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Nairobi City County: Update on Suspected Cholera Outbreak in the Nairobi Hospital (16.04.2019)

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Cyclone Idai briefing: Dr Djamila Cabral, WHO Representative in Mozambique (27.03.2019)

Last Friday I visited Beira, one of the worst-affected areas that was hit by Tropical Cyclone Idai.

The devastation is enormous

More than 100 000 people have lost their homes and all of their possessions. Families, pregnant women, babies are living in temporary camps in horrific conditions, without secure food supplies, or safe drinking water and sanitation.

Around 55 health centres have been severely damaged. I visited the central hospital in Beira where I saw the direct impact of the cyclone. The flooding had damaged essential equipment and the facility is unable to receive patients during this crucial time. As an example, surgical theatre and nursery completely damaged.

Official death toll is more than 446 but we expect the real numbers to be much higher. 1.8 million people in Mozambique need urgent humanitarian assistance.

For WHO, health is our number one priority now

We must not let these people suffer a second disaster through a serious disease outbreak or inability to access essential health services. They have suffered enough.

WHO’s Director General, Dr Tedros has called for a “no regrets” approach – this means that we are doing whatever it takes to address the crisis, investing all the available resources now to save lives and protect health.

We are building up a surge team of over 40 staff from across the Organization, with expertise in logistics, epidemiology, and outbreak prevention and response.

We have a number of key priorities right now. First to set up an early warning disease detection system so that we can respond rapidly as soon as an outbreak is suspected. Then we need to ensure that, as resources come in, they are immediately put to work.

There is increased risk of diseases

We know that after an event like this, there is extremely high risk of diarrhoeal diseases like cholera. WHO is positioning supplies to prepare to treat diarrhoeal diseases – lifesaving intravenous fluids, diagnostic tests, 900 000 doses of oral cholera vaccines are on their way from the global emergency stockpile. We are providing our expertise to set up 3 cholera treatment centres, including an 80-bed treatment centre in Beira.

We are also preparing for a spike in malaria in the coming weeks by procuring 900 000 insecticide-treated bednets to protect all affected families, and ensure rapid diagnostic tests and antimalarials are positioned to high-risk areas.

And we are working at top speed to ensure that the people of Mozambique can access essential health services during this crisis to ensure that:

  • people with HIV, TB or diabetes continue to receive their medications
  • that thousands of pregnant women are able to receive care for safe childbirth
  • that children receive treatment for common infections and are screened (and treated if needed) for acute malnutrition
  • that people in need receive psycho-social support and protection from gender-based violence.

The coming weeks are crucial for WHO in Mozambique. The health sector needs at least $38 million over the next 3 months for the health response to this humanitarian crisis.

The State of Health service delivery and financing: CSO perspectives (17.03.2019)

Ebola virus disease – Democratic Republic of the Congo (15.03.2019)

The greatest concern centres on the neighbouring urban areas of Katwa and Butembo, which continue to contribute about three-quarters of recent cases.

GENEVA, Switzerland, March 15, 2019 – The public health response to the Ebola virus disease (EVD) outbreak continues to make gains. During the last 21 days (20 February – 12 March 2019), no new cases have been detected in 10 of the 20 health zones that have been affected during the outbreak (Figure 1). There has also been fewer new cases observed over the past five weeks compared to January 2019 and earlier in the outbreak (Figure 2).

Currently, the greatest concern centres on the neighbouring urban areas of Katwa and Butembo, which continue to contribute about three-quarters of recent cases. Clusters in other areas of North Kivu and Ituri provinces have been linked to chains of transmission in Katwa and Butembo, and have thus far been contained to limited local transmissions with relatively small numbers of cases. A total of 74 confirmed cases were reported during the last 21 days from 32 of the 125 health areas affected to date (Table 1). Risk of further chains of transmission and spread remain high, as highlighted by the recent spread to Lubero Health Zone, and reintroduction to Biena Health Zone following a prolonged period without new cases.

Response teams are fully operational in all outbreak affected areas and there are encouraging improvements in community acceptance of the response, despite the challenges of ongoing insecurity caused by armed groups. For example, during the last 21 days in Katwa and Butembo, 88% of the 256 families with a family member who died and was suspected to have EVD, accepted the support from response teams to conduct a safe and dignified burial. Seventy-four new vaccination rings were launched, with over 90% of people eligible for vaccination accepting to do so, and over 90% of these participated in follow-up visits. A total of 5974 people (including 2159 health and frontline workers) consented and were vaccinated this period; overall 87,632 people have been vaccinated to date. Vaccination teams are continuing to follow-up on 12 rings wherein the families have not yet accepted the intervention, and two other rings that are in the process of being defined. Seven field laboratories have remained fully operational, sustaining similar testing rates as previous weeks. During the past week, 1213 samples from new suspected cases, community deaths and previously confirmed cases were tested within 48 hours. Outreach teams made up mostly of local volunteers also met with 6000 households during the past week, building local knowledge of Ebola, and referring sick individuals to either Ebola Treatment Centres (ETCs) or other health facilities as appropriate. In the last two weeks, community dialogues were held in several villages in Katwa and Vuhovi to find ways in engaging community members to build trust and ownership in the Ebola response.

