Humanitarian Response

New fund could be a “game-changer” for humanitarian action
Geneva, 8 May 2018 – A ground-breaking new humanitarian fund designed to mitigate and even prevent the damage and trauma caused by natural disasters has been launched by the International Federation of Red Cross and Red Crescent Societies (IFRC).

“We think this is a game-changer, not only for the Red Cross and Red Crescent, but for humanitarian action as a whole,” said Pascale Meige, IFRC’s Director of Disaster and Crisis Prevention, Response and Recovery. “Our new forecast-based action fund means that guaranteed money will be available to help communities prepare for a disaster before it strikes.”

The IFRC’s Forecast-based Action fund uses a combination of weather predictions and historical data to fix triggers for the automatic release of money for pre-agreed early action plans. For example, a combination of forecast rainfall combined with the level of a river at a certain point can be used to activate funding for downstream evacuations and the distribution of shelter kits for the people who have been moved to safer ground.

IFRC’s Meige said: “For decades, humanitarians have been calling for a shift to proactive and preventative humanitarian action, but such action has so far been sporadic. For the first time, this fund, and the work we are doing to build country-level plans and agreements, can consistently deliver on this promise – turning promises into action.

“It means that life-saving action can now take place before anyone is in immediate danger, which will save lives and reduce the need for more costly emergency response and recovery efforts.”

This Forecast-based Action fund is embedded within IFRC’s Disaster Relief Emergency Fund (DREF), a 25-30 million Swiss franc annual fund which has been supporting Red Cross and Red Crescent emergency response efforts for more than three decades.

The Fund is being supported by the German Federal Foreign Office, with technical guidance from the German Red Cross, the Red Cross and Red Crescent Climate Centre and other partners…

Joint Letters
United States Congress: Update Foreign Agent Registration Act in Consideration of Civil Society
May 9, 2018

An Open Letter to the Congress Concerning Foreign Agent Registration Act
Dear Members of the U.S. House of Representatives and U.S. Senate:
The undersigned members and partners of InterAction wish to bring to your attention concerns our broad community has concerning the Foreign Agent Registration Act (FARA). With renewed attention on how foreign governments are influencing U.S. political processes, it is understandable that Members of Congress are looking to bolster enforcement of FARA and are introducing legislation to update the law. As you debate such changes, we urge Members of Congress to consider clarifying and updating language, terminology, and definitions contained within FARA that adversely impact our community.

The current law was first enacted in 1938. In the decades since, many non-profit organizations have evolved and become international institutions with vast global networks. FARA’s provisions are so sweeping though that if interpreted on their face, many non-profits could be covered by the Act. For example, a U.S. non-profit that simply acted at the request of an international partner organization to hold a public meeting on a policy issue would arguably have to register as would an organization that solicited funding in the U.S. for an educational non-profit abroad, despite no connection to a foreign government or political party.

FARA was not written with our contemporary inter-connected non-profit world in mind. FARA’s broad definition of “foreign principal” currently includes not just foreign governments, but also foreign individuals, foundations, nonprofits, companies, or other entities. Under the Act, one can become an “agent” of a foreign principal not just by acting under a foreign principal’s “direction or control,” but simply at their “request,” and covered activity includes engaging in advocacy of any kind or soliciting or dispensing funds in the interests of a foreign principal. The exemptions to these broad provisions in FARA are relatively narrow.

The globalization of non-profits will only continue, and we find this sweeping language outdated, burdensome, and, frequently, confusing. Furthermore, vague definitions open organizations to possible politicized enforcement actions and attack. U.S. nonprofits and philanthropy are also impacted abroad by this loose language, as foreign governments point to FARA to justify their restrictive and controlling “foreign agent” laws that stigmatize non-profits and impede local civil society from working with international partners.

We support Congress’ wish to empower government enforcement of FARA in response to foreign governments efforts to destabilize democracy. We kindly ask Congress to ensure that it also safeguards an independent non-profit sector. Such steps would include updating the definition of an “foreign agent” and revising the definition of “foreign principal” under the Act. Without such revisions, we fear FARA’s burden on non-profits will impede international development and humanitarian assistance and sever global networks that are changing the world for good at a time when better understanding and cooperation is greatly needed…

ACDI/VOCA
Action Against Hunger – USA
ADRA International
AKF USA
American Jewish World Service (AJWS)
Basic Education Coalition
Bethany Christian Services
Better World Campaign
CARE
Center for Health and Gender Equity (CHANGE)
Child Aid
Council on Foundations
Freedom House
Food for the Hungry
Global Communities
Global Health Council
Habitat for Humanity International
Heartland Alliance International
Helen Keller International
Human Rights First
Humentum
IMA World Health
INMED Partnerships for Children
InterAction
International Center for Not-for-Profit Law
International Youth Foundation
Internews
Management Sciences for Health
Mercy Corps
Mercy-USA for Aid and Development
National Cooperative Business Association CLUSA International
Norwegian Refugee Council USA
PATH Physicians for Peace
Plan International USA
Planet Aid, Inc.
Project C.U.R.E.
Project Concern International (PCI)
Relief International
Save the Children
Solidarity Center
The Hunger Project
WaterAid America
World Vision
Zakat Foundation of America

Featured Journal Content

European Journal of International Law
Volume 29, Issue 1, 8 May 2018, Pages 9–82,
https://academic.oup.com/ejil/issue/29/1
The EJIL Foreword
Upholding Democracy Amid the Challenges of New Technology: What Role for the Law of Global Governance?
E Benvenisti eb653@cam.ac.uk
https://doi.org/10.1093/ejil/chy013
Abstract
The law on global governance that emerged after World War II was grounded in irrefutable trust in international organizations and an assumption that their subjection to legal discipline and judicial review would be unnecessary and, in fact, detrimental to their success. The law that evolved systematically insulated international organizations from internal and external scrutiny and absolved them of any inherent legal obligations – and, to a degree, continues to do so. Indeed, it was only well after the end of the Cold War that mistrust in global governance began to trickle through into the legal discourse and the realization gradually took hold that the operation of international organizations needed to be subject to the disciplining power of the law. Since the mid-1990s, scholars have sought to identify the conditions under which trust in global bodies can be regained, mainly by borrowing and adapting domestic public law precepts that emphasize accountability through communications with those affected. Today, although a ‘culture of accountability’ may have taken root, its legal tools are still shaping up and are often contested. More importantly, these communicative tools are ill-equipped to address the new modalities of governance that are based on decision making by machines using raw data (rather than two-way exchange with stakeholders) as their input. The new information and communication technologies challenge the foundational premise of the accountability school – that ‘the more communication, the better’ – as voters turned users obtain their information from increasingly fragmented and privatized marketplaces of ideas that are manipulated for economic and political gain. In this article, I describe and analyse how the law has evolved to acknowledge the need for accountability, how it has designed norms for this purpose and continues in this endeavour, yet also how the challenges it faces today are leaving its most fundamental assumptions open to question. I argue that, given the growing influence of public and private global governance bodies on our daily lives and the shape of our political communities, the task of the law of global governance is no longer limited to ensuring the accountability of global bodies but also serves to protect human dignity and the very viability of the democratic state

