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1105 Sexual violence prevention
and re-integration funding "falls through cracks" [DRC]--While
medical and psychological care are being provided to survivors of
sexual violence in eastern Democratic Republic of Congo, where 7,000
women and girls have been raped this year alone, UN and aid workers
on the ground say the funding response has been too narrow, leaving
key issues inadequately addressed.
"Increased international attention to sexual violence in DRC has led
to a substantial increase of funding, accompanied by a
disproportionate lack of evaluations of the real needs on the ground
and lack of understanding of the complexity of the issues," notes
the Comprehensive Strategy on Combating Sexual Violence in the DRC,
released in 2009 by the Office of the Senior Adviser and Coordinator
for Sexual Violence in the DRC.
"Efforts are unevenly distributed [...] The programmatic focus is
essentially on two sectors: medical and judicial support to sexual
violence survivors, while the remaining sectors show very few
interventions," according to the strategy.
The sectors receiving proportionally less funding and attention
include prevention and reintegration.
"Just treating the results of sexual violence is a catastrophe. No
one is really treating the root or the entirety of the situation. If
you just care for the raped women, you will be caring for them up
until infinity," said Butros Kalere of Women for Women.
Among those feeling the funding pinch is Heal Africa, a Goma-based
NGO that provides medical and social care in the region.
"Sexual violence is not just a physical problem, but we often don't
have enough funding and thus, we are limited to real work only for
the immediate victims," the organization's community health
coordinator, Jean Robert Likofata Esanga, told IRIN, adding that its
programmes that focus on prevention, rehabilitation and
re-integration continually suffer under-funding.
Effective prevention programming, according to Tasha Gill, child
protection officer with the UN Children's Fund (UNICEF) in the DRC,
"employs advocacy and awareness to mobilize the communities through
community leaders, identifying the issues and working towards
longer-term changes within local social norms, while alternately
working towards protecting those who are most vulnerable".
Gill also noted that the UN planned over the next few years to
better direct funding so that "funding for this sort of prevention
programming no longer falls through the cracks".
Even organizations that specialize in protection are feeling the
pinch. "We usually try to reduce vulnerability and protect 1,000
women in the communities on the outskirts of Goma by providing them
with skills training, literacy and financing a portion of their
activities," explained an employee of one such NGO. "Now that our
donor wants us to work more in an 'emergency' setting and we are
confined to working in the IDP camps, it is very difficult as the
population is always in flux. It's hard to keep track of them and be
consistent with the training."
The UN's goals for re-integration include "ensuring victims'
satisfaction and guaranteeing non-recurrence of sexual violence" as
well as ongoing psycho-social care. However, the services are
fragmented due to minimal funding, complicated coordination and the
distances to be covered for transportation and service provision.
Even in Goma's Kibati I IDP camp in July, women were returning
without access to further counselling, education or skills-building.
As Constance, a Heal Africa counsellor, said: "We would like to help
each victim reintegrate smoothly and carry on with counselling
sessions, but we are limited to having a clinic or a skill centre
nearby. We do not have the funds to help every woman through her
The UN's ideal plan for re-integration also includes a "survivor-centred
skill approach". While some NGOs have funding to provide women with
the opportunity to learn skills during their hospital stays, their
use of those skills upon their return can be restricted by location
and availability of material. For example, women are restricted in
practising their sewing skills by lack of access to a sewing
machine, while literacy skills are restricted by the lack of
"Medical, protection, and legal/justice services and psycho-social
care are part of treating sexual violence, but these services also
need to include enabling women to be able to provide for their
families... for them to feel like they can move on and take care of
their children," Mendy Marsh, an independent expert on sexual
violence, told IRIN.
Until funding for programmes addressing sexual violence in the DRC
makes this a priority, prevention and rehabilitation funding and
programming will continue to have to make do with a small percentage
of current funding.
1105 Turning to traditional
medicine in fight against malaria [Africa]--Encouraging
the use of traditional African herbal medicines could prevent some
of the one million malarial deaths on the continent, according to
specialists attending a conference in Nairobi. Many poor
communities, especially in rural settings, cannot afford modern
malarial drugs and many people die due to inaccessibility of
“Malaria kills many people in Africa, both children and adults,
despite the availability of free treatment in certain African
countries. While it is true many governments in Africa, with
development partners, give free pediatric treatment for malaria,
many still cannot access this facilities and resort to home
treatment,” says Merlin Wilcox of the Research Initiative on
Traditional Antimalarial Methods and the University of Oxford.
Some specialists at the ongoing 5th MIM Pan African Malaria
Conference in Nairobi said medicines drawn from plants that abound
in the continent could be utilized to save many people, especially
those in poor settings, from malaria.
BN Prakash, a researcher with the Foundation for the Revitalization
of Local Health Traditions, based in Bangalore, said Africa could
draw on experiences in India where medicinal plants have been used
with great success in the control of malaria-related deaths.
“Research in India has shown a 5-10 times reduction in
malaria-related deaths among communities who use traditional
medicinal plants like Guduchi [tinospore coeditdia], a local
medicinal plant found in India,” said Prakash.
Preserving traditional knowledge
Another speaker, Gemma Burford of the Global Initiative for
Traditional Systems of Health, said while there had been increased
cases of loss of knowledge about traditional medicinal plants,
student-led research could be used to preserve knowledge and create
a database on these plants.
“When we carried out research involving school children in rural
Tanzania about traditional Maasai medicines, we found out that 48
percent of these children already had knowledge about these plants.
We used [this knowledge] to create a database for the purposes of
preserving the knowledge and these plants too,” said Burford.
“It is important to note that many malarial drugs are still bought
from commercial pharmaceutical shops and not many of them are that
cheap. Costs also involve how easy or not it is to access these
government facilities, especially in Africa where medical facilities
are far-flung,” Burford said.
Educating the youth
Speakers at the conference called on African governments to
introduce educational programmes that would teach the younger
generations about the traditional methods of treating malaria and
other diseases plaguing the continent.
“The biggest obstacle to use of traditional medicines is lack of
interest from the youth and teaching them about these medicines
would be the best way to let them appreciate their values.
Evangelical churches and development agencies must also be persuaded
to stop fighting traditional African medicine because modernity and
tradition can be married to provide a formidable force against
malaria,” added Burford.
Effectiveness and dangers
Doumbo Ogobara, director of the Mali Malaria Research and Training
Centre, and a lecturer at the University of Bamako, said there
should be more research to ensure the effectiveness of traditional
medicinal plants in the treatment and management of malaria.
“More research must be directed towards finding out the
effectiveness of these traditional medicinal plants and their safety
and efficacy because initiatives on using them could be
counter-productive if this is not done. More emphasis therefore must
be laid on research for plant-based prophylactics for malaria,” said
Mahamadou Sissoko of the Centre called for caution in taking the
traditional medicinal route, arguing that many malaria-related
deaths have occurred even among communities that have relied heavily
on traditional plants for treatment.
“People are dying even in places where there is still widespread use
of traditional medicinal plants and unless the efficacy of a
traditional plant on malarial treatment can be ascertained through
vigorous research, we could have our backs against the wall. Many
traditional healers will abuse this and give anything as medicine so
long as it is a plant - we must urge caution,” said Sissoko.
