Human Rights – DPRK

People in North Korea trapped in vicious cycle of deprivation, corruption and repression – UN human rights report
GENEVA (28 May 2019) – People in the Democratic People’s Republic of Korea (DPRK) are trapped in a vicious cycle, in which the failure of the State to provide for life’s basic necessities forces them to turn to rudimentary markets where they face a host of human rights violations in an uncertain legal environment, according to a new UN human rights report.

The report, published by the UN Human Rights Office on Tuesday, highlights how the public distribution system in the DPRK has been broken for over two decades and how, as people seek to eke out a living in a legally precarious parallel economy, they are exposed to arbitrary arrest, detention, and extortion.

Based on 214 first-hand accounts of escapees gathered by UN Human Rights staff in South Korea in 2017 and 2018, the report describes how the most fundamental rights of ordinary people in the DPRK are widely violated because of economic mismanagement and endemic corruption.

“The rights to food, health, shelter, work, freedom of movement and liberty are universal and inalienable, but in North Korea they depend primarily on the ability of individuals to bribe State officials,” said UN High Commissioner for Human Rights, Michelle Bachelet.

Since the economic collapse of the 1990s, people have been unable to survive through a State-led model of centralized economic planning and distribution, which includes State-assigned jobs and the dispensation of food, clothes and other rations. As a result, working in the informal sector has become an essential means of survival – or else, as one interviewee put it: “If you just follow instructions coming from the State, you starve to death.”

However, when people try to engage in rudimentary market activity, they face arrest and detention, including for travelling within the country, for which a permit is required.

This situation invariably leads to a series of further serious human rights violations, due to absence of rule of law and due process guarantees. People often experience inhumane and degrading treatment in detention, and are sometimes subjected to torture during interrogation and disciplinary procedures.

The whole system is based on the informal but pervasive practice of bribing State officials who are in a position to enable people to side-step State requirements and regulations in order to work in the private sector and avoid arrest.

The constant threat of arrest and prosecution provides State officials with a powerful means to extort money and other favours from people desperate to avoid detention in inhumane conditions, the report says. In addition, the living conditions and treatment of detainees can also depend on the payment of bribes.

As another escapee said to UN human rights officials: “I felt it unfair that one could bribe one’s way out of [detention], when another suffers much more as a result of being unable to bribe. Bribery is effective in North Korea. One cannot lead a life in North Korea if he or she does not bribe his or her way.”

The report also details how women seeking ways to make ends meet are particularly vulnerable to further abuse at the hands of third parties, including brokers and traffickers.

The UN Human Rights Chief called for far-reaching changes: “Our report is a stark illustration of how important it is that the Government tackles the country’s profound human rights problems. Only then can the endemic system of corruption which pervades all aspects of life be effectively dismantled,” she said….
[Full text at title link above]

Development – “Decade of Family Farming”

Launch of the UN’s Decade of Family Farming to unleash family farmers’ full potential
JOINT PRESS RELEASE FAO/IFAD [International Fund for Agricultural Development]
29 May 2019, Rome – The Food and Agriculture Organization (FAO) and the International Fund for Agricultural Development (IFAD) today launched the United Nations’ Decade of Family Farming and a Global Action Plan to boost support for family farmers, particularly those in developing countries.

The two UN agencies lead the implementation of the Decade of Family Farming declared by the United Nations at the end of 2017.

Family farms represent over 90 per cent of all farms globally, and produce 80 percent of the world’s food in value terms. They are key drivers of sustainable development, including ending hunger and all forms of malnutrition.

The Decade of Family Farming aims to create a conducive environment that strengthens their position, and maximizes their contributions to global food security and nutrition, and a healthy, resilient and sustainable future.

The Global Action Plan provides detailed guidance for the international community on collective and coherent actions that can be taken during 2019-2028…

…The Global Action Plan of the Decade of Family Farming is a guide to develop policies, programs and regulations to support family farmers, putting forward collective and coherent actions that can be taken during the next ten years.

It details specific activities to address interconnected challenges, and target a range of actors – governments, United Nations agencies, international financial institutions, regional bodies, farmers and producer organizations, academic and research institutes, civil society organizations and the private sector, including small and medium enterprises.

Actions include:
:: Developing and implementing an enabling policy environment (including comprehensive and coherent policies, investments and institutional frameworks) that support family farming at local, national and international levels;
:: Supporting rural youth and women by enabling them to access productive assets, natural resources, information, education, markets, and participate in policy making processes;
:: Strengthening family farmers’ organizations and their capacities to generate knowledge and link locally specific (traditional) knowledge with new solutions;
:: Improving family farmers’ livelihoods and enhancing their resilience to multiple hazards though access to basic social and economic services, as well as facilitating and promoting production diversification to reduce risks and increase economic returns;
:: Promoting sustainability of family farming for climate-resilient food systems, and their access, responsible management and use of land, water and other natural resources.

Facts and figures on family farming:
:: More than 80 percent of all farms globally are below two hectares.
:: Family farms occupy around 70–80 percent of farmland and produce more than 80 percent of the world’s food in value terms.
:: Women perform nearly 50 percent of farm labor but hold only 15 percent of farmland.
:: 90 percent of fishers are small-scale operators, which account for half of the capture fisheries production in developing countries.
:: Up to 500 million pastoralists rely on livestock rearing to make a living.
:: Mountain farming is largely family farming.
:: Family farmers include forest communities. Around 40 percent of the extreme rural poor live in forest and savannah areas.
:: Traditional indigenous territories encompass up to 22 percent of the world’s land surface and coincide with areas that hold 80 percent of the planet’s biodiversity.

