The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 18 May 2019

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

PDF:The Sentinel_ period ending 18 May 2019

Contents
:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals  [see PDF]

2019 Digital Rights Corporate Accountability Index

Human Rights – Governance
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2019 Digital Rights Corporate Accountability Index
Ranking Digital Rights [ a non-profit research initiative housed at the New America
Foundation’s Open Technology Institute]
May 2019 :: 104 pages

Executive Summary [excerpts]
The 2019 Ranking Digital Rights Corporate Accountability Index evaluated 24 of the world’s most powerful internet, mobile ecosystem, and telecommunications companies on their publicly disclosed commitments and policies affecting freedom of expression and privacy. These companies held a combined market capitalization of nearly USD 5 trillion.1 Their products and services are used by a majority of the world’s 4.3 billion internet users.2..

People have a right to know. Companies have a responsibility to show. The 2019 RDR Index evaluated 24 companies on 35 indicators examining disclosed commitments, policies, and practices affecting freedom of expression and privacy, including corporate governance and accountability mechanisms. RDR Index scores represent the extent to which companies are meeting minimum standards. Yet few companies scored above 50 percent. While the results reveal some progress, many problems have persisted since the first RDR Index was launched in 2015.

Progress: Most companies have made meaningful efforts to improve. Of the 22 companies evaluated in the previous RDR Index, 19 companies disclosed more about their commitments, policies, and practices affecting users’ freedom of expression and privacy. Many companies improved their privacy-related policies. New privacy regulations in the European Union and elsewhere drove many companies to improve /disclosures about their handling of user information. Some companies improved their governance and oversight of risks to users. More companies improved their public commitment to respect users’ human rights, 2019 RDR Corporate Accountability Index 4 and took steps to demonstrate oversight and accountability around risks to freedom of expression and privacy.

Persistent problems: People around the world still lack basic information about who controls their ability to connect, speak online, or access information, or who has the ability to access their personal information under what circumstances. Governments are responding to serious threats perpetrated through networked communications technologies. While some regulations have improved company disclosures, policies, and practices, other regulations have made it harder for companies to meet global human rights standards for transparency, responsible practice, and accountability in relation to
freedom of expression and privacy. Even when faced with challenging regulatory environments in many countries, companies must take more affirmative steps to respect users’ rights.

PRIVACY: Most companies still fail to disclose important aspects of how they handle and secure personal data. Despite new regulations in the EU and elsewhere, most of the world’s internet users are still deprived of basic facts about who can access their personal information under what circumstances, and how to control its collection and use. Few companies were found to disclose more than required by law.

GOVERNANCE: Threats to users caused or exacerbated by companies’ business models and deployment of new technologies are not well understood or managed. Most companies are not prepared to identify and mitigate risks such as those associated with targeted advertising and automated decision-making. Nor do companies offer adequate grievance and remedy mechanisms to ensure that harms can be reported and rectified.

EXPRESSION: Transparency about the policing of online speech remains inadequate. As companies struggle to address the harms caused by hate speech and disinformation, they are not sufficiently transparent about who is able to restrict or manipulate content appearing on or transmitted through their platforms and services, how, and under what authority. Insufficient transparency makes it easier for private parties, governments, and companies themselves to abuse their power over online speech and avoid accountability.

GOVERNMENT DEMANDS: Transparency about demands that governments make of companies is also uneven and inadequate. Companies disclosed insufficient information about how they handle government demands for access to user data, and to restrict speech. As a result, in most countries, government censorship and surveillance powers are not subject to adequate oversight to prevent
abuse or maintain public accountability….

