The Lancet Global Health
May 2014 Volume 2 Number 5 e242 – 300
http://www.thelancet.com/journals/langlo/issue/current

Comment
Readiness of the primary care system for non-communicable diseases in sub-Saharan Africa
Andre Pascal Kengne, Bongani M Mayosi
Preview |
According to WHO global health estimates,1 chronic non-communicable diseases (NCDs) are the second leading cause of death in Africa. In 2011, NCDs accounted for 30% of the 9•5 million deaths, and 25•8% of the 675•4 million disability-adjusted life years (DALYs) recorded in Africa. NCDs are emerging in both rural and urban areas, most prominently in people living in low-income urban settings, and are resulting in increasing pressure on acute and chronic health-care services.2 Within the broad category of NCDs, stroke, hypertensive heart disease, diabetes, and chronic kidney disease have been identified as the leading disorders in the region.

Comment
Epidemiology of mental health in conflict-affected populations
Madelyn H Hicks
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Full Text | PDF
In their Article in The Lancet Global Health, Derrick Silove and colleagues1 describe how different forms of recurrent political violence have affected mental health in Timor-Leste. The paper establishes several advances in epidemiological studies of mental health in conflict-affected populations. One of the most important is integration of high-quality epidemiological sampling and validated mental health measures with information about relevant social conditions, a good qualitative grounding, personally meaningful experience, and local historical context.

Comment
Reassessing the value of vaccines
Till Bärnighausen, Seth Berkley, Zulfiqar A Bhutta, David M Bishai, Maureen M Black, David E Bloom, Dagna Constenla, Julia Driessen, John Edmunds, David Evans, Ulla Griffiths, Peter Hansen, Farah Naz Hashmani, Raymond Hutubessy, Dean T Jamison, Prabhat Jha, Mark Jit, Hope Johnson, Ramanan Laxminarayan, Bruce Y Lee, Sharmila Mhatre, Anne Mills, Anders Nordström, Sachiko Ozawa, Lisa Prosser, Karlee Silver, Christine Stabell Benn, Baudouin Standaert, Damian Walker
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Full Text | PDF
In May, 1974, WHO launched the Expanded Programme on Immunization—the global programme to immunise children worldwide with a set of (at the time) six core vaccines. 40 years on, the GAVI Alliance has brought us together, a group of 29 leading technical experts in health and development economics, cognitive development, epidemiology, disease burden, and economic modelling to review and understand the broader outcomes of vaccines beyond morbidity and mortality, to identify research opportunities, and to create a research agenda that will help to further quantify the value of this effect.
Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey
Dr Robert Peck MD a b c, Janneth Mghamba MD d, Fiona Vanobberghen PhD a f, Bazil Kavishe MD a, Vivian Rugarabamu MD a, Prof Liam Smeeth PhD e, Prof Richard Hayes DSc f, Prof Heiner Grosskurth PhD f, Saidi Kapiga MD a f
Summary
Background
Historically, health facilities in sub-Saharan Africa have mainly managed acute, infectious diseases. Few data exist for the preparedness of African health facilities to handle the growing epidemic of chronic, non-communicable diseases (NCDs). We assessed the burden of NCDs in health facilities in northwestern Tanzania and investigated the strengths of the health system and areas for improvement with regard to primary care management of selected NCDs.
Methods
Between November, 2012, and May, 2013, we undertook a cross-sectional survey of a representative sample of 24 public and not-for-profit health facilities in urban and rural Tanzania (four hospitals, eight health centres, and 12 dispensaries). We did structured interviews of facility managers, inspected resources, and administered self-completed questionnaires to 335 health-care workers. We focused on hypertension, diabetes, and HIV (for comparison). Our key study outcomes related to service provision, availability of guidelines and supplies, management and training systems, and preparedness of human resources.
Findings
Of adult outpatient visits to hospitals, 58% were for chronic diseases compared with 20% at health centres, and 13% at dispensaries. In many facilities, guidelines, diagnostic equipment, and first-line drug therapy for the primary care of NCDs were inadequate, and management, training, and reporting systems were weak. Services for HIV accounted for most chronic disease visits and seemed stronger than did services for NCDs. Ten (42%) facilities had guidelines for HIV whereas three (13%) facilities did for NCDs. 261 (78%) health workers showed fair knowledge of HIV, whereas 198 (59%) did for hypertension and 187 (56%) did for diabetes. Generally, health systems were weaker in lower-level facilities. Front-line health-care workers (such as non-medical-doctor clinicians and nurses) did not have knowledge and experience of NCDs. For example, only 74 (49%) of 150 nurses had at least fair knowledge of diabetes care compared with 85 (57%) of 150 for hyptertension and 119 (79%) of 150 for HIV, and only 31 (21%) of 150 had seen more than five patients with diabetes in the past 3 months compared with 50 (33%) of 150 for hypertension and 111 (74%) of 150 for HIV.
Interpretation
Most outpatient services for NCDs in Tanzania are provided at hospitals, despite present policies stating that health centres and dispensaries should provide such services. We identified crucial weaknesses (and strengths) in health systems that should be considered to improve primary care for NCDs in Africa and identified ways that HIV programmes could serve as a model and structural platform for these improvements.
Funding
UK Medical Research Council.

Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: a 6-year longitudinal study
Dr Derrick Silove MD a d, Belinda Liddell PhD b, Susan Rees PhD a d, Tien Chey MAppStat d, Angela Nickerson PhD b, Natalino Tam a, Anthony B Zwi PhD c, Robert Brooks PhD e, Lazaro Lelan Sila BPubHealth a, Zachary Steel PhD a d
Summary
Background
Little is known about the effect of recurrent episodes of communal violence on mental health in countries recovering from mass conflict. We report results of a 6-year longitudinal study in post-conflict Timor-Leste assessing changes in mental health after a period of communal violence.
Methods
We assessed 1022 adults (600 from a rural village, 422 from an urban district) exposed to mass conflict during the Indonesian occupation after independence in 2004, and again in 2010—11, following a period of internal conflict. We took a census of all adults living at the two sites. The survey included measures of post-traumatic stress disorder, severe distress, traumatic events, poverty, ongoing conflict, and injustice.
Findings
1247 (80%) of 1554 invited adults participated in the baseline survey. 1038 (89% of those eligible) were followed up. The analysis included 1022 people who had sufficient data at baseline and follow-up. The prevalence of post-traumatic stress disorder increased from 23 of 1022 (2.3%) in 2004, to 171 of 1022 (16.7%) in 2010. The prevalence of severe distress also increased, from 57 of 1022 (5.6%) in 2004, to 162 of 1022 (15.9%) in 2010. Both these outcomes were associated with disability at follow-up. Having post-traumatic stress at follow-up was associated with being a woman (odds ratio [OR] 1.63, 95% CI 1.14—2•32), experience of human rights trauma (OR 1.25, 95% CI 1.07—1.47), or exposure to murder (OR 1.71, 95% CI 1.38—2.10) during the Indonesian occupation (1975—99), human rights trauma during the period of internal violence in 2006—07 (OR 1.46, 95% CI 1.04—2•03), and ongoing family or community conflict (OR 1.80, 95% CI 1.15—2.80) or preoccupations with injustice for two or three historical periods (OR 4.06, 2.63—6.28). Severe distress at follow-up was associated with health stress (OR 1.47, 1.14—1.90), exposure to murder (OR 1.57, 1.27—1.95), and natural disaster (OR 1.65, 1.03—2.64) during the Indonesian occupation, conflict-related trauma during the internal violence (OR 1.33, 1.02—1.74), and ongoing poverty (OR 1.53, 1.36—1.72) or preoccupations with injustice for two or three historical periods (OR 2.09, 1.25—3.50).
Interpretation
Recurrent violence resulted in a major increase in post-traumatic stress disorder and severe distress in a community previously exposed to mass conflict. Poverty, ongoing community tensions, and persisting feelings of injustice contributed to mental disorders. The findings underscore the importance of preventing recurrent violence, alleviating poverty, and addressing injustices in countries emerging from conflict.
Funding
Australian National Health and Medical Research Council.

The Lancet Infectious Diseases
May 2014 Volume 14 Number 5 p359 – 440
http://www.thelancet.com/journals/laninf/issue/current

Editorial
The case for vaccinating against meningitis B
The Lancet Infectious Diseases
Preview |
The four-component meningococcal serogroup B vaccine (4CMenB; Bexsero, Novartis) is the first successful vaccine against the endemic form of this cause of serious bacterial meningitis and septicaemia. The vaccine has been in development for almost two decades and has been approved by licensing authorities in Europe, Canada, and Australia. But it is only now moving towards incorporation into routine infant immunisation programmes following a recommendation from the UK Joint Committee on Vaccination and Immunisation (JCVI), with the proviso that a cost-effective price be negotiated.

Rotavirus vaccination in Europe: drivers and barriers
Dr N Parez PhD a, Prof C Giaquinto MD b, C Du Roure PhD c, F Martinon-Torres PhD d, V Spoulou PhD e, Prof P Van Damme PhD f, Prof T Vesikari MD g
Summary
Rotavirus gastroenteritis is a vaccine-preventable disease that confers a high medical and economic burden in more developed countries and can be fatal in less developed countries. Two vaccines with high efficacy and good safety profiles were approved and made available in Europe in 2006. We present an overview of the status of rotavirus vaccination in Europe. We discuss the drivers (including high effectiveness and effect of universal rotavirus vaccination) and barriers (including low awareness of disease burden, perception of unfavourable cost-effectiveness, and potential safety concerns) to the implementation of universal rotavirus vaccination in Europe. By February, 2014, national universal rotavirus vaccination had been implemented in Belgium, Luxembourg, Austria, Finland, Greece, Luxembourg, Norway, and the UK. Four other German states have issued recommendations and reimbursement is provided by sickness funds. Other countries were at various stages of recommending or implementing universal rotavirus vaccination.

A vaccine against serogroup B Neisseria meningitidis: dealing with uncertainty
Sophie M Andrews BSc a, Prof Andrew J Pollard PhD b c
Summary
Neisseria meningitidis is an important cause of invasive bacterial infection in children worldwide. Although serogroup C meningococcal disease has all but disappeared in the past decade as a direct result of immunisation programmes in Europe, Canada, and Australia, meningitis and septicaemia caused by serogroup B meningococci remain uncontrolled. A vaccine (4CMenB) has now been licensed for use in the European Union, comprising three immunogenic antigens (identified with use of reverse vaccinology) combined with bacterial outer-membrane vesicles. The vaccine has the potential to reduce mortality and morbidity associated with serogroup B meningococci infections, but uncertainty remains about the breadth of protection the vaccine might induce against the diverse serogroup B meningococci strains that cause disease. We discuss drawbacks in the techniques used to estimate coverage and potential efficacy of the vaccine, and their effects on estimates of cost-effectiveness, both with and without herd immunity. For parents, and clinicians treating individual patients, the predicted benefits of vaccination outweigh existing uncertainties if any cases can be prevented, but future use of the vaccine must be followed by rigorous post-implementation surveillance to reassess its value to health systems with directly recorded epidemiological data

