JAMA Pediatrics
April 2016, Vol 170, No. 4
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint
What Pediatricians and Other Clinicians Should Know About Zika Virus FREE
Mark W. Kline, MD; Gordon E. Schutze, MD

Journal of Development Economics
Volume 120, Pages 1-224 (May 2016)
http://www.sciencedirect.com/science/journal/03043878/120

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Regular Articles
The value of children: Inter-generational support, fertility, and human capital
Original Research Article
Pages 1-16
Jaqueline Oliveira
Abstract
This paper offers robust empirical evidence of a Darwinian pro-natalist mechanism: parents can improve their old-age support with an additional child. Using the incidence of first-born twins as an instrument for fertility outcomes, I find that Chinese senior parents with more children receive more financial transfers and are more likely to co-reside with an adult child. They are also less likely to work past retirement age. The estimated effects are large, despite the evidence that adult children from larger families are less educated and earn significantly less. Interestingly, the effect of an increase in the number of children on old-age support does not depend on the child’s gender.

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Impact of Village Savings and Loan Associations: Evidence from a cluster randomized trial
Original Research Article
Pages 70-85
Christopher Ksoll, Helene Bie Lilleør, Jonas Helth Lønborg, Ole Dahl Rasmussen
Abstract
The vast majority of the world’s poor live in rural areas of developing countries with little access to financial services. Setting up Village Savings and Loan Associations (VSLAs) has become an increasingly widespread intervention aimed at improving local financial intermediation. Using a cluster randomized trial we investigate the impact of VSLAs in Northern Malawi over a two year period. We find evidence of positive and significant intention-to-treat effects on several outcomes, including the number of meals consumed per day, household expenditure as measured by the USAID Poverty Assessment Tool, and the number of rooms in the dwelling. This effect is linked to an increase in savings and credit obtained through the VSLAs, which has increased agricultural investments and income from small businesses.

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Airtime transfers and mobile communications: Evidence in the aftermath of natural disasters
Original Research Article
Pages 157-181
Joshua E. Blumenstock, Nathan Eagle, Marcel Fafchamps
Abstract
We provide empirical evidence that Rwandans use the mobile phone network to transfer airtime to those affected by unexpected shocks. Using an extensive dataset on mobile phone activity in Rwanda and exploiting the quasi-random timing and location of natural disasters, we show that individuals make transfers and calls to people affected by disasters. The magnitude of these transfers is small in absolute terms, but statistically significant; in response to the Lake Kivu earthquake of 2008, we estimate that roughly US$84 in airtime was transferred to individuals in the affected region, that 70% of these transfers were immediately used to make outgoing calls, and that US$16,959 was spent calling those near the epicenter. Unlike other forms of interpersonal transfers, mobile airtime is sent over large geographic distances and in response to covariate shocks. Transfers are more likely to be sent to wealthy individuals, and are sent predominantly between pairs of individuals with a strong history of reciprocal favor exchange.

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Witchcraft beliefs and the erosion of social capital: Evidence from Sub-Saharan Africa and beyond
Original Research Article
Pages 182-208
Boris Gershman
Abstract
This paper examines the relationship between witchcraft beliefs, a deep-rooted cultural phenomenon, and various elements of social capital. Using novel survey data from nineteen countries in Sub-Saharan Africa we establish a robust negative association between the prevalence of witchcraft beliefs and multiple measures of trust which holds after accounting for country fixed effects and potential confounding factors at the individual, regional, and ethnic-group levels. This finding extends to other metrics of social capital, namely charitable giving and participation in religious group activities. Such coexistence of witchcraft beliefs and antisocial attitudes stands in stark contrast to a well-explored alternative cultural equilibrium characterized by religious prosociality. Evidence from societies beyond Africa shows that in preindustrial communities where witchcraft is believed to be an important cause of illness, mistrust and other antisocial traits are inculcated since childhood. Furthermore, second-generation immigrants in Europe originating from countries with widespread witchcraft beliefs are generally less trusting.

The Lancet
Apr 09, 2016 Volume 387 Number 10027 p1483-1590
http://www.thelancet.com/journals/lancet/issue/current

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Articles
Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants
NCD Risk Factor Collaboration (NCD-RisC)
Published Online: 06 April 2016
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00618-8
Open access funded by Wellcome Trust
Summary
Background
One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes.
Methods
We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.
Findings
We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target.
Interpretation
Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries.
Funding
Wellcome Trust.