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Ranking Companies on Digital Rights
MacArthur Foundation Grantee Research
May 16, 2019
The 2019 Digital Rights Corporate Accountability Index ranks 24 digital communications companies on 35 indicators of freedom of expression, governance, and privacy. The analysis found most companies had improved in transparency for privacy policies, but they continue to have inadequate governance of new technologies and business models and unclear, inconsistent policies around harmful speech. The Index, supported by MacArthur Foundation, recommends companies go beyond compliance with government regulations and commit to full transparency, more consistent oversight, and consistent applications grievance and remedy mechanism for users…

The 2019 RDR Index ranked 24 companies on 35 indicators across three categories evaluating their disclosure of commitments, policies, and practices affecting freedom of expression and privacy. The RDR Index evaluates policies of the parent company, operating company, and those of selected services (depending on company structure).

Read more about the methodology, research process, and how we score each company:
Download The Full Report

Pre-Exposure Prophylaxis for Homeless Youth: A Rights-Based Perspective

Featured Journal Content

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Journal of Adolescent Health
May 2019 Volume 64, Issue 5, p547-672
https://www.jahonline.org/issue/S1054-139X(19)X0002-6
Editorial
Pre-Exposure Prophylaxis for Homeless Youth: A Rights-Based Perspective
Diane M. Straub, M.D., M.P.H.
Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida

Franklin Delano Roosevelt’s words come to mind when we consider the marked health inequities in access to and use of HIV pre-exposure prophylaxis (PrEP) among youth experiencing homeless (YEH). Delivered over 80 years ago in his inaugural address, Franklin Delano Roosevelt reminds us of the obligations of providers and healthcare systems and states to address these types of extreme health inequities.

YEH are simultaneously one of the populations most at risk for HIV infection and, as demonstrated by Santa Maria et al. in this issue of the Journal of Adolescent Health, one of the least likely to have access to, or to use, PrEP. Adolescent and young adults (AYA) aged 13–24 years comprised 25% of the approximately 32,300 new infections diagnosed in the U.S. in 2017 [2, 3]. Internationally, approximately 590,000 AYA aged 15–24 years were newly infected with HIV in 2017 [4]. In the U.S., many of the highest risk groups—young men who have sex with men; youth of color; heterosexually active black young women; young adults who inject drugs, engage in transactional sex, or are sexually exploited; and transgender young women who have sex with men—disproportionately experience homeless [3, 5, 6]. Indeed, the associated overlapping vulnerabilities likely contribute to estimates that YEH may be upward of 10 times more likely to be HIV infected than their housed peers [7, 8].

For populations at risk for HIV, PrEP is potentially lifesaving. Clinical trials of PrEP have demonstrated efficacy in subpopulations of over 90% when taken daily [9]. Yet, those at highest risk are not getting it. In 2015, only 1% of the estimated approximately 500,000 African Americans who could potentially benefit were prescribed PrEP [10], and in 2016, only 11% of PrEP users in the U.S. were aged <25 years, but that age group constituted 21% of all new infections [11]; this begs the question of how much worse access to PrEP may be in populations with overlapping vulnerabilities such as YEH? Santa Maria evaluated HIV risk, HIV risk perception, and knowledge of and willingness to use PrEP among a sample of 1,427 YEH in seven U.S. cities. Unsurprisingly, risk for HIV acquisition was high, with 84% of participants meeting the study group’s measure of PrEP eligibility. Although knowledge of PrEP was low (29%), 59% of the sample reported that they would be willing to take PrEP. This study demonstrates a staggering unmet need and clear health inequity.

Human rights frameworks provide an ethical approach to addressing the inequities in access to HIV prevention interventions for YEH. The Convention on the Rights of the Child identifies adolescent access to sexual health information and services as a basic human right, advocating that States have an obligation to ensure “access to HIV testing and counseling, evidence-based HIV prevention and treatment programs, and sexual and reproductive health services” [12].

But how do we, as researchers, policymakers, and medical and service providers, begin to address this obligation to address HIV health inequities for YEH? Barriers to PrEP are daunting [11]; in YEH, they seem insurmountable. Compared with their housed peers, YEH experience loss of identification, lack of health insurance and access to consistent healthcare, unstable or nonexistent income, inadequate transportation, and elevated levels of stigma [13, 14]. Our first step is to explicitly recognize the critical importance of homelessness as a social determinant of health driving risk and access. This requires recognition of and investment in addressing the multiple vulnerabilities of YEH, including substance abuse, mental health disorders, and education and vocational needs. Clinical and public health approaches will need to explicitly consider these social determinants to address issues such as funding for medications, legal obstacles to confidential care for minors, transportation, and colocation of mental health services.

