Journal of International Development – March 2015

Journal of International Development
March 2015 Volume 27, Issue 2 Pages 155–312
http://onlinelibrary.wiley.com/doi/10.1002/jid.v27.2/issuetoc

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Research Article
Beyond Aid: A Conceptual Perspective on the Transformation of Development Cooperation
Heiner Janus, Stephan Klingebiel and Sebastian Paulo*
Article first published online: 20 OCT 2014
DOI: 10.1002/jid.3045
Abstract
Development cooperation is part of an international system characterised by fragmentation and limitations in global problem solving. Drawing on the term beyond aid, this article explores the transformation of development cooperation within this system. The article distinguishes four dimensions of beyond aid – actors, finance, regulation and knowledge – where aid loses relevance relative to other fields of international cooperation. Creating links to these beyond aid dimensions is at the core of the transformation of development cooperation. Understanding this transformation as a learning process, the article identifies ‘specialisation’ and ‘integration’ as two options for the future of development cooperation.

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Research Article
Adjustment and Long-Run Economic Performance in 18 African Countries
Fiseha Gebregziabher*
Article first published online: 28 NOV 2014
DOI: 10.1002/jid.3056
Abstract
This paper investigates the link between IMF-World Bank stabilisation-cum-structural adjustment programs and long-run economic performance in 18 African countries on a country-specific basis for the period 1960–2009. We employ a structural break approach to study the impact on long-run growth trajectories of the introduction of adjustment programs. The analysis reveals that only few countries have shown positive and sustained results. The traditional (first-generation) Fund-Bank adjustment package is linked with sustained increase in Gross Domestic Product, export and investment growth rates only in two countries (Ghana and Uganda). Many African economies remained on their pre-reform growth paths whereas some others experienced growth deceleration, despite more-than-a-decade-long adjustment. Taken as a whole, countries in the CFA franc currency zone fared much worse than their non-CFA counterparts because of the different adjustment strategies pursued.

Morality in a time of Ebola

The Lancet
Mar 07, 2015 Volume 385 Number 9971 p829-914 e16-e20
http://www.thelancet.com/journals/lancet/issue/current

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Comment
Morality in a time of Ebola
Arthur L Caplan
Published Online: 19 February 2015
Summary
The first true epidemic of Ebola led to widespread panic. The virus appeared in so many countries in 2014—including Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone, Spain, and the USA—that WHO, officials at the US National Institutes of Health and Centers for Disease Control and Prevention, and many other government officials around the world declared the epidemic to be out of control.1,2 Talk of desperation and apocalypse with reference to Ebola is not uncommon.3 Previous Ebola outbreaks were rapidly contained through a combination of local attentiveness, the availability of resources, focused public education, and a bit of luck.

The Lancet Infectious Diseases – March 2015

The Lancet Infectious Diseases
Mar 2015 Volume 15 Number 3 p249-360
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
Global harmonisation in vaccine price
The Lancet Infectious Diseases
Summary
On Jan 20, 2015, Médecins Sans Frontières published the second edition of the report The right shot: bringing down barriers to affordable and adapted vaccines. The report highlighted the lack of a rational pricing system for vaccines that serves all countries and populations, and, as a consequence, private and public health providers struggle to sustain the costs of immunisation campaigns in many settings. Several factors, such as limited information on vaccine prices, introduction of costly new vaccines, absence of competition in vaccine production, and a paucity of vaccine products suited for low-resource settings, have created a market in which children in many countries are unprotected against life-threatening—but preventable—diseases.

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Comment
Novel observational study designs with new influenza vaccines
Eelko Hak
Published Online: 08 February 2015
Summary
In The Lancet Infectious Diseases, Hector Izurieta and colleagues1 presented results of a cohort study in 929 730 older people (65 years and older) who received a high-dose influenza vaccine (high-dose Fluzone, Sanofi Pasteur, PA, USA, 60 μg per strain) and compared rates of influenza-related visits and hospital admissions with 1 615 545 older people who received a standard dose of the same vaccine (15 μg per strain). The high-dose vaccine seemed to be 22% more effective than the standard-dose vaccine.

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Comparative effectiveness of high-dose versus standard-dose influenza vaccines in US residents aged 65 years and older from 2012 to 2013 using Medicare data: a retrospective cohort analysis
Hector S Izurieta, Nicole Thadani, David K Shay, Yun Lu, Aaron Maurer, Ivo M Foppa, Riley Franks, Douglas Pratt, Richard A Forshee, Thomas MaCurdy, Chris Worrall, Andrew E Howery, Jeffrey Kelman
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Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance
Matthew R Moore, Ruth Link-Gelles, William Schaffner, Ruth Lynfield, Catherine Lexau, Nancy M Bennett, Susan Petit, Shelley M Zansky, Lee H Harrison, Arthur Reingold, Lisa Miller, Karen Scherzinger, Ann Thomas, Monica M Farley, Elizabeth R Zell, Thomas H Taylor, Tracy Pondo, Loren Rodgers, Lesley McGee, Bernard Beall, James H Jorgensen, Cynthia G Whitney

Chains of transmission and control of Ebola virus disease in Conakry, Guinea, in 2014: an observational study
Ousmane Faye, Pierre-Yves Boëlle, Emmanuel Heleze, Oumar Faye, Cheikh Loucoubar, N’Faly Magassouba, Barré Soropogui, Sakoba Keita, Tata Gakou, El Hadji Ibrahima Bah, Lamine Koivogui, Amadou Alpha Sall, Simon Cauchemez