PLoS One
[Accessed 26 April 2014]
http://www.plosone.org/
Research Article
Correlates of Complete Childhood Vaccination in East African Countries
Maureen E. Canavan mail, Heather L. Sipsma, Getnet M. Kassie, Elizabeth H. Bradley
Published: April 21, 2014
DOI: 10.1371/journal.pone.0095709
Abstract
Background
Despite the benefits of childhood vaccinations, vaccination rates in low-income countries (LICs) vary widely. Increasing coverage of vaccines to 90% in the poorest countries over the next 10 years has been estimated to prevent 426 million cases of illness and avert nearly 6.4 million childhood deaths worldwide. Consequently, we sought to provide a comprehensive examination of contemporary vaccination patterns in East Africa and to identify common and country-specific barriers to complete childhood vaccination.
Methods
Using data from the Demographic and Health Surveys (DHS) for Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, we looked at the prevalence of complete vaccination for polio, measles, Bacillus Calmette–Guérin (BCG) and DTwPHibHep (DTP) as recommended by the WHO among children ages 12 to 23 months. We conducted multivariable logistic regression within each country to estimate associations between complete vaccination status and health care access and sociodemographic variables using backwards stepwise regression.
Results
Vaccination varied significantly by country. In all countries, the majority of children received at least one dose of a WHO recommended vaccine; however, in Ethiopia, Tanzania, and Uganda less than 50% of children received a complete schedule of recommended vaccines. Being delivered in a public or private institution compared with being delivered at home was associated with increased odds of complete vaccination status. Sociodemographic covariates were not consistently associated with complete vaccination status across countries.
Conclusions
Although no consistent set of predictors accounted for complete vaccination status, we observed differences based on region and the location of delivery. These differences point to the need to examine the historical, political, and economic context of each country in order to maximize vaccination coverage. Vaccination against these childhood diseases is a critical step towards reaching the Millennium Development Goal of reducing under-five mortality by two-thirds by 2015 and thus should be a global priority.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 26 April 2014)
Policy Forum
Optimal Evidence in Difficult Settings: Improving Health Interventions and Decision Making in Disasters
Martin Gerdin mail, Mike Clarke, Claire Allen, Bonnix Kayabu, William Summerskill, Declan Devane, Malcolm MacLachlan, Paul Spiegel, Anjan Ghosh, Rony Zachariah, Saurabh Gupta,
Virginia Barbour, Virginia Murray, Johan von Schreeb
Published: April 22, 2014
DOI: 10.1371/journal.pmed.1001632
Summary Points
:: As for any type of health care, decisions about interventions in the context of natural disasters, conflict, and other major healthcare emergencies must be guided by the best possible evidence.
:: Disaster health interventions and decision making can benefit from an evidence-based approach.
:: We outline how systematic reviews and methodologically sound research can build a much-needed evidence base.
:: We do this from the standpoint of Evidence Aid, an initiative that aims to improve access to evidence on the effects of interventions, actions, and policies before, during, and after disasters and other humanitarian emergencies, so as to improve health-related outcomes.

PLoS Neglected Tropical Diseases
April 2014
http://www.plosntds.org/article/browseIssue.action
Opportunity Cost for Early Treatment of Chagas Disease in Mexico
Janine M. Ramsey, Miguel Elizondo-Cano, Gilberto Sanchez-González, Adriana Peña-Nieves
Alejandro Figueroa-Lara
Abstract
Background
Given current neglect for Chagas disease in public health programs in Mexico, future healthcare and economic development policies will need a more robust model to analyze costs and impacts of timely clinical attention of infected populations.
Methodology/Principal Findings
A Markov decision model was constructed to simulate the natural history of a Chagas disease cohort in Mexico and to project the associated short and long-term clinical outcomes and corresponding costs. The lifetime cost for a timely diagnosed and treated Chagas disease patient is US$ 10,160, while the cost for an undiagnosed individual is US$ 11,877. The cost of a diagnosed and treated case increases 24-fold from early acute to indeterminate stage. The major cost component for lifetime cost was working days lost, between 44% and 75%, depending on the program scenario for timely diagnosis and treatment.
Conclusions/Significance
In the long term, it is cheaper to diagnose and treat chagasic patients early, instead of doing nothing. This finding by itself argues for the need to shift current policy, in order to prioritize and attend this neglected disease for the benefit of social and economic development, which implies including treatment drugs in the national formularies. Present results are even more relevant, if one considers that timely diagnosis and treatment can arrest clinical progression and enhance a chronic patient’s quality of life.

Science
25 April 2014 vol 344, issue 6182, pages 333-440
http://www.sciencemag.org/current.dtl
Policy Forum
Land Use – Cracking Brazil’s Forest Code
Britaldo Soares-Filho, Raoni Rajão, Marcia Macedo, Arnaldo Carneiro, William Costa, Michael Coe, Hermann Rodrigues, and Ane Alencar
Science 25 April 2014: 363-364.
Brazil’s controversial new Forest Code grants amnesty to illegal deforesters, but creates new mechanisms for forest conservation.
Summary
Roughly 53% of Brazil’s native vegetation occurs on private properties. Native forests and savannahs on these lands store 105 ± 21 GtCO2e (billion tons of CO2 equivalents) and play a vital role in maintaining a broad range of ecosystem services (1). Sound management of these private landscapes is critical if global efforts to mitigate climate change are to succeed. Recent approval of controversial revisions to Brazil’s Forest Code (FC)—the central piece of legislation regulating land use and management on private properties—may therefore have global consequences. Here, we quantify changes resulting from the FC revisions in terms of environmental obligations and rights granted to land-owners. We then discuss conservation opportunities arising from new policy mechanisms in the FC and challenges for its implementation.

From Google Scholar+ [to 26 April 2014]
Selected content from beyond the journals and sources covered above, aggregated from a range of Google Scholar monitoring algorithms and other monitoring strategies.