1024 Mentors to boost
breastfeeding [Mali]--Have you checked in with your
breastfeeding support group? If you were a woman who gave birth in
one of Mali’s 48 “baby-friendly hospitals”, you should have been
assigned to one that checked up on you – often as soon as minutes
after the delivery.
In San village, 380km north of the capital Bamako, dozens of mothers
in 2005 formed the “Good Mothers” group – known in the local
language as Denbanyuma –to tell new mothers about the all-milk rule;
660 mothers across the country are trained to do the same as part of
a government child survival programme adopted in 2007, according to
the Health Ministry.
“Before, women fed their newborns tea and water without knowing the
consequences of this practice,” San mothers’ group leader Aïssa
Tangara Traoré told IRIN. The UN has estimated that 300,000 babies
could be saved every year in West Africa if they were fed only
mother’s milk for the first six months rather than formula, tea,
water or food as is generally the case.
Exclusive breastfeeding has been proven to boost a newborn’s
defences against malnutrition and infections, yet according to the
UN only 20 percent of mothers in West Africa and Central Africa
report practicing it. Mali’s Sahelian neighbours have among the
lowest numbers: 6 percent in Burkina Faso, 4 percent in Niger.
In a 2006 Mali government survey, 38 percent of women said they
breastfed exclusively. The Health Ministry is conducting a new
nutrition survey to be completed in 2010.
To date 48 maternity centres in Mali have been accredited – and 26
are in the review process – as baby-friendly hospitals, which is a
UNICEF initiative launched in 1991 to encourage breastfeeding. One
of the requirements for accreditation is to form breastfeeding
“As soon as the baby is washed, we ask the mother to start
breastfeeding,” San mothers’ group member Oumou Dembélé, 35 and
mother of four, told IRIN. “We visit the mothers every day until
they leave the maternity ward.” She added that one Sunday of each
month, the Good Mothers group organizes a talk at the San health
centre to help convince mothers. “We still have the grandmothers who
demand their daughters give babies tea or water,” said Dembélé.
Still perspiring from childbirth at the commune five health centre
in Bamako, Diaminatou Cissé rested under her mosquito net with her
newborn at her chest. She told IRIN the baby girl would not be fed
the same things her older brother was. “My grandmother gave him
cow’s milk and tap water. She is no longer alive, but my mother
shares her views.” She said she has learned from the centre’s mother
mentors that there is already water in milk.
The centre’s midwife, Djeneba Samaké, told IRIN that at baptisms a
mothers’ support group talks about breastfeeding. She said economics
helps promote breastfeeding: mother’s milk is free. “But even the
richest women here who consider powdered milk as a status symbol and
sign of progress are now choosing to breastfeed exclusively.”
1024 Death toll rises as
cholera spreads [Tanzania]--An outbreak of cholera in
northern Tanzania has continued to spread, claiming 59 lives over
the past two months. Health ministry officials reported 60 new cases
"We have recorded 3,454 cases of cholera in Tanga region during the
last eight weeks," Nsachris Mwamaja, a spokesman for the health
He added that the most affected area was in Handeni District, where
health officials have attributed the outbreak to ignorance of
Mwamaja said the government was making efforts to check the spread
of the disease to other regions such as Arusha, Kilimanjaro, Coast
and the commercial capital, Dar es Salaam.
"Sufficient supplies of medicines and medical personnel have been
sent to the affected areas," he said.
Seif Mpembenwe, Handeni district commissioner, said schools that had
been closed because of the outbreak were expected to re-open in
"We will continue with sensitization campaigns until the situation
improves," he said.
Mpembenwe said residents had been advised to dig and use toilets as
well as boil drinking water to prevent cholera, an acute illness
characterized by watery diarrhoea. The disease is caused by the
bacterium Vibrio cholerae and is spread by eating food or drinking
water contaminated with the bacteria.
Health officials fear that the long rains due now could lead to more
cases of cholera if correct hygiene is not observed.
Meanwhile, the country continues its efforts to curb the spread of
the H1N1 influenza. At least 1,000 suspected cases have been
reported, mostly in the northern district of Mbulu.
Blandina Nyoni, the permanent secretary in the Ministry of Health
and Social Welfare, said of the suspected cases, 339 had been
confirmed from the 985 samples officially tested.
She said the disease had so far caused one death. The government had
stepped up preventive measures, including screening centres at entry
points and enhancing public education.
"People should not panic," Nyoni said. "Much as we don't have
vaccines for swine flu in the country, there are adequate supplies
of tamiflu antibiotics that are used in the treatment of swine flu."
The influenza is caused by a viral infection. Its symptoms are
similar to those of influenza, such as fever, sore throat, muscle
pains, severe headache, coughing, weakness and general discomfort.
1024 Child disability, the
forgotten crisis [DRC]--Looking at herself in the mirror,
nine-year-old Helena squealed with delight at her reflection,
standing upright with just the slightest support of her therapist. A
year before, Helena was diagnosed with cerebral palsy and identified
for therapy in Mugunga II IDP camp in Goma, eastern Democratic
Republic of Congo. Helena, able only to crawl, had been confined to
very specific spaces due to the lava in the IDP camp.
Helena was one of the lucky few to have received regular treatment.
Robert Golden, a doctor, states in the 2008 UN Children’s Agency
(UNICEF) report, Monitoring Child Disability in Developing
Countries, that it is an “important but largely unaddressed issue”.
This is especially true in DRC where child disability receives
little attention among the myriad crises befalling the country.
According to the UN Office for the Coordination of Humanitarian
Affairs (OCHA), two million people are displaced in the eastern DRC.
Combine this figure with World Health Organization (WHO) data that
10 percent of the world’s population suffer some form of disability,
and that would mean 200,000 disabled people among the displaced,
many of them children.
“Attention and funding for programmes addressing disability are
largely under-funded worldwide, and particularly in Congo,” says
Heal Africa’s Laura Keyser.
“The international community might not see disability as an
emergency worth focusing on now, but it will become a full emergency
if nothing is done,” said Loran Hollander of Heal Africa’s hospital
Increasing Risk Factors
While funding for treatment remains minimal for agencies
specializing in treating disabilities, the number of disabled
children and those at risk continues to grow due to the increased
risk factors brought on by the breakdown of the health
infrastructure, ongoing violence and displacement in the eastern
Minimal access to healthcare, clean water, and overall poor
nutrition during pregnancy lead to common congenital disabilities in
children such as spina-bifida and limb deformities, and young
children predisposed to early childhood diseases such as meningitis
and polio, explained Keyser.
Access routes to health centres are often blocked for patients and
medical teams. This lack of access leads frequently to birthing
complications, child developmental delays and maternal mortality.
Furthermore, the prevalence of rape in the DRC is also linked to a
probable increase in child disability. “Frequently women pregnant
from rape do not seek pre- or peri-natal care, which can lead to the
problems aforementioned, as well as birth trauma - either to the
baby (ie lack of oxygen leading to cerebral palsy or some type of
developmental delay) or to the woman (ie a fistula, which may or may
not leave them incontinent),” said Keyser.