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Articles
Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study
Van-Mai Cao-Lormeau, Alexandre Blake, Sandrine Mons, Stéphane Lastère, Claudine Roche, Jessica Vanhomwegen, Timothée Dub, Laure Baudouin, Anita Teissier, Philippe Larre, Anne-Laure Vial, Christophe Decam, Valérie Choumet, Susan K Halstead, Hugh J Willison, Lucile Musset, Jean-Claude Manuguerra, Philippe Despres, Emmanuel Fournier, Henri-Pierre Mallet, Didier Musso, Arnaud Fontanet, Jean Neil, Frédéric GhawchéPublished Online: 29 February 2016
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00562-6
Summary
Background
Between October, 2013, and April, 2014, French Polynesia experienced the largest Zika virus outbreak ever described at that time. During the same period, an increase in Guillain-Barré syndrome was reported, suggesting a possible association between Zika virus and Guillain-Barré syndrome. We aimed to assess the role of Zika virus and dengue virus infection in developing Guillain-Barré syndrome.
Methods
In this case-control study, cases were patients with Guillain-Barré syndrome diagnosed at the Centre Hospitalier de Polynésie Française (Papeete, Tahiti, French Polynesia) during the outbreak period. Controls were age-matched, sex-matched, and residence-matched patients who presented at the hospital with a non-febrile illness (control group 1; n=98) and age-matched patients with acute Zika virus disease and no neurological symptoms (control group 2; n=70). Virological investigations included RT-PCR for Zika virus, and both microsphere immunofluorescent and seroneutralisation assays for Zika virus and dengue virus. Anti-glycolipid reactivity was studied in patients with Guillain-Barré syndrome using both ELISA and combinatorial microarrays.
Findings
42 patients were diagnosed with Guillain-Barré syndrome during the study period. 41 (98%) patients with Guillain-Barré syndrome had anti-Zika virus IgM or IgG, and all (100%) had neutralising antibodies against Zika virus compared with 54 (56%) of 98 in control group 1 (p<0·0001). 39 (93%) patients with Guillain-Barré syndrome had Zika virus IgM and 37 (88%) had experienced a transient illness in a median of 6 days (IQR 4–10) before the onset of neurological symptoms, suggesting recent Zika virus infection. Patients with Guillain-Barré syndrome had electrophysiological findings compatible with acute motor axonal neuropathy (AMAN) type, and had rapid evolution of disease (median duration of the installation and plateau phases was 6 [IQR 4–9] and 4 days [3–10], respectively). 12 (29%) patients required respiratory assistance. No patients died. Anti-glycolipid antibody activity was found in 13 (31%) patients, and notably against GA1 in eight (19%) patients, by ELISA and 19 (46%) of 41 by glycoarray at admission. The typical AMAN-associated anti-ganglioside antibodies were rarely present. Past dengue virus history did not differ significantly between patients with Guillain-Barré syndrome and those in the two control groups (95%, 89%, and 83%, respectively).
Interpretation
This is the first study providing evidence for Zika virus infection causing Guillain-Barré syndrome. Because Zika virus is spreading rapidly across the Americas, at risk countries need to prepare for adequate intensive care beds capacity to manage patients with Guillain-Barré syndrome.
Funding
Labex Integrative Biology of Emerging Infectious Diseases, EU 7th framework program PREDEMICS. and Wellcome Trust.

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Review
Increasing value and reducing waste in biomedical research: who’s listening?
David Moher, Paul Glasziou, Iain Chalmers, Mona Nasser, Patrick M M Bossuyt, Daniël A Korevaar, Ian D Graham, Philippe Ravaud, Isabelle Boutron
Summary
The biomedical research complex has been estimated to consume almost a quarter of a trillion US dollars every year. Unfortunately, evidence suggests that a high proportion of this sum is avoidably wasted. In 2014, The Lancet published a series of five reviews showing how dividends from the investment in research might be increased from the relevance and priorities of the questions being asked, to how the research is designed, conducted, and reported. 17 recommendations were addressed to five main stakeholders—funders, regulators, journals, academic institutions, and researchers. This Review provides some initial observations on the possible effects of the Series, which seems to have provoked several important discussions and is on the agendas of several key players. Some examples of individual initiatives show ways to reduce waste and increase value in biomedical research. This momentum will probably move strongly across stakeholder groups, if collaborative relationships evolve between key players; further important work is needed to increase research value. A forthcoming meeting in Edinburgh, UK, will provide an initial forum within which to foster the collaboration needed.

Maternal and Child Health Journal
Volume 20, Issue 4, April 2016
http://link.springer.com/journal/10995/20/4/page/1

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Commentary
Catalyzing a Reproductive Health and Social Justice Movement
Sarah Verbiest, Christina Kiko Malin, Mario Drummonds…
Abstract
Objectives The maternal and child health (MCH) community, partnering with women and their families, has the potential to play a critical role in advancing a new multi-sector social movement focused on creating a women’s reproductive and economic justice agenda. Since the turn of the twenty-first century, the MCH field has been planting seeds for change. The time has come for this work to bear fruit as many states are facing stagnant or slow progress in reducing infant mortality, increasing maternal death rates, and growing health inequities. Methods This paper synthesizes three current, interrelated approaches to addressing MCH challenges—life course theory, preconception health, and social justice/reproductive equity. Conclusion Based on these core constructs, the authors offer four directions for advancing efforts to improve MCH outcomes. The first is to ensure access to quality health care for all. The second is to facilitate change through critical conversations about challenging issues such as poverty, racism, sexism, and immigration; the relevance of evidence-based practice in disenfranchised communities; and how we might be perpetuating inequities in our institutions. The third is to develop collaborative spaces in which leaders across diverse sectors can see their roles in creating equitable neighborhood conditions that ensure optimal reproductive choices and outcomes for women and their families. Last, the authors suggest that leaders engage the MCH workforce and its consumers in dialogue and action about local and national policies that address the social determinants of health and how these policies influence reproductive and early childhood outcomes.