Review
The development of global vaccine stockpiles
Dr Catherine Yen, MD, Terri B Hyde, MD, Alejandro J Costa, MSc, Katya Fernandez, MSc, John S Tam, PhD, Stéphane Hugonnet, MD, Anne M Huvos, JD, Philippe Duclos, PhD, Vance J Dietz, MD, Brenton T Burkholder, MD
Published Online: 05 February 2015
Summary
Global vaccine stockpiles, in which vaccines are reserved for use when needed for emergencies or supply shortages, have effectively provided countries with the capacity for rapid response to emergency situations, such as outbreaks of yellow fever and meningococcal meningitis. The high cost and insufficient supply of many vaccines, including oral cholera vaccine and pandemic influenza vaccine, have prompted discussion on expansion of the use of vaccine stockpiles to address a wider range of emerging and re-emerging diseases. However, the decision to establish and maintain a vaccine stockpile is complex and must take account of disease and vaccine characteristics, stockpile management, funding, and ethical concerns, such as equity. Past experience with global vaccine stockpiles provide valuable information about the processes for their establishment and maintenance. In this Review we explored existing literature and stockpile data to discuss the lessons learned and to inform the development of future vaccine stockpiles.

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Personal View
Emergency Ebola response: a new approach to the rapid design and development of vaccines against emerging diseases
Claire M Tully, BA[Mod], Teresa Lambe, PhD, Prof Sarah C Gilbert, PhD, Prof Adrian V S Hill, DM
Published Online: 13 January 2015
Summary
The epidemic of Ebola virus disease has spread at an alarming rate despite containment efforts. As a result, unprecedented large-scale international response efforts have been made in an attempt to gain control of the outbreak and reduce transmission. Several international consortia have been formed in a remarkable worldwide collaborative effort to expedite trials of two candidate Ebola virus vaccines: cAd3-EBOZ and rVSV-EBOV. In parallel, both vaccines are being manufactured in large amounts to enable future rapid deployment for management of the crisis.

Good Science + Good Ethics = Good Law: Five Rules for Epidemic Preparedness

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
March 2015 Volume 93, Issue 1 Pages 1–222
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-0009/currentissue

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Op-Ed
Good Science + Good Ethics = Good Law: Five Rules for Epidemic Preparedness
LAWRENCE O. GOSTIN*
Article first published online: 5 MAR 2015
DOI: 10.1111/1468-0009.12100
[No abstract]

Long-Term Efficacy of a Hepatitis E Vaccine

New England Journal of Medicine
March 5, 2015 Vol. 372 No. 10
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Making Hepatitis E a Vaccine-Preventable Disease
Eyasu Teshale, M.D., and John W. Ward, M.D.
N Engl J Med 2015; 372:899-901 March 5, 2015 DOI: 10.1056/NEJMp1415240
A hepatitis E vaccine could become a powerful new tool in the prevention and control of hepatitis E virus transmission and disease. Most immediately, it can have a role in curbing outbreaks of hepatitis E in humanitarian crises.

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Original Article
Long-Term Efficacy of a Hepatitis E Vaccine
Jun Zhang, M.Sc., Xue-Feng Zhang, M.Sc., Shou-Jie Huang, M.Sc., Ting Wu, Ph.D., Yue-Mei Hu, M.Sc., Zhong-Ze Wang, B.Sc., Hua Wang, M.D., Han-Min Jiang, B.Sc., Yi-Jun Wang, M.Sc., Qiang Yan, M.Sc., Meng Guo, B.Sc., Xiao-Hui Liu, B.Sc., Jing-Xin Li, M.Sc., Chang-Lin Yang, B.Sc., Quan Tang, B.Sc., Ren-Jie Jiang, M.Sc., Hui-Rong Pan, Ph.D., Yi-Min Li, M.D., J. Wai-Kuo Shih, Ph.D., Mun-Hon Ng, Ph.D., Feng-Cai Zhu, M.Sc., and Ning-Shao Xia
N Engl J Med 2015; 372:914-922 March 5, 2015 DOI: 10.1056/NEJMoa1406011
Abstract
Background
Hepatitis E virus (HEV) is a leading cause of acute hepatitis. The long-term efficacy of a hepatitis E vaccine needs to be determined.
Methods
In an initial efficacy study, we randomly assigned healthy adults 16 to 65 years of age to receive three doses of either a hepatitis E vaccine (vaccine group; 56,302 participants) or a hepatitis B vaccine (control group; 56,302 participants). The vaccines were administered at 0, 1, and 6 months, and the participants were followed for 19 months. In this extended follow-up study, the treatment assignments of all participants remained double-blinded, and follow-up assessments of efficacy, immunogenicity, and safety were continued for up to 4.5 years.
Results
During the 4.5-year study period, 60 cases of hepatitis E were identified; 7 cases were confirmed in the vaccine group (0.3 cases per 10,000 person-years), and 53 cases in the control group (2.1 cases per 10,000 person-years), representing a vaccine efficacy of 86.8% (95% confidence interval, 71 to 94) in the modified intention-to-treat analysis. Of the participants who were assessed for immunogenicity and were seronegative at baseline, 87% of those who received three doses of the hepatitis E vaccine maintained antibodies against HEV for at least 4.5 years; HEV antibody titers developed in 9% in the control group. The rate of adverse events was similar in the two groups.
Conclusions
Immunization with this hepatitis E vaccine induced antibodies against HEV and provided protection against hepatitis E for up to 4.5 years. (Funded by the Chinese Ministry of Science and Technology and others; ClinicalTrials.gov number, NCT01014845.)

