Lancet Editorial :: Editorial Living in detention: a matter of health justice

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Lancet Public Health
Feb 2020 Volume 5 Number 2 e71-e126
Living in detention: a matter of health justice
The Lancet Public Health
About 11 million people are currently being held in custody across the globe and more than 30 million individuals pass through prisons each year, often for short but disruptive periods of time. According to the UN Global Study on Children Deprived of Liberty, 1·3 million children globally are deprived of liberty each year, with an estimated 410 000 living within the administration of justice. The health profile of the detained population is complex, often with co-occurring physical and mental health disorders, and a backdrop of social disadvantage. Detention can also expose people to new and increased health risks, yet the profiles of the population behind bars and their health needs have often been neglected. In this issue of The Lancet Public Health a series of reports look at detention through a public health lens.

Rohan Borschmann and colleagues review the health of adolescents in detention and report that they have poor health across a broad range of domains. Young people detained have a substantially higher prevalence of mental health disorders, suicidal behaviours, and self-harm than their peers, along with substance use disorders, neurodevelopment disabilities, and sexually transmitted infections. In a companion paper published in The Lancet Child and Adolescent Health, Nathan Hugues and colleagues examined the determinants of adolescent criminalisation. Neurodevelopmental disabilities, poor mental health, and childhood trauma and adversity can increase the risk of contact with the criminal justice system, and such risk is exacerbated by societal marginalisation and inequality. For Lauren Brinkley-Rubinstein and colleagues, the carceral contexts that young people are exposed to are most probably causing irrevocable harm to their health and wellbeing and, as such, the detention of children and adolescents should be used as a last resort.

While in detention, individuals are deprived of their freedom, not of their right to health. The WHO report on prison health in the European Region, stresses how much people involved in the criminal justice system disproportionately experience complex health issues, and continue to do so after release. Mortality among people released from prison exceeds that of those in the community, often due to preventable causes such as suicide, injury, and overdose.

Concerns have been raised about solitary confinement, which has been associated with post-traumatic stress disorders after release and with increased risk of reincarceration. In this issue, Christopher Wildeman and Lars Andersen look at the association between solitary confinement and mortality after release, and report that mortality among formerly incarcerated individuals who were placed in solitary confinement was much higher than for those not exposed, and almost 10 times that in the general population. These findings raise serious questions about how compatible solitary confinement is with the duty of care owed by prison authorities.

Angus Wallace, in his comment, sheds some light on the powerful lever that can be the European Court of Human Rights to improve the health of prison populations—mainly through Article 3 of the European Convention on Human Rights: the prohibition of torture and inhuman or degrading treatment or punishment.

Most people who are incarcerated will return to the community and so addressing their health needs can not only improve the wellbeing of the individual, but also impact that of their families and communities. For WHO “the health of people in prison is a critical part of broader public health.” Prison need not be a place where individuals’ health and wellbeing deteriorate. Time in detention can provide access to health services for people who often faced substantial barriers to accessing health care in the community, and deliver health promotion, health education, and disease prevention interventions.

Those with responsibility for governing societies must find a balance between keeping communities safe (by excluding those judged dangerous to community interests) and protecting the fundamental rights of everyone in society (including those who are incarcerated). Yet the evidence presented in this issue aligns with the conclusion of Arash Anoshiravani’s piece—namely, that addressing the health needs of young people involved with the justice system requires no less than a “reimagining of paediatric and adolescent primary care”. A radical transformation of attitudes and practices in favour of people living in detention is necessary, and public health institutions and practitioners represent a trusted frontline within which lie the origins of this urgent and necessary social change.


Scoping Review
The health of adolescents in detention: a global scoping review
Rohan Borschmann, et al
Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0–95%), substance use disorders (22–96%), self-harm (12–65%), neurodevelopmental disabilities (2–47%), infectious diseases (0–34%), and sexual and reproductive conditions (pregnant by age 19 years 20–37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people.

