The European Journal of Public Health – Volume 26, Issue 2, 1 April 2016

The European Journal of Public Health
Volume 26, Issue 2, 1 April 2016
http://eurpub.oxfordjournals.org/content/26/2?current-issue=y

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Health services research
Substantial between-country differences in organising community care for older people in Europe—a review
Liza Van Eenoo, Anja Declercq, Graziano Onder, Harriet Finne-Soveri, Vjenka Garms-Homolová, Pálmi V. Jónsson, Olivia H.M. Dix, Johannes H. Smit, Hein P.J. van Hout, Henriëtte G. van der Roest Eur J Public Health (2016) 26 (2): 213-219 DOI: http://dx.doi.org/10.1093/eurpub/ckv152 First published online: 2 September 2015 (7 pages)

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Child and adolescent health
Relative deprivation in the Nordic countries—child mental health problems in relation to parental financial stress
Hrafnhildur Gunnarsdóttir, Gunnel Hensing, Lene Povlsen, Max Petzold Eur J Public Health (2016) 26 (2): 277-282 DOI: http://dx.doi.org/10.1093/eurpub/ckv191 First published online: 21 October 2015 (6 pages)

Eurosurveillance – Volume 21, Issue 12, 24 March 2016

Eurosurveillance
Volume 21, Issue 12, 24 March 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Editorials
Impact of migration on tuberculosis epidemiology and control in the EU/EEA
by MJ van der Werf, JP Zellweger

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Research Articles
The effect of migration within the European Union/European Economic Area on the distribution of tuberculosis, 2007 to 2013
by V Hollo, SM Kotila, C Ködmön, P Zucs, MJ van der Werf
Abstract
Immigration from tuberculosis (TB) high-incidence countries is known to contribute notably to the TB burden in low-incidence countries. However, the effect of migration enabled by the free movement of persons within the European Union (EU)/European Economic Area (EEA) on TB notification has not been analysed. We analysed TB surveillance data from 29 EU/EEA countries submitted for the years 2007–2013 to The European Surveillance System. We used place of birth and nationality as proxy indicators for native, other EU/EEA and non-EU/EEA origin of the TB cases and analysed the characteristics of the subgroups by origin. From 2007–2013, a total of 527,467 TB cases were reported, of which 129,781 (24.6%) were of foreign origin including 12,566 (2.4%) originating from EU/EEA countries other than the reporting country. The countries reporting most TB cases originating from other EU/EEA countries were Germany and Italy, and the largest proportion of TB cases in individuals came from Poland (n=1,562) and Romania (n=6,285). At EU/EEA level only a small proportion of foreign TB cases originated from other EU/EEA countries, however, the uneven distribution of this presumed importation may pose a challenge to TB programmes in some countries.

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Migration-related tuberculosis: epidemiology and characteristics of tuberculosis cases originating outside the European Union and European Economic Area, 2007 to 2013
by C Ködmön, P Zucs, MJ van der Werf
Abstract
Migrants arriving from high tuberculosis (TB)-incidence countries may pose a significant challenge to TB control programmes in the host country. TB surveillance data for 2007–2013 submitted to the European Surveillance System were analysed. Notified TB cases were stratified by origin and reporting country. The contribution of migrant TB cases to the TB epidemiology in EU/EEA countries was analysed. Migrant TB cases accounted for 17.4% (n = 92,039) of all TB cases reported in the EU/EEA in 2007–2013, continuously increasing from 13.6% in 2007 to 21.8% in 2013. Of 91,925 migrant cases with known country of origin, 29.3% were from the Eastern Mediterranean, 23.0% from south-east Asia, 21.4% from Africa, 13.4% from the World Health Organization European Region (excluding EU/EEA), and 12.9% from other regions. Of 46,499 migrant cases with known drug-susceptibility test results, 2.9% had multidrug-resistant TB, mainly (51.7%) originating from the European Region. The increasing contribution of TB in migrants from outside the EU/EEA to the TB burden in the EU/EEA is mainly due to a decrease in native TB cases. Especially in countries with a high proportion of TB cases in non-EU/EEA migrants, targeted prevention and control initiatives may be needed to progress towards TB elimination.