Nature
Volume 532 Number 7597 pp5-142 7 April 2016
http://www.nature.com/nature/current_issue.html

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Editorials
Viral complacency
The first outbreak of yellow fever in Angola in almost 30 years illustrates the danger of a short attention span when confronting epidemic threats.

Mind matters
Mental illness is moving up the global agenda — but there is still much to do.

PharmacoEconomics
Volume 34, Issue 4, April 2016
http://link.springer.com/journal/40273/34/4/page/1

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Original Research Article
What Can We Expect from Value-Based Funding of Medicines? A Retrospective Study
Anthony Harris, Jing Jing Li, Karen Yong
Abstract
Objective
Deciding on public funding for pharmaceuticals on the basis of value for money is now widespread. We suggest that evidence-based assessment of value has restricted the availability of medicines in Australia in a way that reflects the relative bargaining power of government and the pharmaceutical industry. We propose a simple informal game-theoretic model of bargaining between the funding agency and industry and test its predictions using a logistic multiple regression model of past funding decisions made by the Pharmaceutical Benefits Advisory Committee in Australia.
Method
The model estimates the probability of a drug being recommended for subsidy as a function of incremental cost per quality-adjusted life-year (QALY), as well as other drug and market characteristics. Data are major submissions or resubmissions from 1993 to 2009 where there was a claim of superiority and evidence of a difference in quality of life. Independent variables measure the incremental cost per QALY, the cost to the public budget, the strength and quality of the clinical and economic evidence, need as measured by severity of illness and the availability of alternative treatments, whether or not a resubmission, and newspaper reports as a measure of public pressure. We report the odds ratio for each variable and calculate the ratio of the marginal effect of each variable to the marginal effect of the cost per QALY as a measure of the revealed willingness to pay for each of the variables that influence the decision.
Results
The results are consistent with a bargaining model where a 10,000 Australian dollar ($A) fall in value (increase in cost per QALY) reduces the average probability of public funding from 37 to 33 % (95 % CI 34–32). If the condition is life threatening or the drug has no active comparator, then the odds of a positive recommendation are 3.18 (95 % CI 1.00–10.11) and 2.14 (95 % CI 0.95–4.83) greater, equivalent to a $A33,000 and a $A21,000 increase in value (fall in cost per QALY). If both conditions are met, the odds are increased by 4.41 (95 % CI 1.28–15.24) times, equivalent to an increase in value of $A46,000. Funding is more likely as time elapses and price falls, but we did not find clear evidence that public or corporate pressure influences decisions.
Conclusion
Evidence from Australia suggests that the determinants of public funding and pricing decisions for medicines reflect the relative bargaining power of government and drug companies. Value for money depends on the quality of evidence, timing, patient need, perceived benefit and opportunity cost; these factors reflect the potential gains from striking a bargain and the risk of loss from not doing so

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 9 April 2016)

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Editorial
Neglected Tropical Diseases in the Anthropocene: The Cases of Zika, Ebola, and Other Infections
Peter J. Hotez
| published 08 Apr 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004648

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Effects of Mother’s Illness and Breastfeeding on Risk of Ebola Virus Disease in a Cohort of Very Young Children
Hilary Bower, Sembia Johnson, Mohamed S. Bangura, Alie Joshua Kamara, Osman Kamara, Saidu H. Mansaray, Daniel Sesay, Cecilia Turay, Francesco Checchi, Judith R. Glynn
Research Article | published 08 Apr 2016 | PLOS Neglected Tropical Diseases

PLoS One
http://www.plosone.org/
[Accessed 9 April 2016]

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Predicting and Evaluating the Epidemic Trend of Ebola Virus Disease in the 2014-2015 Outbreak and the Effects of Intervention Measures
Zuiyuan Guo, Dan Xiao, Dongli Li, Xiuhong Wang, Yayu Wang, Tiecheng Yan, Zhiqi Wang
Research Article | published 06 Apr 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0152438

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Optimizing Real-Time Vaccine Allocation in a Stochastic SIR Model
Chantal Nguyen, Jean M. Carlson
Research Article | published 04 Apr 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0152950
Abstract
Real-time vaccination following an outbreak can effectively mitigate the damage caused by an infectious disease. However, in many cases, available resources are insufficient to vaccinate the entire at-risk population, logistics result in delayed vaccine deployment, and the interaction between members of different cities facilitates a wide spatial spread of infection. Limited vaccine, time delays, and interaction (or coupling) of cities lead to tradeoffs that impact the overall magnitude of the epidemic. These tradeoffs mandate investigation of optimal strategies that minimize the severity of the epidemic by prioritizing allocation of vaccine to specific subpopulations. We use an SIR model to describe the disease dynamics of an epidemic which breaks out in one city and spreads to another. We solve a master equation to determine the resulting probability distribution of the final epidemic size. We then identify tradeoffs between vaccine, time delay, and coupling, and we determine the optimal vaccination protocols resulting from these tradeoffs.

