UN Security Council Resolution: Syria – unhindered humanitarian access across conflict lines and borders

Security Council Unanimously Adopts Resolution 2139 (2013) to Ease Aid Delivery to Syrians, Provide Relief from ‘Chilling Darkness’ (22 February 2014)

Secretary-General Welcomes Security Council Adoption of Resolution on Syria, but Says It Should Not Have Been Needed as Humanitarian Aid Not Negotiable (22 February 2014)

Joint Statement :: Humanitarian, Human Rights and Peace Groups welcome unanimous Security Council Resolution demanding unhindered humanitarian access across conflict lines and borders, urge swift implementation 
22 Feb 2014
A coalition of 17 international Humanitarian, Human Rights and Peace Groups welcome today’s unanimous Security Council resolution demanding safe and unhindered humanitarian access – including across conflict lines and across borders –  to people in need throughout Syria.

Today’s action by the Security Council is an important step towards getting desperately needed aid to millions of Syrians, including a quarter of a million who are trapped in besieged communities. However, this resolution will only be meaningful if it results in real, substantial changes on the ground in Syria…

…Getting aid to all those in need in Syria in the midst of an ongoing conflict is a complex and dangerous challenge. But the test of whether this resolution is being implemented is fairly simple, and requires real progress by all parties, in the next 30 days, on five central points at a minimum:

1. Lifting of sieges on populated areas and ensuring all people in besieged communities have safe and unhindered access to humanitarian aid;

2. Opening of border crossings from neighbouring countries for deliveries of life-saving aid by both the UN and NGOs;

3. Stream-lined procedures for approving humanitarian aid convoys and prompt approval of requests for convoys to travel to hard-to-reach areas;

4. Cessation of attacks on schools and hospitals and the demilitarization of these facilities, as well as the facilitation of free passage for all medical personnel and equipment;

5. Cessation of indiscriminate use of explosive weapons in populated areas, and any methods of warfare which do not respect the obligation under international humanitarian law to distinguish between civilian populations and combatants.

The Security Council’s resolution is a diplomatic breakthrough; it is not yet a humanitarian breakthrough. This will require the swift translation of the Council’s strong, shared words into meaningful action. For the sake of more than 9 million suffering Syrians, we call on all parties to act immediately on the Security Council’s demands and we call on Security Council members to be firm in ensuring the rapid implementation of the resolution.
Full text: http://www.rescue.org/press-releases/joint-statement-18322

Center for Victims of Torture; Center for Civilians in Conflict; Christian Aid; Conectas Human Rights; Global Center for the Responsibility to Protect; Human Rights Watch; International Rescue Committee; Islamic Relief Worldwide; Médecins du Monde; Norwegian Refugee Council; PAX; Pax Christi International; People in Need; Save the Children; Solidarités International; Syrian American Medical Society; Tearfund; World Vision International

Collaboration in Response to Disaster — Typhoon Yolanda and an Integrative Model

New England Journal of Medicine
February 19, 2014DOI: 10.1056/NEJMp1315960

Collaboration in Response to Disaster — Typhoon Yolanda and an Integrative Model
Ofer Merin, M.D., M.H.A., Yitshak Kreiss, M.D., M.H.A., M.P.A., Guy Lin, M.D., Elon Pras, M.D., and and David Dagan, M.D.

The powerful typhoon that struck the Philippines on November 8, 2013, was the strongest in local history, causing massive destruction and affecting 25 million people.1 More than 5000 people were confirmed dead, 22,000 were still reported missing when our team arrived in the country, and many others had lost their homes. The damage to the infrastructure left many areas without running water and electricity and caused total devastation in others. Some hospitals were shut down altogether, and some continued to work at partial capacity, leaving many of the injured without access to medical assistance. Various countries and relief organizations responded by sending medical supplies and personnel.2 Our delegation, from Israel, was assigned by the Philippine government to provide medical assistance to the city of Bogo (population, 75,000), which had been severely affected by the storm.