“Unfortunately, disabled children are more vulnerable to abuse,
exploitation, neglect and discrimination. They face reduced social
participation and have less access to education and other social
services than children without disabilities,” states Golden.
In addition, according to Handicap International and Heal Africa,
inside the camps as well as outside, children with a disability
struggle daily with social stigma and discrimination.
Proper treatment, according to UNICEF, Handicap International and
Heal Africa, provides the children with the physical ability to
function more fully in society while also educating the community to
break down stigma and social restrictions.
UNICEF notes that “early detection and intervention might confer
benefits to children at risk for disability and prevent long-term
Jusbeen, 4, came to the Heal Africa’s clinic with a serious
infection, a noma, which had “scarred down” his mouth, making it
difficult to eat or drink. Therapists discovered that Jusbeen also
suffered from developmental delays. However, since his disability
was caught early, he has undergone a significant transformation.
With ongoing therapy and constant encouragement from his mother,
Keyser notes, “he is now able to walk with hand-held assistance,
smiles, laughs and engages in play activities which were impossible
Due to minimal international attention to child disability amid the
numerous crises afflicting the DRC, children like Jusbeen and
Helena, who received treatment, remain among the minority. “These
children need all the help they can get,” says UNICEF. At present,
that help is limited.
1024 Humanitarian stockpile
takes shape - on paper [West Africa]--When a storm hits
in Togo, disaster relief items must be flown in from Brindisi,
Italy, but that is just too far, according to the Economic Community
of West African States (ECOWAS), which is formalizing the region’s
first government-operated humanitarian stockpile in Mali’s capital
The best-stocked depot that responds to West African requests for
help during natural disasters is in Brindisi, Italy. Managed by the
UN’s World Food Programme since 2000, the depot is one of five UN
humanitarian response depots, with the others located in Panama,
United Arab Emirates, Malaysia and Ghana.
ECOWAS’s Director of Humanitarian and Social Affairs, Dan Eklou,
told IRIN that during 2009 flooding in West Africa, it took more
than one week for some areas to receive materials from the Brindisi
depot, which warehouses everything from tents to toilets, biscuits
to blankets. “If the goods were in Bamako, it would not have taken
that long to reach people who needed help.”
In Abuja, Nigeria in 2000 ECOWAS voted to create two permanent
logistical bases in West Africa, one to store humanitarian supplies
and the other peacekeeping materials to serve ECOWAS member states.
Mali and Liberia were subsequently chosen as sites for the
Nine years later, West African governments are preparing to sign the
humanitarian stockpile into existence through an agreement with the
government of Mali, which is making available 15 hectares at its
airport in Bamako to house the planned depot.
Eklou said it will take time to conduct feasibility studies for
construction. The organization is considering offers from the United
Nations to build and stock the new warehouse.
The region’s stockpile capacity is currently inadequate, according
to head of West Africa’s UN Office for the Coordination of
Humanitarian Affairs (OCHA), Hervé Ludovic de Lys. “Given weather
trends, climate change pressure and other indicators, it will become
increasingly necessary to decrease the distance between depot and
beneficiaries and to increase the stock of materials that can be
deployed in times of catastrophe or crisis.”
As important as ease of access, is sovereignty added Eklou. “We do
not want to depend on others from outside the region. There should
be no constraints to disaster response.”
Pending signature of the agreement, all stockpile operations will be
tax-free and free from import or export restrictions that govern the
movement of goods in and out of Mali. Employees will have diplomatic
The depot is also intended to serve as a training facility for
humanitarian rapid response exercises.
1024 Aid groups mobilize to
help wounded [Guinea]--Aid agencies are mobilizing funds
and relief supplies to help more than 1,000 Guineans injured in 28
September violence, as well as to brace for further unrest as the
country remains “very volatile”, according to the UN.
UN agencies, donors and NGOs in the capital Conakry are providing
meals for hospital patients, giving medical supplies to health
centres and ordering in new supplies to ensure adequate emergency
stocks, aid workers in Guinea told IRIN.
Three weeks after over 150 people were killed in a military
crackdown on demonstrators in the capital Conakry, with women and
girls raped, Guineans are coping with the aftermath, some still
searching for disappeared relatives’ bodies. Uncertainty and tension
“The situation is very volatile and it is feared that protests may
continue with even more casualties in the next days or weeks,” said
a World Health Organization (WHO) document on the situation in
The number of wounded seeking treatment is rising as more people
injured on 28 September visit health centres; aid workers and human
rights activists say many people needing medical care have stayed
home for fear of repression.
Immediately following the violence the Guinean Red Cross deployed
scores of volunteers to assist the wounded, and other aid agencies
including Médecins Sans Frontières provided emergency assistance to
the health sector.
The UN on 14 October allocated US$417,205 from its Central Emergency
Response Fund, CERF, for a WHO project to support health facilities
The funds will go toward medicines, trauma kits, rape treatment kits
and blood transfusion supplies, as well as preparing health
personnel to deal with trauma patients, according to the document.
More than 200 people are known to be in “a very serious” condition
and need lengthy treatment, the document says.
Current emergency stocks of relief supplies are insufficient to deal
with repeated shocks, according to the UN in Guinea.
“The main issue now is to determine the gaps in medical and relief
supplies,” said Philippe Verstraeten, head of the Office for the
Coordination of Humanitarian Affairs in Guinea. “We are working on
defining those needs so we can mobilize for further funding.”
The NGO Terre des hommes (Tdh) is providing meals to patients in
Donka Hospital, one of Conakry’s main public hospitals, according to
Tdh’s Marie-Jeanne Hautbois. The Health Ministry’s crisis committee
requested this assistance, as the ministry has said victims would
receive free treatment including food, she said. The food is
provided by the ministry, private donations and Tdh.
Guinea’s health system has long been in a dismal condition, with
frequent ruptures in medicines and medical supplies. Since the junta
took power in December 2008 government ministries, including the
Health Ministry, have had no budget, according to a ministry
official. In July the Health Ministry chaired an emergency meeting
about a shortage of equipment for blood transfusions.
1024 Shift aid base to "safe"
areas in-country, urges UN official [Somalia]--Humanitarian
agencies should move from Nairobi to "relatively safe" areas of
Somalia to be able to better serve more than 1.5 million internally
displaced people (IDPs) caught up in a "deepening" humanitarian
crisis, Walter Kälin, Representative of the UN Secretary-General on
the Human Rights of IDPs, said on 21 October.
"It is essential to find ways to improve humanitarian access and
security of humanitarian workers," Kälin told a news conference in
Nairobi. "To the extent possible, humanitarian agencies must shift
their operations from Nairobi to Puntland, Somaliland and other
areas from where the affected regions can be serviced."
He said these agencies must be given the staff and resources
necessary to effectively work in such a difficult and dangerous
environment, and should receive respective support by donors.
Marcus Prior, a spokesman for the World Food Programme in Nairobi,
told IRIN: “WFP retains several operational bases across Somalia and
has international and national staff inside the country. We would
like to have an even greater presence, but Somalia is probably the
most dangerous place in the world for humanitarian workers to
Conflict in Somalia over the past 18 years has led to hundreds of
deaths and the displacement of millions of others internally and
externally. The UN Refugee Agency (UNHCR-Somalia) estimates that
1,550,000 Somalis are IDPs while there are some 312,800 Somali
refugees in Kenya and another 146,000 in Yemen.