Education

Education Under Attack 2018 – A Global Study of Attacks on Schools, Universities, their Students and Staff, 2013-2017
The Global Coalition to Protect Education from Attack
2018 :: 159 pages
PDF: http://www.protectingeducation.org/eua2018
This study is published by the Global Coalition to Protect Education from Attack (GCPEA), which was formed in 2010 by organizations working in the fields of education in emergencies and conflict-affected contexts, higher education, protection, and international human rights and humanitarian law that were concerned about ongoing attacks on educational institutions, their students, and staff in countries affected by conflict and insecurity. GCPEA is a coalition of organizations that includes: co-chairs Human Rights Watch and Save the Children, the Council for At-Risk Academics (Cara), the Education Above All Foundation (EAA), the Institute of International Education (IIE), the Office of the United Nations High Commissioner for Refugees (UNHCR), the United Nations Children’s Fund (UNICEF), and the United Nations Educational, Scientific and Cultural Organization (UNESCO).

In countries across the globe from Afghanistan to Colombia to India to Mali to Turkey to Yemen and on, students, teachers, and educational facilities are under siege. Targeted killings, rape, abduction, child recruitment, intimidation, threats, military occupation, and destruction of property are just some of the ways in which education is being attacked.
Between 2013 and 2017, there were more than 12,700 attacks, harming more than 21,000 students and educators in at least 70 countries. In 28 countries profiled in this report, at least 20 attacks on education occurred over the last 5 years.

RECOMMENDATIONS
To protect education more effectively, GCPEA urges states, international agencies, and civil society organizations to:
· Endorse, implement, and support the Safe Schools Declaration to ensure that all students and educators, male and female, can learn and teach in safety.
· Avoid using schools and universities for military purposes, including by implementing the Guidelines for Protecting Schools and Universities from Military Use during Armed Conflict.
· Strengthen monitoring and reporting of attacks on education, including disaggregating data by type of attack on education, sex, age, and type of schooling, in order to improve efforts to prevent and respond to attacks on education.
· Systematically investigate attacks on education and prosecute perpetrators.
· Provide nondiscriminatory assistance for all victims of attacks on education, taking into account the different needs and experiences of males and females.
· Ensure that education promotes peace instead of triggering conflict, and that it provides physical and psychosocial protection for students, including by addressing gender-based stereotypes and barriers that can trigger, exacerbate, and follow attacks on education.
· Where feasible, maintain safe access to education during armed conflict, including by engaging with school and university communities and all other relevant stakeholders in developing risk-reduction strategies and comprehensive safety and security plans for attacks on education.

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UNICEF welcomes Education Under Attack report
Statement
YORK, 10 May 2018 – Speaking today at the launch of Education under Attack 2018, a new report by the Global Coalition to Protect Education from Attack (GCPEA), Shahida Afzar, UNICEF Deputy Executive Director, said: “Today’s report is helping us shine a light on an issue that is too often overlooked. Children are under attack around the globe.

“Because of attacks on places of education, children are putting their lives at risk just going to learn each day. Their parents are forced to make a grim choice: their children’s education or their children’s safety. Rather than places to learn and to grow — places of learning have become places to fear.

“The report also demonstrates a particularly troubling pattern of attacks on girls and their education. Girls were targeted simply for wanting to learn in over half of the countries profiled in this report. In countries like Afghanistan, Mali, Pakistan, and Somalia, girls have suffered acid attacks, brutal abductions, and even execution in their pursuit of education. We must not forget the girls in Chibok, kidnapped from their school dormitory beds. Over 100 of these girls are still missing.

“As a global community, we must ask ourselves: What has humanity become when children face kidnapping or death when they are trying to learn? When parents are forced to deny their children a chance to learn because the danger is too great? When parties to conflict deliberately target schools and hospitals? When schools are used as military bases?

“Our outrage is not enough. Our anger is not enough. The scale of the problem demands that we match our outrage with practical solutions, new investments and a renewed commitment to deliver education to every child.”

Heritage Stewardship – Forests, Livelihoods

Making forest concessions in the tropics work to achieve the 2030 Agenda: Voluntary Guidelines
FAO – 2018
Forestry Paper 180 :: 130 pages
Y.T. Tegegne, J., Van Brusselen, M. Cramm, T. Linhares-Juvenal, P. Pacheco, C. Sabogal
and D. Tuomasjukka
Executive summary
The importance of forests in helping to achieve global sustainable development has been largely acknowledged by the Sustainable Development Goals (SDGs) and the Paris Agreement. In order to ensure that forests deliver their socio-economic and environmental benefits, it is crucial to expand sustainable forest management (SFM) based on the best available practices. Although some progress towards SFM has been noted, the global proportion of land area covered by forests continues to decline. Loss of forests has mainly occurred in sub-Saharan Africa and Latin America and the Caribbean, while many countries in Asia and the Pacific are still sustaining significant deforestation and forest degradation.

The challenge of improving forest conservation and the expansion of SFM as stated in the 2030 Agenda for Sustainable Development demands that due consideration be given to forest production. Although often associated with deforestation and forest degradation, sustainable forest production can have a positive effect on biomass stocks, besides generating revenues that can increase the value of standing forests, eventually contributing to reduced deforestation. Furthermore, products generated from sustainable harvesting contribute to raising local and national incomes and increasing employment, while harvested wood products that store carbon reduce emissions in other economic sectors. In sum, sustainable forest production can contribute to enhanced rural livelihoods, rural development and low-carbon economies.

Forest concessions are not used uniformly across regions, or even across all tropical regions. In some countries, forest concessions overlap with land concessions and are used as land allocation or land management instruments, with objectives other than those of sustainable forest management. The proposed Voluntary Guidelines focus on promoting SFM in concessions of public natural production forests in tropical regions. They build on the ITTO Voluntary Principles and Guidelines for the Sustainable Management of Natural Tropical Forests, as well as other relevant guidance for good forest governance and SFM, providing practical guidance to new forest concession regimes, or existing ones. The concession guidelines stem from lessons learned in Africa, Latin America and Southeast Asia. In combination with criteria and indicators (C&I) processes, these guidelines provide a framework for implementation and monitoring of concessions to deliver true SFM.