Global Health: Science and Practice (GHSP) – March 2016 | Volume 4 | Issue 1

Global Health: Science and Practice (GHSP)
March 2016 | Volume 4 | Issue 1
http://www.ghspjournal.org/content/current

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EDITORIALS
Birthing Centers Staffed by Skilled Birth Attendants: Can They Be Effective … at Scale?
Peripheral-level birthing centers may be appropriate and effective in some circumstances if crucial systems requirements can be met. But promising models don’t necessarily scale well, so policy makers and program managers need to consider what requirements can and cannot be met feasibly at scale. Apparently successful components of the birthing center model, such as engagement of traditional birth attendants and use of frontline staff who speak the local language, appear conducive to use in other similar settings.
Glob Health Sci Pract 2016;4(1):1-3. http://dx.doi.org/10.9745/GHSP-D-16-00063
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COMMENTARIES
Social Entrepreneurship: A Case Study From Brazil
Through careful sourcing of commodities, cost-cutting efficiencies, and realistic pricing, 3 large contraceptive social marketing programs evolved into profit-making enterprises while continuing to make low-priced contraceptives available to low-income consumers on a substantial scale.
Phil Harvey
Glob Health Sci Pract 2016;4(1):6-12. http://dx.doi.org/10.9745/GHSP-D-15-00182
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Mapping the Prevalence and Sociodemographic Characteristics of Women Who Deliver Alone: Evidence From Demographic and Health Surveys From 80 Countries
An estimated 2.2 million women surveyed in low- and middle-income countries between 2005 and 2015 gave birth alone. This practice was concentrated in West and Central Africa and parts of East Africa. Women who delivered with no one present were very poor, uneducated, older, and of higher parity. Experience from northern Nigeria suggests the practice can be reduced markedly by mobilizing religious and civil society leaders to improve community awareness about the critical importance of having an attendant present.
Nosakhare Orobaton, Anne Austin, Bolaji Fapohunda, Dele Abegunde, Kizzy Omo
Glob Health Sci Pract 2016;4(1):99-113. First published online March 9, 2016. http://dx.doi.org/10.9745/GHSP-D-15-00261
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Original Articles
Routine Immunization Consultant Program in Nigeria: A Qualitative Review of a Country-Driven Management Approach for Health Systems Strengthening
Meghan O’Connell, Chizoba Wonodi
Glob Health Sci Pract 2016;4(1):29-42. http://dx.doi.org/10.9745/GHSP-D-15-00209
ABSTRACT
Background: Since 2002, the Nigerian government has deployed consultants to states to provide technical assistance for routine immunization (RI). RI consultants are expected to play a role in supportive supervision of health facility staff, capacity building, advocacy, and monitoring and evaluation.
Methods: We conducted a retrospective review of the RI consultant program’s strengths and weaknesses in 7 states and at the national level from June to September 2014 using semi-structured interviews and online surveys. Participants included RI consultants, RI program leaders, and implementers purposively drawn from national, state, and local government levels. Thematic analysis was used to analyze qualitative data from the interviews, which were triangulated with results from the quantitative surveys.
Findings: At the time of data collection, 23 of 36 states and the federal capital territory had an RI consultant. Of the 7 states visited during the study, only 3 states had present and visibly working consultants. We conducted 84 interviews with 101 participants across the 7 states and conducted data analysis on 70 interviews (with 82 individuals) that had complete data. Among the full sample of interview respondents (N = 101), most (66%) were men with an average age of 49 years (±5.6), and the majority were technical officers (63%) but a range of other roles were also represented, including consultants (22%), directors (13%), and health workers (2%). Fifteen consultants and 44 program leaders completed the online surveys. Interview data from the 3 states with active RI consultants indicated that the consultants’ main contribution was supportive supervision at the local level, particularly for collecting and using RI data for decision making. They also acted as effective advocates for RI funding. In states without an RI consultant, gaps were highlighted in data management capacity and in monitoring of RI funds. Program design strengths: the broad terms of reference and autonomy of the consultants allowed work to be tailored to the local context; consultants were often integrated into state RI teams but could also work independently when necessary; and recruitment of experienced consultants with strong professional networks, familiarity with the local context, and ability to speak the local language facilitated advocacy efforts. Key programmatic challenges were related to inadequate and inconsistent inputs (salaries, transportation means, and dedicated office space) and gaps in communication between consultants and national leadership and in management of consultants, including lack of performance feedback, lack of formal orientation at inception, and no clear job performance targets.
Conclusions: While weaknesses in managerial and material inputs affect current performance of RI consultants in Nigeria, the design of the RI consultant program employs a unique problem-focused, locally led model of development assistance that could prove valuable in strengthening the capacity of the government to implement such technical assistance on its own. Despite the lack of uniform deployment and implementation of RI consultants across the country, some consultants appear to have contributed to improved RI services through supportive supervision, capacity building, and advocacy.