Cyber – Armed Conflict

The potential human cost of cyber operations
29-05-2019 | ICRC Report
This report provides an account of the discussions that took place during a meeting of experts organised by the ICRC in November 2018 on the potential human cost of cyber operations.

Cyber attacks and their consequences are on top of the agenda around the world. Apart from causing substantial economic loss, cyber operations can cause physical damage and affect the delivery of essential services to civilians. Cyber attacks against electrical grids and the health-care sector have underscored the vulnerability of these services.

The use of cyber operations during armed conflicts is also a reality. While only a few States so far have publicly acknowledged that they use them, an increasing number of States are developing military cyber capabilities.

To move towards a realistic assessment of the potential human cost of cyber warfare, the ICRC convened a meeting of scientific and cyber security experts from all over the world. They analysed some of the most sophisticated known cyber operations, regardless of whether they occurred during conflict or in peacetime, focusing on the risk that cyber operations may result in death, injury or physical damage, affect the delivery of essential services to the population, or affect core internet services.

The rich discussions provided a nuanced picture of the risks that cyber warfare can entail for the civilian population. The ICRC looks forward to the feedback to this report to continue to follow the evolution of cyber operations, in particular during armed conflicts.

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The potential human cost of cyber operations
ICRC EXPERT MEETING
14–16 NOVEMBER 2018 – GENEVA :: 80 pages
PDF: https://www.icrc.org/en/download/file/96008/the-potential-human-cost-of-cyber-operations.pdf
Report prepared and edited by Laurent Gisel, senior legal adviser, and Lukasz Olejnik, scientific adviser on cyber, ICRC

Executive Summary [except]
…Avenues that could be explored to reduce the potential human cost of cyber operations
Cyber security measures
Beyond the restraints imposed by IHL upon those carrying out cyber operation, it is critical to enhance the cyber security posture and resilience of the actors potentially affected. While cyber security and defence are constantly improving, older systems with outdated or even non-existing cyber security are particularly vulnerable to cyber attacks and will remain a concern in the years to come. Both the public and private sectors have a role to play through industry standards and legal regulation.

In the health-care sector, for instance, the regulatory environment should be adapted to the increased risk, such as through standardization requirements, with a view to ensuring resilience in the event of a cyber attack. Cyber security needs to be taken into account in the design and development of medical devices and updated throughout their lifetime, no matter how long they last. Similarly, for industrial control systems, industry standards, whether imposed or self-imposed, are critical. This includes reporting incidents and sharing information between trusted partners.

In terms of IHL, parties to armed conflicts must take all feasible precautions to protect civilians and civilian objects under their control against the effects of attack. This is one of the few IHL obligations that States must already implement in peacetime.

Disclosing vulnerabilities
The preferred option for enhancing the safety of cyber space should be disclosing vulnerabilities to the appropriate software developer so that the vulnerabilities can be fixed. Some States have therefore put in place equity processes to balance competing interests and risks and decide whether to disclose the vulnerabilities they identify.

Measures to prevent proliferation
Those who develop cyber weapons should consider creating obstacles in order to make repurposing difficult and expensive. While it is hardly possible from a technical standpoint to guarantee that malware cannot be repurposed, methods like encrypting its payload and including obstacles in different components of the code, for example, could raise the bar in terms of the expertise required to reengineer malicious tools. While there is currently no express obligation under IHL to create obstacles to the repurposing of cyber tools, this could prevent at least some actors from doing so and therefore reduce the risk of subsequent misuse that their proliferation entails. The unique way in which cyber tools proliferate also raises the question of whether existing law is adequate or sufficient to address this phenomenon.

Marking of certain civilian infrastructure
Another avenue, which builds on existing international law, could be to create a “digital watermark” to identify certain actors or infrastructure in cyber space that must be protected (such as objects that enjoy specific protection under IHL). The aim would be to help their identification and prevent them from being targeted during armed conflicts. The potentially positive effects in terms of protection against unintended harm by law-abiding actors would however need to be balanced against the risk of disclosing information on critical infrastructure to potential adversaries, including criminals. The prospects of positive effects might depend in part on attribution becoming easier.

Improving attribution and accountability
Finally, enhanced attribution capacities would help ensure that actors who violate international law in cyber space can be held accountable, which is a means to strengthen compliance with the law and more generally encourage responsible behaviour in cyber space.

Way forward
The use of cyber operations in armed conflict is likely to continue and might remain shrouded in secrecy. Analysing its consequences is a complex and long-term endeavour that requires
multidisciplinary expertise and interaction with a wide variety of stakeholders.

Building upon the conclusions reached at the expert meeting, the ICRC would like to pursue the dialogue with governments, experts and the IT sector. It looks forward to the feedback to this report to continue to follow the evolution of cyber operations, in particular during armed conflicts, and their potential human cost, explore avenues that could reduce them, and work towards a consensus on the interpretation of existing IHL rules, and potentially the development of complementary rules that
afford effective protection to civilians.

Global Governance – Technology

World Economic Forum Inaugurates Global Councils to Restore Trust in Technology
:: Six councils formed to design how emerging technology can be governed for the benefit of society
:: Top decision-makers and experts from the public and private sectors, civil society and academia participate in inaugural Global Fourth Industrial Revolution Council meeting in San Francisco
:: Leaders of Chinese Academy of Medical Sciences, Dana-Farber, European Commission, Microsoft, Qualcomm, Uber, World Bank among chairs
:: Major global summit on technology governance announced, to take place in April 2020

San Francisco, USA, 29 May 2019 – To help policy-makers and businesses strike the right balance between enabling emerging technologies and proactively mitigating the social risks that can result, the World Economic Forum launched six Global Fourth Industrial Revolution Councils today.