Given the widespread adoption of forest concessions in tropical regions, reviewing and framing them as appropriate forest policy instruments to deliver SFM offers opportunities for turning concessions into effective vehicles to address the Sustainable Development Goals, as well as Nationally Determined Contributions under the Paris Agreement. The multidimensional nature of SFM results in a holistic contribution to the SDGs through interlinkages with other sectors and an intrinsic need for multistakeholder processes and partnerships. Sustainable forest concessions can make a direct contribution to achieving SDGs 1, 5, 7, 8, 12, 13 and 15.

The Voluntary Guidelines were developed around four dimensions of concessions
management: improved governance, economic feasibility, social inclusion and environmental
integrity. They were structured under eight principles that call for:
(1) coherence with forest and forest-related policies for sustainable landscapes;
(2) clear, credible and efficient legal and institutional frameworks;
(3) transparent and accountable planning, allocation, implementation and monitoring of forest concessions;
(4) technical capacity for management and operation of concession regimes at all levels;
(5) long-term economic and financial feasibility;
(6) clarity and security of tenure rights;
(7) community participation and benefits; and
(8) environmental integrity in forest concessions.

…The Voluntary Guidelines are part of FAO’s work to support sustainable forest production and unlock contributions to the SDGs and climate change. Application of these guidelines in specific local contexts should help to deliver socio-economic benefits to enhance local livelihoods, while supplying harvested wood products that will contribute to the transformational change needed in order to achieve the 2030 Agenda.

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Press Release
Making forest concessions more transparent, accountable and pro-poor
First voluntary guidelines for forest concessions in the tropics launched
10 May 2018, Rome/New York – The Food and Agriculture Organization (FAO) launched today the first voluntary guidelines for forest concessions in the tropics to make concessions more transparent, accountable and inclusive – all for the benefit of some of the poorest and most isolated communities in the world.

Over 70 percent of forests in the tropics used for harvesting timber and other forest products are state-owned or public; most of the public forests are managed through concessions that governments give to private entities or local communities.

Forest concessions have existed in many of the world’s poorest nations for decades, but their contributions have not always been positive. While they have generated more jobs and better income for people in remote areas, in many cases, they have also left behind a trail of degraded forests and tenure conflicts, says the new Making forest concessions in the tropics work to achieve the 2030 Agenda: Voluntary Guidelines.

Forest concessions can be poorly managed due to a lack of adequate skills in tropical forest management; weak governance; over-complicated rules and expectations; focus on short-term benefits, leading to overharvesting; inadequate benefit sharing, infringement and lack of recognition of local people’s rights; no economic returns.

Most forest losses in the past two decades occurred in developing countries in sub-Saharan Africa, Southeast Asia and Latin America, highlighting the need for a better management of public production forests in the tropics.

The new voluntary guidelines build on lessons learned to offer practical guidance for a more sustainable management of public production forests in the tropics through concessions…

Featured Journal Content

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 12 May 2018]
Review
9 May 2018
Mechanisms of change for interventions aimed at improving the wellbeing, mental health and resilience of children and adolescents affected by war and armed conflict: a systematic review of reviews
Authors: Tania Josiane Bosqui and Bassam Marshoud
Abstract
Despite increasing research and clinical interest in delivering psychosocial interventions for children affected by war, little research has been conducted on the underlying mechanisms of change associated with these interventions. This review aimed to identify these processes in order to inform existing interventions and highlight research gaps. A systematic review of reviews was conducted drawing from academic databases (PubMed, PILOTS, Cochrane Library for Systematic Reviews) and field resources (e.g. Médecins Sans Frontières and the Psychosocial Centre of the International Federation of Red Cross and Red Crescent Societies), with extracted data analysed using Thematic Content Analysis. Thirteen reviews of psychosocial or psychological interventions for children and adolescents (< 25 years old) affected by war, armed conflict or political violence were identified, covering over 30 countries worldwide.

Qualitative analysis identified 16 mechanisms of change, one of which was an adverse mechanism. Themes included protection from harm, play, community and family capacity building, strengthening relationships with caregivers, improved emotional regulation, therapeutic rapport, trauma processing, and cognitive restructuring; with the adverse mechanism relating to the pathologising of normal reactions. However, only 4 mechanisms were supported by strong empirical evidence, with only moderate or poor quality evidence supporting the other mechanisms. The poor quality of supporting evidence limits what can be inferred from this review’s findings, but serves to highlight clinically informed mechanisms of change for existing and widely used non-specialist interventions in the field, which urgently need rigorous scientific testing to inform their continued practice

CFMS Position Paper on Immigrants, Refugees and Asylum Seekers
Canadian Federation of Medical Students (CFMS)
We are an organization representing over 8,000 medical students from 15 Canadian medical student societies from coast to coast.
M Bushra, S Hashmi, A Agarwal, C Brown…
[Excerpts]
Position Statement:
Increased efforts towards addressing needs of immigrant, refugee and asylum seeking populations within medical school curricula, medical trainee programs and informal education initiatives will translate to better provision of health care services upon arrival, and create medical graduates and future physicians who are well trained to provide healthcare for newcomer populations.

Key Principles:
The CFMS endorses the following principles in support of immigrants, refugees and asylum seekers:
1. Immigrants, refugees and asylum seekers have unique healthcare needs and requirements.
2. Since the reinstatement of the Interim Federal Health Program (IFHP) in 2016, physicians and other health care providers are eligible to provide care for patients who have received coverage. However, potential patients continue to be turned away by providers because of uncertainty regarding coverage and perceived administrative burden.
3. Newcomer populations face significant system-level barriers in access to healthcare in Canada, including limited pre-arrival healthcare, issues with eligibility and entitlement and difficulty navigating a complex healthcare system
4. Newcomer populations face significant individual and societal barriers to success and optimal health, including unemployment, cultural and language challenges, mental health issues and social isolation
5. Canadian medical students can be better trained on the physical and psychosocial healthcare needs of immigrants, refugees and asylum seekers. Such education and training should be incorporated into Canadian medical curricula…

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The CFMS recommends the following policy level changes to the Government of Canada, and medical licensing and regulatory bodies of Canada :
1. Establish a national refugee and immigrant health strategy tasked with the creation and implementation of recommendations for healthcare providers to ensure high quality, ethical and safe care for refugees and immigrants to Canada. 1.1. Increase education and training in IFHP coverage and usage.
1.2. Eliminate inefficiencies and barriers in providers accessing and using IFHP for their patients.
1.3. Create and implement a streamlined and regularly analyzed process for provider application and reimbursement under IFHP.
2. Establish sufficient coverage of interpreter coverage across provinces.
3. Increase healthcare education opportunities for patients.
3.1. Towards IFHP and non-IFHP coverage components.
3.2. Preventative medicine education.
3.2.2. Emphasis of usage of alternative forms of medicine.
3.2.3. Education on use of primary health resources.
3.3. Encourage education on healthy lifestyles in Canada.
3.3.2. Increase awareness of available local community supports.