Pediatrics – March 2015, VOLUME 135 / ISSUE 3

Pediatrics
March 2015, VOLUME 135 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

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Advancing Informed Consent for Vulnerable Populations
Willliam J. Heerman, MD, MPHa, Richard O. White, MD, MScb, and Shari L. Barkin, MD, MSHSa
Author Affiliations
aDepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; and
bDivision of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida
Extract
Informed consent is essential for the conduct of ethical biomedical research.1 Despite its importance, obtaining informed consent is often a complex process, which raises concerns about the extent to which participants are truly informed. Effective implementation is especially difficult among research participants who have limited health literacy. Often, these potential participants are from traditionally high-risk groups, including underrepresented minorities and children. With this in mind, we suggest an innovative approach that uses low health-literacy communication strategies and visual aids to augment and potentially replace the traditional approach to informed consent.
The tension is clear. To provide a comprehensive review of the proposed research, the informed consent document and process are often lengthy, complex, and burdensome.2 Consequently, research participants who sign or verbalize consent often do so without truly understanding the form that they are being asked to sign. In a recent systematic review, participants in one-third of trials assessed did not have adequate understanding in the areas of risks, benefits, randomization, study aims, withdrawal, and voluntarism.3 There are no clear standards for “how much” understanding is adequate. Furthermore, we know that lower education levels, lower literacy, and a participant’s primary language are all associated with poor comprehension of the informed consent process.4 These issues are particularly important when studies are being done in children, adding an additional dimension to vulnerable populations….

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Vaccination, Underlying Comorbidities, and Risk of Invasive Pneumococcal Disease
Inci Yildirim, MD, MSca,b, Kimberly M. Shea, DSc, MPHa,b, Brent A. Little, PhDa, Amy L. Silverio, MAa, and Stephen I. Pelton, MDa,b on behalf of the Members of the Massachusetts Department of Public Health
Author Affiliations
aSection of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts; and
bDepartment of Epidemiology, Boston University, School of Public Health, Boston, Massachusetts
Abstract
OBJECTIVES: Children with underlying conditions remain at increased risk for invasive pneumococcal diseases (IPD). This study describes the epidemiology, serotype distribution, clinical presentations, and outcomes of IPD in children with and without comorbidity.
METHODS: Cases of childhood IPD in Massachusetts were identified via enhanced surveillance from 2002 through 2014. Demographic and clinical data were collected via follow-up telephone interviews with parents and/or primary care providers. Underlying conditions were classified according to the 2012 Report of the Committee on Infectious Diseases and 2013 recommendations by the Advisory Committee on Immunization Practices.
RESULTS: Among 1052 IPD cases in Massachusetts children <18 years old, 22.1% had at least 1 comorbidity. Immunocompromising conditions (32.7%) and chronic respiratory diseases (22.4%) were most common. Children with comorbidities were older at the time of IPD diagnosis (median 54 vs 23 months, P < .001), had higher hospitalization (odds ratio 2.5; 95% confidence interval 1.7–3.6) and case-fatality rates (odds ratio 3.7; 95% confidence interval 1.5–8.9) compared with children without known underlying conditions after adjusting for age, gender, year of diagnosis, and pneumococcal vaccination status. During the last 2 years of the study, IPD among children with comorbidities was caused by non–pneumococcal conjugate vaccine 13 serotypes in 23-valent polysaccharide pneumococcal vaccine (6/12, 50%) or serotypes that are not included in any of the vaccines (6/12; 50%).
CONCLUSIONS: In children with comorbidity, IPD results in higher mortality, and a large proportion of disease is due to serotypes not included in current conjugate vaccines. Further research is needed, specifically to develop and evaluate additional strategies for prevention of IPD in the most vulnerable children.

The Humanitarian Situation in Syria: A Snapshot in the Third Year of the Crisis

PLOS Currents: Disasters
[Accessed 7 March 2015]
http://currents.plos.org/disasters/

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The Humanitarian Situation in Syria: A Snapshot in the Third Year of the Crisis
March 3, 2015 • Research article
Between April and June 2014, International Orthodox Christian Charities (IOCC), an International NGO, and the Greek Orthodox Patriarchate of Antioch and All the East (GOPA) conducted a needs assessment of Syrians affected by the crisis with the objective of gaining a better understanding of humanitarian needs and assistance priorities. Findings suggest that interventions that increase access to non-food items, food, medication and education should be prioritized where cost was the primary barrier to accessing goods and services. Cash transfer programs and direct provision of material assistance should be considered, though the most appropriate assistance modality is likely to vary by sector, location and the preferences and prior experience of donors and implementing organizations. Renewed international commitment to funding humanitarian assistance efforts in Syria and neighboring countries where the burden of refugees is greatest is essential from both a human rights perspective and in terms of maintaining stability in the region.

Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis

PLoS One
[Accessed 7 March 2015]
http://www.plosone.org/

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Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis
Nisha Thampi, Ipek Gurol-Urganci, Natasha S. Crowcroft, Beate Sander
Research Article | published 06 Mar 2015 | PLOS ONE 10.1371/journal.pone.0119271
Abstract
Background
Recent pertussis outbreaks have prompted re-examination of post-exposure prophylaxis (PEP) strategies, when immunization is not immediately protective. Chemoprophylaxis is recommended to household contacts; however there are concerns of clinical failure and significant adverse events, especially with erythromycin among infants who have the highest disease burden. Newer macrolides offer fewer side effects at higher drug costs. We sought to determine the cost-effectiveness of PEP strategies from the health care payer perspective.
Methods
A Markov model was constructed to examine 4 mutually exclusive strategies: erythromycin, azithromycin, clarithromycin, or no intervention, stratified by age group of contacts (“infant”, “child”, and “adult”). Transition probabilities, costs and quality-adjusted life years (QALYs) were derived from the literature. Chronic neurologic sequelae were modeled over a lifetime, with costs and QALYs discounted at 5%. Associated health outcomes and costs were compared, and incremental cost-effectiveness ratios (ICER) were calculated in 2012 Canadian dollars. Deterministic and probabilistic sensitivity analyses were performed to evaluate the degree of uncertainty in the results.
Findings
Azithromycin offered the highest QALYs in all scenarios. While this was the dominant strategy among infants, it produced an ICER of $16,963 per QALY among children and $2,415 per QALY among adults. Total QALYs with azithromycin were 19.7 for a 5-kg infant, 19.4 for a 10-year-old child, and 18.8 for a 30-year-old adult. The costs of azithromycin PEP among infants, children and adults were $1,976, $132 and $90, respectively. While results were sensitive to changes in PEP effectiveness (11% to 87%), disease transmission (variable among age groups) and hospitalization costs ($379 to $59,644), the choice of strategy remained unchanged.
Interpretation
Pertussis PEP is a cost-effective strategy compared with no intervention and plays an important role in contact management, potentially in outbreak situations. From a healthcare payer perspective, azithromycin is the optimal strategy among all contact groups

Qualitative Health Research – April 2015; 25 (4)

Qualitative Health Research
April 2015; 25 (4)
http://qhr.sagepub.com/content/current

Special Issue: Perceptions of Caregivers

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Exploring the Mental Health Effects of Political Trauma With Newly Arrived Refugees
Patricia J. Shannon1, Elizabeth Wieling1, Jennifer Simmelink McCleary2, Emily Becher1
1University of Minnesota, St. Paul, Minnesota, USA
2Tulane University, New Orleans, Louisiana, USA
Abstract
We explored the mental health effects of war trauma and torture as described by 111 refugees newly arrived in the United States. We used ethnocultural methodologies to inform 13 culture-specific focus groups with refugees from Bhutan (34), Burma (23), Ethiopia (27), and Somalia (27). Contrary to the belief that stigma prevents refugees from discussing mental health distress, participants readily described complex conceptualizations of degrees of mental health distress informed by political context, observation of symptoms, cultural idioms, and functional impairment. Recommendations for health care providers include assessment processes that inquire about symptoms in their political context, the degree of distress as it is culturally conceptualized, and its effect on functioning. Findings confirm the cross-cultural recognition of symptoms associated with posttraumatic stress disorder; however, refugees described significant cultural variation in expressions of distress, indicating the need for more research on culture-bound disorders and idioms of distress.

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Vicarious Resilience in Counselors of Child and Youth Victims of Interpersonal Trauma
Fabiane S. Silveira1, Wanda Boyer2
1Open Doors Movement, Florianópolis, Santa Catarina, Brazil
2University of Victoria, Victoria, British Columbia, Canada
Abstract
In this study, we investigated how bearing witness to clients’ resilience processes during treatment impacts the personal and professional lives of counselors who work with child and youth victims of interpersonal trauma. We used a qualitative instrumental multiple-case study design and thematic analysis to explore the research question. The participants indicated that they experienced an increased sense of hope and optimism, and were inspired by the strengths of their clients while working with this population. As the participants reflected on the challenges that their clients faced, the participants put their own challenges and strengths into perspective; they reported positive changes in their personal relationships. We suggest that future research might investigate the relationships we found between optimism, hope, and vicarious resilience processes, as well as the potential relationship between the counseling approach that counselors adopt and the development of vicarious resilience responses.

A sustainable model for antibiotics; A return to the pre-antimicrobial era?

Science
6 March 2015 vol 347, issue 6226, pages 1041-1168
http://www.sciencemag.org/current.dtl

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Perspective
Infectious Disease
A sustainable model for antibiotics
Manos Perros
Author Affiliations
AstraZeneca Innovative Medicines and Early Development, Gatehouse Drive, Waltham, MA 02451, USA.

Despite the alarming increase in the prevalence of drug-resistant bacterial infections, far fewer new antibiotics have been approved in the past decade than at the peak in the 1980s (1). The situation is particularly alarming for serious infections by Gram-negative bacteria, some of which are becoming untreatable by modern antibiotics (2–4). Particularly in low- and middle-income countries, untreatable infections are becoming an everyday reality in hospital and care settings (5). Increasing recognition of this problem is spurring a number of public and private initiatives on both sides of the Atlantic (6–8). To more effectively counter the threat of emerging resistance, we must increase the number of innovative new antibiotics in development and harness advances in diagnostic technology to preserve their efficacy.

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Perspective
Infectious Disease
A return to the pre-antimicrobial era?
Stephen Baker1,2,2
Author Affiliations
1Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
2Centre for Tropical Medicine, Oxford University, Oxford, UK.
3London School of Hygiene and Tropical Medicine, London, UK.