Efforts to strengthen case finding and investigation, and contact tracing activities are also bearing fruit. Of 74 confirmed cases reported in the last 21 days, 83% (62 cases) have been epidemiologically linked to active chains of transmission; either listed as contacts at illness onset (47 cases) or linked retrospectively to other cases or health centre where they were likely exposed (15 cases). Investigations are ongoing to identify links for the remaining cases.

Challenges include further attacks by armed groups on affected communities and ETCs, elements of community mistrust, and persistent delays in getting people into care in ETCs for various reasons. The Ministry of Health, WHO and partners continue to work actively to build community trust and participation in the response, while reinforcing security measures to protect patients and response teams. The ETC in Butembo has been rebuilt following two attacks and is treating patients again, and the Katwa Transit Centre remains operational.

Since the beginning of the outbreak to 12 March 2019, 927 EVD cases1 (862 confirmed and 65 probable) have been reported, of which 57% (525) were female and 30% (280) were children aged less than 18 years. Cumulatively, cases have been reported from 125 of 319 health areas across 20 health zones of the North Kivu and Ituri provinces (Table 1). Overall, 584 deaths (case fatality ratio: 63%) have been reported, and 308 patients have been discharged from ETCs.

*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning.

 

PHR Demands Sudan End Detention of Doctors, Attacks on Hospitals; Calls for Accountability of Sudanese Government (01.03.2019)

Transfer of party leadership to deputy Ahmed Haroun appears merely symbolic.

Physicians for Human Rights (PHR) today called on the Sudanese government, which on February 22 declared a yearlong state of emergency, to immediately cease ongoing detention and abuse of doctors, students, and civilians. Since the beginning of the protests against the government in December 2018, PHR has learned about dozens of doctors and other health workers who have been arrested, held without charges, threatened and subjected to abusive treatment – including beatings and sexual abuse – for their care of injured demonstrators, as well as raids on health care facilities, inhibiting the provision of care.

PHR supports the Sudan Doctors Syndicate’s demand for an immediate cessation of the Sudanese government’s human rights violations against its people, joins the Sudan Consortium’s call for the African Commission for Human and People’s Rights to investigate allegations of excessive use of force against peaceful demonstrators, and calls for accountability in the face of the vicious crackdown on fundamental human rights in Sudan.

According to reliable reports compiled by PHR, 26 doctors currently remain imprisoned, most of them denied communication with their families and left untreated for injuries sustained during their arrests.

Physicians for Human Rights Medical Expert Dr. Rohini Haar said the following in response to the ongoing attacks against Sudanese doctors and health care facilities:

“President al-Bashir’s delegation today of Sudan’s ruling party leadership to his deputy and long-time ally, Ahmed Haroun, is likely to be merely symbolic, and must be accompanied by accountability for the government’s ongoing human rights violations. Sudanese authorities’ detention of doctors, incursions into hospitals, and interference with the provision of medical care not only represent egregious violations of the norms protecting the ethical delivery of medical care, but also cause significant health impacts for the entire community, which is no longer able to rely on hospitals as safe facilities to seek care. The Sudanese government’s use of tear gas, live ammunition, and violence – both within hospitals and on the streets – to quell peaceful protests and deter medical professionals’ ability to provide care to Sudanese citizens must cease immediately.

“The government must release detained Sudanese physicians, cease interrupting their efforts to provide health care to the Sudanese people, and be held accountable for human rights violations.”

Among the specific violations against health personnel and facilities committed at the end of February in Sudan, on the night of al-Bashir’s February 22 declaration of the state of emergency, security forces raided Central Doctors Housing in Khartoum, the largest doctors’ residence in the country, and detained all those on the premises. The estimated 56 doctors detained were released over the next few days, and many reported being beaten or subjected to psychological abuse. Reported physical injuries sustained by the detainees included a spinal fracture, limb fractures, bruises, and hematomas.

On February 24, armed security forces raided the University of Medical Science and Technology (UMST) and assaulted and detained students, including firing tear gas inside lecture halls and sexually harassing women students. After UMST students sought safe haven in Dar Alilaj hospital, security forces reportedly entered it and fired tear gas inside.

Since 1988, PHR has documented and advocated to stop the unlawful detention, torture, and killing of medical workers. PHR has advocated against the interference with medical care in violation of human rights and international laws and principles that protect the impartial delivery of health care, especially in times of civil unrest or conflict. Among other violations, the organization has reported on systematic attacks on doctors in Bahrain, the jailing of AIDS doctors in Iran, attacks and persecution of medical workers in Turkey, and the targeting and destruction of medical facilities and killing of medical personnel in Syria and Yemen.

Ebola virus disease – Democratic Republic of the Congo (28.02.2019)

Katwa and Butembo remain the major health zones of concern, while simultaneously, small clusters continue to occur in various geographically dispersed locations.