DRC – Ebola

WHO and partners working with national health authorities to contain new Ebola outbreak in the Democratic Republic of the Congo
11 May 2018 News Release Geneva/Brazzaville/Kinshasa
The World Health Organization (WHO) and a broad range of partners are in the Democratic Republic of the Congo (DRC) working with the Government to contain an outbreak of Ebola virus disease (EVD) in Bikoro health zone, Equateur Province. The outbreak was declared three days ago. WHO Director-General Dr Tedros Adhanom Ghebreyesus will travel to the DRC over the week-end to take stock of the situation and direct the continuing response in support of the national health authorities.

As of 11 May, 34 Ebola cases have been reported in the area in the past five weeks, including 2 confirmed, 18 probable (deceased) and 14 suspected cases. Five samples were collected from 5 patients and two have been confirmed by the laboratory. Bikoro health zone is 250 km from Mbandaka, capital of Equateur Province in an area of the country that is very hard to reach.

“WHO staff were in the team that first identified the outbreak. I myself am on my way to the DRC to assess the needs first-hand,” said Dr Tedros. “I’m in contact with the Minister of Health and have assured him that we’re ready to do all that’s needed to stop the spread of Ebola quickly. We are working with our partners to send more staff, equipment and supplies to the area.”

A multidisciplinary team including WHO experts, along with staff from the Provincial Division of Health and Médecins Sans Frontières (MSF), arrived in Bikoro on 10 May. This first group of responders is now gathering more data to understand the extent and drivers of the epidemic. The team will also set up an active case search and contact tracing, establish Ebola treatment units to care for patients, set up mobile labs, and engage the community on safe practices. WHO will also work with national authorities in planning further public health measures such as vaccination campaigns.

“WHO is supporting the Government of the Democratic Republic of the Congo in coordinating this response; this is the country’s ninth Ebola outbreak and there is considerable expertise in-country,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “However, any country facing such a threat may require international assistance. WHO and its partners including MSF, World Food Programme (WFP), UNICEF, International Federation of Red Cross and Red Crescent Societies (IFRC) and the Congolese Red Cross, UNOCHA and MONUSCO , US Centers for Disease Control and Prevention (US-CDC), the International Organization for Migration (IOM), are all stepping up their support.”

The response plan to the outbreak includes surveillance, case investigation, and contact tracing; community engagement and social mobilization; case management and infection prevention and control; safe and dignified burials; research response including the use of ring vaccination and antivirals; and coordination and operations support.

“It is too early to judge the extent of this outbreak,” said Dr Peter Salama, WHO Deputy Director-General for Emergency Preparedness and Response. “However, early signs including the infection of 3 health workers, the geographical extent of the outbreak, the proximity to transport routes and population centres, and the number of suspected cases indicate that stopping this outbreak will be a serious challenge. This will be tough and it will be costly. We need to be prepared for all scenarios.”

In its latest Disease Outbreak News, WHO lists the risks to surrounding countries as moderate. WHO has however, already alerted those countries and is working with them on border surveillance and preparedness for potential outbreaks. WHO does not at this time advise any restrictions on travel and trade to the Democratic Republic of the Congo.

Yemen

Fighting the world’s largest cholera outbreak: oral cholera vaccination campaign begins in Yemen
Aden, 10 May 2018 – The first-ever oral cholera vaccination campaign in Yemen was launched on 6 May and concludes on 15 May, just before the start of Ramadan. The campaign aims to prevent the resurgence of the world’s largest cholera outbreak. The volatile mix of conflict, a deteriorating economic situation, and little or no access to clean drinking-water and sanitation have resulted in more than one million suspected cholera cases since the outbreak began in April 2017.

A race against time
This campaign is part of a broader cholera integrated response plan, implemented by national health authorities, WHO and UNICEF. Outbreak response activities include surveillance and case detection, community engagement and awareness, enhancing laboratory testing capacity, improving water and sanitation, and training and deploying rapid response teams to affected areas.

This epidemic has affected the entire country, and the implementation of this oral cholera vaccination campaign, as part of the entire response to cholera, marks a milestone in the combined efforts of WHO and UNICEF, in partnership with the World Bank and Gavi, the Vaccine Alliance, through the generous support of our donors.

“The ongoing conflict, lack of access to safe drinking-water, weak sewage systems due to lack of fuel for pumps and the collapsing health system is the perfect mix for a new explosion of cholera during Yemen’s rainy season, which is already in its beginning stages,” said Dr Nevio Zagaria, WHO Representative in Yemen.

“Hot” districts prioritized to prevent spread
On 24 April, UNICEF delivered the first batch of 455 000 doses of oral cholera vaccine from the Gavi-funded global stockpile, targeting people over the age of 1 year, including pregnant women. The Global Task Force for Cholera Control approved the request of more than 4.6 million doses of the vaccine from the global stockpile to target cholera hotspots across the country.

“This vaccination campaign comes at such a critical time. Children in Yemen were the worst hit by last year’s outbreak and remain the most vulnerable due to widespread malnutrition and deteriorating sanitation and hygiene,” said Meritxell Relaño, UNICEF Representative in Yemen.
Recent reports revealed that in the first 3 days of the campaign, more than 124 000 doses of oral cholera vaccine were administered. This represents 35% of the estimated target population in the 4 districts where the campaign began. A fifth district, will be included in the coming days, bringing the total target population to 470 905 individuals. The campaign currently involves 11 fixed teams and 328 mobile teams.

Update to follow shortly….

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 5 May 2018

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

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

pdf version: The Sentinel_ period ending 5 May 2018

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

Human Rights – Press Freedom

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Human rights experts urge media protection and end to attacks on journalists
World Press Freedom Day – 3 May 2018
GENEVA (2 May 2018) – The UN Special Rapporteur on Freedom of Expression, David Kaye, and rights experts from around the world have joined forces to highlight growing threats to media independence and diversity worldwide, particularly those affecting digital outlets.