Veridical data science

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PNAS – Proceedings of the National Academy of Sciences of the United States of America
Inaugural Article
Veridical data science
Bin Yu and Karl Kumbier
PNAS first published February 13, 2020.
Predictability, computability, and stability (PCS) are three core principles of data science. They embed the scientific principles of prediction and replication in data-driven decision making while recognizing the central role of computation. Based on these principles, we propose the PCS framework, including workflow and documentation (in R Markdown or Jupyter Notebook). The PCS framework aims at responsible, reliable, reproducible, and transparent analysis across fields of science, social science, engineering, business, and government. It can be used as a recommendation system for scientific hypothesis generation and experimental design. In particular, we propose (basic) PCS inference for reliability measures on data results, extending statistical inference to a much broader scope as current data science practice entails.
Building and expanding on principles of statistics, machine learning, and scientific inquiry, we propose the predictability, computability, and stability (PCS) framework for veridical data science. Our framework, composed of both a workflow and documentation, aims to provide responsible, reliable, reproducible, and transparent results across the data science life cycle. The PCS workflow uses predictability as a reality check and considers the importance of computation in data collection/storage and algorithm design. It augments predictability and computability with an overarching stability principle. Stability expands on statistical uncertainty considerations to assess how human judgment calls impact data results through data and model/algorithm perturbations. As part of the PCS workflow, we develop PCS inference procedures, namely PCS perturbation intervals and PCS hypothesis testing, to investigate the stability of data results relative to problem formulation, data cleaning, modeling decisions, and interpretations. We illustrate PCS inference through neuroscience and genomics projects of our own and others. Moreover, we demonstrate its favorable performance over existing methods in terms of receiver operating characteristic (ROC) curves in high-dimensional, sparse linear model simulations, including a wide range of misspecified models. Finally, we propose PCS documentation based on R Markdown or Jupyter Notebook, with publicly available, reproducible codes and narratives to back up human choices made throughout an analysis. The PCS workflow and documentation are demonstrated in a genomics case study available on Zenodo.

The Prioritization of Island Nations as Refuges from Extreme Pandemics

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Risk Analysis
Volume 40, Issue 2 Pages: 215-438 February 2020
Original Research Articles
The Prioritization of Island Nations as Refuges from Extreme Pandemics
Matt Boyd, Nick Wilson
Pages: 227-239
First Published: 23 September 2019
In this conceptual article with illustrative data, we suggest that it is useful to rank island nations as potential refuges for ensuring long‐term human survival in the face of catastrophic pandemics (or other relevant existential threats). Prioritization could identify the several island nations that are most suitable for targeting social and political preparations and further investment in resiliency. We outline a prioritization methodology and as an initial demonstration, we then provide example rankings by considering 20 sovereign island states (all with populations greater than 250,000 and no land borders). Results describe each nation in nine resilience‐relevant domains covering location, population, resources, and society according to published data.



Editor’s Note:
While we have concentrated key reports below, COVID-19 announcements, analysis and commentary will be found throughout this issue, in all sections.

Coronavirus [COVID-19]
Public Health Emergency of International Concern (PHEIC)

Situation report – 25
Novel Coronavirus (COVID-19)
14 February 2020
Globally :: 49,053 laboratory-confirmed [2056 new]
China :: 48,548 laboratory-confirmed [1998 new]
:: 1,381 deaths [121 new]
Outside of China
:: 505 laboratory-confirmed [58 new]
:: 24 countries
:: 2 deaths [1 new]

China – Very High
Regional Level – High
Global Level – High

:: No new countries reported cases of 2019-nCoV in the past 24 hours.
:: The second death has been reported outside of China, in Japan. This individual did not have known travel history to China.
:: In China, health care workers account for 1716 confirmed cases of COVID-19 including six deaths.

WHO’s strategic objectives for this response are to:
:: Limit human-to-human transmission including reducing secondary infections among close contacts and health care workers, preventing transmission amplification events, and preventing further international spread from China*;
:: Identify, isolate and care for patients early, including providing optimized care for infected patients;
:: Identify and reduce transmission from the animal source;
:: Address crucial unknowns regarding clinical severity, extent of transmission and infection, treatment options, and accelerate the development of diagnostics, therapeutics and vaccines;
:: Communicate critical risk and event information to all communities and counter misinformation;
:: Minimize social and economic impact through multisectoral partnerships.

*This can be achieved through a combination of public health measures, such as rapid identification, diagnosis and management of the cases, identification and follow up of the contacts, infection prevention and control in health care settings, implementation of health measures for travelers, awareness-raising in the population and risk communication.