Five days after the catastrophic event, the delegation’s 147 members landed on the island of Cebu with 80 tons of supplies and set out for the Severo Verallo Memorial District Hospital, which serves more than 250,000 people living in the region. This 80-bed hospital had a staff of five physicians and included an emergency room, a single operating room, a delivery room, four wards (pediatrics, maternity, male, and female), and basic laboratory and x-ray facilities. When we arrived, the hospital had no electricity, no running water, and about 120 hospitalized patients. The operating room, laboratory, and x-ray apparatus were not functional, and the two physicians assigned to each shift were struggling to cope with the overwhelming number of patients.

Foreign medical teams customarily arrive at a disaster zone and follow the World Health Organization (WHO) guidelines for field hospitals, which recommend being “entirely self-sufficient.”3 Our team has had experience in relief missions throughout the world and had previously deployed as a freestanding, self-sufficient field hospital. In such instances, we followed a model of “nonintegrative collaboration,” which is especially suitable for a chaotic area with a nonfunctioning infrastructure. This time, however, we realized that we’d entered an unusual situation in which there was a local system in place. We decided to rethink our standard operating procedure and combine our physical setup with the local structure and our medical and auxiliary staff with the local staff in order to provide the most benefit. Thus, we created a model of “fully integrative collaboration.”

With the support of the local health care administrators, we deployed our field hospital to abut the local one, thereby creating one integrated medical facility. We were familiar with and respected the need to be sensitive to cultural differences and language barriers, but we had always functioned as a tightly knit and independent unit. Although we had brought advanced medical supplies that were not available locally, and our team included 25 physicians representing most medical subspecialties as well as first-class logistics support, we had to relinquish sole authority for decisions regarding use of our own and other supplies. In order to overcome the basic differences between our military unit and the local civilian facilities, we needed to quickly improvise and establish a model of cooperation; the protocol we developed had four major parts, and both teams agreed to adhere to it.

Patients would first be seen at our field hospital, where they would be triaged. Those who needed to be hospitalized (including candidates for surgery) would first be stabilized and then be admitted, with the concurrence of a local physician.

Open discussions between the two teams were held to establish clear lines of responsibility regarding patient care. It was agreed that registering, documenting, evaluating, and treating potential outpatients would be carried out solely by the Israeli staff, whereas inpatients would be the responsibility of the local staff, with the assistance of the Israeli team. By unanimous agreement, a senior physician from the Israeli team was assigned to act as the principal coordinator. Morning inpatient rounds would be conducted by a combined team, but the documentation and physician’s orders would be written and executed by the local team. The responsibility for auxiliary services, including laboratory work, imaging, and pharmacy services for both inpatients and outpatients, was assigned to the Israeli team.

A protocol for the use of the operating room was established that specified that priority would be given to nonelective procedures (e.g., lifesaving or limb-saving procedures) and any surgery for conditions associated with unrelenting pain. Indications for surgery would be approved by a local physician and at least two senior physicians from the Israeli team. Surgical procedures would be performed by surgeons from both teams after written informed consent had been obtained from the patient by a local physician. Given the limited quantities of free medications, which would last only a short time, the combined teams decided not to offer pharmacologic treatment to the many outpatients with chronic diseases (e.g., hypertension or diabetes mellitus) but instead to have the Israeli team explain to patients the nature of their condition and offer suggestions for risk-factor modification.

It went without saying that reimbursement would be entirely in the hands of the local medical system, since our mission was a humanitarian one. The local authorities decided that patients who did not need to be hospitalized would not be charged, but hospitalized patients would continue to pay the usual fees even if they had been partially treated by our team.

During the 10 days of our joint operation, we were able to provide medical assistance to about 300 new patients daily, for a total of 2686 cases. These results were achieved thanks to the full cooperation and coordination between the two teams. Our primary mission has always been to treat the victims, and this time we aimed to do so in partnership with the local medical team.    We could also provide assistance in rebuilding the local hospital, in restoring electricity by means of generators, and in leaving many much-needed supplies, including a mobile x-ray machine, an autoclave, and a large quantity of pharmaceuticals.