After many years out of the limelight, antimicrobial resistance (AMR) in bacteria is firmly back on the international political and scientific agenda (1, 2). The potential impact of AMR on hospital-acquired bacterial infections such as Staphylococcus aureus and Acinetobacter baumannii in higher-income countries has created both fear and a surge of motivation aimed at providing new solutions for the problem (3, 4). The political will and momentum to tackle AMR lies in higher-income countries, but the medical, social, and economic effects of AMR are likely to be felt more in lower-income countries, particularly those in South and Southeast Asia and in sub-Saharan Africa. The identification and development of new drugs is a potential solution but is challenging and costly; any novel therapies introduced into low-income settings without a suitable infrastructure to understand and prevent the rapid development of resistance will likely be expensive and futile.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 28 February 2015

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, consortiums 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 &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf verion: The Sentinel_ week ending 28 February 2015

blog edition: comprised of the 35+ entries to be posted below on 1 March 2015

United Nations Security Council – Open Briefing on the Humanitarian Situation in Syria – 26 February 2015

United Nations Security Council – Open Briefing on the Humanitarian Situation in Syria
26 February 2015
UN High Commissioner for Refugees Antonio Guterres
– Written text of speech to the UN Security Council –

Mr. President, Excellencies, Ladies and Gentlemen,
Briefing this Council in 2013, I said the Syrian war not only had unleashed the worst humanitarian crisis of our times but also was posing a terrible threat to regional stability and to global peace and security.

This is the reality we face today.

Iraq has seen the most frightening and complete spill-over of an internal conflict into a neighbouring country in recent history. Lebanon has been on near-permanent security alert, and there have been increasing threats even to Jordan in the past months. As many as 20,000 foreign fighters from over 50 countries have reportedly traveled to Syria and Iraq since 2011, with their number nearly doubling during the course of last year.

Meanwhile, the Syrian refugee crisis has overwhelmed the existing response capacities, with 3.8 million registered refugees in the neighbouring countries.

Lebanon and Jordan have seen their populations grow, in the space of a few years, to a point they were prepared to reach only in several decades. One-third of the Lebanese population today is Palestinian or Syrian. Jordan is facing a similar challenge. And Turkey has now become the biggest refugee-hosting country in the world.

In addition, more than 2 million Iraqis were internally displaced in 2014, and some 220,000 sought refuge in other countries.

The continued growth in displacement is staggering. But at the same time, the nature of the refugee crisis is now changing. As the level of despair rises, and the available protection space shrinks, we are approaching a dangerous turning point.

After years in exile, refugees’ resources are long depleted, and their living conditions are drastically deteriorating. I have met middle-class families with children who are barely surviving on the streets and praying to make it through the winter. Well over half of Syrian refugees in Lebanon are living in insecure dwellings – up from a third last year. And a survey of 40,000 Syrian families in Jordan found that two-thirds were living below the absolute poverty line. One father of four compared life as a refugee to being stuck in quicksand – every time you move, you sink down further. With humanitarian appeals systematically underfunded, there just isn’t enough assistance to provide for Syrian refugees.

At the same time, host communities are severely overstretched. The refugee influx has heavily impacted economies and societies, mostly in Lebanon, Jordan and Northern Iraq, overwhelming social services, infrastructure and government resources. International support is far from keeping pace with the magnitude of the needs.

As host countries face growing security risks due to the regional spread of the conflict, and do not get the help they need to cope with the refugee influx, Syrians are finding it increasingly difficult to reach safety. UNHCR’s monthly registration figures in Lebanon have dropped nearly 80 per cent compared to early 2014, and the number of those entering Jordan has also substantially reduced.

Meanwhile, it is important to underline that refugees continue to cross the border into Turkey in significant numbers. The Turkish Government has already spent around six billion dollars in direct assistance to Syrian refugees. In a landmark decision last year, Turkey’s temporary protection decree gave Syrians access to the country’s labor market as well as free education and health care.

But in the global context I described, it is no surprise that growing desperation is forcing more and more Syrian refugees to move further afield. The dramatic situation in the Mediterranean illustrates this, with Syrians accounting for one third of the nearly 220,000 boat arrivals last year.

Excellencies,
With the refugee situation growing more protracted and more desperate, almost two million Syrian refugees under 18 risk becoming a lost generation. And many of the over 100,000 refugee children born in exile could face the risk of statelessness. If this is not properly addressed, this crisis-in-the-making could have huge consequences for the future, not only of Syria but also of the region.

As humanitarian resources dwindle, abandoning refugees to hopelessness only exposes them to even greater suffering, exploitation and dangerous abuse. Abandoning their hosts to manage the situation on their own could result in serious regional destabilization, and more security concerns elsewhere in the world.

It should be obvious that in order to prevent this and to preserve the protection space in the region, refugees and host countries need massive international support. The Regional Refugee and Resilience Plan (or 3RP) aims to bring together the humanitarian and longer-term efforts of the host governments and over 200 UN and NGO partners. Its programmes are designed to be funded not only from humanitarian, but increasingly from development cooperation budgets.

I hope the upcoming Kuwait III conference will play a determining role in stabilizing the situation in the refugee hosting countries. Beyond the immediate humanitarian priorities, it is crucial that development actors fund the 3RP’s resilience pillar and the host governments’ plans. Countries like Lebanon and Jordan need much more financial assistance – not only to local refugee hosting communities, but also through government budget support for necessary structural investments in health systems, education, water and electricity supply and other public infrastructure cracking under the huge pressure.

As discussed at length during the Berlin Conference, the Syria situation illustrates the dangerous inadequacy of today’s development cooperation policies in a time of multiplying conflicts. To address this, bilateral and multilateral donors, and international financial institutions, should review existing criteria and priorities. It is absurd, for example, that Lebanon or Jordan have no access to World Bank grants because they are considered as middle-income countries.

Excellencies,
As High Commissioner for Refugees, it breaks my heart to see Syrian families fleeing from a horrible war, forced to risk their lives again, on unsafe boats, to find protection in Europe. Since the start of 2015, over 370 people have died trying to cross the Mediterranean – that’s one person drowning for every twenty who made it. But Italy’s Mare Nostrum operation has ended, and the EU’s Triton initiative is limited both in mandate and in resources. Europe must step up its capacity to save lives, with a robust search and rescue operation in the Central Mediterranean – or thousands more, including many, many Syrians, will perish.