National Health Commission of the People’s Republic of China
:: Daily briefing on novel coronavirus cases in China
Updated: 2020-02-15
…As of 24:00 on Feb 14, the National Health Commission had received 66,492 reports of confirmed cases and 1,523 deaths in 31 provincial-level regions on the Chinese mainland and the Xinjiang Production and Construction Corps, and in all 8,096 patients had been cured and discharged from hospital. There still remained 56,873 confirmed cases (including 11,053 in serious condition) and 8,969 suspected cases. So far, 513,183 people have been identified as having had close contact with infected patients. 169,039 are now under medical observation…

China pushes for differentiated measures to battle coronavirus
Updated: 2020-02-14 Xinhua
Epidemic prevention and control in Hubei Province, particularly in the capital city of Wuhan, remain the top priority, said Premier Li Keqiang.
BEIJING, Feb. 13 (Xinhua) — Chinese authorities on Feb 13 stressed differentiated measures for different regions to fight the novel coronavirus outbreak at a high-level meeting chaired by Premier Li Keqiang.
The leading group of the Communist Party of China (CPC) Central Committee on the prevention and control of the novel coronavirus outbreak also demanded efforts to improve patient treatment and expedite research on drugs.
Epidemic prevention and control in Hubei Province, particularly in the capital city of Wuhan, remain the top priority, said the leading group headed by Li, who is also a member of the Standing Committee of the Political Bureau of the CPC Central Committee.
While ordering Wuhan to speed up hospital admission and suspected case quarantine, the leading group instructed hard-hit cities in Hubei such as Xiaogan and Huanggang to carry out equally strict measures as in Wuhan in surveillance, quarantine and treatment.
The demand for more medics in Hubei and Wuhan should be fulfilled, and the departure channels of the city and the province need further control, according to the meeting.
Multiple steps such as spacing out return trips have prevented large-scale flows of people after the Spring Festival, said the meeting.
Each province is responsible for formulating differentiated epidemic prevention and control strategies based on their own conditions, according to the meeting.
No one-size-fits-all approach should be taken and unfair and extreme practices must be corrected without delay, said the meeting…


New York Times
Accessed 15 Feb 2020
China’s Leader, Under Fire, Says He Led Coronavirus Fight Early On
In pushing a new account of the country’s response, officials said President Xi Jinping was aware of the outbreak nearly two weeks before he first spoke publicly about it. It could draw him directly into questions about whether Chinese officials did too little, too late.
By Amy Qin
Feb. 15, 2020
Under fire for its response to the coronavirus epidemic, China’s authoritarian government appears to be pushing a new account of events that presents President Xi Jinping as taking early action to fight the outbreak that has convulsed the country.

But in doing so, the authorities have acknowledged for the first time that Mr. Xi was aware of the epidemic and involved in the response nearly two weeks before he first spoke publicly about it — and while officials at its epicenter in the city of Wuhan were still playing down its dangers.
That confirmation risks drawing the president, China’s most powerful leader in decades, directly into questions about whether top officials did too little, too late.

In an internal speech published on Saturday, Mr. Xi said he had “issued demands about the efforts to prevent and control” the coronavirus on Jan. 7, during a meeting of the Politburo Standing Committee, the highest council of the Communist Party, whose sessions are typically cloaked in secrecy.

In the speech, he also said he had authorized the unprecedented lockdown of Wuhan and other cities beginning on Jan. 23.

“I have at every moment monitored the spread of the epidemic and progress in efforts to curtail it, constantly issuing oral orders and also instructions,” Mr. Xi said of his more recent involvement…


WHO News release 12 February 2020
World experts and funders set priorities for COVID-19 research
Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks.

The 2-day forum was convened in line with the WHO R&D Blueprint – a strategy for developing drugs and vaccines before epidemics, and accelerating research and development while they are occurring.

“This outbreak is a test of solidarity — political, financial and scientific. We need to come together to fight a common enemy that does not respect borders, ensure that we have the resources necessary to bring this outbreak to an end and bring our best science to the forefront to find shared answers to shared problems. Research is an integral part of the outbreak response,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I appreciate the positive response of the research community to join us at short notice and come up with concrete plans and commitment to work together.”

The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including:
:: the natural history of the virus, its transmission and diagnosis;
:: animal and environmental research on the origin of the virus, including management measures at the human-animal interface;
:: epidemiological studies;
:: clinical characterization and management of disease caused by the virus;
:: infection prevention and control, including best ways to protect health care workers;
:: research and development for candidate therapeutics and vaccines;
:: ethical considerations for research;
:: and integration of social sciences into the outbreak response.

“This meeting allowed us to identify the urgent priorities for research. As a group of funders we will continue to mobilize, coordinate and align our funding to enable the research needed to tackle this crisis and stop the outbreak, in partnership with WHO,” said Professor Yazdan Yazdanpanah, chair of GloPID-R. “Equitable access – making sure we share data and reach those most in need, in particular those in lower and middle-income countries, is fundamental to this work which must be guided by ethical considerations at all times.”