Covering the most pressing technology areas of artificial intelligence, autonomous mobility, blockchain, drones, internet of things and precision medicine, global councils bring together more than 200 leaders from the public and private sectors, civil society and academia from around the world.

Council members will work together to develop policy guidance and address “governance gaps” or the absence of well-defined rules for emerging technology. They met for the first time today at Forum’s Centre for the Fourth Industrial Revolution in San Francisco.

“Companies and governments are not moving fast enough to anticipate social expectations in the Fourth Industrial Revolution,” said Richard Samans, Managing Director and Head of Policy and Institutional Impact, World Economic Forum. “We believe that that this bottom-up, societally-focused approach can help to build and maintain public trust in the technologies while strengthening the evidence base on which policy decisions are made by governments and companies. This is the first place where this kind of high-level, strategic dialogue on the governance of these technologies will take place across stakeholders and regions on an ongoing basis.”

Global Fourth Industrial Revolution Councils will:
:: Enable cross-country exchange of policy and regulatory experience, including through case studies;
:: Identify and take action to address gaps in public policy or corporate governance through multistakeholder cooperation;
:: Shape a common understanding of “best” or “good” policy practice as a means of enabling better policy coordination within and among countries;
:: Provide strategic guidance to the Centre for the Fourth Industrial Revolution Network regarding the governance projects and pilots it undertakes.

Councils are organized by the World Economic Forum Centre for the Fourth Industrial Revolution Network. Headquartered in San Francisco, the Network expanded internationally last year to the People’s Republic of China, India and Japan. Affiliate centres in Colombia and the United Arab Emirates opened in early 2019. Five of the G7 countries and more than 100 organizations are officially partnered with the Network to create policy frameworks, pilot them and scale up around the world.

Global Technology Governance Summit
Input from council members will inform the agenda of the Global Technology Governance Summit in April 2020. This event will be the world’s premiere leader-level, multistakeholder meeting dedicated to shaping the governance of emerging technologies. It will bring together government ministers, chief executive officers, civil society leaders, start-ups and international organizations. It will be catalyst a for driving new approaches and collaborative efforts across stakeholders that are human-centred.

Global Artificial Intelligence Council
Co-chairs
Lee Kai-Fu, Chairman and Chief Executive Officer, Sinovation Ventures
Bradford Smith, President, Microsoft Corp

Global Autonomous and Urban Mobility Council
Co-chairs
Brian Gu Hong-Di, Vice-Chairman and President, Xpeng Motors
Keiichi Ishii, Minister of Land, Infrastructure, Transport and Tourism of Japan
Dara Khosrowshahi, Chief Executive Officer, Uber Technologies

Global Blockchain Council
Co-chairs
Elizabeth Rossiello, Chief Executive Officer, Founder, BitPesa
Denis Robitaille, Vice President, Information and Technology Solutions, World Bank

Global Drones and Aerial Mobility Council
Chair
Violeta Bulc, Commissioner for Transport, European Commission

Global Internet of Things Council
Co-chairs
Cristiano Amon, President, Qualcomm Incorporated
Mariya Gabriel, Commissioner for Digital Economy and Society, European Commission
Adrian Lovett, President and Chief Executive Officer, World Wide Web Foundation

Global Precision Medicine Council
Co-chairs
Laurie Glimcher, President and Chief Executive Officer, Dana-Farber Cancer Institute
Peer Schatz, Chief Executive Officer, QIAGEN
Wang Chen, President, Chinese Academy of Medical Sciences

Governance/UN Agencies: Parental Leave

Joint Statement: One UN for family leave and childcare
Posted on June 1, 2019
We, the Heads of UNICEF, UN WOMEN, UNDP and UNFPA, representing over 37,000 UN staff members under the United Nations Common System, are committed to strong gender-responsive, family-friendly policies for all United Nations staff. We are committed to achieving, inter-alia, paid parental leave for all parents regardless of gender, including parents who adopt, foster, or have children through surrogacy or assisted reproductive technology; flexible working arrangements for parents; designated private rooms and appropriate breaks for nursing and pumping; and child-care support for parents with young children.

We encourage the 89th session of the International Civil Service Commission to endorse these policies for the well-being of all UN staff and their families because:

It is the right thing to do:
Family-friendly policies support staff to balance their work and family responsibilities so one need not be chosen over the other. They help reduce the stress and conflict that can arise among families struggling to manage competing work obligations with family demands. They enable bonding between parents and their children, providing a foundation for individual success, family cohesion, and stronger, more sustainable societies.

It is the equitable thing to do:
The United Nations is committed to gender parity for its staff, at all levels, everywhere, as well as to gender equality as a global goal and prerequisite for sustainable development. Companies such as Google, Accenture, and Aetna have reported a significant decrease in employment attrition rates among female employees when effective family-friendly policies are in place. Evidence show that when such policies support greater paternal involvement in child rearing, this is beneficial to children’s social, emotional and cognitive growth, and decreases gender-stereotyping. Additionally, studies show that “the motherhood penalty” – discrimination against mothers in the form of lower likelihood of hiring or promotion, lower salaries, and lower perceived competence and commitment – diminishes in terms of career trajectory in organizations where both parents receive equitable leave.