In a joint declaration to mark World Press Freedom Day on 3 May, they emphasise the essential role of independent media in democratic societies, and express grave concern about physical attacks on journalists, as well as surveillance, marginalization and squeezing out of independent outlets around the world.

Mr. Kaye welcomed the declaration saying: “Free and independent media facilitate democratic institutions and accountability, while attacks on journalists and journalism undermine the very idea of public participation and governmental accountability.”

“Attacks on journalists are deplorable and State authorities must do more to prevent them. These attacks stem in part from increasingly irresponsible framing of journalists as ‘enemies’ by political and business leaders, but are also aimed at deterring investigative reporting in the public interest. All those committed to independent and diverse media must join together now to stop such attacks,” the Special Rapporteur stressed.

“In addition to physical attacks, those acting on behalf of the State threaten journalism on political, legal and technological fronts. They abuse public resources by placing advertisements only with friendly outlets, assert financial or other forms of control, and promote or permit media concentrations,” Mr. Kaye added.

The Joint Declaration on Media Independence and Diversity in the Digital Age has been issued by Mr. Kaye and counterparts from the Organization for Security and Co-operation in Europe, the Inter-American Commission on Human Rights, and the African Commission on Human and Peoples’ Rights.

It also urges governments to promote media independence and diversity, emphasizes fundamental norms of human rights law and urges States to meet their obligations, and calls on others, such as the media and private internet companies, to take steps to ensure that independent media can continue to play a central role in democratic societies.
The joint declaration is published in English and Spanish.

Development – Informal Employment, Poverty and Social Protection
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Women and men in the informal economy: A statistical picture
ILO Report – Third Edition
30 April 2018 :: 164 pages
PDF: http://www.ilo.org/wcmsp5/groups/public/—dgreports/—dcomm/documents/publication/wcms_626831.pdf

Main findings [excerpt p. 67]
This publication aims to provide a statistical overview on informality by applying a harmonized
definition of informal employment and employment in the informal sector to micro data for more than 100 countries representing more than 90 per cent of the world’s employed population. The estimates are based on a common set of standardized criteria to determine informal employment and employment in the informal sector as the main job. The estimates are comparable across developed and developing countries and regions, but the ILO’s country estimates may differ from national ones when they exist. This edition also provides global and regional estimates for 2016 based on percentages calculated from the latest available data.

The statistics show that informal employment plays a significant role in the global labour market. Two billion workers, representing 61.2 per cent of the world’s employed population, are in informal employment. Half of the world’s employed population work informally in non-agricultural activities. The level of socio-economic development is positively related to formality.

Emerging and developing countries have substantially higher rates of informality than developed countries. The informal sector comprises the largest component of informal employment in all regions. When the share of informal employment is disaggregated by sex, men (63.0 per cent) have higher rates of informal employment than women (58.1 per cent) around the world, but there are actually more countries (55.5 per cent) where the share of women in informal employment exceeds the share of men. Women are more exposed to informal employment in sub-Saharan Africa, the Latin American countries and most low- and lower-middle income countries. They are more often found in the most vulnerable situations.

Young people and older persons are found to be more affected by informality than persons aged between 25 and 64. The level of education is another key factor affecting the level of informality. Globally, increases in the level of education are related to decreases in the level of informality. People living in rural areas are almost twice as likely to be in informal employment (80.0 per cent) as those living in urban areas (43.7 per cent). The agricultural sector by nature is the sector with the highest level of informality (93.6 per cent) around the world. The industry (57.2 per cent) and service (47.2 per cent) sectors have relatively less informality…

Informal employment and key social and economic indicators
Informal employment is related to the level of economic development. Informality rate among
developed countries is usually well below 40 per cent with an average of 18.3 per cent, while informality rates among developing and emerging countries have a higher variation with an average of 69.6 per cent. Countries with high informality also have low HDIs. There is a negative correlation between the share of informal employment in total employment and the proportion of waged workers and a positive correlation with the proportion of own-account workers. Women are more likely to be in informal employment than men in countries with the lowest level of GDP per capita. In sub-Saharan Africa, Latin America and most low- and lower-middle income countries, a larger proportion of women’s employment than men’s is informal employment.

There is a clear positive relation between informal employment and poverty, but the data also show that some informal workers are not poor and some formal workers are poor.

In all regions of the world and for all statuses in employment, people with higher level of education are less likely to be in informal employment. Half of all those engaged in informal employment globally have either no or primary level of education and just above 7 per cent of informal workers worldwide reach tertiary level. The positive effect of the increase in the level of education on access to formal employment is obvious among employees and employers, but far less among own-account workers, whose exposure to informal employment remains high (over 60 per cent) whatever their level of education. The share of informal employment among employees is always lower than for other statuses even when the level of education is considered. Nearly 91 per cent of women with either no education or primary education are in informal employment as compared to 87.2 per cent of men with similar level of education. Among the less educated workers, women have higher levels of informality than men in both developing, emerging and developed countries, but this pattern is reversed among women and men at secondary or higher levels of education.

Globally, 15.7 per cent of employees in permanent full-time employment hold informal jobs, i.e.
having no employment related social and labour protections. The proportion of employees in informal employment increases significantly among part-time employees (44.0 per cent), and among employees in temporary employment (59.6 per cent) and is highest for employees in “temporary part-time jobs” (64.4 per cent), especially among men (68.1 per cent). Women part time employees are less likely than men to be informal. Just above one-third of women employees working less than 35 hours a week are in informal employment, as compared to 54.2 per cent among men.

Worldwide, the share of informal employment varies significantly from 56.5 per cent among workers in full-time employment to 75.1 per cent for workers in part-time employment and 78.5 per cent for marginal employment (less than 20 working hours a week). The incidence of informal employment is more limited when employees are considered alone: 48.3 per cent of employees in marginal employment hold informal jobs, compared to 41.8 per cent for employees working 35 hours or more. The percentage of workers with very short working hours is higher among workers in informal employment compared to those in formal employment. Globally, 10.1 per cent of workers in informal employment work less than 20 hours a week compared to 4.2 per cent of workers in formal employment. The difference is greater for women and for own-account workers.

More than 14 per cent of all women in informal employment work less than 20 hours a week compared to 3.1 per cent among women in formal employment. The percentage of the own-account employed working very short hours is significantly higher among those operating in the informal sector (14.4 per cent) when compared to the formal (6.3 per cent). The proportion of workers in time-related underemployment is higher among workers in informal employment in most countries.