During the meeting, the more than 300 scientists and researchers participating both in person and virtually agreed on a set of global research priorities. They also outlined mechanisms for continuing scientific interactions and collaborations beyond the meeting which will be coordinated and facilitated by WHO. They worked with research funders to determine how necessary resources can be mobilized so that critical research can start immediately.

The deliberations will form the basis of a research and innovation roadmap charting all the research needed and this will be used by researchers and funders to accelerate the research response.

WHO News release 13 February 2020
Remarks by Dr Michael Ryan, Executive Director, WHO Health Emergencies Programme at media briefing on COVID-19 on 13 February 2020


Transcript for CDC Media Telebriefing: Update on COVID-19
Friday, February 14, 2020

FDA’s Actions in Response to 2019 Novel Coronavirus at Home and Abroad
Feb 14, 2020


The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
Week ending 8 February 2020 :: Number 304

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
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice

PDF: The Sentinel_ period ending 8 Feb 2020

:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: 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  [see PDF]

UN agencies raise alarm in the Central Sahel where millions face hunger amid rapidly escalating humanitarian crisis

Central Sahel

UN agencies raise alarm in the Central Sahel where millions face hunger amid rapidly escalating humanitarian crisis
Joint UNFAO, UNICEF and WFP press release
DAKAR, 3 February 2020 – The number of people facing a critical lack of food and vital livelihood opportunities in the Central Sahel has spiked in one year due to rising insecurity and climatic shocks. The situation may further deteriorate unless the international community acts now, three United Nations agencies warned today.

Despite an overall satisfactory agricultural production, 3.3 million people need immediate assistance in the Central Sahel, according to the latest Cadre Harmonisé food security analyses, the Food and Agriculture Organization of the United Nations (FAO), the United Nations Children’s Fund (UNICEF) and the United Nations World Food Programme (WFP) said. Experts forecast that close to 4.8 million people in the Central Sahel will be at risk of food insecurity during the lean season (June-August 2020) if no appropriate actions are taken urgently.

The unprecedented escalation of humanitarian needs in the Central Sahel is a major factor for the alarming situation that the overall West Africa region is facing in 2020, where the number of people at risk of food insecurity could rise up to a total 14.4 million, a level that has not been reached since 2012.

Of biggest concern are the Central Sahelian countries of Burkina Faso, Mali, and Niger, where conflict and its impacts on communities have become the main cause of food insecurity. The three countries are experiencing a rise in the number of security incidents, including attacks by armed groups and community conflicts that frequently lead to population movements.

In Burkina Faso in particular, the situation is alarming. The number of internally displaced people (IDPs) is now six times higher than it was in January 2019, going from 90,000 to 560,033 in December 2019. This shows how quickly and massively the situation deteriorated during in 2019.

“We are seeing a staggering rise in hunger in the central Sahel. The number of food-insecure people has doubled after harvest time when it should have dropped. Unless we act now, a whole generation are at risk,” said Chris Nikoi, Regional Director for WFP in West and Central Africa.

Climate change is disrupting already fragile livelihoods. There are already early departures of transhumance herds. This situation is exacerbated by armed and community conflicts, theft, and banditry, which disrupt the mobility of animal herds, access to fodder and water resources. It also leads to a concentration of animals in some more secure areas, with the risk of aggravating farmer-pastoralist conflicts.

Overall, the increasing vulnerability of rural populations, insecurity and conflict over resources, are disrupting social cohesion amongst communities, leading to a longer-term worsening of the crisis in the Sahel. Therefore, immediate assistance to respond to urgent needs must be coupled with substantial investments in rural livelihoods and social services, in order to reinforce social cohesion and provide the foundations for peace in the region.

“Unless we address these crises from their roots, millions of vulnerable pastoralists and agro-pastoralists will continue requiring urgent assistance each year, as it was in 2019 and as it will be in 2020,” said Robert Guei, FAO Sub-regional Coordinator for West Africa, adding that the Global Network against Food Crises provides framework for that support.

Thanks to collective efforts in providing essential preventive and curative services, the results of the 2019 national nutrition surveys in the Sahel do not show an immediate decline in children’s nutritional status. However, the situation remains fragile with rates of global acute malnutrition that are still above or close to the WHO “serious threshold” in Niger (10.9%), and Mali (9.4%). The situation is particularly worrying in northern Burkina Faso where widespread insecurity is significantly hindering the prevention and treatment of acute malnutrition among mothers and young children. Rapid nutrition assessments conducted in municipalities with high numbers of internally displaced people show a sharp deterioration of the nutritional status among children under five. More in-depth analysis involving both institutional and operational partners is ongoing to identify the most at-risk areas.