To reduce the number of people getting on boats in the first place, more legal avenues are needed for Syrians to seek protection in third countries. Several States provide resettlement and humanitarian admission programmes, but the needs far exceed available spaces. We believe one-tenth of the Syrian refugees would require resettlement as the adequate solution for their protection situation. Flexible visa policies, expanded family reunification, academic scholarships and private sponsor schemes must complement these measures. Following the example of countries like Germany and Sweden, other States in Europe and the Gulf region should consider offering legal access with more opportunities, so as to alleviate some of the pressure on Syria’s neighbours and give more refugees an alternative way of reaching safety.

Without such alternatives, the number of people taking to the seas will continue to grow. And not only are they facing serious human rights violations at the hands of smugglers and traffickers. We now also see armed groups threatening to enter the smuggling business for their own purposes of sowing fear.

This should remind us that protecting refugees also means tackling racism and xenophobia. In today’s climate of rising panic, it deeply worries me that refugees are becoming mixed up with security concerns, confronting hostility in places where they thought they were safe. In several public debates they are made scapegoats for any number of problems, from terrorism to economic hardship and perceived as threats to their host communities’ way of life. But we need to remember that the primary threat is not from refugees, but to them.

Syrians are now the biggest refugee population under UNHCR’s mandate. As their number keeps growing and they become more vulnerable, the serious repercussions this has across the region only highlight the obvious – the urgent need for the international community to bring together all key actors and to put an end to the conflict… There are no winners in this war; everyone is losing. But the highest price is paid by the refugees and the other innocent victims inside the country.

Thank you very much.

WHO: Health crises in Central African Republic, Iraq, South Sudan and Syria need US$1 billion

WHO: Health crises in Central African Republic, Iraq, South Sudan and Syria need US$1 billion
24 February, 2015 Geneva – Raging conflict and beleaguered health services are threatening the health of tens of millions of people across the Central African Republic, Iraq, South Sudan and Syria. To respond, the World Health Organization today called on the international community to provide $US1 billion to support its on-going efforts – and those of partners – to treat, immunize and provide the wide range of life-saving health services needed to populations in need.
Read the full news release on WHO’s increased funding needed to meet health needs
More information on Central African Republic
More information on Iraq
More information on South Sudan
More information on Syrian Arabic Republic

Amnesty International – Global response to atrocities by states and armed groups ‘shameful and ineffective’

Amnesty International – Global response to atrocities by states and armed groups ‘shameful and ineffective’
Press Release – 25 February 2015
[Excerpts]
:: Amnesty International releases Annual Report along with forecast of human rights trends for the coming year
:: Says governments must ‘stop pretending the protection of civilians is beyond their power’
:: Forecasts more civilians at risk of abuses by armed groups, continued attacks on freedom of expression, and a worsening humanitarian and refugee crisis; unless there is a fundamental change to the global response to conflict
:: Calls for global action including renouncement of veto rights by five permanent members of UN Security Council in situations of mass atrocities

2015/16 forecast
Amnesty International’s Annual Report provides a comprehensive overview of human rights in 160 countries during 2014. Unless the world’s leaders act immediately to confront the changing nature of conflict and address other shortcomings identified in the report, the human rights outlook for the coming year is bleak:
:: more civilian populations forced to live under the quasi-state control of brutal armed groups, subject to attacks, persecution, and discrimination
:: deepening threats to freedom of expression and other rights, including violations caused by new draconian anti-terror laws and unjustified mass surveillance
:: a worsening humanitarian and refugee crisis with even more people displaced by conflict as governments continue to block borders and the international community fails to provide assistance and protection.
Of particular concern is the rising power of non-state armed groups, including the group which calls itself Islamic State (IS).
Armed groups committed abuses in at least 35 countries in 2014, more than 1 in 5 of the countries that Amnesty International investigated.
“Governments must stop pretending the protection of civilians is beyond their power and help roll back the tide of suffering of millions. Leaders must embrace a fundamental change in the way they respond to crises around the world.”

UN Security Council veto
In Syria, Iraq, Gaza, Israel and Ukraine, the UN Security Council (UNSC) has failed to deal with crises and conflict, even in situations where horrific crimes are being committed against civilians by states or by armed groups, based on vested interests or political expediency.
Amnesty International is now calling for the five permanent UNSC members to renounce their veto rights in situations of genocide and other mass atrocities.
“This could be a game changer for the international community and the tools it has at its disposal to help protect civilian lives. By renouncing their veto rights the five permanent members of the Security Council would give the UN more scope to take action to protect civilians when lives are at grave risk and send a powerful signal to perpetrators that the world will not sit idly by while mass atrocities take place,” said Salil Shetty.

Arms trade
The bloody legacy of the flooding of weapons into countries where they are used for grave abuses by states and armed groups claimed tens of thousands of civilian lives in 2014.
Amnesty International is calling for all states—including the US, China, Canada, India, Israel and Russia—to ratify or accede, and adhere, to the Arms Trade Treaty which came into force last year after decades of campaigning by Amnesty International and others.
“Huge arms shipments were delivered to Iraq, Israel, South Sudan and Syria in 2014 despite the very high likelihood that these weapons would be used against civilian populations trapped in conflict. When IS took control of large parts of Iraq, it found large arsenals, ripe for the picking. The irresponsible flow of weapons to human rights abusers must stop now,” said Anna Neistat.