A frequent criticism of the human rights–based approach is that individuals should take personal responsibility for their own health, particularly if they are co-responsible for their risk for disease, which is a pervasive attitude toward HIV infection [15]. Santa Maria’s data are less than encouraging [2]. Although 84% of participants were deemed at risk for HIV acquisition, only 66% had a similar perception of risk, only 47% were worried about getting HIV, only 14% were actively trying to protect themselves from HIV infection, and only about half reported that they would take a daily pill if they knew it would greatly reduce their chance of getting HIV. Why the disconnect? The authors suggest that issues related to adolescent brain development and the impact of high levels of trauma in this population play a role, and other literature supports this [16]. Yet functional magnetic resonance imaging is not needed to understand this. In 1943, Maslow described a hierarchy of needs, which theorized that higher level needs such as prevention and medical care are only addressed after basic physiological (food, shelter, clothing) and safety are addressed [17]. By definition, YEH are not able to meet even these most basic and immediate needs. It is not surprising that they have difficulty with prevention, a future-oriented behavior. Here, we as a society fail from a human rights perspective. Youth have a basic human right to housing and food, as well as protection from violence [12], and we are unlikely to increase uptake of PrEP until we address these larger social determinants of health.

In its 2018 position statement on PrEP, the Society for Adolescent Health and Medicine recommends [18]:
1.Increased access to PrEP for AYAs through youth-focused PrEP research and legislative advocacy on minors’ consent, confidentiality, and healthcare financing.
2.Incorporation of PrEP information into comprehensive sexual health educational and screening tools coupled with developmentally appropriate, PrEP skills–building interventions to increase AYA adherence.
3.The development of evidence-based, developmentally appropriate, culturally sensitive, and accessible PrEP service delivery models as part of routine care offered to AYAs.

Drawing on human rights frameworks and Maslow’s work, we would like to take this a few steps forward. First, these same standards should apply equally for additional biomedical prevention interventions, specifically nonoccupational postexposure prophylaxis for HIV. Individuals seek nonoccupational postexposure prophylaxis due to acute events that may dramatically increase their risk for HIV. This is certainly a likely scenario in the life of a YEH and one which may open the door to additional services, potentially allowing them to address basic needs such as homelessness, access to food, and safety, and, in so doing, increase their ability to engage in prevention such as PrEP [19]. Second, in our attempts to increase the overall uptake of PrEP, we need to focus on YEH and other AYA at highest risk. Clearly, there is a mountain of obstacles to providing “enough” for this population that has “too little.” To borrow again from FDR, perhaps we need a new New Deal for our YEH.
References at title link above

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Original Articles
Knowledge and Attitudes About Pre-Exposure Prophylaxis Among Young Adults Experiencing Homelessness in Seven U.S. Cities
Diane Santa Maria, Charlene A. Flash, Sarah Narendorf, Anamika Barman-Adhikari, Robin Petering, Hsun-Ta Hsu, Jama Shelton, Kimberly Bender, Kristin Ferguson
p574–580
Published online: September 22, 2018