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Original Articles
Meeting Postpartum Women’s Family Planning Needs Through Integrated Family Planning and Immunization Services: Results of a Cluster-Randomized Controlled Trial in Rwanda
Lisa S Dulli, Marga Eichleay, Kate Rademacher, Steve Sortijas, Théophile NsengiyumvaGlob Health Sci Pract 2016;4(1):73-86. First published online February 22, 2016. http://dx.doi.org/10.9745/GHSP-D-15-00291
ABSTRACT
Objective The primary objective of this study was to test the effectiveness of integrating family planning service components into infant immunization services to increase modern contraceptive method use among postpartum women.
Methods The study was a separate sample, parallel, cluster-randomized controlled trial. Fourteen randomly selected primary health facilities were equally allocated to intervention (integrated family planning and immunization services at the same time and location) and control groups (standard immunization services only). At baseline (May–June 2010), we interviewed postpartum women attending immunization services for their infant aged 6 to 12 months using a structured questionnaire. A separate sample of postpartum women was interviewed 16 months later after implementation of the experimental health service intervention. We used linear mixed regression models to test the study hypothesis that postpartum women attending immunization services for their infants aged 6–12 months in the intervention facilities will be more likely to use a modern contraceptive method than postpartum women attending immunization services for their infants aged 6–12 months in control group facilities.
Results We interviewed and analyzed data for 825 women from the intervention group and 829 women from the control group. Results showed the intervention had a statistically significant, positive effect on modern contraceptive method use among intervention group participants compared with control group participants (regression coefficient, 0.15; 90% confidence interval [CI], 0.04 to 0.26). Although we conducted a 1-sided significance test, this effect was also significant at the 2-sided test with alpha = .05. Among those women who did not initiate a contraceptive method, awaiting the return of menses was the most common reason cited for non-use of a method. Women in both study groups overwhelmingly supported the concept of integrating family planning service components into infant immunization services (97.9% in each group), and service data collected during the intervention period did not indicate that the intervention had any negative effect on infant immunization service uptake.
Conclusion Integrating family planning service components into infant immunization services can be an acceptable and effective strategy to increase contraceptive use among postpartum women. Additional research is needed to examine the extent to which this integration strategy can be replicated in other health care settings. Future research should also explore persistent misconceptions regarding the relationship between return of menses and return to fertility during the postpartum period.

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METHODOLOGIES
Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries
Many program implementers have difficulty collecting and analyzing data on program beneficiaries’ wealth because a large number of survey questions are required to construct the standard wealth index. We created country-specific measures of household wealth with as few as 6 questions that are highly reliable and valid in both urban and rural contexts.
Nirali M Chakraborty, Kenzo Fry, Rasika Behl, Kim Longfield
Glob Health Sci Pract 2016;4(1):141-154. http://dx.doi.org/10.9745/GHSP-D-15-00384

A critical analysis of the review on antimicrobial resistance report and the infectious disease financing facility

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 26 March 2016]

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Commentary
A critical analysis of the review on antimicrobial resistance report and the infectious disease financing facility
David M. Brogan and Elias Mossialos
Globalization and Health 2016 12:8
Published on: 22 March 2016
Abstract
Over the past year, two major policy initiatives have been introduced focusing on stimulating antibiotic development for human consumption. The European Investment Bank has announced the development of the Infectious Disease Financing Facility (IDFF) and the British government commissioned the Review on Antimicrobial Resistance, led by Jim O’Neill. Each constitutes a major effort by the European community to address the evolving crisis of antimicrobial resistance. Though both have similar goals, the approaches are unique and worthy of consideration.
This manuscript utilizes a previously published framework for evaluation of antibiotic incentive plans to clearly identify the strengths and weaknesses of each proposal. The merits of each proposal are evaluated in how they satisfy four key objectives: 1) Improve the overall net present value (NPV) for new antibiotic projects; 2) Enable greater participation of Small to Medium Sized Enterprises (SME); 3) Encourage participation by large pharmaceutical companies; 4) Facilitate cooperation and synergy across the antibiotic market. The IDFF seeks to make forgivable loans to corporations with promising compounds, while the O’Neill group proposes a more comprehensive framework of early stage funding, along with the creation of a stable global market.
Ultimately, the proposals may prove complementary and if implemented together may form a more comprehensive plan to address an impending global crisis. Substantial progress will only be made on these efforts if action is taken at an international level, therefore we recommend consideration of these efforts at the upcoming G20 summit.