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A Performance Analysis of Public Expenditure on Maternal Health in Mexico
Edson Servan-Mori, Leticia Avila-Burgos, Gustavo Nigenda, Rafael Lozano
Research Article | published 04 Apr 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0152635

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 9 April 2016)

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Biological Sciences – Sustainability Science:
Tradeoffs between fisheries harvest and the resilience of coral reefs
Yves-Marie Bozec, Shay O’Farrell, J. Henrich Bruggemann, Brian E. Luckhurst, and Peter J. Mumby
PNAS 2016 ; published ahead of print April 4, 2016, doi:10.1073/pnas.1601529113
Significance
Fisheries management must avoid adverse impacts on the ecosystem. Doing so can be challenging in highly complex systems, particularly if the target species serves an important ecosystem function. Caribbean coral reefs provide a classic example in which herbivorous parrotfish are both an important fishery and key driver of ecosystem resilience. We developed and tested a multispecies fisheries model of parrotfish and linked it to a coral reef ecosystem experiencing climate change. We found that corals can remain resilient if less than 10% of the fishable parrotfish biomass is harvested and a minimum size of 30 cm is implemented. To our knowledge, this work is the first attempt to identify harvest levels that have little adverse effect on corals.
Abstract
Many countries are legally obliged to embrace ecosystem-based approaches to fisheries management. Reductions in bycatch and physical habitat damage are now commonplace, but mitigating more sophisticated impacts associated with the ecological functions of target fisheries species are in their infancy. Here we model the impacts of a parrotfish fishery on the future state and resilience of Caribbean coral reefs, enabling us to view the tradeoff between harvest and ecosystem health. We find that the implementation of a simple and enforceable size restriction of >30 cm provides a win:win outcome in the short term, delivering both ecological and fisheries benefits and leading to increased yield and greater coral recovery rate for a given harvest rate. However, maintaining resilient coral reefs even until 2030 requires the addition of harvest limitations (<10% of virgin fishable biomass) to cope with a changing climate and induced coral disturbances, even in reefs that are relatively healthy today. Managing parrotfish is not a panacea for protecting coral reefs but can play a role in sustaining the health of reefs and high-quality habitat for reef fisheries.

Science
08 April 2016 Vol 352, Issue 6282
http://www.sciencemag.org/current.dtl
Special Issue: Metastasis

In Depth
Infectious Diseases
Yellow fever outbreak triggers vaccine alarm
Kai Kupferschmidt
Science 08 Apr 2016:
Vol. 352, Issue 6282, pp. 128-129
DOI: 10.1126/science.352.6282.128
Summary
A big yellow fever outbreak in Angola has depleted the world’s emergency vaccine stockpile and raised worries that future outbreaks of the mosquito-borne virus could be impossible to control. The Angolan outbreak has caused 490 confirmed cases and 198 deaths so far, but experts say the real toll may be 10 times as high. A vaccination campaign has already reached 6 million people in Luanda, where the outbreak began, but the disease has spread to other provinces as well and the vaccine is running out. Only four facilities in the world produce yellow fever vaccine, and their production methods are antiquated and difficult to scale up. Additional outbreaks in other African cities, or in Asia, where yellow fever has never gained a foothold, could be catastrophic, experts say.

TORTURE Journal
Volume 26, Nr. 1, 2016
http://www.irct.org/Default.aspx?ID=5768

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Lilla Hárdi, Editor in Chief
Editorial

Scientific Articles
Reviewing outcomes of psychological interventions with torture survivors: Conceptual, methodological and ethical Issues
Nimisha Patel, Amanda C de C Williams, Blerina Kellezi

Mental health interventions and priorities for research for adult survivors of torture and systematic violence: a review of the literature
William M. Weiss, Ana M. Ugueto, Zayan Mahmooth, Laura K. Murray, Brian J. Hall, Maya Nadison, Andrew Rasmussen, Jennifer S. Lee, Andrea Vazzano, Judy Bass, Paul Bolton

Group Treatment for Survivors of Torture and Severe Violence: A Literature Review
Mary Bunn, Charles Goesel, Mélodie Kinet, Faith Ray

Tropical Medicine & International Health
April 2016 Volume 21, Issue 4 Pages 455–567
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2016.21.issue-3/issuetoc
Series: who cares for women? Towards a greater understanding of reproductive and maternal healthcare markets