[PDF] Community-Led Disaster Risk Reduction in Mongu, Zambia Project Effectiveness Review
Oxfam Great Britain
Adaptation and Risk Reduction Outcome Indicator
Publication Date: February 2014
Executive summary
Under Oxfam Great Britain’s (OGB) Global Performance Framework (GPF), sufficiently mature projects are being randomly selected each year and their effectiveness rigorously assessed. Zambia’s ‘Community-Led Disaster Risk Reduction’ project was randomly selected for an Effectiveness Review under the adaptation and risk reduction thematic area. The project aims to increase resilience to climatic shocks among target groups in Mongu district of western Zambia, through: a) strengthening the capacity of target communities to manage and respond to floods and droughts; and b) encouraging livelihood diversification and asset growth.The community-level activities undertaken to achieve the first objective included the development of early-warning systems, based on local knowledge and linked to wider support systems (e.g. weather stations). In order to achieve the second objective, a range of activities, including provision of fishing nets, canal clearing, embankment building, establishment of banana plantations and use of conservation agriculture were implemented. These project activities were undertaken between 2009 and 2012 in six communities located in the Zambezi floodplain by a local partner organisation – Peoples Participation Service (PPS).

To assess the effectiveness of this project, a quasi-experimental impact evaluation was implemented. This involved carrying out surveys with households in the six communities supported by the project, as well as with households in six nearby comparison communities. In all, surveys were carried out with 491 households. At the analysis stage, the statistical tools of propensity-score matching and multivariable regression were used to control for demographic and baseline differences between the intervention and comparison groups.

The effectiveness of the project in effecting 31 ‘resilience characteristics’ was assessed through this process. These characteristics fall under five interrelated dimensions: livelihood viability; innovation potential; access to contingency resources and support; integrity of the natural and built environment; and social response capability. Composite indices were developed to aggregate the data associated with the 31 characteristics, following the Alkire-Foster method used by the Oxford Poverty and Human Development Initiative (OPHI) to measure multi-dimensional poverty. One of these indices, in particular, referred to as the Alkire-Foster resilience index informs Oxfam GB’s global outcome indicator for its adaptation and risk reduction thematic area.

Following analysis of the data, there is evidence that the project positively affected several characteristics assumed important for promoting resilience among the intervention population. In particular, even after controlling for measured differences between the intervention and comparison households, the former performed between eight and 13 percentage points, and four to six points, better than the latter on Oxfam GB’s global Adaptation and Risk Reduction (ARR) indicator and the Alkire-Foster resilience index, respectively. Such performance in relation to the global indicator shows that in total, 64 per cent of surveyed intervention households demonstrate greater ability to reduce risk and adapt to emerging trends and uncertainty (as measured by the ARR resilience index).

While this Effectiveness Review generated some positive results, it also identified opportunities for reflection and learning. Oxfam in general, and the Zambia country team and partners in particular, are encouraged to consider the following:
:: Undertake further research to evaluate the effects of advocacy efforts connected to this project.
:: Explore how to involve community members more widely in community-level drought preparedness activities, and to ensure that training and early-warning information is fully disseminated.
:: Continue monitoring changes in behaviour and experiences of households in the project communities to learn whether the project activities will eventually result in higher-level changes in risk-reduction behaviour.

Military Medical Research
2014, 1:5
[PDF] Organization and implementation of mass medical rescue after an earthquake
Yan-Ling Zhang1
1 Health Department, General Logistics Department, Chinese People’s Liberation
Army (PLA), Beijing 100842, China
doi:10.1186/2054-9369-1-5
Abstract
On May 12, 2008, an 8.0-magnitude earthquake occurred in Wenchuan, Sichuan Province. In this disaster, 69,000 people were killed, 18,000 people were reported missing, and 37,000
people were injured, including more than 10,000 who were seriously injured. Trauma was the most commonly observed type of injury, with fractures accounting for 74% of all injury
cases. On April 14, 2010, a 7.1-magnitude earthquake occurred in Yushu of Qinghai Province. In this disaster, 2,698 people were killed, 270 people were reported missing, and
11,000 people were injured, including more than 3,100 who were seriously injured. Fracture injury accounted for 58.4% of all injury cases. After each earthquake, the Chinese Army
Medical Services responded promptly, according to the previously established guidelines, and sent out elite forces to the disaster areas, with the objectives of organizing, coordinating and
participating in an efficient and evidence-based medical rescue effort. After the Wenchuan earthquake, 397 mobile medical service teams including 7,061 health workers were sent to
the disaster areas. A total of 69,000 casualties were treated, and 22,000 surgeries were performed. After the Yushu earthquake, 25 mobile medical service teams involving 2,025
health workers were sent. They performed 1,635 surgeries and created an astounding outcome of “zero deaths” in the aftermath of the earthquake during their treatment of
casualties in a high-altitude region. Within a week after each earthquake, the military teams rescued approximately 60% of the total number of rescued casualties and evacuated
approximately 80% of the total number of evacuated sick or wounded victims, playing a critical role and making invaluable contributions to earthquake relief. The experience and
lessons learned from the rescue efforts of the Chinese military after the two earthquakes have highlighted several key aspects in emergency medical rescue: (1) medical rescue theories
must be updated; (2) military-civilian cooperation must be stressed; (3) professional rescue forces must be strengthened; (4) supporting facilities must be improved; and (5) international
exchanges and cooperation must be deepened.

Computer
Volume:47 Issue:4
Rethinking Context: Leveraging Human and Machine Computation in Disaster Response
Vieweg, Sarah ; Qatar Computing Research Institute ; Hodges, Adam
Abstract
Human-computer systems that treat context simply as enumerated facts, rules, or axioms about the surrounding physical and social environment will always have trouble handling information requiring human pragmatic interpretation. One way to overcome such limitations is to draw upon human pragmatic awareness to create hybrid systems capable of both extracting large quantities of data and processing that data in a way that is meaningful to users. The Web extra at http://youtu.be/pqI2qcigiCw is a video demonstrating Artificial Intelligence for Disaster Response (AIDR), a free, open source, and easy-to-use platform to filter and classify relevant microblog messages during humanitarian crises.