International Migration Review – Spring 2016 Volume 50, Issue 1 Pages 1–266, e1–e16

International Migration Review
Spring 2016 Volume 50, Issue 1 Pages 1–266, e1–e16
http://onlinelibrary.wiley.com/doi/10.1111/imre.2016.50.issue-1/issuetoc

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IMMIGRANTS IN WESTERN EUROPE
Constructing Immigrants: Portrayals of Migrant Groups in British National Newspapers, 2010–2012 (pages 3–40)
Scott Blinder and William L. Allen
Article first published online: 23 OCT 2015 | DOI: 10.1111/imre.12206

As French as Anyone Else: Islam and the North African Second Generation in France (pages 41–69)
Jean Beaman
Article first published online: 4 MAY 2015 | DOI: 10.1111/imre.12184

Cultural Integration in the Muslim Second Generation in the Netherlands: The Case of Gender Ideology (pages 70–94)
Mieke Maliepaard and Richard Alba
Article first published online: 8 MAY 2015 | DOI: 10.1111/imre.12118

Social Position and Place-Protective Action in a New Immigration Context: Understanding Anti-Mosque Campaigns in Catalonia (pages 95–132)
Avi Astor
Article first published online: 2 SEP 2014 | DOI: 10.1111/imre.12115

Long-Term Effects of Language Course Timing on Language Acquisition and Social Contacts: Turkish and Moroccan Immigrants in Western Europe (pages 133–162)
Jutta Hoehne and Ines Michalowski
Article first published online: 10 APR 2015 | DOI: 10.1111/imre.12130

Native Friends and Host Country Identification among Adolescent Immigrants in Germany: The Role of Ethnic Boundaries (pages 163–196)
Benjamin Schulz and Lars Leszczensky
Article first published online: 6 FEB 2015 | DOI: 10.1111/imre.12163

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DEPORTATION AND REMITTANCE EFFECTS
Deporting Fathers: Involuntary Transnational Families and Intent to Remigrate among Salvadoran Deportees (pages 197–230)
Jodi Berger Cardoso, Erin Randle Hamilton, Nestor Rodriguez, Karl Eschbach and Jacqueline Hagan
Article first published online: 3 JUL 2014 | DOI: 10.1111/imre.12106

Is Money Enough?: The Effect of Migrant Remittances on Parental Aspirations and Youth Educational Attainment in Rural Mexico (pages 231–266)
Adam Sawyer
Article first published online: 2 SEP 2014 | DOI: 10.1111/imre.12103

Pregnancy in the Time of Zika: Addressing Barriers for Developing Vaccines and Other Measures for Pregnant Women

JAMA
March 22/29, 2016, Vol 315, No. 12
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
Pregnancy in the Time of Zika: Addressing Barriers for Developing Vaccines and Other Measures for Pregnant Women FREE
Saad B. Omer, MBBS, MPH, PhD; Richard H. Beigi, MD, MSc

Three recent infectious disease outbreaks of global importance—H1N1 influenza, Ebola, and now Zika—have had specific implications for pregnant women. For the H1N1 pandemic, pregnant women and their infants were high-risk groups for severe complications and death. During the Ebola outbreak, there were concerns about worse outcomes among pregnant women and specific concerns regarding vertical transmission of infection to newborns. The current Zika outbreak, with its ostensible association with microcephaly, has direct and highly concerning implications for pregnant women and women of reproductive age.

Yet the global public health community again lacks the optimal tools for dealing with a disease that has specific and important implications for pregnant women. There are substantial knowledge gaps in current understanding of Zika, irrespective of the affected population. However, Zika’s association with adverse fetal outcomes requires that pregnant women be a priority group for developing and evaluating vaccines and other measures. There are several current scientific and structural barriers to developing vaccines for pregnant women. These barriers challenge the ability to prepare and respond to epidemics and are particularly highlighted during a public health emergency that has pregnant women and their unborn fetuses as the primary affected population.

One barrier is a lack of a broadly accepted ethical framework for guiding clinical research during pregnancy. For example, the term minimal risk1—a concept that informs ethical review of research—is not well defined for research in pregnancy. Therefore, institutional review boards (IRBs) often resort to categorizing most intervention research in pregnancy as high risk, often without a balanced consideration of the risks of not performing the research. Moreover, the risks and benefits to the fetus also need to be considered along with risks and benefits to the mother, adding to the challenge. This lack of a broadly accepted ethical framework has a chilling effect on both academic and industry-led clinical research in pregnancy.2,3 Therefore, there is a need for development and articulation of a pregnancy-specific ethical framework that can offer guidance to investigators and IRBs.