Our experience suggests that the WHO guidelines3 are sound and appropriate when there is a total collapse of the local medical infrastructure. When the local facility is partly functional, however, there are important short- and long-term benefits to integrating foreign teams with the local units. Foreign medical groups that blend with local ones can quickly gain the trust of the local population. A merged model allows the deployment of functioning parts of the local facility. In the Philippines, we also observed that a cooperative model facilitates departure; after treating hundreds of patients every day, we were able to hand over care to our local partners and a small medical group that had arrived from Austria, Germany, and Slovakia, rather than abruptly discontinue medical assistance.

It is always easier to be in full control of these kinds of operations, especially when the balance of experience lies on the side of the “guest” team. Following a cooperative model may pose some challenges, particularly if the visiting team must strike compromises regarding either its own beliefs about the best management of care or important administrative issues, such as patient responsibility or setting up priorities for triage. In this instance, however, by relinquishing our well-established habit of operating as a highly independent unit, we found that, when feasible, a cooperative model can have additional and important benefits for the victims of a disaster.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on February 19, 2014, at NEJM.org.
Source Information
From the Israel Defense Forces Medical Corps Field Hospital, Tel Hashomer (O.M., Y.K., G.L., E.P., D.D.); the Department of Cardiac Surgery, Trauma Unit, Shaare Zedek Medical Center (O.M.), and the Department of Military Medicine (Y.K.), Hebrew University, Jerusalem; the Trauma Unit, Meir Medical Center, Tel Aviv University Sackler School of Medicine, Kfar Saba (G.L.); and the Danek Gertner Institute of Human Genetics, Sheba Medical Center, Ramat Gan (E.P.) — all in Israel.

UNICEF Humanitarian Action for Children 2014

UNICEF Humanitarian Action for Children 2014

February 2014
Humanitarian Action for Children highlights the situation of children and women living in the most challenging circumstances, outlines the support required to help them survive and thrive, and shows the results UNICEF and its partners have achieved and are working towards.
Overview: http://www.unicef.org/appeals/files/HAC_Overview_2014_WEB.pdf

Every year, UNICEF responds to the needs of children in more than 250 humanitarian situations around the world – delivering medicines, vaccines, safe drinking water and other life-saving assistance, as well as ensuring that children have a safe learning environment and are protected from harm, abuse and exploitation…

Gender at Work: A Companion to the World Development Report on Jobs

Gender at Work: A Companion to the World Development Report on Jobs
World Bank Group
February 2014

:: Women around the world are more economically excluded than men.
:: Social norms affect women’s work by dictating the way they spend their time and undervaluing their potential.
:: Legal discrimination is a remarkably common barrier to women’s work.

WASHINGTON, Feb. 20, 2014—Women around the world still face huge, persistent gender gaps at work, according to a new report by the World Bank Group, which calls for bold, innovative measures to level the playing field and unleash women’s economic potential.

By virtually every global measure, women are more economically excluded than men, according to Gender at Work. Trends suggest women’s labor force participation worldwide has stagnated over the past 30 years, dropping from 57 to 55 percent globally, despite accumulating evidence that jobs benefit women, families, businesses, and communities.

“The reasons for this will differ from country to country, but we think that the persistence of norms—which means that women don’t have as much choice over their livelihoods as men—as well as legal barriers to work are both playing important roles,” said Jeni Klugman, World Bank Group Gender and Development Director.

A companion to the 2013 World Development Report on jobs, the report notes that since women face multiple constraints to jobs, starting early and extending throughout their lives, progressive, broad-based, and coordinated policy action is needed to close gender gaps. Common constraints include lack of mobility, time, and skills, exposure to violence, and the absence of basic legal rights.

Gender at Work also finds that legal discrimination is a remarkably common barrier to women’s work. Restrictive laws can hinder women’s ability to access institutions, own or use property, build credit, or get a job. In 15 countries, women still require their husbands’ consent to work.