Workers in informal employment are even more likely to work excessive hours (more than
48 hours a week or even more than 60 hours a week), especially employees. This phenomenon
in Asia and the Pacific is extreme, but working longer hours when holding informal jobs seems to be the reality for half of all employees in the developing and emerging world. This reality is significantly different from the situation of employees in developed countries, as less than 16 per cent work long hours, without any difference between formal or informal employment. Own-account workers show a different picture, as own-account workers owning formal economic units tend to work longer hours than their counterparts operating informally.

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Press Release
More than 60 per cent of the world’s employed population are in the informal economy
30 April 2018
A new ILO report shows that 2 billion people work informally, most of them in emerging and developing countries. The majority lack social protection, rights at work and decent working conditions.
GENEVA (ILO News) – Two billion people – more than 61 per cent of the world’s employed population – make their living in the informal economy, the ILO said in a report, stressing that a transition to the formal economy is a condition to realize decent work for all.

Women and men in the informal economy: A statistical picture (Third edition) provides comparable estimates on the size of the informal economy and a statistical profile of informality using criteria from more than 100 countries.

When excluding agriculture, half of the employed population are in informal employment, according to the report.

In Africa, 85.8 per cent of employment is informal. The proportion is 68.2 per cent in Asia and the Pacific, 68.6 per cent in the Arab States, 40.0 per cent in the Americas and 25.1 per cent in Europe and Central Asia.

The report shows that 93 per cent of the world’s informal employment is in emerging and developing countries.
… Two of the report’s authors, Florence Bonnet and Vicky Leung, point out that while not all informal workers are poor, poverty is both a cause and a consequence of informality. “The report shows that the poor face higher rates of informal employment and that poverty rates are higher among workers in informal employment,” said Leung.

Bonnet, for her part, stressed: “There is an urgent need to tackle informality. For hundreds of millions of workers, informality means a lack of social protection, rights at work and decent working conditions, and for enterprises it means low productivity and lack of access to finance. Data on those issues are crucial for designing appropriate and integrated policies that are tailored to the diversity of situations and needs.”

… “The high incidence of informality in all its forms has multiple adverse consequences for workers, enterprises and societies and is, in particular, a major challenge for the realization of decent work for all and sustainable and inclusive development. Having managed to measure this important dimension, now included in the SDG indicators framework, this can be seen as an excellent step towards acting on it, particularly thanks to more available comparable data from countries,” said Rafael Diez de Medina, Director of ILO’s Department of Statistics.

Human Rights – Development

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Economic impacts of child marriage : Ethiopia synthesis report
World Bank
Working Paper 2018 :: 101 pages
Wodon, Quentin T.; Male, Chata; Onagoruwa, Adenike Opeoluwa; Savadogo, Aboudrahyme; Yedan, Ali; Kes, Aslihan; John, Neetu; Steinhaus, Mara; Murithi, Lydia; Edmeades, Jeff; Petroni, Suzanne
PDF: http://documents.worldbank.org/curated/en/149721525196131393/pdf/125883-WP-P151842-PUBLIC-Ethiopia-EICM-May-1-2018.pdf
Abstract
The international community is increasingly aware of the negative impacts of child marriage on a wide range of development outcomes. Ending child marriage is now part of the Sustainable Development Goals. Yet investments to end the practice remain limited across the globe. Ethiopia recently adopted a strategy to end child marriage, and some of the projects being implemented in the country should contribute to reduce the practice child marriage. Still, more could be done. In order to inspire greater commitments towards ending child marriage, this study demonstrates the negative impacts of the practice and their associated economic costs. The study looks at five domains of impacts: (i) fertility and population growth; (ii) health, nutrition, and violence; (iii) educational attainment and learning; (iv) labor force participation and earnings; and (v) participation, decision-making, and investments. Economic costs are estimated for several of the impacts. Overall, the costs are high. They suggest that investing to end child marriage is not only the right thing to do, but also makes sense economically.

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Media Release
Child Marriage May Cost Ethiopia Billions of Dollars, Says New World Bank Report
ADDIS ABABA, May 3, 2018 – Ethiopia’s economy could potentially lose billions of dollars annually due to child marriage, says a new report by the World Bank and the International Center for Research for Women, which was launched today together with the Ministry of Women and Children’s Affairs. In contrast, ending the practice of child marriage would have a large positive effect on the educational attainment of girls and their children, reduce population growth, and increase women’s expected earnings and household welfare.

The report, titled Economic Impacts of Child Marriage: Ethiopia Synthesis Report, is part of a global program of work funded by the Bill and Melinda Gates Foundation, the Children’s Investment Fund Foundation, and the Global Partnership for Education. According to the study, the prevalence of child marriage (marriage or union before the age of 18) remains high in Ethiopia, affecting more than one in three girls. In addition, almost one in five girls gives birth before the age of 18.

“Child brides are often robbed of their rights to safety and security, to health and education, and to make their own life choices and decisions,” said Quentin Wodon, Lead Economist at the World Bank and author of the report. “Child marriage not only puts a stop to girls’ hopes and dreams. It also hampers efforts to end poverty and achieve economic growth and equity. Ending this practice is not only the morally right thing to do but also the economically smart thing to do.”…

Development Finance – Disruptive Technologies

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World Bank Group and Credit Suisse Launch Disruptive Technologies for Development Fund
LOS ANGELES, May 1, 2018 – The World Bank Group (WBG) today announced the launch of the Disruptive Technologies for Development Fund in partnership with Credit Suisse to harness technologies such as blockchain, 3D printing, and the Internet of Things to pioneer innovative solutions for development challenges.

“The urgency of the challenges around us – from climate change to forced displacement – requires a re-think of strategic partnerships,” World Bank Group President Jim Yong Kim said. “Collaborating with new partners to end poverty will help us make innovative use of technology and maximize finance for development. We have no time to lose. If we work together, we can tackle the biggest global challenges of our lifetime.”

With this fund, the WBG is pushing forward its commitment to harness public and private sector technology, data, and expertise to help its clients manage the opportunities and risks of rapid technological change. The fund aligns a global network of technology leaders, philanthropists, and development experts to identify and pilot the use of technologies to foster sustainable, tech-enabled growth in developing countries. The fund will seek contributions from donors, who, for the first time, can leverage the World Bank Group’s global expertise and portfolio of operations to maximize their philanthropic impact.