Family planning, antenatal and delivery care: cross-sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low- and middle-income countries (pages 486–503)
Oona M. R. Campbell, Lenka Benova, David MacLeod, Rebecca F. Baggaley, Laura C. Rodrigues, Kara Hanson, Timothy Powell-Jackson, Loveday Penn-Kekana, Reen Polonsky, Katharine Footman, Alice Vahanian, Shreya K. Pereira, Andreia Costa Santos, Veronique G. A. Filippi, Caroline A. Lynch and Catherine Goodman
Article first published online: 7 MAR 2016 | DOI: 10.1111/tmi.12681

Why women bypass front-line health facility services in pursuit of obstetric care provided elsewhere: a case study in three rural districts of Tanzania (pages 504–514)
A. M. Kanté, A. Exavery, J. F. Phillips and E. F. Jackson
Article first published online: 17 FEB 2016 | DOI: 10.1111/tmi.12672

Measuring the impact of non-monetary incentives on facility delivery in rural Zambia: a clustered randomised controlled trial (pages 515–524)
P. Wang, A. L. Connor, E. Guo, M. Nambao, P. Chanda-Kapata, N. Lambo and C. Phiri
Article first published online: 3 APR 2016 | DOI: 10.1111/tmi.12678

Criteria-based audit of caesarean section in a referral hospital in rural Tanzania (pages 525–534)
S. Heemelaar, E. Nelissen, P. Mdoe, H. Kidanto, J. van Roosmalen and J. Stekelenburg
Article first published online: 4 MAR 2016 | DOI: 10.1111/tmi.12683

Characteristics of neonatal near miss in hospitals in Benin, Burkina Faso and Morocco in 2012–2013 (pages 535–545)
Carine Ronsmans, Jenny A. Cresswell, Sourou Goufodji, Schadrac Agbla, Rasmané Ganaba, Bouchra Assarag, Oscar Tonouhéoua, Cheick Diallo, Fatima-Zahra Meski and Véronique Filippi
Article first published online: 4 MAR 2016 | DOI: 10.1111/tmi.12682

Decreasing child mortality, spatial clustering and decreasing disparity in North-Western Burkina Faso (pages 546–555)
Heiko Becher, Olaf Müller, Peter Dambach, Sabine Gabrysch, Louis Niamba, Osman Sankoh, Seraphin Simboro, Anja Schoeps, Gabriele Stieglbauer, Yazoume Yé and Ali Sié
Article first published online: 19 FEB 2016 | DOI: 10.1111/tmi.12673

UN Chronicle
Vol. LII No. 4 2015 April 2016
http://unchronicle.un.org/

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Implementing the 2030 Agenda: The Challenge of Conflict
This issue looks at the link between conflict and the implementation and attainment of the Sustainable Development Goals. The articles examine, among other things, children and armed conflict, climate change, terrorism and food security.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 2 April 2016

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

pdf version: The Sentinel_ week ending 2 April 2016

blog edition: comprised of the 35+ entries  posted below.

EU Turkey Agreement

Editor’s Note:
We lead again this week with the “EU-Turkey Agreement” as it continues to generate serious concern, analysis, and action from agencies, NGOs and other actors in the European migrant-refugee crisis. Equally, we see it as establishing new and disconcerting precedents.

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UNHCR urges immediate safeguards to be in place before any returns begin under EU-Turkey deal
Briefing Notes, 1 April 2016
This is a summary of what was said by UNHCR spokesperson Melissa Fleming – to whom quoted text may be attributed – at the press briefing, on 1 April 2016, at the Palais des Nations in Geneva.

UNHCR is today urging parties to the recent EU-Turkey agreement on refugees and migrants to ensure all safeguards are in place before any returns begin. This is in light of continued serious gaps in both countries.

UNHCR does not object to returns of people without protection needs and who have not asked for asylum, providing that human rights are adhered to.

Across Greece, which has been compelled to host people because of closed borders elsewhere in Europe, numerous aspects of the systems for receiving and dealing with people who may need international protection are still either not working or absent. There are currently around 51,000 refugees and migrants in the country, 5000 on the islands and 46,000 on the mainland. Recent arrivals spiked on 29th March at 766 after several days of arrivals averaging about 300 people a day.

On Lesvos, conditions have been deteriorating at the Moria “hotspot” facility, which since 20 March has been used to detain people pending a decision on deportation. There are now some 2,300 people there. This is above its stated capacity of 2,000. People are sleeping in the open, and food supply is insufficient. Anxiety and frustration is widespread. Making matters worse, many families have become separated, with family members now scattered across Greece – and presenting an additional worry should returns begin.

On Samos, at the Vathy hotspot, reception conditions have also been worsening. Sanitation is poor, there is little help available for persons with special needs, and food distributions are chaotic. There are currently up to 1,700 people staying at the Vial hotspot on Chios, which has a maximum capacity of 1,100. We are very worried about the situation there. Rioting last night left three people with stab injuries.

In line with its global policy on promoting alternatives to detention, UNHCR has had to suspend services at all closed facilities, with the exception of protection monitoring and providing information on asylum procedures.