GENEVA, Switzerland, February 28, 2019 –  The Ebola virus disease (EVD) outbreak is continuing with moderate intensity. Katwa and Butembo remain the major health zones of concern, while simultaneously, small clusters continue to occur in various geographically dispersed locations. During the last 21 days (6 – 26 February 2019), 77 new cases have been reported from 33 health areas within nine health zones (Figure 1), including: Katwa (45), Butembo (19), Vuhovi (4), Kyondo (3), Kalunguta (2), Oicha (1), Beni (1), Mandima (1), and Rwampara (1).

Although there are decreasing trends in case incidence (Figure 2), the high proportion of community deaths reported among confirmed cases and relatively low number of new cases who were known contacts under surveillance could increase the risk of further chains of transmission in affected communities. Response teams must maintain a high degree of vigilance across all areas with declining case incidence and contact tracing activity, as well as in areas with active cases, to rapidly detect new cases and prevent onward transmission. Following attacks this week on the treatment centres in Katwa and Butembo, WHO is working with partners to ensure the safety of the patients and staff. These incidents are disruptive to the response on many levels and can also hamper surveillance activities in the field.

As of 26 February, 879 EVD cases1 (814 confirmed and 65 probable) have been reported, of which 57% (499) were female and 30% (264) were children aged less than 18 years. Cumulatively, cases have been reported from 119 of 301 health areas across 19 health zones. Overall, 553 deaths (case fatality ratio: 63%) have been reported and as of 19 February 2019, 257 survivors have been reported. There is ongoing cleaning of the case database to correct the number deaths and survivors discharged from Ebola Treatment Centres (ETCs).

Public health response

For further detailed information about the public health response actions by the MoH, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:

Ebola situation reports: Democratic Republic of the Congo

WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. National and regional risk levels remain very high, though global risk levels remain low. This EVD outbreak is affecting primarily the north-eastern provinces of the Democratic Republic of the Congo bordering Uganda, Rwanda and South Sudan. There is a potential risk for transmission of EVD at the national and regional levels due to extensive travel between the affected areas, the rest of the country, and neighbouring countries for economic and personal reasons, as well as due to insecurity. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria, measles), and a long-term humanitarian crisis. Additionally, the fragile security situation in North Kivu and Ituri, further limits the implementation of response activities.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

WHO advice

International traffic: WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.

North Kivu, Democratic Republic of the Congo (DRC): Médecins Sans Frontières (MSF) Ebola centre not functional after violent attack (26.02.2019)

Ebola response at risk of failing without gaining acceptance of communities.

GENEVA, Switzerland, February 26, 2019 – Médecins Sans Frontières/Doctors Without Borders (MSF) has suspended activities in an Ebola Treatment Centre in Katwa, North Kivu, the international medical organization announced today. This comes after a violent attack on 24 February when the facility was partially burnt down.

At 10 pm on 24 February, unidentified assailants attacked the MSF-managed Ebola Treatment Centre in Katwa. After throwing stones at the facility, they set parts of the structure on fire and destroyed wards and equipment. The brother of a patient died while reportedly trying to escape the scene. The exact circumstances of his death are still unclear at this point.

“This attack was traumatic for patients, their relatives and staff present inside the centre at the time,” said Emmanuel Massart, MSF’s Emergency Coordinator in Katwa. “We managed to relocate all four confirmed and six suspected patients to nearby treatment centres, but this attack has crippled our ability to respond to what is now the epicentre of the outbreak.”

“Although the reasons behind the attack are unclear and such violence is unacceptable, what we know is that the actors of the Ebola response – MSF included – have failed to gain the trust of a significant part of the population,” said Meinie Nicolai, MSF’s General Director currently visiting North Kivu. “All those involved in this response must change their approach and truly engage with the grievances and fears of the communities.”

Previous Ebola outbreaks have demonstrated the importance of gaining the acceptance of the community. Without the communities trust, the sick and dead remain hidden and health workers risk being threatened or assailed.

More than six months after the beginning of the Ebola outbreak in North-Kivu and Ituri, the epidemic is not under control with more than 870 confirmed patients and more than 540 deaths. After some successes in stopping transmission in the initial epicentres of Mangina and Beni, and some ancillary locations such as Tchomia, Mutwanga, and Masereka, the epidemic has spread from four to 19 health zones. People continue to die in the community, and become infected in health centres, and the majority of new cases cannot be traced to known Ebola cases.

MSF activities in the Ebola response continue in Butembo, Bunia, Bwena Sura, Kayna and Biena.

Kenya: Joint Statement between the Ministry of Health And Council of Governors on Nurses Strike (19.02.2019)

DRC: Ministry of Health – Response of DRC Ministry of Health to the Guardian article “Ebola vaccine offered in Exchange for, Congo taskforce meeting told” (12.02.2019)

Zimbabwe: Acting Secretary Dr. G. Mhanga letter to Chief Executive Officers/Provincial Medical Officers – “Proposal Interim Flexible Working Hours for Health Workers: Public Health Sector” (01.02.2019)

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