Explosive weapons
Amnesty International is calling for world leaders to introduce new restrictions to tackle the use of explosive weapons—such as aircraft bombs, mortars, artillery, rockets and ballistic missiles—in populated areas, which led to countless civilian deaths in 2014.
“Further restrictions on the use of explosive weapons which cannot be precisely targeted or which otherwise have wide-area effect in populated areas could have helped save thousands of lives lost in recent conflicts, including in Israel, Gaza and Ukraine. The international community can and must do more to protect civilians whose homes have become the frontline battle zone of warring parties,” said Anna Neistat….

Refugees
A tragic consequence of the international community’s inability to deal with the changing face of conflict is one of the worst refugee crisis the world has seen, as millions of people – including 4 million from Syria alone – continue to flee violence and persecution.
“It is abhorrent to see how wealthy countries’ efforts to keep people out take precedence over their efforts to keep people alive. The global refugee crisis is only likely to get worse, unless urgent measures are taken,” said Salil Shetty.
“Leaders have it in their power to alleviate the suffering of millions—by committing political and financial resources to assist and protect those fleeing danger, delivering humanitarian aid generously, and resettling the most vulnerable.”

Call to action
“The global outlook on the state of human rights is bleak, but there are solutions. World leaders must take immediate and decisive action to avert an impending global crisis and take us one step closer to a safer world in which rights and freedoms are protected,” said Salil Shetty.
:: Human rights in numbers

Research: Childhood and Migration in Central and North America: Causes, Practices and Challenges

Childhood and Migration in Central and North America: Causes, Practices and Challenges
Funded by MacArthur Foundation, Ford Foundation
February 2015 :: 390 pages
:: Karen Musalo, Director; Lisa Frydman, Associate Director, Center for Gender & Refugee Studies, University of California Hastings College of the Law; and Pablo Ceriani Cernadas, Coordinator, Migration & Asylum Program, Justice and Human Rights Center, National University of Lanús, Argentina
Downloads at : http://cgrs.uchastings.edu/Childhood-Migration-HumanRights

[Excerpts from Overview and Executive Summary]
Childhood and Migration in Central and North America: Causes, Policies, Practices and Challenges results from a two-year, multi-partner, multi-national and regional investigation into the treatment of Honduran, Salvadoran, Guatemalan, Mexican, and United States citizen and permanent resident children affected by migration. The book illuminates the overall gaps in protection and in guaranteeing rights for children and adolescents affected by migration. It examines the root causes of children and family migration in the region and its recent spike, and explores whether conditions and policies in children’s countries of origin, transit countries, and destination countries in the region protect their best interests and ensure their rights.

It also assesses whether host or destination countries effectively integrate children and adolescents affected by migration, and whether existing programs ensure—on a case-by-case basis—safe and sustainable reintegration of repatriated children and adolescents. Interviews with children and adolescents, parents, and key social and political actors in the five countries studied, combined with the experience of experts working with migrant children and adolescents on a range of issues, form the basis of the book’s findings and recommendations.

II. General findings [Excerpt]
Children and adolescents affected by migration in Central and North America represent an urgent human rights, human development, refugee, and humanitarian challenge. The crux of the problem lies in the sending countries of Honduras, El Salvador, Guatemala, and Mexico where childhood has become synonymous with witnessing or suffering violence; experiencing human rights violations and discrimination on various grounds; suffering from social exclusion; and being deprived of education, employment opportunities, medical services, and even food. These conditions force children and/or their parents to migrate. The challenges continue during transit, especially in Mexico—with governmental actors and criminal syndicates preying on children and families by raping, kidnapping, extorting, or beating them, and with the governmental institutions enforcing migration control policies that are designed to punish and
deter migration rather than to protect children and respect their human rights.

The problem endures in the destination countries of Mexico and the United States, where policies focused on migration enforcement take priority over children’s best interests and rights, resulting all too often in children and adolescents being repatriated to the very conditions they fled. It also persists in Mexico and the United States for migrant children and children in mixed status families who live in the shadows and on the margins of society, fearing their own or their family members’ deportation. Rather than being able to pursue their right to develop, learn, and grow, these children lack access to education, healthcare and other vital services, and they often land in exploitative labor conditions. Children’s rights to family and development are violated when undocumented parents cannot obtain residency status based on having children in regular migration status; are not entitled to work or to other basic rights; and can be reported without consideration of a child’s best interests. Finally, the violation of rights comes full circle in children’s countries of origin following their return, because the key root causes that forced them to migrate from Central America and Mexico—violence, social exclusion, poverty, and separation from family—remain unchanged.

This complex and multi-faceted human dilemma requires urgent attention and a fundamental paradigm shift. It will only be solved when conditions in children’s countries of origin do not force them or their parents to migrate, when increased options exist for children and families to migrate through regular channels, and when policies at the regional, national, and local levels adhere to rights-based principles with the best interests of the child as a core standard and guaranteed access to international protection. Truly resolving this human dilemma may take years, but efforts must begin now….

ECOWAS MEMBERS ADOPT A DECLARATION ON ERADICATION OF STATELESSNESS IN WEST AFRICA

ECOWAS MEMBERS ADOPT A DECLARATION ON ERADICATION OF STATELESSNESS IN WEST AFRICA [Economic Community of West African States]
ABIDJAN, CÔTE D’IVOIRE, 25 February 2015

JOINT UNHCR / ECOWAS PRESS RELEASE
Following two days of high level consultations on 23-24 February, Member States of the Economic Community of West African States (ECOWAS) adopted today a Declaration on the prevention, reduction and elimination of statelessness in West Africa at a joint UNHCR/ECOWAS Ministerial Conference hosted by the Government of Côte d’Ivoire.