It is the smart thing to do:
Family-friendly policies are irrefutably linked to better workforce productivity and the ability to attract, motivate, and retain employees. Additionally, by unifying child care and parental leave provisions across United Nations agencies, we not only can streamline human resource systems, inter-agency coordination and career mobility opportunities, but also set good practice standards that support a United Nations-wide enabling environment for high employee morale, job satisfaction and productivity.

It is the healthy thing to do:
Parents in Bangladesh have reported greater productivity and lower absenteeism because of nursing programmes in the workplace, as children were sick less often and parents took less time off as a result. Studies show better development outcomes as well as learning and cognitive improvements for children whose fathers take paternity leave.

We recognize the important consultative efforts of members of formal and informal staff groups from our United Nations agencies who are in support of this statement, including UN Globe who released their Guiding Principles and Proposals on an Inclusive Parental Leave Policy, and advocated for these changes in 2015, UN Feminist Network, UNDP Parents Association, staff associations of all UN agencies through Coordinating Committee for International Staff Unions and Associations, UNICEF Gender Push group, and UNICEF #EarlyMomentsMatter campaign.

It is further supported by UN Women’s Goodwill Ambassador Anne Hathaway who addressed the ICSC on this subject, noting that strong, gender-neutral parental leave policies and child care services for staff are critical to the UN’s role as a standard setter and promoter of equality.

We also rely on the strategic guidance and support from our respective governing bodies in pursuing these goals.

We commit to reviewing our policies to ensure they reflect best practice and consistency across our agencies, including in the following areas and with a focus on exploring options for:
:: Increasing the duration of parental leave (up to 24 weeks) to ensure that all parents have equal rights and adequate time to bond with a child;
:: Official designated nursing and pumping rooms and regular breaks;
:: Child-care support for parents with young children, and
:: Equal treatment and respect for all methods of becoming a parent.

Since its founding, the United Nations has advocated for social and economic empowerment, gender equality, and children’s positive development all over the world. As the global champion for human rights, equity and dignity, we consider it our duty to support the women and men who work every day to make these aspirations a reality. We jointly commit to ‘walk the talk’ for our staff, setting the standards of inclusivity, diversity, and flexibility, that we would want to see in a truly gender equal world, ready to accomplish the aims of the 2030 Agenda for Sustainable Development.

SIGNED BY:
Achim Steiner, UNDP
Natalia Kanem, UNFPA
Henrietta H. Fore, UNICEF
Phumzile Mlambo-Ngcuka, UN Women

Project Anqa Final report
International Council on Monuments and Sites (ICOMOS)
Written on 24 May 2019.
ICOMOS is releasing its final report on Project Anqa which seeks to preserve endangered cultural heritage sites in Syria through their digitalization using state of the art technology, build capacity in the region, promote the transfer of knowledge and create permanent architectural inventory units.

The project resulted in the creation of a web platform which includes virtual tours of 7 endangered heritage sites along with comprehensive data on the sites.

Project Anqa which means “phoenix” in Arabic is a joint initiative of ICOMOS, the non-profit organization CyArk, the Carleton University Immersive Media Studio and Yale University’s Institute for the Preservation of Cultural Heritage (IPCH).
The project began in 2015 in response to the catastrophic loss of cultural heritage in the Middle East and is funded by the Arcadia Fund, a UK grant-making fund whose mission is to protect endangered culture and nature.

The project started in Syria, in partnership with the Directorate General of Antiquities and Museums (DGAM), and has documented seven sites located in Damascus that illustrate the architectural variety of historic buildings in the ancient city.

CONCLUSION:
Although Project Anqa’s partners faced challenges to overcome, the project still successfully reached its goal of creating an online web platform with 3D scans and comprehensive data in open access on built heritage at risk in Syria. Teams from different countries effectively worked together, and the training allowed to build capacity in the region. With the exposure the project has received, it will hopefully serve as an example to inspire future similar projects that seek to preserve endangered cultural heritage.

Heritage Stewardship

The continued and lasting legacy of Peru
May 28, 2019 – Gordon and Betty Moore Foundation Press Release
As Peru approaches its independence bicentennial in 2021, it does so on a wave of economic prosperity that has transformed the nation. The poverty rate has fallen dramatically, from 52.2 percent in 2005 to 26.1 percent in 2013 — but at the same time, threats to protected areas have risen sharply.

Today, illegal resource extraction and poorly planned infrastructure projects endanger the wild areas that make Peru one of the world’s “megadiverse” countries – 17 nations which comprise 70 percent of the planet’s total biodiversity. Peru ranks first in the world for its diversity of butterflies and fish, second for its species of birds, fourth for its amphibians and fifth for its mammals. Between human-induced pressures and a changing climate, the vast wild places of Peru face unprecedented risks. To ensure that these national natural treasures are protected for the next 200 years and beyond, long-term funding and management are critical.

This starts with making sure that Peru’s National Parks — from the spectacular rainforests of Manu to the glaciers and milky blue lagoons of Huascarán — have the institutional resources and management capacity in place to ensure sustainability. Patrimonio Natural del Perú, or “National Parks: Peru’s Natural Legacy,” is a government-led “Project Finance for Permanence” initiative, kickstarted in 2014 at the World Parks Congress, that aims to establish a system of financial sustainability for Peru’s National Parks, starting with the country’s verdant heart, the Peruvian Amazon. On the ground, this will translate into more and better supported staff, better equipment and improved protection protocols.
Now, after years of work and collaboration, the Amazon portion of Patrimonio del Peru is “closed.” This means that the funding goal of $140 million needed to expand and manage 41.6 million acres in the Peruvian Amazon has been met, along with other closing conditions designed to secure the success of this initiative.