Since 1 July, the agency says, some 89,000 civilians have been
displaced from Mogadishu due to fighting between government forces
and Islamist militias opposed to the government.
Since the ousting of President Siad Barre in 1991, Somalia has been
largely controlled by warlords backed by different militias. At
least 15 attempts have been made to re-establish a national
government, the latest being the installation of President Sheik
Sharif Ahmed in January 2009. However, Islamic militias opposed to
Ahmed have continued attacks on government forces and civilians as
well as African Union peacekeepers.
The country is divided into three regions: the self-declared
republic of Somaliland in the northwest; the autonomous Puntland
region in the northeast; and the south-central part of the country,
housing most of the IDPs.
Puntland welcomed Kälin’s call and said it was ready to cooperate
with humanitarian agencies.
"We will welcome and ensure the security of any agency that wants to
establish a base here," said Ali Mohamed Hayaan, director-general of
Puntland’s ministry of security.
Hayaan said it made sense for aid agencies, wanting to access
south-central Somalia, to operate out of Puntland, "since it would
be cheaper and closer to those in need".
Ali Sheikh Yassin, deputy chairman of the Mogadishu-based Elman
Human Rights Organization (EHRO), said while there were "massive
violations of the rights of the displaced and, ideally, agencies
should be close to them to monitor these violations, however it
won’t be easy for aid agencies to move to Somalia.
"Unfortunately, the security situation is such that even Somalis
like us are operating under the most extreme insecurity."
Kälin, who visited Somalia from 14 to 21 October, said the
international community was failing the IDPs when the humanitarian
crisis was deepening. He said there was a need for a stronger
engagement of the international community in Somalia.
"I am shocked by the degree of violence facing the civilian
population in central and south Somalia," he said. "Serious
violations of international humanitarian and human rights law, in
particular indiscriminate attacks and shelling of areas populated or
frequented by civilians, are being perpetrated by all parties to the
conflict with total impunity.
"Such acts are a major cause of displacement and may amount to war
crimes and other crimes under international law."
Kälin urged all parties to the conflict - state actors and
anti-government groups - to abide by their obligations under
international humanitarian and human rights law.
Deplorable camp conditions
"I am deeply concerned about the unacceptable living conditions in
some of the IDP settlements I have visited, including lack of proper
shelter, food and drinking water; severe malnutrition of children,
very poor sanitation, lack of education and health facilities and
severe overcrowding," Kälin said.
Calling on donors to be prepared, Kälin added: "Torrential El Niño
rains are expected to further aggravate an already dramatic
He said lack of humanitarian access to those most in need, dangers
for humanitarian workers, such as abductions, as well as a sharp
decline in donor contributions, had exacerbated the "long-standing
humanitarian crisis and risks bringing it to hitherto unknown
Although he noted there was risk of aid being diverted, Kälin urged
donors not to reduce humanitarian aid. "This would only mean
punishing the most vulnerable among already destitute communities
but also playing into the hands of radical elements who could easily
exploit the situation," he said, urging all actors to grant
humanitarian access and ensure safety of humanitarian workers.
Although he did not visit south and central Somalia, Kälin said he
had received testimonies regarding violence and the appalling living
conditions of IDPs in the Afgoye corridor, close to the Somali
capital, which has one of the highest IDP densities worldwide.
"Existing humanitarian aid is pitifully insufficient compared to the
needs of the displaced who often face severe protection risks and
marginalization," he said. "Vulnerabilities are heightened by the
fact that many IDPs have been displaced more than once."
1024 US troops help build
disaster response capacity [East Africa]--Military
contingents from five East African countries have begun field
training in disaster and emergency response as well as
anti-terrorism in the northern Ugandan district of Kitgum.
"The joint field training being conducted in northern Uganda is
expected to develop further the capacity of the East African
Community's armed forces in humanitarian assistance; disaster relief
management; and, to some extent, peace support operations,
counter-terrorism operations, disaster management and crisis
response," Beatrice Kiraso, the deputy secretary-general of the East
Africa Community (EAC) in charge of the community's political
federation, told IRIN.
Supported by the US army, the 10-day training is codenamed "Natural
Fire 10" because it is the 10th time such exercises have taken place
since their inception in 1998. It began on 16 October with
contingents from Burundi, Kenya, Rwanda, Tanzania and Uganda
participating. At least 550 US marine personnel and 133 military
personnel from each of the five countries are taking part.
An LRA connection?
US military officials have dismissed speculation that Natural Fire
is being held in preparation for a new offensive against the Lord’s
Resistance Army (LRA), whose rebellion has devastated northern
Uganda, the Kitgum area in particular. In late 2008 the US was a
partner with Ugandan troops in Operation Lightning Thunder, a
botched attempt to capture LRA leader Joseph Kony in the Democratic
Republic of Congo. Tens of thousands of civilians in the DRC,
Southern Sudan and the Central African Republic have been displaced
because of LRA activity.
According to long-time regional observer Peter Eichstaedt, author of
First Kill Your Family - Child Soldiers in Uganda and the Lord’s
Resistance Army, the joint exercises convey a clear, if tacit,
message to Kony. “That message being, of course, that a
multi-national force of 1,000 - an effective number for a fighting
force anywhere in the world - can be assembled in this strategic
location with relative ease,” Eichstaedt wrote on his blog.
“Such a force would be a huge problem for someone like Kony, should
he think about a return to northern Uganda. It shows that Uganda has
allies who are willing not only to donate moral support and money in
the fight against Kony and his maniacal militia, but are willing to
put boots on the ground.
“This is an acknowledgement that Kony is much more than Uganda's
problem, and has become a regional nightmare,” he writes.
While it makes no mention of the LRA, the US Army's Africa website
says of Natural Fire: “By building capacity within partner nations
and increasing our ability to work together, US Army Africa will be
better prepared for future engagements. In doing so, the US Army
also solidifies military rapport with allies in East Africa, key to
supporting stability in the region.”
Kiraso said the training was taking place while the EAC was
embarking on a new phase of strengthening regional integration even
as the region faces "real and potential complex emergencies", which
could translate into threats to socio-economic, cultural and
political wellbeing of East Africans.
These threats, she said, ranged from natural to man-made disasters;
poverty and disease; porous borders and the proliferation of small
arms and light weapons; internal strife; and insecurity in states
neighbouring the EAC.
"It is very important to develop the East African Community’s
capacity to handle such emergencies and threats to peace, security
and stability," Kiraso said.
Maj-Gen William B. Garrett, the commanding general, US Army-Africa
and US Army-Southern European Taskforce, said the training would
help build the capacity of East African armies in combating
terrorism and responding to humanitarian catastrophes.
Ugandan army commander, Gen Aronda Nyakarima, said the LRA was no
longer a threat to Uganda’s peace as the group was now in the
Democratic Republic of Congo and in the Central African Republic.
Regional cooperation, he added, was therefore required to get rid of
1024 Humanitarian crisis now
unfolding in Angola - DRC [Luanda-Kinshasa]--A burgeoning
humanitarian crisis among the tens of thousands of people expelled
by the Democratic Republic of Congo (DRC) to neighbouring Angola is
beginning to unfold.