Power and Energy Magazine, IEEE
Volume:12 , Issue: 3 May 2014
Powering Through the Storm: Microgrids Operation for More Efficient Disaster Recovery
Abbey, C. ; Hydro-Quebec Research Institute, Quebec, Canada ; Cornforth, D. ; Hatziargyriou, N. ; Hirose, K.
Abstract
Disasters, whether natural or man-made, compromise the quality of life for all involved. In such situations, expeditious recovery activities are deemed imperative and irreplaceable for the restoration of normalcy. However, recovery activities rely heavily on the critical infrastructures that supply basic needs like electricity, water, information, and transportation. When disasters strike, it is likely that the critical infrastructures themselves are affected significantly, hampering efficient recovery processes, thus presenting a Catch-22 conundrum. In this article, we present examples from different parts of the world where distributed energy resources, organized in a microgrid, were used to provide reliable electricity supply in the wake of disasters, allowing recovery and rebuilding efforts to occur with relatively greater efficiency.

Social Science & Medicine
Available online 18 April 2014
Rapid response: Email, immediacy, and medical humanitarianism in Aceh, Indonesia
Jesse Hession Grayman
Highlights
:: Content analysis of email reveals everyday practices of humanitarian agencies.
:: Email’s immediacy can enact and amplify the urgency of the humanitarian imperative.
:: Email may abstract humanitarian practitioners out of local and moral context.
:: Email communications closely mirror and reproduce organizational hierarchy.
:: Immediacy favors a humanitarian focus on acute crisis but effaces chronic crisis.
Abstract
After more than 20 years of sporadic separatist insurgency, the Free Aceh Movement and the Indonesian government signed an internationally brokered peace agreement in August 2005, just eight months after the Indian Ocean tsunami devastated Aceh’s coastal communities. This article presents a medical humanitarian case study based on ethnographic data I collected while working for a large aid agency in post-conflict Aceh from 2005-2007. In December 2005, the agency faced the first test of its medical and negotiation capacities to provide psychiatric care to a recently amnestied political prisoner whose erratic behavior upon returning home led to his re-arrest and detention at a district police station. I juxtapose two methodological approaches—an ethnographic content analysis of the agency’s email archive and field-based participant-observation—to recount contrasting narrative versions of the event. I use this contrast to illustrate and critique the immediacy of the humanitarian imperative that characterizes the industry. Immediacy is explored as both an urgent moral impulse to assist in a crisis and a form of mediation that seemingly projects neutral and transparent transmission of content. I argue that the sense of immediacy afforded by email enacts and amplifies the humanitarian imperative at the cost of abstracting elite humanitarian actors out of local and moral context. As a result, the management and mediation of this psychiatric case by email produced a bureaucratic model of care that failed to account for complex conditions of chronic political and medical instability on the ground.

Book: Crises, Conflict and Disability: Ensuring Equality
Consultant Oral and Maxillofacial Surgeon Honorary Consultant and Senior Clinical Lecturer David Mitchell, David Mitchell, Valerie Karr
Routledge, Apr 3, 2014 – – 260 page
Overview
People with disabilities are among the most adversely affected during conflict situations or when natural disasters strike. They experience higher mortality rates, have fewer available resources and less access to help, especially in refugee camps, as well as in post-disaster environments. Already subject to severe discrimination in many societies, people with disabilities are often overlooked during emergency evacuation, relief, recovery and rebuilding efforts.

Book: Meeting Needs: NGO Coordination in Practice
Jon Bennett
Routledge, Apr 8, 2014 – 204 pages
Overview
This critical analysis of aid organizations illustrates the expanding role of NGOs in international relief operations, and highlights the problems confronted by humanitarian groups. The book presents an overview of recent trends in the international relief community. Various relief operations are compared, to demonstrate why NGO co-ordination has become such an important issue. Case studies show how enhanced international co-ordination could improve the overall performance of NGOs and the United Nations.

UN: Unanimously Adopting Resolution 2150 (2014), Security Council Calls for Recommitment to Fight against Genocide (16 April 2014)
SC/11356
Excerpt
Twenty years after the genocide in Rwanda, the Security Council condemned without reservation any denial of the genocide and urged member States to develop educational programmes to help prevent similar events.

Unanimously adopting resolution 2150 (2014), the Council called upon States to recommit to prevent and fight against genocide and other serious crimes under international law.
Through the resolution, the Council also called upon States that had not yet ratified or acceded to the Convention on the Prevention and Punishment of the Crime of Genocide to consider doing so as a matter of high priority.

Jan Eliasson, Deputy Secretary-General, described the genocide in Rwanda as one of the “darkest chapters in human history” and said the world remembered with heavy hearts the international community’s collective failure to recognize and act on the warning signs of genocide. Through the events in Rwanda, the world had seen that genocide was not a single event, but rather a process developing over time and requiring planning and resources. That reality meant that genocide could be prevented with information and mobilization, as well as courage and political will.

“We must do more as a community of nations and as global citizens if we are going to live up to the promise of ‘never again’ and act upon our collective responsibility to protect,” he said.
Eugène-Richard Gasana ( Rwanda) stressed the need for “historical clarity” regarding the events in Rwanda, saying it was the world’s duty to remember that the genocide had been carried out due to systemic indifference. In the case of his country’s suffering, it was not a lack of information or resources that prevented action, but a lack of political will that left the international community paralysed in the face of the atrocities.

He continued, saying recent events in the Central African Republic, Syria and South Sudan could convince many that the United Nations was still struggling to match its normative principles with realities on the ground, and that the prevention of mass atrocities still had a long way to go.

Colin Keating ( New Zealand) was President of the Council in 1994 and said his country apologized for the international community’s failure and asked that New Zealand’s apology be formally inscribed in the records of the Security Council.