“I believe that the protection of our natural resources is vital for the needs we will have in the future,” says Pedro Gamboa Moquillaza, who leads Peru’s National Park Service. “If we don’t work together, the only thing that we are destined to have soon is a nation poor in natural resources.” Institutional partners leading the collaboration include the Peruvian National Park Service, Ministry of Environment, President of Peru, Peruvian Environmental Law Society and World Wildlife Fund who have joined with funders — the Government of Peru, the Peruvian Trust Fund for National Parks and Protected Areas (PROFONANPE), World Wildlife Fund, Amazon Andes Fund, the Global Environment Facility and Moore — to deliver on the promise of Peru’s Legacy…

Featured Journal Content

The Lancet Child & Adolescent Health
Jun 2019 Volume 3Number 6p365-436, e4
https://www.thelancet.com/journals/lanchi/issue/current
Editorial
Partnership between health and education in early childhood
The Lancet Child & Adolescent Health
While primary school enrolment rate in developing regions reached 91% at the end of the Millennium Development Goal era, 60% of children and adolescents worldwide (617 million) are not achieving basic proficiency in reading and mathematics expected of their school year. One reason for this disappointing outcome is that many young children are not developmentally on track at the time they enter primary school because of scarce investment in preschool education, according to UNICEF in their latest report, A World Ready to Learn.

UNICEF’s analysis found that “attending an early childhood education programme is one of the strongest predictors for supporting a child’s readiness for school, regardless of household or national income level”. Evidence shows that positive stimulation in early childhood affects brain development and the neurobiological pathways that underlie functional development. Quality preschool education supports a child’s cognitive, physical, social, and emotional development, providing a safe and nurturing environment for young children to learn and interact with their peers. It can also ameliorate some of the vulnerability stemming from early adversity such as poverty, and offer a powerful opportunity to break intergenerational cycles of inequity in future health, academic, and economic outcomes.

Despite the well recognised importance of investment in these formative years, only half of the world’s preschool-aged children are enrolled in pre-primary education (from age 3 years up to the start of primary education, often age 6 years). In low-income countries, only two in ten have this privilege, and barriers are even higher for marginalised groups (eg, indigenous populations, rural communities, and children with disabilities). Given the current situation, UNICEF warns that a “business as usual” approach will not reach the target of universal, quality pre-primary education in Sustainable Development Goal (SDG) 4.2.

This target is achievable, but only if there is a substantial increase in investment alongside strong political commitment. Globally, 38% of countries, most of which are low and lower-middle income, invest less than 2% of their education budgets in pre-primary education—a huge gap from the 10% recommended internationally. Distribution of these scarce resources highly favours the wealthy within these countries. The shortfall in funding is also apparent at the donor level, with less than 1% of international aid for education being allocated to the preschool years. Even among upper-middle-income and high-income countries, nearly a third will need to accelerate their progress to be on track for 2030.

Early childhood education needs to be prioritised and recognised as a core strategy for strengthening a country’s education system and population health. To accelerate progress towards multiple SDGs, the synergy between the health and education sectors—alongside nutrition, child protection, and social protection—should be leveraged. Such intersectoral collaboration is crucial to ensure that every child receives the nurturing care that will allow them to reach their full developmental potential. Building on the foundations of quality antenatal care, child health professionals, community workers, and early-years practitioners can support responsive parenting, conduct regular health and developmental milestone checks, and deliver nutritional and other interventions as necessary. Preschools provide an important setting for deworming, vaccination, early identification of developmental disorders, and other health screening and interventions; distributing nutritious meals; and establishing lifelong healthy habits such as handwashing and personal hygiene.

Equity and quality must be at the heart of such a multisectoral response. The most disadvantaged children must be considered at the start—not as an afterthought. UNICEF recommends that resource-constrained countries should start with providing one year of universal free pre-primary education, before expanding to include additional years. Quality should be upheld with clear standards, indicators, and expenditure tracking. Capacity building through training more qualified teachers is needed to progressively reach the recommended ratio of no more than 20 children per teacher.

Education and health are integral to human capital development. Given their synergy, the two sectors should forge deeper partnerships to accelerate progress towards the ambitious, but not unreachable, SDGs. The period between the first 1000 days of life and the start of primary school is an important window of opportunity for nurturing care that should not be overlooked. Sustainable investment in the preschool years is the foundation of future population health, prosperity, and social equality—and must be prioritised.