"The fears of a humanitarian emergency and the needs of the people
have been confirmed," said the UN Refugee Agency (UNHCR)
representative, Bohdan Nahajlo, after an assessment visit to the
affected region in northern Angola.
The most urgent needs of the expelled are shelter, food, medicine
and sanitation facilities.
Tit-for-tat expulsions since August 2009 by the governments of
Angola and DRC have led to more than 32,000 Angolans being
repatriated to Angola, and about 18,800 Congolese nationals being
deported from Angola. Following talks on 13 October in the DRC
capital, Kinshasa, both countries agreed to "immediately stop the
expulsions of citizens of their respective states".
Nahajlo told IRIN that providing humanitarian assistance to the
displaced was becoming a race against time, as the rainy season was
closing in and would make the roads from the Angolan capital,
Luanda, impassable, and the M'banza Congo airport in Angola's
northern province of Zaire was not an option because it was closed
"Sanitation [in the reception centres] is very bad," he said. Around
17,500 expelled Angolans were in the Mama Rosa settlement in the
border-crossing town of Luvo.
Three settlements close to the town of Cuimba, near the DRC border
in Zaire, were also hosting displaced people: there were about 5,000
in Lendi, about 2,500 in Casileha, and around 2,600 in Buela.
In Lendi more than 5,000 refugees had hastily erected very basic
shelters. "Water is being given directly to the population in
buckets - there are reports of people ill with diarrhoea and
vomiting," Nahajlo said.
However, the exact number of people displaced to Angola is unclear,
as people may have fled to Cabinda, the oil-rich Angolan province
surrounded by DRC, or other areas bordering DRC, he told IRIN.
A recent UNHCR assessment of Angolan refugees in the DRC found that
about 43,000 were willing to be repatriated voluntarily, but "in
this atmosphere people will be encouraged to return," and the
refugee agency was expecting a second wave of about 50,000 people,
"Besides addressing the immediate humanitarian and protection needs,
we should also prepare for a continuous flow of Angolans into the
country," who were crossing the border out of fear, and the hope of
being reunited with their families in Angola, he warned.
The speed of the expulsions meant that some people had been driven
from their places of work without being able to inform their
families, people in mixed nationality marriages had been forbidden
to accompany their spouses to Angola, and families had been split,
with children divided among their parents.
"I met a man who told me he was given 24 hours to leave, but he
could not reach his wife, who had travelled to another town to visit
her sick mother. He ended up leaving the family behind," Yolanda
Ditewig, a UNHCR Protection Officer who was part of the assessment
team, told IRIN.
The Angolan government has estimated that about 10,000 tents, of
which UNHCR is expected to provide about half, would be required to
provide shelter for the expelled Angolans.
During Angola's almost three decades of civil war, which ended in
2002, the DRC hosted more than 100,000 Angolan refugees; since then,
thousands of undocumented Congolese migrants - mostly thought to be
illegal diamond diggers – have been working in Angola.
The ebb and flow of people expelled from both sides of the border
has become a common spat between the neighbours. According to the UN
Office for the Coordination of Humanitarian Affairs (OCHA) there
have been six major waves of expulsions since 2003, in which a total
of 140,000 Congolese were deported from Angola.
Back in the DRC
"There are no sites to host the expelled people [from Angola]," said
Willy Iloma, who chairs a human rights organisation and coordinates
NGOs in Muanda territory on the Angolan border, in the extreme west
of the DRC's Bas-Congo Province. "They are now scattered in churches
and among host families; some have gone to Kinshasa [capital of DRC]
and other towns."
According to the UN Office for the Coordination of Humanitarian
Affairs, there are two groups in Muanda and Tshela territories:
"forced voluntary expulsees who left following threats, and those
who were physically deported to the border. Most of them are
small-businesspeople, as well as women and children. Although these
expulsees have humanitarian needs, the situation is now under
control and aid is not currently required [in DRC]."
Iloma said the expulsees "have gone through a hell that began in
Angola when they were arrested and held in cells for three days.
Women were raped and men molested, and their goods were taken away
before they crossed the border. Some turn to begging; others sell
what few possessions they have left in the market."
Some of the women who were raped were pregnant, said Marie Munzi,
who was among the DRC citizens expelled from the Angolan enclave of
Cabinda. "Some women gave birth during their journey."
Angolan "security agents searched us, even our private parts. They
took everything. Women had to abandon their husbands and here we
are, abandoned; nobody is looking out for us," she said.
Simon Mbatshi, the governor of Bas-Congo, said steps had been taken
to meet humanitarian needs, such as making trucks available to send
food to the affected areas, and "the government has decided to
vaccinate all the children crossing the border."
1024 Cholera returns and kills
five, so far [Zimbabwe]--Five people have died from
cholera at two different locations in Zimbabwe, and 30 other people
are undergoing treatment for the waterborne disease, raising the
spectre of another epidemic.
The permanent secretary for health, Gerald Gwinji, told the
state-run newspaper, The Herald, on 20 October that three people had
died from cholera in Mashonaland West Province, in the northeast of
the country, while two other deaths were recorded in Midlands
Province, in central Zimbabwe.
Gwinji attributed the deaths in Gokwe North, Midlands, to "religious
objectors who for a long time have been reluctant to seek medical
attention. We are still trying to come up with ways of addressing
this special group."
A cholera outbreak that began in August 2008 and lasted for a year
before it was officially declared at an end in July 2009 caused the
deaths of more than 4,000 people and infected nearly 100,000 others.
The cause of this epidemic was dilapidated and broken sanitation and
water infrastructure, much of which is still in the same state as a
year ago, so the coming rainy season is likely to facilitate the
spread of the disease.
"We have received confirmation of the cholera cases from the
government and this poses a new challenge, in the sense that there
is need to educate and sensitise some communities which are
resisting prevention and medication for cholera," said Tsitsi
Singizi, a spokesperson for the UN Children's Fund (UNICEF).
"Our education teams are already out in full force, and we hope that
this time the effect of cholera will not be as it was last time,"
Samuel Sipepa Nkomo, the minister for water resources development
and management, told IRIN that repairing the water and sanitation
infrastructure in the capital, Harare, was the main priority, as
this had been the epicentre of the previous cholera outbreak.
Depressed state of affairs
"I am currently touring water sources throughout the country to
establish the state of collapse and dilapidation, and what I have
seen so far is very depressing," he said.
"In some parts of the country, some settlements have stopped using
some dams because too much raw sewage was discharged into them. We
want to ensure that if Harare is rehabilitated we will not have
other potential sources of cholera outbreaks."
Dams are the usual source of water for drinking and household use in
towns as well as rural areas, but when many of these became too
polluted, people resorted to digging shallow wells to obtain water.
Pit latrines were often dug too near the wells, which became
contaminated and not only helped spread cholera, but also made the
disease difficult to combat.
The chairperson of the Combined Harare Residents Association,
Simbarashe Moyo, told IRIN there was concern over the slow pace of
infrastructure repairs, but acknowledged that "After many years of
neglecting our water and sewer infrastructure by many
administrators, it is only fair to acknowledge the good work that
the current administration at the municipality is doing."