Child friendly spaces impact across five humanitarian settings: a meta-analysis

Featured Journal Content

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 18 May 2019)
Research article
Child friendly spaces impact across five humanitarian settings: a meta-analysis
Authors: Sabrina Hermosilla, Janna Metzler, Kevin Savage, Miriam Musa and Alastair Ager
Citation: BMC Public Health 2019 19:576
Published on: 15 May 2019
Abstract
Background
Humanitarian crises present major threats to the wellbeing of children. These threats include risks of violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak evidence-base regarding the impact of such interventions. This analysis assesses the impact of Child Friendly Spaces (CFS), one such commonly implemented intervention after humanitarian emergencies.
Methods
We completed baseline and endline (three-six months post-baseline) assessments regarding protection concerns, psychosocial wellbeing, developmental assets and community resources for a total of 1010 children and 1312 carers in catchment areas for interventions with humanitarian populations in Ethiopia, Uganda, Iraq, Jordan, and Nepal. We estimated intervention effect-sizes with Cohen’s d for difference in mean difference scores between attenders and non-attenders – who proved comparable on baseline measures – by site. We then pooled findings for a meta-analysis summarizing overall impacts across domains.
Results
Amongst children aged 6–11, significant intervention impacts were observed through site-level analysis for protection concerns (Ethiopia, Cohen’s d=0.48, 95% CI 0.08–0.88), psychosocial wellbeing (Ethiopia, d=0.51, 95% CI 0.10–0.91; and Uganda, d=0.21, 95% CI 0.02–0.40), and developmental assets (Uganda, d=0.37, 95% CI 0.15–0.59; and Iraq, d=0.86, 95% CI 0.18–1.54). Pooled analyses for this age group found impacts of intervention to be significant only for psychosocial wellbeing (d=0.18, 95% CI 0.03–0.33). Among children aged 12–17, site-level analysis indicated intervention impact for protection concerns in one site (Iraq, d=0.58, 95% CI 0.07–1.09), with pooled analysis indicating no significant impacts.
Conclusion
CFS can provide – albeit inconsistently – a protective and promotive environment for younger children. CFS show no impact with older children and in connecting children and carers with wider community resources. A major reappraisal of programming approaches and quality assurance mechanisms is required.

Declaration of the Rights of People Affected by Tuberculosis : STOP TB Partnership, TB People :: May 2019

Health – Human Rights :: TB

UNAIDS Press Release
Declaration of the Rights of People Affected by Tuberculosis launched
16 May 2019
Tuberculosis (TB) is the world’s number one cause of death from an infectious disease and remains the leading cause of death among people living with HIV, despite being preventable and curable. Reacting to the unacceptable burden of disease and death caused by TB, a new network of TB survivors and affected communities, called TB People, compiled the Declaration of the Rights of People Affected by Tuberculosis, with the support of leading human rights lawyers and the Stop TB Partnership.

The declaration, launched on 14 May at the Global Health Campus in Geneva, Switzerland, will guide countries to implement the commitments made at the 2018 United Nations High-Level Meeting on Tuberculosis and will inform the last board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) before its replenishment meeting in Lyon, France, in October…

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Declaration of the Rights of People Affected by Tuberculosis
STOP TB Partnership, TB People
May 2019 :: 27 pages
[Excerpts]
Article 4. Right to the highest attainable standard of physical and mental health(right to health)
Every person affected by tuberculosis has the right to enjoy the highest attainable standard of physical and mental health.

This includes the right to available, accessible, acceptable and high quality health care for tuberculosis, as an integral component of universal health coverage, including child-friendly fixed dose combinations and testing and preventive therapy for tuberculosis infection for members of key and vulnerable populations, from the moment of presentation with presumptive tuberculosis, to the completion of treatment, and beyond for people requiring continuing care, delivered by trained health care workers, at the community level, when appropriate, in a respectful, dignified, manner, free
from coercion and stigmatization, on a nondiscriminatory basis, regardless of age, birth, color,
culture, citizenship status, disability, ethnicity, financial status, gender identity, language, legal status, political or other opinion, presence of other diseases, national or social origin, race, religion, sex, sexual orientation or any other status, including for people detained by the State or otherwise deprived of their liberty, with special attention to tuberculosis key populations.

Article 5. Right to freedom from torture and other cruel, inhuman or degrading treatment
Every person affected by tuberculosis has the right to be free from torture and other cruel, inhuman or degrading treatment or punishment.
This includes the right to health care for tuberculosis on a nondiscriminatory basis, at State expense, for all people detained by the State or otherwise deprived of their liberty. It also includes the right to dignified, safe and hygienic conditions of detention, free from overcrowding, with adequate ventilation and provision of nutritious food. The right also applies to the treatment of people with tuberculosis by health care workers in public health facilities that rises to the level of torture or other cruel, inhuman or degrading treatment.