For the next generation of strategic philanthropists, the fund will support a technology component in new or existing WBG projects, helping donors achieve social impact at an unprecedented scale. It also establishes a unique knowledge and networking platform to inform future grant making. The first disbursement is expected in the Fall. Credit Suisse will act as an intermediary, arranging donor contributions and reaching out to technology partners on project proposals.

Credit Suisse CEO, Tidjane Thiam added: “We are delighted to partner with the World Bank Group on launching this major impact initiative following the formation of Credit Suisse’s Impact Advisory and Finance (IAF) Department in the Fall of 2017. We believe this Fund can serve as a showcase to demonstrate the significant impact that innovative public private partnerships can have on society. Our strategic ambition is to leverage Credit Suisse’s 15-year history in impact investing through the IAF Department to continue to innovate with key partners and clients in order to foster greater socio-economic progress”

The future objective of the fund is to scale up pilots that harness disruptive technology to accelerate progress towards the World Bank Group’s goals of ending poverty by 2030 and boosting shared prosperity.

Right to Health – Immunization

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A review of evidence on equitable delivery, access and utilization of immunization services for migrants and refugees in the WHO European Region
WHO Health Evidence Network Synthesis Reports 53.
Editors – De Vito E, Parente P, de Waure C, Poscia A, Ricciardi W.
Source – Copenhagen: WHO Regional Office for Europe; 2017.
PDF: https://www.ncbi.nlm.nih.gov/books/n/whohen53/pdf/
Excerpt
This review focuses on existing immunization policies and practices for migrants and refugees and provides an overview of barriers and facilitators for access to and utilization of immunization services. Evidence was obtained by a scoping review of academic and grey literature in English and a further 11 languages and included official documents available from the websites of ministries of health and national health institutes of the WHO European Region Member States. The review highlights that vaccination policies tailored to migrants and refugees are very heterogeneous among WHO European Region Member States. By comparison, common barriers for the implementation and utilization of immunization services can be identified across countries. Outlined policy options are intended to strengthen information about immunization for migrants and refugees, support future evidence-informed policy-making, enable the achievement of national vaccination coverage goals and improve the eligibility of migrants and refugees to access culturally competent immunization services.

SUMMARY
The issue
Providing equitable access to safe and cost-effective vaccines is vital to protect vulnerable groups in any country and to reduce morbidity and mortality from vaccine-preventable diseases (VPDs), particularly among children. Migrants and refugees in the WHO European Region may be particularly vulnerable to VPDs. Children, who constitute approximately 25% of the total migrant population, are considered at greatest risk of VPDs because they may not have yet been vaccinated or may not have completed the schedule for all vaccines. In November 2015, WHO, the United Nations High Commissioner for Refugees and the United Nations Childrens Fund made a joint recommendation that migrants and refugees in the WHO European Region should be vaccinated without unnecessary delay according to the immunization schedule of the host countries. The WHO European Region’s Strategy action plan and resolution on refugee and migrant health, adopted in September 2016, addresses the issue of immunization among migrants and refugees…

Results
Immunization policies, vaccine delivery practices and barriers to access and utilization of immunization services by migrants and refugees vary widely in WHO European Region:
:: national immunization programmes seldom include specific recommendations for immunization for migrants and refugees;
:: fewer than one third of the countries have specific directives on immunization focusing on migrants and refugees, including children and pregnant women;
:: undocumented migrants receive immunization services in very few countries because of inbuilt administrative barriers in the host countries related to their entitlement to free health services, including immunization;
:: in most of the countries of the Region, the delivery of immunization services is primarily carried out by the public health care systems, but international organizations and nongovernmental organizations are also involved in a few;
:: lack of financial and human resources, in particular cultural mediators and/or interpreters, is seen as a barrier to the effective implementation of national immunization policies and to the systematic collection and evaluation of data for corrective actions;
:: socioeconomic, sociocultural and educational issues remain important obstacles for migrants and refugees in accessing the available immunization services in the host countries; and
:: targeted interventions have been shown to be successful in improving the uptake of immunization programmes among migrants and refugees, for example door-to-door vaccination initiatives, media campaigns, thematic lectures, peer-to-peer interactions and health promotion days.

Health – AI, Governance, Ethics

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Ethical, social and political challenges of artificial intelligence in health
Future Advocacy 2018 – A Report with Wellcome Trust
Written and researched by Matthew Fenech, Nika Strukelj, Olly Buston for the Wellcome Trust April 2018 :: 59 pages

Executive Summary [Excerpt]
…As AI systems become better at sorting data, finding patterns, and making predictions, these
technologies will take on an expanded role in health and care, from research, to medical diagnostics, and even in treatment. This increasing use of AI in health is forcing nurses, doctors and researchers to ask: “How do longstanding principles of medical ethics apply in this new world of technological innovation?”

In order to address this question, we have undertaken a detailed review of existing literature, as well as interviewing more than 70 experts all round the world, to understand how AI is being used in healthcare, how it could be used in the near future, and what ethical, social, and political challenges these current and prospective uses present. We have also sought the views of patients, their representatives, and members of the public.

We have categorised the current and potential use cases of AI in healthcare into 5 key areas:
:: Process optimisation e.g procurement, logistics, and staff scheduling
:: Preclinical research e.g drug discovery and genomic science
:: Clinical pathways e.g. diagnostics and prognostication
:: Patient-facing applications e.g delivery of therapies or the provision of information
:: Population-level applications e.g. identifying epidemics and understanding non-communicable chronic diseases…

SUMMARY OF ETHICAL, SOCIAL, AND POLITICAL CHALLENGES AND SUGGESTIONS FOR FURTHER RESEARCH
01 What effect will AI have on human relationships in health and care?
:: What effect will these technologies have on relationships between patients and healthcare practitioners?
:: What effect will these technologies have on relationships between different healthcare practitioners?
:: What do healthcare practitioners think about the potential for these technologies to change their jobs, or to lead to job displacement?
:: How do these tools fit into the trend of enabling patients to have greater knowledge and
understanding of their own conditions? How different are they from looking up one’s symptoms on a search engine before going to see a healthcare practitioner?
:: Given that AI is trained primarily on ‘measurable’ data, does reliance on AI risk missing non-quantifiable information that is so important in healthcare interactions?
:: If AI systems become more autonomous, how should transitions between AI and human control be incorporated into care pathways?

02 How is the use, storage, and sharing of medical data impacted by AI?
:: How is medical data different from other forms of personal data?
:: What is the most ethical way to collect and use large volumes of data to train AI, if the consent model is impractical or insufficient?
:: How do we check datasets for bias or incompleteness, and how do we tackle these where we find them?
:: Should patients who provide data that is used to train healthcare algorithms be the primary beneficiaries of these technologies, or is it sufficient to ensure that they are not exploited?