Household food insecurity, compounded by population displacement, limited access to health services and safe drinking water, as well as poor knowledge on optimal child feeding practices will have a serious impact on the nutritional status of young children, and on the capacities of communities to bounce back, if nothing is done now to protect the nutritional status of young children and prevent life-threatening acute malnutrition. Integrated approaches for the prevention and care of acute malnutrition must be implemented at scale immediately in the most affected areas.

“The conflict in the Central Sahel is a cascading crisis sweeping across the region, putting a whole generation of children at risk. Hundreds of thousands of children are deprived of education, vulnerable to exploitation and at risk of malnutrition. Children and young people continue to pay the highest price for a crisis not of their making. We need to act now with partners to avert a tragedy”, said Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa.

Unleashing Youth Power: A Decade of Accelerating Actions Towards Zero Female Genital Mutilation


Unleashing Youth Power: A Decade of Accelerating Actions Towards Zero Female Genital Mutilation
Joint statement by UNFPA Executive Director Dr. Natalia Kanem, UNICEF Executive Director Henrietta Fore, UN Women Executive Director Phumzile Mlambo-Ngcuka and WHO Director-General Dr. Tedros Adhanom Ghebreyesus
NEW YORK, 6 February 2020 – “When Tabitha was growing up in rural Kenya, most of her 16-year-old peers were subjected to female genital mutilation – a human rights violation that more than 4 million girls worldwide are at risk of this year. Yet Tabitha remains unharmed, thanks to the unwavering support of her parents, who, in spite of enormous social pressure, saved their daughter from the same fate.

“On the International Day of Zero Tolerance for Female Genital Mutilation, we join with Tabitha and young people around the world who are standing up for their rights with urgency and energy. They are engaging their peers, families, communities and governments with a call to end this harmful act of gender-based violence once and for all, as promised by the international community in the 2030 Agenda for Sustainable Development.

“While significant progress in eliminating the practice has been made in the last 30 years, approximately 200 million girls and women alive today have had their genitals mutilated. This can lead to long-term physical, psychological and social consequences.

“Support for the practice is dwindling. Adolescent girls aged 15 to 19 in countries where female genital mutilation is prevalent are less supportive of continuing the practice than are women aged 45 to 49. And in many countries, young girls are at much lower risk of being subjected to female genital mutilation than their mothers and grandmothers were. However, rapid youth population growth in countries where female genital mutilation is prevalent could lead to a significant rise in the number of girls at risk by 2030.

“Today’s young people can play a critical role in ending the practice. Unleashing the power of youth means investing in youth-led movements to champion gender equality, an end to violence against women and girls and the elimination of harmful practices. This requires including young people as partners when designing and implementing national action plans, building relationships with youth-led organizations and networks that work to end female genital mutilation and recognize it as a form of violence against women and girls, empowering young people to lead community campaigns that challenge social norms and myths, and engaging men and boys as allies.

“But this is not a goal young people can achieve alone, nor can it be addressed in isolation from other forms of violence against women and girls or from gender inequality. It also requires strong political leadership and commitment.

“Last year, at the Nairobi Summit on ICPD25, governments, civil society, faith-based organizations and private companies recommitted to ending gender-based violence and harmful practices – such as female genital mutilation – in 10 years, the same timeframe for achieving the Sustainable Development Goals. In March, we mark 25 years since the Beijing Platform for Action, a global commitment to advance women’s rights across 12 critical areas, including the elimination of all harmful practices against girls and women. This year, we will announce the creation of a new Generation Equality to drive further investment and results for gender equality.

“Now is the time to invest, translating the political commitments already made into concrete action. Now is the time to do more and do it better and faster to end the practice once and for all. Now is the time to keep our promise to Tabitha and all girls of reaching zero female genital mutilation by 2030.”


UNICEF Press release
Approximately 1 in 4 survivors of female genital mutilation were cut by a health care provider
Increased prevalence in medicalized FGM obscures global progress on eliminating support for the practice. Twice as many women in high-prevalence countries want the practice to end compared to 20 years ago… Read the full analysis here


6 February 2020
Secretary-General Calls for Decade of Zero Female Genital Mutilation, Calling Practice ‘Extreme Violence against Girls’, in Observance Message