To address these inequalities, the report recommends governments target actions that cover a woman’s life cycle—saying interventions that focus only on women of productive age start too late and end too early….

Prespective: Why ageing is an issue for emerging markets

Prespective: Why ageing is an issue for emerging markets
Toby Porter
World Economic Forum Blog  Feb 12th 2014
Toby Porter is Chief Executive Officer of HelpAge International, a global movement for the rights of older people.

One in every two children born today will see their 104th birthday. This was just one of many remarkable predictions that former US Vice-President Al Gore placed in front of participants at the recent World Economic Forum Annual Meeting 2014 in Davos.

The implications of population ageing have been high on the Forum agenda for many years. It’s an issue that’s multi-dimensional, complex and, above all, pressing: By 2030 there will be 1 billion people over the age of 60; more than children under 10.

The degree of success in reshaping our world around population ageing will define the civil, economic and political rights of an increasingly large segment of the world’s population. It’s not yet clear how institutions will adapt, particularly those delivering health, care and social security services. What is sure, however, is that this reshaping will be felt by hundreds of millions of older people, and alter the relationship and expectations between state and individual in developed economies in the next few decades.

The Annual Meeting is one of the few places where the top representatives of governments, business and civil society can convene around such a key issue as health. Take the discussion on dementia, for example, which brought together the world’s top experts on Alzheimer’s and other dementias, government and private healthcare providers, along with CEOs of major pharmaceutical companies and venture capital firms that invest in new medicines. They were joined by experts on social security, senior politicians and top civil servants.

I left Davos with two impressions. The first was how we deal with the implications of people living longer lives. We don’t yet have the answers, but many critical questions are being asked of politicians, businesses and society at large. And second, is how we need to more systematically include developing countries in these discussions.

In many of the fastest emerging economies, social security infrastructures are taking shape, offering some degree of health, care and economic security for their older citizens. In countries such as Brazil and South Africa, for example, basic pensions have had a noticeable impact on the poverty of older people and also of the households in which they live. The picture for some of these societies is, however, mixed, with India yet to translate its growing wealth into a secure old age for the one-third of older Indians which the government estimates to be living in poverty.

But what about the hundreds of millions of older people in countries where hardly any such services or social security architecture exist? By 2050, 80% of the world’s population over 60 will be living in developing countries.

The older age to which they can look forward to will depend, as it does in the rich world, on the priorities set by governments and societies. Again, the picture is mixed, with some countries outperforming their economic status in terms of their provision for older people, while others lag behind in the Global AgeWatch Index.

Everyone is talking about inclusion, yet older people in the poorest contexts continue to be excluded. The oft-quoted adage that poor countries “are growing old before they grow rich” just doesn’t bear scrutiny. It’s a political choice, not a matter of fiscal inevitability to rule out older people from early inclusion in social security systems. Even countries with limited resources can decide to support their citizens throughout life, ensuring a reasonable quality of life in old age.

I left Davos knowing that the most important contribution that the HelpAge network can make is to redouble our advocacy efforts to ensure that future discussions around population ageing are truly global, relevant and ultimately have a positive impact on the lives of older people wherever they are living.

The Mobile-Finance Revolution – How Cell Phones Can Spur Development

The Mobile-Finance Revolution – How Cell Phones Can Spur Development
Jake Kendall, Rodger Voorhies
Foreign Affairs – March/April 2014 Issue

The roughly 2.5 billion people in the world who live on less than $2 a day are not destined to remain in a state of chronic poverty. Every few years, somewhere between ten and 30 percent of the world’s poorest households manage to escape poverty, typically by finding steady employment or through entrepreneurial activities such as growing a business or improving agricultural harvests. During that same period, however, roughly an equal number of households slip below the poverty line. Health-related emergencies are the most common cause, but there are many more: crop failures, livestock deaths, farming-equipment breakdowns, even wedding expenses.