However, Mluleki Dube, who lives in Ashdown Park, a middle-class
suburb in Harare, told IRIN that the area had been without water for
the past 10 days. "The sanitation situation ... is a ticking health
time bomb because some residents now resort to using secluded areas
to relieve themselves, while others have sunk shallow and
unprotected wells to provide water."
1024 Rains wash away IDP
shelters in Mogadishu [Somalia]--Flash floods have
rendered homeless thousands of internally displaced persons (IDPs)
living in camps in and around Mogadishu, the Somali capital, locals
"The rains that fell on Friday and Saturday [16 and 17 October]
destroyed many of the makeshift shelters," Jowahir Ilmi, head of the
Somali Women Concern (SWC), a local NGO, said. "The resulting floods
washed away many of the shelters."
Ilmi said many IDP families lost everything - "the floods took their
utensils and anything that was not fixed to the ground”.
Bilmo Nur, who is looking after four grandchildren, told IRIN she
sought shelter with another family after the rains destroyed her
makeshift home. “My grandson [18 months old] was almost swept away
by the water.”
Nur said the children were weak and she was worried the cold weather
would make matters worse.
"We don’t have food but we need shelter more urgently,” she said,
adding that there had been a break in the rains but it was not
expected to last long. “I hope we will get some tents and plastic
sheeting before the next [flood].”
Khadra Ali, a community activist in the camps, told IRIN that many
in the Ali Somali displaced camp, home to 350 families (2,100
people), were sleeping in the open. “If, as expected, we get another
downpour today or tomorrow, we don’t have any place to shelter.”
Ilmi said the rains were also making the sanitary conditions of the
camps worse. “The conditions were bad to begin with but the rains
are making them worse.”
At the mercy of mosquitoes
Meanwhile, in the southern coastal city of Kismayo, 500km south of
Mogadishu, heavy rains are adding to the misery of the displaced who
fled the city during the recent fighting between two Islamist
groups, a local activist told IRIN.
The source said thousands of IDP families who had not returned to
city were at the "mercy of the rains and mosquitoes".
"Around 6,000 families [36,000 people] are living in the open or in
very poor conditions," the source said, adding that most of those
who fled the city [on 30 September and 1 October] had not returned.
Some 900,000 people who fled the fighting in Mogadishu between the
government and Islamist insurgents have settled in the Mogadishu and
Afgoye corridor, according to aid agencies.
Conflict, drought and hyperinflation have combined to create a
humanitarian crisis in Somalia, with some 3.6 million needing food
aid, according to the UN.
1017 Cholera kills at least 51
in north [Cameroon]--Cholera has killed at least 51
people in the past few weeks in northern Cameroon, where health
experts say safe water and proper sanitation are sorely lacking.
“[The fight against cholera] here will be difficult because the
hygiene conditions are awful,” said a health official who was not
authorized to be quoted. He noted that most people defecate in open
The regions affected are Cameroon’s North and Extreme North, with
the first infections reported in September, according to the Health
As of 14 October 23 people had died in Extreme North, of 144
infected, according to a Health Ministry document that is updated
regularly, while in neighbouring North region 28 people had died of
This area of Cameroon is on the southern fringe of the Sahel and
water is scarce; existing boreholes and wells are insufficient to
meet the needs of the population, according to UN Children’s Fund
(UNICEF) in Cameroon.
In rural Cameroon only 30 percent of inhabitants have access to safe
water and 15 percent to sanitation systems, according to UNICEF.
In the cholera-hit areas local authorities have begun disinfecting
wells and other water points, according to Albert Friki, prefect in
one affected department of Extreme North region. Authorities are
also urging communities to practice proper hygiene.
“We are urging people to be careful with the food and water they
consume, and with how they handle the remains of people who died of
cholera,” he said.
Cholera epidemics are frequent in northern Cameroon but the current
outbreak is particularly severe, the health ministry official told
IRIN. The highest number of cholera deaths in recent years was in
the commercial capital Douala in 2004 when cholera killed 100
Some 75 percent of people infected with cholera develop no symptoms
but can pass on the infection, according to the World Health
Organization; the disease is extremely virulent and can kill healthy
adults within hours, WHO says.
1017 Stopping cholera
emergencies [West Africa]--Cholera outbreaks in West
Africa generally trigger extra hand-washings in households and
panic-buying of bleach for treating water. But beating the deadly –
but easily preventable – illness requires that such hygiene
practices become routine, health experts say.
Researchers with the London School of Hygiene and Tropical Medicine
(LSHTM) say knowing the drivers behind behaviour and tying hygiene
messages to those impulses is crucial for preventing cholera, which
has become a recurring health emergency in West Africa.
“If we want sustainable change we need to make sure people practice
things so they become habits,” Jeroen Ensink of LSHTM’s
environmental health group told IRIN.
One way for aid agencies to do so, he said, is to dissociate hygiene
messages from cholera – which is seasonal – and link them instead to
general diarrhoeal disease.
Ensink also said it might be time to “re-brand” hygiene and health
messages, as knowledge of cholera’s causes does not always translate
into new habits. “Hand-washing messages need not be just about
health; they can be about: if you want to be modern, to smell nice,
to be attractive to the opposite sex, use soap.” The use of proper
latrines can be linked to privacy instead of just proper hygiene, he
LSHTM has studied the impact of government and aid agency prevention
and preparedness measures in Guinea and Guinea-Bissau as part of a
project funded by the European Commission humanitarian aid
The ECHO project aims to build a more coherent approach to cholera
control with sound preparedness and early response. And ECHO says
‘quick impact’ actions in vulnerable communities should be
accompanied by longer-term prevention measures.
To date, emergency and development strategies fail to address the
disease properly, lacking common objectives and complementary
actions, ECHO says.
ECHO is focusing on Guinea and Guinea-Bissau, where cholera has
become endemic; during 2007 and 2008 over 23,000 people were
infected and 560 died in the two countries.
But all of West Africa is highly vulnerable to cholera and a
regional approach is needed; ECHO and its partners will study
lessons from Guinea and Guinea-Bissau to see what might be applied
As part of the ECHO-funded project UN Children’s Fund and NGOs are
training local health workers in responding to cholera, boosting
communications strategies and developing emergency kits, which
include sanitation and water purification materials, to keep
outbreaks in check.
“We know that the solution to cholera is an overall improvement in
water, sanitation and environmental conditions,” said ECHO water and
sanitation expert Francisco Gonzalez. But he said before such
significant and permanent changes can be made, proper preparedness
and response can save a lot of lives.
But to be effective anti-cholera actions must not be merely
reactive, health experts say. LSTHM researchers observed in
Guinea-Bissau that while most people could recite verbatim
hand-washing and other hygiene messages, they apply them
consistently only when cholera strikes. Changing such behaviour
takes years, not months, said LSHTM’s Ensink.
The World Health Organization calls cholera a principal indicator of
social development. Overcrowding in poor-sanitation urban areas is a
main driver of cholera. And the disease hits the poorest of the poor
most heavily. With factors like poverty, rapid and unregulated
urbanization and poor infrastructure all favouring cholera
outbreaks, substantial socio-economic fixes are necessary to
eliminate cholera as a cyclical health disaster.