03 What are the implications of issues around algorithmic transparency and explainability on health?
:: Are expert systems or rule-based AI systems more suitable for healthcare applications than less interpretable machine learning methods?
:: What do patients and healthcare practitioners want from algorithmic transparency and explainability?
:: Are improved patient outcomes, efficiency and accuracy sufficient to justify the use of ‘black box’ algorithms? If such an algorithm outperforms a human operator at a particular healthcare-related task, is there an ethical obligation to use it?
: Could ‘explanatory systems’ running alongside the algorithm be sufficient to address ‘black box’ issues?

04 Will these technologies help eradicate or exacerbate existing health inequalities?
:: Which populations may be excluded from these technologies, and how can these populations be included?
:: Will these technologies primarily affect inequalities of access, or of outcomes?

05 What is the difference between an algorithmic decision and a human decision?
: How do we rank the importance of a human decision as compared to an algorithmic decision, particularly when they are in conflict?
:: Do human and algorithmic errors differ simply in degree, or is there an essential, qualitative difference between a machine ‘giving the wrong answer’ and a human making a mistake?
:: How will patients and service users react to algorithmic errors?
:: Who will be held responsible for algorithmic errors?

06 What do patients and members of the public want from AI and related technologies?
:: How do patients and members of the public think these technologies should be used in health and medical research?
:: How comfortable are patients and members of the public with sharing their medical data to develop these technologies?
:: How do patients and other members of the public differ in their thinking on these issues?
What is the best way to speak to patients and members of the public about these technologies?

07 How should these technologies be regulated?
:: Are current regulatory frameworks fit for purpose?
:: What does ‘duty of care’ mean when applied to those who are developing algorithms for use in healthcare and medical research?
:: How should existing health regulators interact with AI regulators that may be established?
:: How should we regulate online learning, dynamic systems, as opposed to fixed algorithms?

08 Just because these technologies could enable access to new information, should we always use it?
:: What would the impact of ever-greater precision in predicting health outcomes be on patients and healthcare practitioners?
:: What are the implications of algorithmic profiling in the context of healthcare?

09 What makes algorithms, and the entities that create them, trustworthy?

10 What are the implications of collaboration between public and private sector organisations in the development of these tools?
:: What are the most ethical ways to collaborate?
:: How do we ensure value for both the public sector and for the private sector organisation, for example in the use of data? In publicly-owned/taxpayer-funded healthcare systems, such as the UK NHS, how do we ensure that citizens receive value too?
:: What are the implications of the concentration of intellectual capacity in private sector organisations?

Featured Journal Content

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 5 May 2018]
Review
2 May 2018
Review of attacks on health care facilities in six conflicts of the past three decades
Authors: Carolyn Briody, Leonard Rubenstein, Les Roberts, Eamon Penney, William Keenan and Jeffrey Horbar
Abstract
Background
In the ongoing conflicts of Syria and Yemen, there have been widespread reports of attacks on health care facilities and personnel. Tabulated evidence does suggest hospital bombings in Syria and Yemen are far higher than reported in other conflicts but it is unclear if this is a reporting artefact.
Objective
This article examines attacks on health care facilities in conflicts in six middle- to high- income countries that have occurred over the past three decades to try and determine if attacks have become more common, and to assess the different methods used to collect data on attacks. The six conflicts reviewed are Yemen (2015-Present), Syria (2011- Present), Iraq (2003–2011), Chechnya (1999–2000), Kosovo (1998–1999), and Bosnia and Herzegovina (1992–1995).
Methods
We attempted to get the highest quality source(s) with summary data of the number of facilities attacked for each of the conflicts. The only conflict that did not have summary data was the conflict in Iraq. In this case, we tallied individual reported events of attacks on health care.
Results
Physicians for Human Rights (PHR) reported attacks on 315 facilities (4.38 per month) in Syria over a 7-year period, while the Monitoring Violence against Health Care (MVH) tool launched later by the World Health Organization (WHO) Turkey Health Cluster reported attacks on 135 facilities (9.64 per month) over a 14-month period. Yemen had a reported 93 attacks (4.65 per month), Iraq 12 (0.12 per month), Chechnya > 24 (2.4 per month), Kosovo > 100 (6.67 per month), and Bosnia 21 (0.41 per month). Methodologies to collect data, and definitions of both facilities and attacks varied widely across sources.
Conclusion
The number of reported facilities attacked is by far the greatest in Syria, suggesting that this phenomenon has increased compared to earlier conflicts. However, data on attacks of facilities was incomplete for all of the conflicts examined, methodologies varied widely, and in some cases, attacks were not defined at all. A global, standardized system that allows multiple reporting routes with different levels of confirmation, as seen in Syria, would likely allow for a more reliable and reproducible documentation system, and potentially, an increase in accountability.

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 1 May 2018 [GPEI]
:: In Iraq, polio vaccinators work to protect conflict-affected children.
:: In preparation for the Seventy-first World Health Assembly, taking place on 21-26 May, the Director-General’s office has finalized the Strategic Action Plan on Polio Transition. The Plan has three strategic objectives, which are highly interlinked:

1. a) Sustaining a polio-free world after eradication (with the Post-Certification Strategy as its main pillar);
2. b) Strengthening immunization systems;
3. c) Strengthening emergency preparedness, detection and response capacity.

The Plan aims at aligning these objectives with the overall vision of the 13th General Programme of Work and WHO’s support at the country level, with the eventual phasing out of resources from the Global Polio Eradication Initiative. The action plan in all official UN languages may be found here.

Summary of newly-reported viruses this week:
Afghanistan: One new wild poliovirus type 1 (WPV1)  positive environmental sample has been reported, in Kandahar province.
Pakistan: Five new wild poliovirus type 1 (WPV1)  positive environmental samples have been reported, one in Balochistan province, two in Khyber Pakhtunkhwa province, and two in Sindh province.
Nigeria: Three circulating vaccine-derived poliovirus type 2 (cVDPV2)  positive environmental samples have been confirmed, one in Gombe province, and two in Jigawa province.

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WHO Grade 3 Emergencies  [to 5 May 2018]
[Several emergency pages were not available at inquiry]

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WHO Grade 2 Emergencies  [to 5 May 2018]
[Several emergency pages were not available at inquiry]

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Somalia
:: Humanitarian Bulletin Somalia, 5 April – 2 May 2018
:: OCHA Somalia Flash Update #3 – Humanitarian impact of heavy rains | 2 May 2018