Stranded groups await relocation on the mainland
On the mainland, where people who arrived before 20 March are staying, the situation is equally difficult. Refugees and migrants are spread across some 30 sites, many awaiting the chance of relocation. Conditions at the port of Piraeus and around Eidomeni near the border with former Yugoslav Republic of Macedonia are dismal.

The risk of panic and injury in these sites and others is real in the current circumstances. There have been further incidents reported in local media of fighting this week.

Without urgent further EU support, the limited capacity of the Greek asylum service to register and process asylum claims will create problems. Limited hours of registration, daily ceilings on registrations, a lack of access to the Skype system for registration set up by the Asylum Services, are at present adding to the anxiety.

In Turkey, UNHCR has requested access to people returned from Greece, to ensure people can benefit from effective international protection and to prevent risk of refoulement.

UNHCR has set out the safeguards that would be required for safe readmission from Greece to Turkey, most recently in a paper of 23 March. http://www.refworld.org/docid/56f3ee3f4.html. [see below]

Sea arrivals down in Greece, up in Italy
Sea arrivals in Greece for the first three months of 2016 are at over 150,700 albeit with lower arrivals in March http://data.unhcr.org/mediterranean/country.php?id=83.

Sea arrivals on the other main Mediterranean route – from North Africa to Italy -stand at 18,784. This represents a more than 80 per cent increase over the same period in 2015 (10,165 people), with March arrivals showing a four-fold increase http://data.unhcr.org/mediterranean/country.php?id=105. These are predominantly Nigerians, Gambians, Senegalese, Malians and other West African nationals. So far UNHCR is not seeing big increases in Syrians, Afghans, and Iraqis using this route. On Thursday, a boat carrying 22 Syrian and Somali nationals was reported to have arrived at Otranto in South-eastern Italy, having travelled from Greece.

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Legal considerations on the return of asylum-seekers and refugees from Greece to Turkey as part of the EU-Turkey Cooperation in Tackling the Migration Crisis under the safe third country and first country of asylum concept
UN High Commissioner for Refugees (UNHCR),
23 March 2016 :: 8 pages, available at: http://www.refworld.org/docid/56f3ee3f4.html
[accessed 1 April 2016]
[Excerpts: Introduction and Conclusion]
1. Introduction
This paper sets out the legal considerations, based on international and European refugee and human rights law1 relevant for the return and readmission of persons in need of international protection from Greece to Turkey under the (proposed) EU-Turkey cooperation, as discussed during European Council meetings with Turkey on 7 and 17-18 March 2016.

The EU-Turkey cooperation inter alia foresees the return to Turkey of asylum-seekers and refugees who have entered Greece via Turkey. According to the European Commission (EC), such returns will be in accordance with international and European law. It is stated that the legal bases for these returns are found in the EU recast Asylum Procedures Directive (APD),2 in particular in the concept of ‘first country of asylum’ and the concept of ‘safe third country’ through an admissibility procedure.

It is said that applications for international protection by ‘Syrians’3 can be declared inadmissible by Greece under Article 33(1) and (2)(b) of the APD because Turkey can be considered a first country of asylum for ‘Syrians’ pursuant to Article 35(b) APD. Applications for international protection by ‘non-Syrians’ may be declared inadmissible by Greece under Article 33(1) and (2)(c) APD because Turkey can be regarded as a safe third country pursuant to Article 38 APD…

…2.4. Conclusion
International refugee law and European asylum legislation foresee the possibility of returning persons seeking and/or in need of international protection to a safe third country on the basis of the ‘first country of asylum’ or ‘safe third country’ concept. Strict substantive criteria and procedural safeguards, which are set out in the EU recast Asylum Procedures Directive, regulate the application of these concepts. Further, under the EU Dublin Regulation another member state may be responsible for examining the asylum application in particular on the basis of family unity and the best interests of the child, precluding return to a safe third country.

Geneva conference on Syrian refugees ends with new pledges of places, recognition of challenges ahead
UNHCR Press Release, 30 March 2016

An international meeting in Geneva on the plight of Syrian refugees concluded today with new offers of resettlement places and other forms of humanitarian admission places by States, but also highlighting the challenges over the next three years in narrowing the gap between the number of places countries are willing to offer for Syrian refugees and the number UNHCR believes is urgently required.

In his closing remarks High Commissioner for Refugees Filippo Grandi spoke of the conference having achieved “a clear recognition of the need for solidarity and responsibility-sharing for refugees”. But he also reminded delegates of the wider global displacement context and the immense challenges ahead, including finding a political settlement for Syria, and dealing with ongoing displacement and secondary flows from conflicts elsewhere.

“I am under no illusion that we are appealing for this at a very difficult time, and within a troubling context…,” he said. “The solidarity required is a global one. The collective effort of many states, and many actors within states, is essential.”