1017 Driving home the cholera
message [Guinea-Bissau]--In Bafata, Guinea-Bissau,
children go door-to-door counting mosquito nets, monitoring
hand-washing and checking the distance between kitchens and
latrines. The activities are among efforts by health NGOs and
authorities to fill the gap between cholera-prevention messages and
behaviour, after a 2008 epidemic killed some 220 people and infected
at least 13,000.
The national flag is hoisted in front of the cleanest house, and the
family is feted in schools and on local radio, Ingrid Kuhfeldt, head
of NGO Plan International in Bissau, told IRIN. Plan International,
which has been working in Bafata for 15 years, launched the scheme
to prevent future cholera outbreaks.
“There is much more competition now on who has the best hygiene
materials and the cleanest house – we hadn’t seen this kind of
rivalry before,” Kuhfeldt said.
Children also try to dispel hygiene “myths” with families – for
example that lemon juice can disinfect water – and show people how
much chlorine to drop into a well to clean the water, Kuhfeldt said.
Rather than resenting the children, adults listen, partly because of
children’s rising status in society over recent years, according to
Kuhfeldt. “[People] have a growing respect for their children having
seen them make speeches in front of audiences in schools, heard them
on the radio and seen them set up committees,” she said. “They’re
starting to realize they can learn from [the children].”
In Guinea, with the support of aid agencies and the local health
services, a local radio station in Kindia helps spread hygiene
messages through radio spots and village contests. A team from the
radio station organizes public games in remote communities, quizzing
people on hygiene and cholera prevention and asking people to make
up songs on a hygiene-related theme, according to Aboubacar Sylla,
head of programming at the station. Prizes include radios, water
buckets or farming tools.
"Hundreds of people come out for these activities; people really
like it," Sylla said. "And it is quite interactive; we encourage
everyone to talk about the subject at hand."
Bafata and Kindia recorded no cholera in 2008, despite infections in
Jeroen Ensink of the London School of Hygiene and Tropical Medicine
– which recently studied prevention and preparedness efforts in
Guinea and Guinea-Bissau – said it is not enough to simply impart
knowledge; people must have incentives to begin forming new habits.
He noted that research at LSHTM showed just 60 percent of the
university’s staff clean their hands after defecating, despite
Plan International's Kuhfeldt said programmes such as Plan's in
Bafata work well because of the long-term trust the NGO has already
built up among inhabitants and local authorities in the small
community. The NGO has been engaged in education, clean water,
children’s rights and health in Bafata for 15 years. “In Bafata we
know everyone – the governor, the ministers of education and health
and the communities."
But not all at-risk communities have the long-term presence of an
international NGO. The European Commission humanitarian aid
department (ECHO) says in a paper on cholera in West Africa: “The
reported lethality rates in most of the countries show weak response
mechanisms to the [cholera] outbreaks, mainly in those [countries]
where no external assistance has been provided; and the low
lethality rates of some countries are due to an external
Health experts say it is essential that locals apply and perpetuate
long-term education and prevention measures.
1013 Fifty quarantined as first
H1N1 death reported [Tanzania]--At least 50 people have
been quarantined in Tanzania's northern district of Mbulu to curb
the spread of influenza H1N1, a highly contagious viral disease that
killed one person last week, say health officials.
The death is the first in East Africa.
"We are struggling to control [the] further spread of the disease.
Until late yesterday [11 October], the number of people suspected to
have been infected had reached 158," said Anael Pallangyo, Mbulu
District Medical Officer.
Pallangyo said a 40-year-old primary school teacher died of H1N1 at
the local district hospital where she was admitted for treatment two
days earlier. All 18 dispensaries in the district were now on alert
and about 50 patients placed in isolation wards.
Tanzanian health authorities have stepped up surveillance at all the
country's entry points, where people with flu-related symptoms such
as coughing, fever and sneezing are taken to hospital for screening
The ministry of health recently announced 172 confirmed cases of
H1N1 at the end of September.
As of 9 October, 24 countries in Africa had officially reported
12,456 laboratory-confirmed human cases of H1N1, including 70
deaths, according to the UN World Health Organization (WHO). South
Africa has reported most of the cases at 11,545 and 59 deaths.
WHO, however, notes that the reported number of cases understates
the real number as countries are no longer required to test and
report individual cases.
1013 How To: Rescue people
trapped in a collapsed building [Kenya]--When an
earthquake strikes a town, or a building is levelled by an
explosion, news footage invariably shows search and rescue teams
trawling through the rubble looking for survivors. But what does it
take to rescue people trapped under tons of concrete?
Step one - coordination
The first thing is to activate search and rescue teams, often highly
"Most of our members are doctors, ambulance operators, engineers or
fire fighters," said John Holland, operations director of Rapid UK,
a charitable search and rescue group.
They go through a rigorous two-year training process before they are
allowed to assist in disasters.
"We try to deploy within 24 hours because the earlier we are on the
ground, the better the chances of rescuing survivors," Holland said.
"During the Pakistan earthquake [in 2005], we were able to deploy in
The International Search and Rescue Advisory Group (INSARAG) - a
global network of more than 80 countries and disaster response
organizations under the UN umbrella - has standardized guidelines
for rescue missions.
"Once a government has made that call for international assistance,
we alert our members, who begin mobilizing to travel to the area,"
said INSARAG's Winston Chang, a Singapore Civil Defence Force
veteran who coordinated the search and rescue efforts following the
recent earthquake in Padang, Indonesia. "We run a portal where once
a disaster occurs, we pool information and our various teams can
input data on their movements - whether they are on standby,
mobilizing or have reached the ground."
INSARAG will usually set up an “on site operations coordination
centre” where all search and rescue teams get instructions -
depending on their area of specialty - on where to go and how to
operate; the desk holds regular meetings to update itself and the
teams on the progress being made on the ground.
"These operations can be quite large; just now in Padang, there were
a total of 21 teams with 668 personnel and 67 search dogs," Chang
said. "They need bases of operation where they will fuel their heavy
equipment, coordinate their internal logistics and sleep."
"We also ensure that they follow specific standards of operation and
remain culturally sensitive, especially since the teams are from
such diverse backgrounds," he added.
Step two - analysis
Once in the disaster area, the first step is to analyze the task at
hand, said Julie Ryan, a volunteer with the British NGO, the
International Rescue Corps.
In a collapsed building, "you need to analyze the building, assess
its history and try to establish where in the building people are
most likely to be", she told IRIN. "You also need to determine how
badly a building has been damaged and whether it is likely to
collapse any further, causing damage to [survivors] and rescue
The assessment also involves checking for hazards such as downed
power lines, gas leaks, flooding and hazardous materials. Protective
gear includes special suits, gloves, masks, and oxygen and carbon
monitoring systems for air quality.
Step three - search mode
At its most basic, this involves trying to spot limbs in the rubble,
and calling out to survivors to identify their locations.
Rescuers look for "voids", or pockets where people may be trapped
when walls collapse or where survivors may have hidden, such as
under desks, in bath tubs or stairwells.
"We feed a camera on the end of a flexible pole into the collapsed
building - this shows where people are and how much of the
building's structure is left," Ryan said.