He continued, warning that if the international community truly wanted prevention to work, there must be political, operational and financial mechanisms for the Council and the wider United Nations system to achieve better outcomes…

GPEDC [Global Partnership for Effective Development Co-operation]: Global leaders pledge new actions to boost development co-operation in Mexico
16 Apr 2014
Excerpt
Mexico City – Thirty-eight new initiatives were launched by governments, business, private foundations and civil society to push forward effective development co-operation at the first High-Level Meeting of the Global Partnership for Effective Development Co-operation.

Launched in Busan, South Korea in December 2011 and led by Ministers from Indonesia, Nigeria and the United Kingdom, the Global Partnership helps nations, business and organizations work better together to end poverty.

Over 1500 participants from more than 130 countries, including developing nations like the Central African Republic, emerging providers like Brazil and Turkey, Northern donors, parliamentarians and leaders from big business like Unilever and H&M, came together to discuss progress in development co-operation and to anchor the Global Partnership in a post-2015 development framework.

Opening the conference Mexican President Peña Nieto said: “We have the opportunity to join forces and move together toward a new era of effective co-operation to enable us to achieve inclusive and sustainable development for the world we want. We’re able to build the new architecture of international aid necessary to realize the post-2015 development agenda.”

Concrete commitments launched at the forum include:
:: Increasing aid aimed at strengthening tax administrations in developing countries to ensure they get more of their own money. The initiative, led by Germany, the World Bank and OECD also aims to measure how much aid goes into boosting developing countries tax administrations.
:: The Arab donor co-ordination group pledged to step up development co-operation with developing countries in ways that are fully in line with the Global Partnership Principles.
:: Philanthropic foundations launched a set of guidelines on how the philanthropic sector can engage with governments and other stakeholders in the reality of post-2015 development…

Helen Clark: Speech at the Opening of the First High Level Meeting of the Global Partnership for Effective Development Co-operation
15 Apr 2014
Helen Clark, UNDP Administrator
Speech at the Opening of the First High Level Meeting of the Global Partnership for Effective Development Co-operation, Mexico City, Mexico
[Excerpt]
…In the new development architecture, the role of South-South and triangular co-operation, civil society organizations, the private sector, and major foundations will continue to grow. This proliferation of actors brings opportunities, but only if it can be navigated. It is important to support building the capacity of the poorest countries and communities to access those opportunities.
This reminds us of the catalytic role ODA can play in supporting the development of national institutions and capacities to leverage all available sources of development finance to reach national development objectives and make progress on internationally agreed development goals.
This can be the generation which eradicates poverty and turns the tide on inequalities, citizen insecurity, and climate change and other forms of environmental degradation. Achieving those objectives needs the inclusive approaches to which the Global Partnership has committed. The more effective this partnership is, the greater the progress the world will make on an ambitious post-2015 agenda. That is why what happens in these discussions in Mexico City matters.

SWA(Sanitation and Water for All): Unprecedented attendance at the 2014 HLM to address access to water and sanitation, bolster growth and reduce inequalities
[Excerpt]
12 Apr, 2014
At the 2014 SWA High Level Meeting (HLM), ministers for finance, water, sanitation and development cooperation from over 40 developing countries tabled over 250 individual commitments designed to speed up access for the 2.5 billion people lacking improved sanitation and the 748 million people without improved drinking water.

On Friday, 11 April, the United Nations Secretary-General Ban Ki-moon, World Bank Group President Dr. Jim Yong Kim and SWA Chair John Kufuor led the third biennial HLM, held at the World Bank in Washington DC. They noted the vast health, economic, social and environmental consequences of poor water, sanitation and hygiene, and called their meeting an important step forward.

“At the beginning of this meeting, I challenged the ministers in this room to make concrete and practical commitments,” said Kufuor, the former president of Ghana. “I am now more confident than ever, that our name – Sanitation and Water for All – will become our achievement.”

The SWA partnership is a global coalition of 90 developing country governments, donors, civil society organizations and other partners. It aims to catalyse political leadership and action, improve accountability and use scarce resources more effectively.

The meeting yielded 265 new commitments from over 40 countries. Broadly speaking, the commitments aim to increase the amount and improve the use of financial resources, reduce inequality in access, build capacity of institutions charged with delivering water and sanitation services, and coordinate resources more effectively, both from governments and external aid.

Some 1,400 children die each day from preventable diarrhea diseases linked to a lack of safe water, adequate sanitation and hygiene, and countries lose out on 260 billions of dollars of economic growth. Meanwhile, hundreds of millions of women and girls, disabled persons, pastoralists and other poor and marginalized communities are disproportionally affected without services…

WHO: Special report for the Sanitation and Water for All (SWA) High-Level Meeting (HLM)
Investing in water and sanitation: Increasing access, reducing inequalities
The objective of the UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) is to monitor the inputs required to extend and sustain water, sanitation and hygiene (WASH) systems and services. This third UN-Water GLAAS report will present data received from developing countries, covering all the Millennium Development Goal regions, and from external support agencies.

Download the Special Report for the Sanitation and Water for All High-Level Meeting
pdf, 2.24Mb

Research: Lost in intermediation: how excessive charges undermine the benefits of remittances for Africa
ODI
Kevin Watkins and Maria Quattri
16 April 2014
[Excerpt from Summary]
Africans living abroad face some of the highest fees in the world to send money home, costing their families approximately $1.8 billion a year in lost income. This report, funded by Comic Relief and Unbound Philanthropy, analyses global charges on money sent to sub-Saharan Africa, and estimates that reducing charges to global average levels would generate enough income to put 14 million children into school and provide safe water to 21 million people…

…This is because workers are paying an average of 12% in fees to transfer money back to relatives in sub-Saharan Africa. To put that in context, a worker sending $200 home to provide for a relative’s education would incur a $25 fee.

The global community pledged to cut remittance charges to 5% by 2014, yet this ‘super tax’ shows there is a long way to go.