In many such situations, the most important buffers against crippling setbacks are financial tools such as personal savings, insurance, credit, or cash transfers from family and friends. Yet these are rarely available because most of the world’s poor lack access to even the most basic banking services. Globally, 77 percent of them do not have a savings account; in sub-Saharan Africa, the figure is 85 percent. An even greater number of poor people lack access to formal credit or insurance products. The main problem is not that the poor have nothing to save — studies show that they do — but rather that they are not profitable customers, so banks and other service providers do not try to reach them. As a result, poor people usually struggle to stitch together a patchwork of informal, often precarious arrangements to manage their financial lives.

Over the last few decades, microcredit programs — through which lenders have granted millions of small loans to poor people — have worked to address the problem. Institutions such as the Grameen Bank, which won the Nobel Peace Prize in 2006, have demonstrated impressive results with new financial arrangements, such as group loans that require weekly payments. Today, the microfinance industry provides loans to roughly 200 million borrowers — an impressive number to be sure, but only enough to make a dent in the over two billion people who lack access to formal financial services.

Despite its success, the microfinance industry has faced major hurdles. Due to the high overhead costs of administering so many small loans, the interest rates and fees associated with microcredit can be steep, often reaching 100 percent annually. Moreover, a number of rigorous field studies have shown that even when lending programs successfully reach borrowers, there is only a limited increase in entrepreneurial activity — and no measurable decrease in poverty rates. For years, the development community has promoted a narrative that borrowing and entrepreneurship have lifted large numbers of people out of poverty. But that narrative has not held up.

Two trends, however, indicate great promise for the next generation of financial-inclusion efforts. First, mobile technology has found its way to the developing world and spread at an astonishing pace. According to the World Bank, mobile signals now cover some 90 percent of the world’s poor, and there are, on average, more than 89 cell-phone accounts for every 100 people living in a developing country. That presents an extraordinary opportunity: mobile-based financial tools have the potential to dramatically lower the cost of delivering banking services to the poor.

Second, economists and other researchers have in recent years generated a much richer fact base from rigorous studies to inform future product offerings. Early on, both sides of the debate over the true value of microcredit programs for the poor relied mostly on anecdotal observations and gut instincts. But now, there are hundreds of studies to draw from. The flexible, low-cost models made possible by mobile technology and the evidence base to guide their design have thus created a major opportunity to deliver real value to the poor…


WHO: 140,000 people to get cholera vaccine in South Sudan

WHO: 140,000 people to get cholera vaccine in South Sudan
News release – Excerpt
22 February 2014 | GENEVA – WHO is working with the South Sudan Government and partners to provide vaccines to protect nearly 140,000 people living in temporary camps in South Sudan against cholera.

The vaccines come from an emergency stockpile managed by WHO, the International Federation of the Red Cross and Red Crescent Societies (IFRC), Médecins Sans Frontières (MSF) and UNICEF. It is the first time the stockpile, created in 2013 by WHO, is being activated.

Although currently there is not a cholera outbreak, people displaced by the recent conflict and living in the camps are at risk due to poor sanitary conditions and overcrowding.

Starting today, 94,000 people will be vaccinated in the Minkaman camp, Awerial County, targeting displaced people and host communities, followed by vaccination campaigns in camps based in Juba, covering an additional 43 000 people.

Two doses of vaccine are required for an individual to be protected. The campaign begins with an initial round of vaccinations followed by – after a required 14 day interval – a second round of doses, which will complete the vaccination. For such a campaign to be effective, it is vital that a second dose is administered and this factor has led to the decision to begin with Minkaman, Awerial County, and Juba camps.

“Minkaman camp in Awerial County and Juba camp have been selected because of the relative stability of the situation and easier access in those places,” says Dr Abdinasir Abubakar, from WHO’s Disease Surveillance and Response team, in South Sudan. “We are also looking at other camps, and once the accessibility and security improves, we will expand the cholera vaccination campaigns into these areas. We will be reviewing the situation day by day.” …