Featured Journal Content

Bulletin of the World Health Organization
Volume 97, Number 6, June 2019, 377-440
https://www.who.int/bulletin/volumes/97/6/en/

EDITORIALS
Health systems research in fragile settings
— Alastair Ager, Shadi Saleh, Haja Wurie & Sophie Witter
http://dx.doi.org/10.2471/BLT.19.233965
Population health indicators have improved in recent decades. Deaths in children younger than five years have declined from over 16 million in 1970 to around 5 million in 20161 and life expectancy at birth has increased from 58 to over 70 years in the same period.2

However, a major constraint to such progress, and in some contexts a potential source of reversal, is fragility. Of the 10 countries with the highest rates of infant mortality, seven are classified as fragile states. Of the 20 countries with the weakest progress on reducing maternal mortality from 1990 to 2015, 14 were fragile.3 However, fragility is increasingly recognized as a phenomenon that is not limited to countries that meet the profile of fragile and conflict-affected states.4 Of those countries that currently meet the Organisation for Economic Cooperation and Development criteria of experiencing significant fragility, comprising political, societal, economic, environmental and security dimensions of instability, almost half are middle-income countries.5

A better understanding of the implications of health-care provision in contexts of fragility is necessary. We have, therefore, established a research unit on health in situations of fragility at Queen Margaret University, Edinburgh, Scotland. This unit is supported by the National Institute for Health Research and builds on the experiences of several institutions in post-conflict health reconstruction strategy, recovery from the Ebola virus disease outbreak in West Africa and response to political instability in the Eastern Mediterranean Region. In our analysis of how the concept of fragility is used in the global health literature, we found that fragility is most often used to describe the circumstances of states or their public health systems; however, it also increasingly addresses the relationship with communities. Where the state’s agenda and communities’ needs are poorly aligned, the strained or ruptured relationship between the two has direct implications for health.

Understanding the weaknesses of health systems and how systems strengthening strategies may address these weaknesses must remain a core component of any approach to secure improvements in population health. However, in contexts of fragility, a key focus is needed on threats to the interface between public health provision and community processes. This exercise inevitably requires a systems for health approach6 that sees community, civil society, private sector actors and the state as key agents within a complex system adjusting to the prevailing drivers of fragility.

Earlier work on health systems resilience in contexts of fragility7,8 repeatedly pointed to the importance of this interface with communities. We are now exploring this further in three countries: El Salvador, Lebanon and Sierra Leone. In each setting, our focus is on the prevention and treatment of noncommunicable diseases and mental health and psychosocial support. Providing a response to these health needs requires an effective connection over time between diverse service providers, patients, carers and communities.

Scoping reviews in each of these fragile settings have identified recurrent challenges at this interface. When fragile settings experience acute shocks, there is a risk that the surge of local provision supported by international agencies will not strengthen health systems in the long-term. Lack of knowledge of available services, uncertain or restricted access, financial barriers or perceptions of health-care settings not constituting a safe place are also repeatedly identified across fragile settings at the community-service interface.9

Participatory group model building10 is a promising method for exploring the connections between the various actors of the systems for health in these fragile settings, and for identifying potential strategies to make these actors’ engagement more effective. Policy-level and health systems interventions are clearly relevant, but it is at the interface of public health provision and community processes that major barriers persist.

Mapping of social connection and trust11 can also clarify key processes supporting or inhibiting engagement within and between communities and health services in contexts of fragility.
We plan to develop a series of studies of strategic interventions designed to secure high-quality and accessible service provision in contexts of fragility. Therefore, we encourage other researchers to engage in this framing of strategic health interventions in such settings. The core goal must be achieving forms of service design and community engagement that prove durable and effective in circumstances of fragility. To the extent that these strategies are effective in building trust and social connection between (and within) the state and local communities, they may also prove of value in addressing the drivers of fragility itself.12

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Research
Comparison of essential medicines lists in 137 countries
— Nav Persaud, Maggie Jiang, Roha Shaikh, Anjli Bali, Efosa Oronsaye, Hannah Woods, Gregory Drozdzal, Yathavan Rajakulasingam, Darshanand Maraj, Sapna Wadhawan, Norman Umali, Ri Wang, Marcy McCall, Jeffrey K Aronson, Annette Plüddemann, Lorenzo Moja, Nicola Magrini & Carl Heneghan
http://dx.doi.org/10.2471/BLT.18.222448
Abstract
Objective
To compare the medicines included in national essential medicines lists with the World Health Organization’s (WHO’s) Model list of essential medicines, and assess the extent to which countries’ characteristics, such as WHO region, size and health care expenditure, account for the differences.
Methods
We searched the WHO’s Essential Medicines and Health Products Information Portal for national essential medicines lists. We compared each national list of essential medicines with both the 2017 WHO model list and other national lists. We used linear regression to determine whether differences were dependent on WHO Region, population size, life expectancy, infant mortality, gross domestic product and health-care expenditure.
Findings
We identified 137 national lists of essential medicines that collectively included 2068 unique medicines. Each national list contained between 44 and 983 medicines (median 310: interquartile range, IQR: 269 to 422). The number of differences between each country’s essential medicines list and WHO’s model list ranged from 93 to 815 (median: 296; IQR: 265 to 381). Linear regression showed that only WHO region and health-care expenditure were significantly associated with the number of differences
Conclusion
The substantial differences between national lists of essential medicines are only partly explained by differences in country characteristics and thus may not be related to different priority needs. This information helps to identify opportunities to improve essential medicines lists

World Health Assembly Update, 27 May 2019
27 May 2019 WHO News release
Member States have agreed a five-year global action plan to promote the health of refugees and migrants. The plan focuses on achieving universal health coverage – and the highest attainable standard of health – for refugees and migrants and for host populations.

The plan includes short and long-term steps to mainstream refugee and migrant health care; enhance partnerships; strengthen health monitoring and information systems and counter misperceptions about migrant and refugee health.

Member States are requesting that the Director-General report back on progress at the 74th World Health Assembly. Reports to the 74th and 76th World Health Assemblies will also include information provided by Member States on a voluntary basis, and UN agencies as appropriate.