Our report urges governments to increase competition in money transfer remittances and to establish greater transparency on how fees are set by all market operators.
Full Report: http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/8901.pdf

AMREF Health Africa [to 19 April 2014]

Amref Health Africa ‏@AMREF_Worldwide Apr 13
Monday 14 April @teguestguerma, DG, @AMREF_Worldwide on @citizentvkenya at 10.30pm on @AfricaLD with @juliegichuru pic.twitter.com/wo6HQM3ucw

Amref Health Africa ‏@AMREF_Worldwide Apr 14
@teguestguerma it’s the right time for #Africa to invest in its civil society to provide services, #health

Amref Health Africa ‏@AMREF_Worldwide Apr 14
@teguestguerma the ideal #Africa is educated, economically dvpd, healthy@AMREF_Worldwide

BRAC [to 19 April 2014]

GSMA mWomen grants BDT 14 million of Innovation Fund to BRAC
15 April 2014, Dhaka. The Groupe Speciale Mobile Association (GSMA) mWomen programme based in London announced BRAC as one of its Innovation Fund grant recipients on 11 April 2014. The grant is for BDT 14 million. This fund will launch a mobile service for adolescent girls to develop their English skills to improve their employment prospects. BRAC will partner with Robi Axiata and the British Council in Bangladesh to launch the service. 3,000 adolescent girls from BRAC Adolescent Development Pr……Read More

BRAC ‏@BRACworld Apr 18
Updates on global poverty from BRAC USA April 2014- http://eepurl.com/R7qXL

BRAC ‏@BRACworld Apr 16
are you following us on Instagram yet? http://instagram.com/bracworld

BRAC ‏@BRACworld Apr 16
BRAC are supporting the survivors of Rana Plaza. “Made in Bangladesh should be a mark of pride, not shame.” Sir Abed. http://bit.ly/1qJclVH

BRAC ‏@BRACworld Apr 15
Watch @UNICEFSL & BRAC’s innovative ways to reduce pregnancy in adolescent girls of Sierra Leone-http://bit.ly/1ewUZcx . Via-@alicekorngold

Casa Alianza [to 19 April 2014]
Covenant House [to 19 April 2014]

Bipartisan Group of NJ Lawmakers Raise Money and Awareness For Our Kids
In the first-ever Covenant House Legislative Sleep Out, lawmakers from across New Jersey slept on the grass in front of the Statehouse in Trenton in an inspiring statement of solidarity with homeless youth.

Covenant House ‏@CovenantHouse 11h
Follow @CovHousePrez as he tweets about our service w/ homeless youth across 6 countries. A Twitter feed of light, love, laughter and hope!

Covenant House ‏@CovenantHouse Apr 18
Follow 1 of our National Community Partners @SavingDaughters who have inspired #CovenantHouse kids in #NYC, #LA, Houston & #Atlanta! #FF

ECPAT [to 19 April 2014]

ECPAT International ‏@ECPAT Apr 16
ECPAT in #Chile, @Paicabi is supporting the vulnerable children affected by the wildfire in Valparaíso. http://bit.ly/1naDEc6

ECPAT-USA ‏@ecpatusa 9h
Future @TheCodeOrg members @AirlineAmbIntl help prevent #childsextrafficking by training airline staff > http://ow.ly/vWRFc

ECPAT-USA ‏@ecpatusa Apr 16
Our new online #humantrafficking awareness trainings are available on the @AHLEI website > http://ow.ly/vRIaz #DSBChat

Handicap International [to 19 April 2014]

Handicap Intl UK ‏@HI_UK Apr 16
VIDEO: Our team in #Nepal have made this promotional film to champion #inclusion – What do you think of the film? http://bit.ly/1l0ISr4

Retweeted by Handicap Intl UK
UNHCR Ireland @UNHCRIreland
New report from @helpage & @HI_UK: http://bit.ly/1eETXWO – 30% of #Syrian refugees have specific needs – 1 in 20 suffers from injury

Heifer International [to 19 April 2014]

Heifer International ‏@Heifer 13h
Watch how biogas is providing “free” power to a couple in Uganda: http://hefr.in/1i5b5Fb

Heifer International ‏@Heifer Apr 18
What do girls in developing countries need to be empowered? Powerful role models. http://hefr.in/1iyop9D

Retweeted by Heifer International
Pierre Ferrari ‏@HeiferCEO Apr 15
Working together, we go farther: @Heifer Partner @GreenMtnCoffee on Improving Lives of #Coffee Growers http://www.heifer.org/join-the-conversation/blog/2014/April/heifer-partner-kuerig-green-mountain-improving-lives-of-coffee-growers.html …

HelpAge International [to 19 April 2014]

HelpAge ‏@helpage Apr 17
@JaredDiamond3 #TEDTalks on ageing http://bit.ly/1m9vvVg Good policies can make ageing good. Check out our age index http://bit.ly/V8d7tv

Retweeted by HelpAge
UK in Bolivia ‏@UKinBolivia Apr 16
@helpage celebró 4 años de trabajo para el bienestar de los adultos mayores en #Bolivia – http://bit.ly/1qYegUw pic.twitter.com/bDktXI9Qk8

HelpAge ‏@helpage Apr 17
Congrats to our partner in #India, HelpAge India on the launch of their new website! Check it out here: http://www.helpageindia.org

HelpAge ‏@helpage Apr 16
@Pontifex highlights dignity & value of older & disabled people. Interview with our deputy CEO, Silvia: http://en.radiovaticana.va/news/2014/04/16/holy_thursday:_pope_francis_highlights_the_dignity_and_value_of/en1-791399 … @HI_UK

HelpAge ‏@helpage Apr 16
Nice video from our partner in #Nepal, @AgeingNepal showing games older people play to fight loneliness: http://youtu.be/Z2nCsCOc-cU