Article 6. Right to equality and freedom from discrimination
Every person affected by tuberculosis is equal before the law and entitled, without any discrimination, to the equal protection of the law and to be free from all forms of discrimination on any ground, such as age, birth, color, culture, citizenship status, disability, ethnicity, financial status, gender identity, language, legal status, political or other opinion, presence of other diseases, national or social origin, race, religion, sex, sexual orientation or any other status.
This includes the right of every person affected by tuberculosis to be free from all forms of discrimination in all areas of their life, including, but not limited to, access to social security and public entitlements, child birth and motherhood, education, employment, health care, housing and marriage.

Article 7. Right to liberty and security of person
Every person affected by tuberculosis has the right to liberty and security of person. No person with
tuberculosis shall be deprived of their liberty except on such grounds and in accordance with such procedure as are established by law. And every person affected by tuberculosis deprived of their liberty shall be treated with humanity and with respect for their inherent dignity.
Involuntary detention, hospitalization or isolation of a person with tuberculosis is a deprivation of liberty and violation of the security of person. Involuntary hospitalization or isolation is therefore only permissible as a measure of last resort, in narrowly defined circumstances, for the shortest duration possible, in accordance with Chapter 15 of the World Health Organization’s Ethics Guidance for the Implementation of the End TB Strategy, when a person, based on accurate medical evidence:
:: Is known to be contagious, refuses effective treatment, and all reasonable measures to ensure adherence have been attempted and proven unsuccessful; OR
:: Is known to be contagious, has agreed to ambulatory treatment, but lacks the capacity to institute infection control in the home, and refuses inpatient care; OR
:: Is highly likely to be contagious (based on laboratory evidence) but refuses to undergo assessment of his/her infectious status, while every effort is made to work with the person to establish a treatment plan that meets their needs.

Moreover, in accordance with the United Nations Economic and Social Council’s Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, the deprivation of liberty involved in the involuntary detention, hospitalization or isolation of people with tuberculosis is only justified if it is:
1. In accordance with national law in force at the time of the deprivation;
2. Based on, and proportionate to, a legitimate objective in response to a serious threat to the health of the population or individual members;
3. Strictly required by the exigencies of the situation;
4. The least restrictive means available to achieve the objective;
AND
5. Not arbitrary, abusive or discriminatory.

If justified, detention, hospitalization or isolation of a person with tuberculosis must: occur in a medically appropriate setting, with effective infection control measures, for the shortest duration possible, only as long as the above circumstances apply; the person must be provided health care on a voluntary basis; all other rights and freedoms must be protected; due process and appeal mechanisms must be available and accessible; and the State must meet, at least, the person’s basic needs, including, but not limited to, adequate food and water, as well any further needs as required to ensure
the restriction of their rights effectively serves its purpose.

Article 8. Freedom of movement
Every person affected by tuberculosis lawfully within a territory of a State has the right to liberty of movement and freedom to choose their residence.
Every person affected by tuberculosis is free to leave any country, including their own.
The above-mentioned rights cannot be subject to any restrictions, except those which are provided by law, are necessary to protect national security, public order, public health or morals or the rights and freedoms of others, and are consistent with the rights recognized in international human rights treaties, including the right to liberty and security of person in Article 7 of this Declaration.
This means tuberculosis cannot be used as a ground for denying entry or re-entry into the territory of a State, nor as a ground for deportation or removal from the territory of a State. It also means tuberculosis cannot be used as a ground for restricting movement or travel within the territory of a State, except in accordance with the narrowly defined circumstances established in Article 7 of this Declaration, in line with Chapter 15 of the World Health Organization’s Ethics Guidance for the Implementation of the End TB Strategy.