Globally, the number of international migrants has grown. During the period 2000–2017, the total number of international migrants rose from 173 million to 258 million, an increase of 49%. The number of forcibly displaced people, 68.5 million, is also the highest ever, and includes 25.4 million refugees. Ten million stateless people lack a nationality and access to basic rights such as education, health care, employment and freedom of movement.

DRC – Ebola/Cholera/Measles

Major cholera vaccination campaign begins in North Kivu in the Democratic Republic of the Congo
Agencies warn of unprecedented situation in the DRC as cholera and measles epidemics compound Ebola challenges
Geneva / Goma 27 May 2019 – More than 800,000 people will be immunised against cholera in North Kivu in the Eastern part of the Democratic Republic of the Congo (DRC) following the launch of a major vaccination campaign today.

The campaign will be implemented by the DRC Ministry of Health with support from the World Health Organization (WHO) and partners, and funded by Gavi, the Vaccine Alliance. A total of 835,183 people in Binza, Goma, Kayina, Karisimbi, Kibirizi, Kirotshe and Rutshuru areas will be vaccinated by 1 June 2019. The campaign will administer the first of two doses of oral cholera vaccine (OCV) to people in these areas. Following successful implementation, a campaign to administer the second dose will take place at a later stage to provide full protection against cholera.

Over 10,000 cases of cholera have been reported in the country since January 2019, leading to more than 240 deaths. In addition, over 80,000 suspected cases of measles have led to over 1,400 deaths so far this year while a case of circulating vaccine-derived poliovirus type 2 was reported in Kasai province earlier this month.

“The DRC is confronted with an unprecedented combination of deadly epidemics,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “While the Ebola outbreak continues to cause untold misery in the East, measles and cholera epidemics are claiming the lives of thousands of people throughout the country. That’s why we are stepping up our response, through this cholera vaccination campaign, through ongoing measles vaccinations in health zones affected by measles outbreaks, as well as through our continued support for Ebola vaccinations in both the DRC and neighbouring countries. We cannot allow this needless suffering to continue.”…

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 15 May 2019
:: Health leaders at the World Health Assembly last week in Geneva, Switzerland, welcomed the new Polio Endgame Strategy 2019-2023, and acknowledged that while a lot had been accomplished, more efforts were needed in order to achieve a lasting polio-free world by 2023.

:: Following the group’s meeting earlier this month, the latest report of the International Health Regulations (IHR) Emergency Committee is available.  The Committee evaluated the latest global poliovirus epidemiology and concluded that the effort to eradicate polio remained a Public Health Emergency of International Concern (PHEIC).  More.

:: In Cameroon, a circulating vaccine-derived poliovirus type 2 (cVDPV2) was detected from an environmental sample collected on 20 April 2019 in Extreme Nord.  The virus was detected in an environmental sample only – no associated cases of paralysis have been detected.

Summary of new viruses this week:
:: Pakistan – two wild poliovirus type 1 (WPV1) cases and six WPV1-positive environmental samples;
:: Afghanistan – one WPV1-positive environmental sample; Nigeria – two circulating vaccine-derived poliovirus type 2 (cVDPV2)-positive environmental samples;
:: Somalia – one cVDPV2 case;
:: Cameroon – one cVDPV2-positive environmental sample; and, Iran – one WPV1-positive environmental sample.

Polio: Statement of the Twenty-first IHR Emergency Committee
Regarding the International Spread of Poliovirus
29 May 2019 Statement Geneva
The twenty-first meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director-General on 14 May 2019 at WHO headquarters with members, advisers and invited Member States attending via teleconference, supported by the WHO secretariat.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties provided an update on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 19 February 2019: Afghanistan, DR Congo, Indonesia, Nigeria, Pakistan and Somalia.

The committee commended all countries that presented on the quality of information provided, and the transparency with which countries discussed their challenges.

Wild poliovirus
The Committee is gravely concerned by the significant further increase in WPV1 cases globally in 2019, particularly in Pakistan where 15 cases have already been reported. In Pakistan transmission continues to be widespread, as indicated by the number of positive environmental isolates in many areas of the country, and the proportion of samples that detect WPV1 is rising. The recent cluster of cases in Lahore also indicates that vulnerabilities still exist outside the high-risk corridors. Notably, the increased rate of infection during what is usually the low season may herald even higher rates of infection in the coming high season unless urgent remedial steps are taken. The committee was very concerned about attacks on vaccinators and on the police protecting them. The increasing refusal by individuals and communities to accept vaccination also needs to be actively addressed. While the committee understood that the recent elections and political transition may have adversely affected delivery of the polio program, it is now essential that the new government renews its efforts, noting that the eradication program in the country is no longer on-track.

Highlighting these concerns, the committee noted the recent detection of WPV1 in sewage in Iran in an area close to the international border with Pakistan. Based on genetic sequencing, the virus is most closely linked to viruses found recently in Karachi, Pakistan. While there is no evidence currently that transmission has occurred in Iran and routine immunization coverage is high there, this finding together with the resumption of WPV1 international spread between Pakistan and Afghanistan suggests that rising transmission in Pakistan correlates with increasing risk of WPV1 exportation beyond the single epidemiological block formed by the two countries. The Iran event is the first such exportation detected since 2014 and signals that the hard fought gains of recent years can easily be reversed…