Overall, he said, progress was seen on Wednesday in six areas:
:: Together, States pledged modest increases in the number of resettlement and humanitarian admission places, bringing the total to date to some 185,000. Several countries offered to significantly increase their global resettlement programmes further this year and in the coming years. In addition, the EU committed to resettle further refugees from Turkey.
:: A number of States affirmed their commitment to family reunification, including willingness to ease procedures.
:: Several Latin American and European countries announced new humanitarian visa programmes or the expansion of existing ones.
:: Thirteen states confirmed scholarships and student visas for Syrian refugees.
:: Speeding of admission processes for refugees through the removal or simplification of administrative barriers was mentioned by several States.
:: Important financial commitments in support of UNHCR’s resettlement programmes came from two countries. Several existing resettlement countries offered to share expertise with new resettlement ones.

UNHCR estimates that at least 10 per cent of the 4.8 million refugees in countries neighbouring Syria will need resettling or other humanitarian help to safely move elsewhere before the end of 2018. This includes people considered acutely vulnerable, such as survivors of torture, refugees with serious medical conditions or women left alone with several children to care for and without family support.

Wednesday’s Conference also looked at measures intended to complement existing resettlement or humanitarian admission such as humanitarian visas, private sponsorship, family reunification, scholarships, medical evacuation and labour mobility programmes – including through the involvement of the private sector. These mechanisms complement existing resettlement programmes and help to ensure that quotas are still available for refugees in need from elsewhere in the world.

The conference, chaired by UNHCR, is one of several key events in 2016 to do with Syria’s refugees. It follows February’s London Conference on Syria, which focused on the financial dimensions of the humanitarian challenge posed by the more than 13.5 million people in need inside Syria and the 4.8 million refugees in the surrounding region along with the needs of communities in countries hosting them. And it comes in the run up to September’s summit on refugees to be held at the General Assembly meeting.

Turkey: Illegal mass returns of Syrian refugees expose fatal flaws in EU-Turkey deal
1 April 2016, 00:01 UTC
Large-scale forced returns of refugees from Turkey to war-ravaged Syria expose the fatal flaws in a refugee deal signed between Turkey and the European Union earlier this month, Amnesty International revealed today.

New research carried out by the organization in Turkey’s southern border provinces suggests that Turkish authorities have been rounding up and expelling groups of around 100 Syrian men, women and children to Syria on a near-daily basis since mid-January. Over three days last week, Amnesty International researchers gathered multiple testimonies of large-scale returns from Hatay province, confirming a practice that is an open secret in the region.

All forced returns to Syria are illegal under Turkish, EU and international law.

“In their desperation to seal their borders, EU leaders have wilfully ignored the simplest of facts: Turkey is not a safe country for Syrian refugees and is getting less safe by the day,” said John Dalhuisen, Amnesty International’s Director for Europe and Central Asia.

“The large-scale returns of Syrian refugees we have documented highlight the fatal flaws in the EU-Turkey deal. It is a deal that can only be implemented with the hardest of hearts and a blithe disregard for international law…

Agencies criticise rich countries’ failure to resettle more Syrians
Press Release
(31.03.2016)
Oxfam, Save the Children and Norwegian Refugee Council criticised the deeply disappointing outcome of the international pledging conference for resettlement of refugees fleeing the ongoing crisis in Syria.

All three agencies have been calling for rich countries to resettle or provide other forms of humanitarian admission to 10 per cent of the more than 4.8 million refugees registered in Syria’s neighbouring countries, by the end of 2016, as well as offer other safe and legal routes. However, today’s meeting offered to resettle only a tiny fraction of the most vulnerable people with a less ambitious timeline. The agencies said governments have shown a shocking lack of political and moral leadership.

Almost all states attending have failed to show the level of generosity required. A number of states have simply not been willing to make any new commitments despite the overwhelming need. Moreover, the few commitments made by EU Member States comes after the new EU-Turkey deal, where resettlement is being discussed as part of a migration management agreement that seeks to discourage hundreds of thousands of people from seeking a safe haven in Europe.

Andy Baker, head of Oxfam’s response to the Syria crisis, said: “Many rich countries seem more preoccupied with keeping Syrians out, or using them as bargaining chips in political deals, instead of offering the most vulnerable a safe haven. The Geneva meeting was an opportunity for them to show support to thousands of refugees who are in dire need of finding a safe home. In the end it delivered little”.

Save the Children’s Regional Advocacy Director, Misty Buswell, said: “nternational governments have once again denied children fleeing horrific violence a route to safety. Without legal routes, including resettlement for the most vulnerable, children will continue to be pushed into the hands of smugglers and traffickers. The answer to this crisis is not more barbed wire and detention centres, but wealthy countries accepting their fair share of the responsibility”.

Norwegian Refugee Council Secretary General, Jan Egeland,said: “Europe gave birth to the Refugee Convention when our forefathers were displaced by war. Now Europe risks becoming the same convention’s burial agent. European and world leaders in 2016 prefer sealing borders and building open air prisons, instead of living up to their legal obligations to protect refugees and support safe routes for those seeking asylum. The collapse of international solidarity witnessed in Geneva undermines half a century of efforts to build international refugee law”.