Article 9. Right to privacy and family life
Every person affected by tuberculosis has the right not to be subjected to arbitrary or unlawful interference with their privacy, family, home or correspondence, nor to unlawful attacks on their honor and reputation. Every person affected by tuberculosis has the right to protection of the law against such interference or attacks.
This includes the right of people with tuberculosis to keep their health status and personal health information and data private. It also includes the right to marry, found a family, and to have and care for children….

Article 11. Right to information
Every person affected by tuberculosis has the right to seek, receive and impart information.
This means information about tuberculosis infection and disease, including disease symptoms, tuberculosis medical research and health technology development, and prevention, testing and treatment services, including possible adverse events during treatment, must be fully available, accessible and acceptable, of good quality, age and gender appropriate, culturally-sensitive, and
imparted in a non-technical, comprehensible manner in a language understood by the person receiving the information.
It also means that every person affected by tuberculosis,
at a minimum, has the right to:
:: Request and receive official copies of their medical records;
:: Receive a timely, accurate and understandable explanation of their health status and diagnosis for tuberculosis disease or infection, especially for tuberculosis key and vulnerable populations;
:: Access voluntary counseling at any time from diagnosis to completion of their treatment; and
:: Receive an explanation of the benefits, risks and financial cost, if any, of their proposed treatment, including preventive therapy, as well as possible treatment alternatives, with complete
information about the specific drugs prescribed, such as their names, dosages, potential side effects and ways to prevent or reduce their likelihood, as well as possible effects from interactions with other drugs, such as antiretrovirals taken for HIV, when comorbidities or coinfections are present.

Article 12. Right to informed consent
Every person affected by tuberculosis has the right to informed consent.
This means respecting a person’s autonomy, self determination and dignity through voluntary health services delivery. It includes the right to informed consent—verbal or written, depending on the
situation—to all forms of testing, treatment and medical research associated with tuberculosis, with information provided in an age and gender appropriate, culturally sensitive manner, imparted in a non-technical, comprehensible manner in a language understood by the person receiving the information. For children affected by tuberculosis who lack capacity to give informed consent, all decisions made by their parents or legal guardians with respect to testing, treatment or medical research associated with tuberculosis must be made in the best interests of the child, based on accurate medical evidence.
The right to informed consent includes the right to refuse health care for tuberculosis, in accordance with Chapter 15 of the World Health Organization’s Ethics Guidance for the Implementation of the End TB Strategy. The Ethics Guidance establishes that it is never appropriate to force treatment of people with tuberculosis because, among other things, it amounts to an invasion of bodily integrity and may put health care workers at risk…

Article 23. Right to enjoy the benefits of scientific progress (right to science)
Every person affected by tuberculosis has the right to enjoy the benefits of scientific progress and its application.
This means every person affected by tuberculosis must be able to access scientific advancements, without discrimination, respecting and protecting indigenous peoples’ natural resources and individual and collective intellectual properties, whether these advancements are intangible things like knowledge and information or tangible outputs like new technologies for preventing, diagnosing or treating tuberculosis. It also includes the right to participate in the scientific process, from shaping research agendas, to participating in clinical trials.
The right to science also requires States to conserve, develop and diffuse science and its benefits. This means governments must: invest in and create legal and policy environments that enable research; make science and its applications widely available by, among other things, publishing results, establishing regulatory systems to evaluate new interventions, and basing public health programs and policies in scientific evidence; and ensure scientific progress and its benefits are preserved and maintained for future generations…

Ebola virus disease – Democratic Republic of the Congo ::16 May 2019

DRC – Ebola

Disease Outbreak News (DONs)
Ebola virus disease – Democratic Republic of the Congo
16 May 2019
Although the security situation has subsided mildly into an unpredictable calm, the transmission of Ebola virus disease (EVD) continues to intensify in North Kivu and Ituri provinces with more than 100 confirmed cases reported this week.
The main drivers behind the continued rise in cases stems from insecurity hampering access to critical hotspot areas, persistent pockets of poor community acceptance and hesitation to participate in response activities, and delayed detection and late presentation of EVD cases to Ebola Treatment Centres (ETCs)/Transit Centres (TCs)…