HelpAge ‏@helpage Apr 16
Updated version of our #infographic on older, disabled and injured Syrian #refugees. Feel free to share! #Syria pic.twitter.com/nmNbkpx1DQ

HelpAge ‏@helpage Apr 14
A new @ilo brief on targets & indicators for #post2015 agenda supports inclusion of older people: http://bit.ly/1epY4Lw (via @HelpAge_USA)

HelpAge ‏@helpage Apr 14
Age Helps is out! http://paper.li/helpage/1360751304 … Stories via @PensionWatch @Aging_Society @HelpAge_USA

International Rescue Committee [to 19 April 2014]

This Week’s Voices: April 18, 2014
Posted by The IRC on April 18th, 2014
This Week’s Voices is a roundup of recent eyewitness reports and commentary by IRC experts and others. This week: the drawings of Syrian refugees and what they taught an IRC aid worker about taking the time to understand what refugees want to express, how they understand things and what they aspire to.

Humanitarian data revolution?
Posted by Jeannie Annan on April 18th, 2014
Several recent reports have pointed out that the humanitarian sector has insufficient evidence and that makes decisions based on poor information. The IRC’s Jeannie Annan discusses her thoughts and experiences on the humanitarian aid and impact evaluations.

Women in Congo: Daring to Defy
Posted by giselle benatar on April 17, 2014
Acclaimed photojournalist Lynsey Addario shows through photos and video how women in Congo are defying the odds to become powerful agents for change in their communities.

Getting the big picture and the little picture: listening to Syrian refugees
Posted by Emmanuel d’Harcourt on April 15th, 2014
What’s difficult when it comes to understanding conflict in Syria is actually listening: taking the time to understand not just what we want to hear, but what refugees want to express, how they understand things, and what they aspire to. That’s true even for those working directly on the front lines.
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Mother Support Groups improve the health of families in rural Myanmar
Posted by The IRC on April 16, 2014
As the sun sets behind the steep mountains rising above this small community, a group of women gather in a small, barely lit hut. They have just finished a long day at work and sit talking among themselves as they wait for the monthly meeting of the Mother Support Group to begin.

From the Frontlines: How the IRC responds to emergencies [VIDEO]
Posted by Jamison Dufour on April 15, 2014
When catastrophe strikes, the IRC’s Emergency Preparedness and Response Unit is poised to deliver rapid, lifesaving support. Watch this video to learn more about how we respond to sudden, complex emergencies.

South Sudan Crisis: Displaced and starving, families rely on water lilies to survive [Photo Essay]
Posted by Peter Biro on April 14, 2014
After three years of fragile peace, renewed ethnic conflict and food shortages in South Sudan are conspiring to create a new humanitarian catastrophe. IRC’s Peter Biro visits the town of Ganyliel where displaced families are now forced to survive on grass, roots, and water lilies.

The IRC in 30 seconds [Video]
Posted by The IRC on April 14, 2014
At work in more than 40 countries and 22 U.S. cities, the IRC helps millions of people each year to survive and rebuild their lives. Watch our new video to learn how we help

Intl Rescue Comm IRC ‏@theIRC Apr 17
.@DMiliband, Amb Ford & @AndrewTabler will be @washinstitute’s #Syria humanitarian & strategic forum.12:30EST, LIVE: http://bit.ly/1te3jSR

Intl Rescue Comm IRC ‏@theIRC Apr 16
VIDEO: How we respond to sudden, complex #emergencies: http://bit.ly/1iZYNjY pic.twitter.com/MaFF5vnbms

Retweeted by Intl Rescue Comm IRC
David Miliband ‏@DMiliband Apr 15
For exclusive pictures that tell the story of @theIRC’s 80 years of humanitarian work, follow us on @instagram: http://instagram.com/theirc

Intl Rescue Comm IRC ‏@theIRC Apr 14
An interesting piece on community-based disaster risk management in #Zimbabwe. cc: @theOFDA>> http://bit.ly/1gWQ7Ix

IRCT [to 19 April 2014]

News
IRCT mark 20th anniversary of Rwandan Genocide with stories from survivors
07-04-2014
In 100 days, over 800,000 people were killed for being part of a different ethnic community. On numbers and timescale alone, the 1994 Rwandan genocide remains the largest of modern times.
But it is not just numbers – behind the numbers are people who lost their lives, their homes, their loved ones, and more. They were victims of the military forces but also of their neighbours, ordinary citizens. Twenty-years later, the effects are still being felt across the country.

Among those who suffered the most, are the women who were victims of sexual violence. To highlight the voices of those women, the IRCT is launching the campaign ‘Of death and rebirth: Life histories of Rwandan female genocide survivors’ which follows the progress of 10 women as they go through rehabilitation.

The women – who have all participated in psychotherapy treatment to overcome the trauma from torture – tell of a range of experiences both hard-hitting an horrifying, but also hopeful. But they all share one common theme: rehabilitation from torture works.

Triggered by the death of the Rwandan President Juvenal Habyarimana, a Hutu, when his plane was brought down by a rocket on 6 April 1994, hours of violence and protest quickly transformed into three months of terror.

Most of the dead during this time were Tutsis, the bulk of whom were killed by the Hutu majority.
The effects of the Rwandan genocide were not just confined to the country though, and the presence of Hutu forces in the Democratic Republic of Congo led to years of conflict there, with some estimates claiming five-million people have been killed.

Today, the tensions still remain apparent. However, some progress has been made in providing hope to victims of torture in the 1994 genocide.
The first story will be published in a special section of the IRCT website where a new story will feature every 10 days thereafter.

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Retweeted by IRCT
WorldWithoutTorture ‏@withouttorture Apr 15
New blog: We hear from three doctors from @IRCT partner PCATI about their work and what inspired them to end #torture http://wp.me/p1FGNE-yu