkeley Human Rights Center and Insecurity Insight: Violence Against Health Care: Attacks During a Pandemic. Excerpt:

Atlas of Attacks 

While health care workers worldwide have been lauded as heroes for providing much-needed medical services to fight COVID-19, countless others have faced attacks directly related to their essential work. 

In the midst of a global pandemic, attacks on health workers and services further exacerbate fragile health care systems, highlight weaknesses in resources and equipment, and deprive citizens of basic rights to health, medicine, and protection under international human rights and humanitarian law. 

The UC Berkeley Human Rights Center and Insecurity Insight documented more than 1,100 attacks and threats of violence against health care, including medical personnel, patients, health care facilities, and transport. Some 400 of these attacks appear to be specifically COVID-19 related. 

The Atlas of Attacks maps each report of a violent attack or reported threat of violence against health care, which may include attacks on people or health facilities. Where multiple events are reported, these events will be displayed on the map in clusters, with the number of unique events displayed.

Health care attacks during a pandemic 

Attacks on health care have become more apparent in the midst of the pandemic and impeded the response to COVID-19 in numerous countries. Health workers caring for the infected or sick have been subjected to individual and collective assaults as well as coercion and punishment by security forces for speaking up about their or their patients’ needs. 

While attacks on health care have been prominent in conflict settings, the COVID-19 pandemic has thrown into stark relief the risks health workers face from both the virus and public violence as communities grow fearful, angry, and frustrated. Moreover, health workers have suffered psychologically as a result of these constant threats while having to deal with the trauma of watching patients die.

Butembo: Trial of alleged murderers of Dr Mouzoko begins

Via Radio Okapi: Butembo: trial of alleged murderers of Dr Mouzoko begins. The Google translation and then a comment:

The trial on the assassination of Doctor Richard Mouzoko opened on Monday February 22 in Butembo. This Cameroonian doctor was shot dead by armed men in April 2019.   

He was in full response to the tenth Ebola epidemic at the Graben university clinics in Butembo.    

Out of twenty-five people arrested in this case, only eight were present at the trial, including three Congolese doctors. 

All the defendants absent from this trial have been on the run since the recent massive escape of prisoners from Kangbayi to Beni. The president of the order of doctors of Butembo, Dr Kalima Nzanzu, who deplores the state of health of its members, hopes to wait for the true verdict:

“All 3 (doctors), at least those who are here in Butembo, are already hypertensive and even diabetic. However, these are people who were not really known to have these pathologies. So you feel it was the stress that made them uncomfortable. Our expectations: we want justice to say the true verdict. If there are any culprits, let them be condemned. If there are innocent people, let them be released. That's all we ask."    

For his part, the vice-president of the provincial coordination of civil society in North Kivu, Edgar Mateso. expresses some concerns about this trial:   

“The first concern is that some people who were arrested fled. The second concern is that we wanted this trial to be highly publicized. Many inhabitants of our region are not even informed, there are even some who do not know where the trial is being held. It is appropriate, for example, to broadcast this trial live on the radio, but at the same time we would like this trial to be quickly speeded up.”

The assassination of Dr. Mouzoko was an appalling outrage, and it's equally appalling that most of the accused have not just evaded justice for so long, but have escaped from prison.  

Ebola in Guinea: Remembering the Womey massacre

As if the new outbreak in Guinea, combined with the new outbreak in the DRC, and the pandemic itself, weren't discouraging enough, I've remembered that southern Guinea is also the site of the town of Womey, whose residents attacked and murdered part of a team of health workers, officials, and journalists in September 2014.

The town is a short drive from Gouécké, and attitudes toward the authorities are unlikely to have changed dramatically since then. The response this time could be very difficult to carry out without triggering more violence.