Emergencies

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 15 May 2019
:: On 9 May 2019, the World Health Organization received notification of the detection of wild poliovirus type 1 (WPV1) from an environmental sample, collected on 20 April, in Seestan and Balochistan province, Iran. The virus collected is an environmental sample only, and no associated cases of paralysis have been detected.  Genetic sequencing confirmed it is linked to WPV1 circulating in Karachi, Pakistan.
:: On 21 May 2019, taking advantage of the presence of major Global Polio Eradication Initiative (GPEI) stakeholders attending the World Health Assembly (WHA) in Geneva, the GPEI is hosting an informal reception marking the launch of its new Polio Endgame Strategy 2019-2023: To Succeed by 2023 – Reaching Every Last Child for a Polio-Free World. Delegates who will be in Geneva are invited. Please RSVP here.

Summary of new viruses this week:
:: Pakistan — four wild poliovirus type 1 (WPV1) cases and four WPV1-positive environmental samples;
: Iran—one WPV1-positive environmental sample three wild poliovirus type 1 (WPV1) cases and five WPV1-positive environmental samples

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 18 May 2019]

Democratic Republic of the Congo
:: 41: Situation report on the Ebola outbreak in North Kivu 14 May 2019
:: Disease Outbreak News (DONs) Ebola virus disease – Democratic Republic of the Congo
16 May 2019
[See Ebola DRC above for detail]

Bangladesh – Rohingya crisis
:: Bi-weekly Situation Report #09 Date of issue: 09 May 2019
HIGHLIGHTS
:: The Mental Health and Psychosocial Support (MHPSS) team conducted an mhGAP training for health workers from Sadar Hospital, Ukhiya, Ramu and Moheskhali Upazila health complexes.
:: Refurbishment work for Microbiology Room of Institute of Epidemiology, Disease Control and Research(IEDCR) Field Lab in Cox’s Bazaar Medical College has been completed.
:: Acute respiratory infection (ARI), acute watery diarrhea (AWD) and unexplained fever were the conditions with highest proportional morbidity this week.
:: World Immunization Week was observed in Rohingya camps from 24-30 April 2019 with the theme of ‘Protected Together – Vaccine works’. The week has featured, among others, an advocacy meeting with relevant stakeholders, awareness meetings with community influencers, dropout listing and vaccination by vaccinators, distribution of Information, Education and Communication (IEC) materials to service providers and others.
:: The health sector held bilateral meetings with a UN agency to plan on establishing first line support and referral services on gender-based violence (GBV) for ten of its supported health posts where GBV services are currently not available to meet minimum essential service package.
:: The Health Sector coordinated preparation for potential damage from heavy rains and winds, associated with cyclone Fani.

Mozambique floods
:: More than 500 000 doses of cholera vaccine available for Cabo Delgado 18 May 2019

Myanmar – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 18 May 2019]

Iraq
:: WHO mobile medical clinics reach displaced persons in Kalar district, Sulaymaniyah governorate, Iraq 16 May 2019

Zimbabwe
:: The rush to deliver cholera vaccines to remote communities in Zimbabwe 10 May 2019

Cyclone Idai – No new digest announcements identified
Libya – No new digest announcements identified
Brazil (in Portugese) – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified

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WHO Grade 1 Emergencies [to 18 May 2019]
Peru
:: Países avanzan hacia la eliminación de la transmisión de la madre al hijo del VIH, la sífilis, la hepatitis B y la enfermedad de Chagas

Afghanistan – No new digest announcements identified
Chad – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018 – No new digest announcements identified
Kenya – No new digest announcements identified
Lao People’s Democratic Republic – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Philippines – Tyhpoon Mangkhut – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syria: Situation Report 2: Recent Developments in Northwestern Syria (as of 17 May 2019)
Northweste ..

Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
CYCLONE IDAI and Kenneth
:: Mozambique: Brave mothers in the midst of hardship 11 May 2019