Vaccine derived poliovirus 
The multiple cVDPV2 outbreaks on the continent of Africa are as concerning as the WPV1 situation in Asia. The emergence of new strains of cVDPV2 in areas where mOPV2 has been used, the recent spread of cVDPV2 into southern Nigeria, including the densely populated Lagos region, and evidence of missed transmission in Nigeria and Somalia suggests that the situation continues to deteriorate. Insufficient coverage with IPV exacerbates the growing vulnerability on the continent to cVDPV2 transmission. Early detection of any international spread from the five currently infected countries and prioritized use of mOPV2 is essential to mitigate further depletion of the limited mOPV2 supply. Repeatedly, cases have occurred in border districts (in Nigeria, close to Benin, in DR Congo close to Angola, in Somalia, close to Ethiopia, and in Mozambique, close to Malawi)…

Conclusion
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:

Rising risk of WPV1 international spread: The progress made in recent years appears to be reversing, with the committee’s assessed risk of international spread the highest since 2014 when the PHEIC was declared. This risk assessment is based on the following:
:: the first WPV1 exportation outside of the single epidemiological block of Afghanistan and Pakistan since 2014;
:: rising number of WPV1 cases in Pakistan;
:: rising proportion of environmental samples that are positive for WPV1 in Afghanistan and Pakistan;
:: widespread detection of WPV1 in Pakistan in environmental samples;
:: clusters of cases in areas not considered high risk such as Lahore;
:: the fact that all of these observations have been made during the part of the year normally considered as low transmission season;
:: increasing community and individual resistance to the polio program.

Rising risk of cVDPV spread: The newly emerged strains of cVDPV2 in Nigeria and DR Congo, and the increased number of infected states / provinces in these two countries, together with evidence of missed transmission in Nigeria, Somalia and Indonesia also suggests the risk of international spread of cVDPV, especially type 2, is rising.

Falling PV2 immunity: Global population immunity to type 2 polioviruses (PV2) continues to fall, as the cohort of children born after OPV2 withdrawal grows, exacerbated by poor coverage with IPV particularly in some of the cVDPV infected countries. Protracted outbreaks: The difficulty in rapidly controlling cVDPV outbreaks in Nigeria and DR Congo is another risk.

Weak routine immunization: Many countries have weak immunization systems that can be further impacted by various humanitarian emergencies, and the number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies poses a growing risk, leaving populations in these fragile states vulnerable to outbreaks of polio.

Surveillance gaps: The appearance of highly diverged VDPVs in Somalia and Indonesia are examples of inadequate polio surveillance, heightening concerns that transmission could be missed in various countries. Similar gaps exist in Lake Chad countries and around the Horn of Africa.

Lack of access: Inaccessibility continues to be a major risk, particularly in several countries currently infected with WPV or cVDPV, i.e. Afghanistan, Nigeria, Niger, Somalia and Papua, Indonesia, which all have sizable populations that have been unreached with polio vaccine for prolonged periods.

Population movement: The risk is amplified by population movement, whether for family, social, economic or cultural reasons, or in the context of populations displaced by insecurity and returning refugees. There is a need for international coordination to address these risks. A regional approach and strong cross-border cooperation is required to respond to these risks, as much international spread of polio occurs over land borders….

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

WHO Grade 3 Emergencies [to 1 Jun 2019]

Democratic Republic of the Congo
:: Major cholera vaccination campaign begins in North Kivu in the Democratic Republic of the Congo 27 May 2019
:: 43: Situation report on the Ebola outbreak in North Kivu 28 May2019
:: Disease Outbreak News (DONs) Ebola virus disease – Democratic Republic of the Congo
30 May 2019
[See Ebola DRC above for detail]

South Sudan
:: In South Sudan, grandmothers breastfeed malnourished grandchildren 28 May 2019
:: The Government of Japan and WHO donate six ambulances to boost health service delivery in South Sudan 28 May 2019

Yemen
:: Donations from Saudi Arabia and United Arab Emirates provide access to health care for millions in Yemen
27 May 2019, Aden/Sana’a — The World Health Organization (WHO) expressed its gratitude to Saudi Arabia and United Arab Emirates for a grant of US$ 20 million, which will support ongoing efforts to stop the spread of cholera in Yemen…

Bangladesh – Rohingya crisis – No new digest announcements identified
Mozambique floods – No new digest announcements identified
Myanmar – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified

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WHO Grade 2 Emergencies [to 1 Jun 2019]

Libya
:: Photo essay: WHO emergency teams at work in Libya 26 May 2019

occupied Palestinian territory
:: The Gaza trauma response: One-year analysis of trauma injuries in Gaza 29 May 2019
:: Overcoming barriers to health care access in the West Bank with mobile clinics 27 May 2019

Brazil (in Portugese) – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Cyclone Idai – No new digest announcements identified
Ethiopia – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Malawi floods – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 1 Jun 2019]

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018 – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syria: Situation Report 3: Recent Developments in Northwestern Syria (as of 31 May 2019)
HIGHLIGHTS
:: Over the past week, airstrikes, shelling and ground fighting intensified across the demilitarized zone in northwest Syria, exacerbating the impact of the conflict on civilians, civilian infrastructure, and humanitarian service provision in northern Hama, southern Idleb, and western Aleppo governorates.
:: Almost 270,000 displacements from northern Hama and southern Idleb governorates were recorded between 1 and 22 May.
:: A total of 24 health facilities, 35 schools, four facilities providing protection services, three IDP settlements, and one refugee camp were reportedly affected by hostilities in recent weeks…

:: Syria: Humanitarian Response in Al Hol camp, Situation Report No. 4 – As of 29 May 2019 [EN/AR]

Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
CYCLONE IDAI and Kenneth – No new digest announcements identified

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