World Bank approves US$100 million in financing to create 100,000 jobs for Jordanians, Syrian refugees

AMMAN, March 27, 2016 – Aiming to create 100,000 new jobs for Jordanians and Syrian refugees in the next five years, the World Bank’s Board of Directors has agreed to offer Jordan US$100 million in financing at rates usually reserved for the poorest countries, World Bank Group President Jim Yong Kim announced today.

The World Bank’s Board extended the highly unusual financing offer because of the extraordinarily difficult situation facing both the refugees and their Jordanian hosts. A partnership among the Jordanian government, donor countries and development actors will use the financing to develop and strengthen existing special economic zones to attract international and domestic investments. Additional details of the job-creation plans will be announced in coming months.

The announcement was made during a joint visit by Kim and United Nations Secretary General Ban Ki-moon. The visit reaffirms the global commitment to help address the impact of the Syria crisis through immediate humanitarian assistance and long-term development support. The focus of the visit is to find innovative solutions that begin to address the severe economic and social stresses resulting from the influx of refugees, including shoring up basic services and creating job opportunities for Syrian refugees and Jordanians alike.

“The Jordanian government has done an exceptional job in helping to meet the challenges posed by the large flows of refugees,” said World Bank Group President Jim Yong Kim, who was visiting Jordan for the second time in two years. “It is now up to the international community to do more to help Jordan – and provide it with the innovative financing it needs to continue hosting refugees. It’s also important for Jordan to enact necessary reforms that will attract investments needed for the economy to grow and provide shared prosperity for all Jordanians.”

The leaders of the two organizations met with King Abdullah II in the presence of Queen Rania. The World Bank confirmed its commitment to provide Jordan with additional concessional financing at zero interest rates to contribute to alleviating the country’s burden in managing the refugee crisis. The Bank committed to strengthening its work on governance and transparency issues, as well as bolstering human resources, in particular through improving quality and access in the education sector.

The Bank-UN delegation also met with Prime Minister Ensour and senior government officials. The visit included a trip to Zaatari camp where Jim Kim and Ban Ki-moon had an opportunity to witness the living conditions of the refugees and to listen to their personal stories and aspirations. In addition, they engaged in a conversation with students at Jordan University, to hear about challenges young people are facing and what they might need to overcome them.

The announcement came three days after Kim announced a separate $100 million financing to support education of Lebanese and Syrian refugee children living in Lebanon. The terms, approved by the World Bank’s Board of Directors, will be similar to those announced today for Jordan. In both cases, the Board broke new ground in giving a middle-income country financing at a rate reserved for the poorest countries.

Government of India and World Bank Sign US$1.5 Billion Agreement to Support India’s Universal Sanitation Initiative

NEW DELHI, March 30, 2016 – The Government of India and the World Bank today signed a US$1.5 billion loan agreement for the Swachh Bharat Mission (SBM) Support Operation Project to support the Government of India in its efforts to ensure that all citizens in the rural areas have access to improved sanitation with a focus on changing behaviour and eliminating the practice of open defecation by 2019.

The loan agreement for the project was signed by Raj Kumar, Joint Secretary, Department of Economic Affairs, Ministry of Finance on behalf of the Government of India and Onno Ruhl, World Bank Country Director, India on behalf of the World Bank.

“The Government of India’s Swachh Bharat Mission is the country’s largest-ever drive to improve sanitation. The SBM aims to end open defecation and improve the management of liquid and solid wastes. The project will promote behaviour change among rural communities and help accelerate results in India’s states by giving performance-based incentives,” said Raj Kumar, Joint Secretary, Department of Economic Affairs, Ministry of Finance, Government of India.

Specifically, this project will support the rural component, known as SBM – Gramin (SBM-G), over a five-year period using a new performance-based program which links funds directly to results, ensuring that benefits are delivered to the people in need – more than 60 percent of India’s population that resides in rural areas.

The SBM-G program focuses on ensuring usage of toilets along with their construction. States and their implementing agencies will be given incentives for meeting performance standards. Performance will be measured against the states’ ability to reduce open defecation, sustaining their open defecation free (ODF) status and improving solid and liquid waste management in rural areas. The financing mechanism promotes the leadership of the states, which will have flexibility in innovating and adopting their own delivery models.

“One in every ten deaths in India is linked to poor sanitation. And studies show that low-income households bear the maximum brunt of poor sanitation. This project, aimed at strengthening the implementation of the Swachh Bharat Initiative of the government, will result in significant health benefits for the poor and vulnerable, especially those living in rural areas,” said Onno Ruhl, World Bank Country Director for India. “Incentivizing good performance by states and the focus on behavioural changes are two important components of this project,” he added.

The Ministry of Drinking Water and Sanitation (MDWS) will oversee and coordinate the project and support the participating states. Funds will also be used to develop the capacity of MDWS in program management, advocacy, monitoring and evaluation.
The World Bank will also provide a parallel US$25 million technical assistance to build the capacity of select state governments in implementing community-led behavioural change programs targeting social norms to help ensure widespread usage of toilets by rural households…