At least 750,000 people are stateless or at risk of statelessness in the region and, as such, are often subject to life in limbo, with limited access to education, healthcare, and employment. They are also vulnerable to discrimination and abuse as they have no legal existence and are not recognized in the eyes of the law.

The Declaration contains 25 commitments and highlights in particular the necessity for States in the ECOWAS region to first obtain concrete information on the causes of statelessness and the number and profile of stateless persons in the region. It also stresses that every child should acquire a nationality at birth and that all foundlings should be considered nationals of the State in which they are found. It also focuses on the need to ensure that men and women have equal rights to acquire, change and retain their nationality and confer nationality to their children.

The text also stresses the importance of protecting stateless persons by restoring their dignity and, in particular, by providing them with a legal identity and documentation. It invites Member States who have not yet done so to accede, as soon as possible, to the 1954 Convention Relating to the Status of Stateless Persons and the 1961 Convention on the Reduction of Statelessness…

:: Ministerial Conference on Statelessness in the ECOWAS region
Full Meeting Documentation: http://www.unhcr.org/54ef26126.html

:: Abidjan declaration of Ministers of ECOWAS Member states on eradication of statelessness: Ministerial Conference on Statelessness in the ECOWAS region
Abidjan, Côte d’Ivoire, 25 February 2015 :: 10 pages
http://www.unhcr.org/54ef26126.html

EBOLA/EVD [to 28 February 2015]

EBOLA/EVD [to 28 February 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 25 February 2015
[Excerpt; Editor’s text bolding]
SUMMARY
:: A total of 99 new confirmed cases of Ebola virus disease (EVD) were reported in the week to 22 February. Guinea reported 35 new confirmed cases. Cases continue to arise from unknown chains of transmission. Transmission remains widespread in Sierra Leone, with 63 new confirmed cases. A spike of 20 new confirmed cases in Bombali is linked to the previously reported cluster of cases in the Aberdeen fishing community of the capital, Freetown. There were 14 new confirmed cases in Freetown over the same period, with cases still arising from unknown chains of transmission in Freetown and elsewhere. Transmission continues at very low levels in Liberia, with 1 new confirmed case reported in the 7 days to 22 February: a registered contact associated with a known chain of transmission in the capital, Monrovia.

:: Engaging effectively with communities remains a challenge in several geographical areas. Nearly one-third of prefectures in Guinea reported at least one security incident in the week to 22 February, often as a result of rumours and misinformation linking response efforts with the spread of EVD. A total of 16 new confirmed cases were identified in Guinea and Sierra Leone after post-mortem testing of individuals who died in the community, indicating that a significant number of individuals are still either unable or reluctant to seek treatment. Ideally these individuals would have been identified as contacts associated with known chains of transmission, and have been rapidly diagnosed, isolated, and treated after the initial onset of symptoms. In Guinea and Sierra Leone, 19 and 15 unsafe burials were reported, respectively.

:: Most new cases in Guinea were reported from 3 neighbouring western prefectures: Conakry (6 new confirmed cases), Coyah (8 new confirmed cases), and Forecariah (16 confirmed cases). However, the eastern prefecture of Lola, on the border with Côte d’Ivoire, reported 1 new confirmed case. Case incidence has fluctuated in this prefecture. The northern prefecture of Mali, which borders Senegal, also reported 1 new confirmed case.

:: The steep decline in case incidence nationally in Sierra Leone from December until the end of January has halted. Transmission remains widespread, with 8 districts reporting new confirmed cases. A significant proportion of cases are still arising from unknown chains of transmission.

:: Of laboratories that report results to the relevant ministry of health, between 84% and 98% of laboratory samples were tested within 1 day of collection in the 22 days to 22 February. At present there are no data on how rapidly results are communicated to patients.

:: In the week to 22 February, 3 new health worker infections were reported (2 from Guinea, 1 from Sierra Leone), bringing the total of health worker infections reported since the start of the outbreak to 837, with 490 deaths.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been over 23,500 reported confirmed, probable, and suspected cases cases of EVD in Guinea, Liberia and Sierra Leone (table 1), with over 9,500 reported deaths (outcomes for many cases are unknown). A total of 35 new confirmed cases were reported in Guinea, 1 in Liberia, and 63 in Sierra Leone in the 7 days to 22 February….

United Nations – Secretary General, Security Council, General Assembly [to 28 February 2015]

United Nations – Secretary General, Security Council, General Assembly
[to 28 February 2015]
Selected Press Releases/Meetings Coverage
http://www.un.org/en/unpress/

27 February 2015
ECOSOC/6675
Speakers in Economic and Social Council Welcome ‘Mushrooming’ Partnerships as Vital for New Development Scheme, But Stress Need for Oversight
Expanding the United Nations’ partnerships — with Governments, business, the philanthropic community, civil society and academia — would be central to effectively implement the new development agenda, Martin Sajdik, President of the Economic and Social Council, told the 54-member body today, as delegates evaluated how to harness their potential, including by setting up voluntary review mechanisms to assess results.

UNOCHA [to 28 February 2015]

UNOCHA [to 28 February 2015]
http://www.unocha.org/media-resources/press-releases

26 Feb 2015
Syrian Arab Republic: Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator, Kyung-Wha Kang: Security Council Briefing on Syria – New York, 26 February 2015

24 Feb 2015
World: Under-Secretary-General Valerie Amos: Lecture at Universiti Teknologi Malaysia -“The Future of Humanitarian Action”