"Rescuers also use sound location devices connected to a microphone
system; the device bangs on the rubble three times and if people tap
back or call out for help, they can be tracked and assisted," she
Listening is a crucial part of the operation, and search teams will
often stop for several minutes to try to hear any calls, scratches
Other search tools include a thermal image camera system, which
shows areas of body heat, and trained sniffer dogs. "We also use a
carbon dioxide analyzer, which helps us detect people who might be
unconscious but still breathing," Ryan said.
Buildings that have been searched are marked with INSARAG-recognized
signs to avoid duplication of searches.
As survivors are found, rescuers try to get them to keep talking to
determine their exact location, and dig towards them - the least
dangerous way to do this is by hand.
Step four - the rescue operation
If survivors are trapped under rubble, it may need to be stabilized
first; a process called cribbing - the construction of a rectangular
wooden framework, a box crib, underneath the debris - may be used.
Survivors who are not able to move usually need to be lifted,
dragged or carried out of the rubble using special equipment.
"If people cannot be manually dug out, then we can cut them out -
there are specialized tools that can cut through concrete, metal and
wood to reach survivors," Ryan said. "There is also a process known
as 'slabbing', where heavy slabs of concrete are removed in order to
free survivors - this is always a very difficult judgment call,
because it risks further collapse, which could injure or kill more
Concrete saws, jackhammers, chainsaws, bolt cutters, cranes and
bulldozers are all part of the tool kit; chains, cables, anchors and
rope-hauling systems are used to remove large pieces of masonry.
Other equipment may include flat bags that are inserted under heavy
objects and inflated with an air pump, and “shoring” equipment,
which ensures passageways are stable and safe.
As survivors are removed, their medical condition is determined;
patients are prioritized according to triage - based on the severity
of their condition.
Search and rescue teams usually start the most urgent medical
procedures on site; the most experienced teams may have
defibrillators and endo-tracheal equipment to shock people back to
life or perform emergency tracheotomies.
Step five - closure
Deciding when to end a rescue operation is always difficult.
"Obviously, the more time passes the less likely you are to find
people alive," said Ryan. "But sometimes - especially if they have
water available - people can remain alive for many days. In
Pakistan, our team rescued two boys five days after the earthquake;
they had survived on trickles of rainwater through the rubble."
According to Ryan, finding bodies - cadaver rescue - after the
search for survivors is over is a very important part of any
"Even when people haven't survived the collapse of a building,
families find that having a body to bury is an important part of
getting closure," she said.
According to INSARAG's Chang, the high octane operations can take
their toll on rescuers, especially when they have to pull hundreds
of dead people out of buildings.
"Most of them are used to dealing with blood and death in their
daily professions, but from time to time it can become very
difficult," he said. "Many teams are equipped to deal with trauma -
the Swiss government's team, for instance, has a psychologist on
hand, while doctors in the Singapore team have been trained to
search for signs of trauma in team members."
Once the host government officially calls off the search, INSARAG
starts the process of withdrawing the teams. A few remain and become
part of the humanitarian relief effort, rebuilding hospitals and
schools or shelter for families, but most will head back to their
day jobs and await the next call to action.
1013 Cholera kills 29 as water
shortage bites [Kenya]--At least 29 people have died of
cholera and hundreds more are being treated for cholera-related
symptoms such as acute watery diarrhoea (AWD) in the larger Turkana
District in the northwest and in the eastern regions of Garbatulla
and Laisamis, say health officials.
"Two people have died in Garbatulla, five in Laisamis, three in
Turkana North, one in Turkana South and 18 in Turkana Central," said
an official in Kenya's Ministry of Public Health and Sanitation.
The regions are not only facing an acute water shortage, due to a
prolonged drought, but also have poor latrine coverage.
In the past week, he said, a total of 246 AWD cases have been
reported and are being treated as cholera due to confirmation of the
disease. Some 42 cases of cholera have been confirmed in the region.
Laisamis is in the larger Marsabit District, a vast region
stretching about 66,000 sqkm. Residents are forced to trek long
distances to health centres.
David Kasanga, Laisamis medical officer, told IRIN that three of the
deceased had "died at home before they could reach [the] nearest
Kasanga said health workers had been deployed to the affected areas,
and the local Elmolo health centre has been reopened to deal with
the new outbreak.
He said tents had been set up to serve as temporary wards. "We have
managed to get drugs but we need more assistance as [the drugs]
might not be enough to handle the rising number of new cases," he
Mark Ekale, a local leader, told IRIN that families had been forced
to spend more on healthcare. "People are selling relief food... so
that they can afford to pay for transport to the nearest health
According to residents, the number of dead may be higher due to a
lack of access to medical services.
Laisamis Member of Parliament, Joseph Lekuton, said mobile clinics
should be set up and additional health personnel sent to the area.
Regions around Laisamis have experienced recurrent cholera outbreaks
in the past six months. At least 834 cholera cases were reported in
a previous outbreak there in June.
According to Lekuton, disease is just one of many challenges
affecting local residents. "This is the worst year for Laisamis
residents. Many have died as a result of hunger and disease[s] like
cholera and malaria," he said, calling for more control initiatives.
"...We must [prevent] more deaths and [the] burying of people every
day," he said.
Like most of northern Kenya, Marsabit is facing an acute water
shortage due to a prolonged drought and last saw rain in May 2008.
The water scarcity has been blamed for the outbreak as residents are
being forced to use water from sources that are believed to have
"The cholera outbreaks move from one locality to another but have
similar causes - water problems, poor hygiene and a low latrine
coverage," said the health ministry official, adding that the
government was trucking in water and providing hygiene education.
"We are encouraging affected residents to build and use latrines."
1013 Rains, poor roads hamper
mystery disease response [Sudan]--Efforts to identify a
haemorrhagic disease that has killed four people in a remote corner
of Southern Sudan have been thwarted by bad roads made impassable by
heavy rainfall, according to officials.
The deaths took place in Kitkit, a military outpost in Western Bahr
al-Ghazal state. On 23 September, the state's director-general of
health, Martin Mayen Wol, had written to Southern Sudan's health
ministry in Juba to report the deaths and that six soldiers were
complaining of nose bleeds and vomiting blood.
"As there is no means to verify the situation and confirm the
condition due to the bad roads attributed to the rainy season, we
ask your esteemed office for direct intervention through the
international and UN bodies," wrote Wol. "The situation is urgent,
A team from Southern Sudan's health ministry, the UN World Health
Organization and the Sudan People’s Liberation Army (SPLA) could
only get as far as Timsah, 70km away.
"... Not even a vehicle could move," Nathan Atem, the
Director-General of Preventive Medicine, said. "They had to come
Without a landing strip, Kitkit is inaccessible even to aircraft. A
doctor sent to the region on a flight with the UN Mission in Sudan,
following an appeal for help issued in late September, had to turn
Blood samples of those infected have been sent to the US Centers for
Disease Control labs in Atlanta for analysis.
Ministry of Health Under-Secretary Majok Yak Majok played down fears
that Ebola might be to blame for the deaths: "It could be any other
disease that can cause bleeding," said Majok. "For a serious
outbreak, it could have not remained [as] contained since 23
He noted that if it was a viral infection it would have engulfed the
entire region in the three weeks.