Pregnancy is a physiologically dynamic state. The immune profile of a pregnant woman is responsive to the changing levels of sex hormones and evolves through the course of pregnancy.4 However, most of the current knowledge base for vaccine response is derived from observational studies conducted in the latter part of pregnancy, with limited data available from the first and early second trimester or from randomized clinical trials. On the other hand, clinical, practical, and public health considerations require that vaccine use not be restricted to women with advanced gestational age. Given that a substantial portion of Zika’s teratogenic effects may occur in the earlier phase of pregnancy, administration of any forthcoming Zika vaccine will be most beneficial prior to or during the early parts of pregnancy. The knowledge gap for early pregnancy vaccine responses and safety will make the task of developing and recommending an effective Zika vaccine for use across pregnancy challenging.

Until recently, the pregnancy and lactation sections of US Food and Drug Administration (FDA)-approved labels for vaccines and pharmaceuticals contained ambiguous information with limited clinical utility. For example, the labels were required to contain determination of letter risk categories (A, B, C, D, or X) for pregnancy. These categories were an attempt to summarily convey risk of reproductive and developmental adverse effects. However, the categories were somewhat simplistic and challenging to translate into practice in a clinically meaningful manner.

After years of deliberations, revisions, and public comment, FDA recently issued the Pregnancy and Lactation Labeling Rule (PLLR).5 This rule will enable inclusion of clinically relevant and interpretable information in drug and vaccine labels and creates a consistent format for communicating information on risks as well as benefits relevant to pregnant and lactating women and for males and females of reproductive potential. Moreover, the new rule allows for incorporating information about risk and benefits from a variety of sources, including non–industry-sponsored epidemiological and interventional studies. Although the release of the PLLR is important and holds promise to provide more clinically useful information, its implementation faces many logistical challenges. For example, there is a need for a “mock label” (ie, a sample label providing examples of information to be included in the sections relevant to pregnancy and lactation) to provide guidance for inclusion and format of pregnancy-related information in sections relevant to pregnant women.

General understanding of the new categorization system is insufficient among clinicians who provide obstetrical care. Therefore, it will take concerted efforts to phase in this categorization. Having clarity regarding vaccine (and drug) labeling related to pregnancy will help ensure that clinicians have a higher level of confidence in pregnancy-related vaccines and could provide a road map for conducting research that can inform labeling and hence clinical decisions.
Robust safety evaluation is a cornerstone of any vaccine development and deployment program. There has been an increase in the number of studies evaluating the safety of currently recommended maternal vaccines, such as influenza and pertussis vaccines.6 Despite increased attention on the evaluation of safety of immunization in pregnancy, barriers remain. For example, a review commissioned by the World Health Organization highlighted the lack of standard definitions of outcomes, and standards for measurement of these outcomes, relevant to evaluation of vaccines in pregnancy.7 This lack of standardization poses a challenge for conduct of clinical trials, generalizability of safety data, and merging of large safety data sets. This last point is critical because large multilocation data sets could optimize the evaluation of rare but clinically important outcomes, such as microcephaly.

Moreover, safety assessment for pharmaceutical interventions against emerging public health threats requires real-time assessment of risk vs benefit. Baseline outcome rates are an essential input for such an assessment. The value of baseline rates was recognized during the H1N1 pandemic.8 Since then, there has been little progress in ascertaining baseline rates in different geographic locations of outcomes such as first trimester miscarriages. Ascertainment of baseline rates of outcomes is even more important when a disease emerges in the context of other infections (eg, malaria) that are associated with adverse birth outcomes.

Drug and vaccine development and evaluation in children may provide some context for the current outbreak response. Pediatricians and child health researchers recognized many parallel challenges in the amount and quality of data available for the care of children. The term therapeutic orphans was coined for children, stressing the concept of the lack of information available to prevent and treat disease in children. To address these challenges, efforts were mobilized around the conceptualization and passing of legislation (Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act). These efforts have contributed to improving the quantity and quality of research that has been conducted in children.9 A similar approach may also be relevant to fostering research in pregnancy.

Pregnant women have been a high-risk group requiring special consideration for several recent global public health emergencies. Currently, pregnant women and their unborn children are the focal point of the Zika outbreak. Although there are several barriers for developing vaccines and other measures for pregnant women, these barriers are surmountable with concerted efforts and leadership. Strategic planning and action have allowed for advances in pediatric drug development and provide a good model. However, the time to act is now, before the next epidemic takes its toll.
[References at link above]

Journal of Humanitarian Logistics and Supply Chain Management :: Volume 6 Issue 1 2016

Journal of Humanitarian Logistics and Supply Chain Management
Volume 6 Issue 1 2016
http://www.emeraldinsight.com/toc/jhlscm/6/1

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Conceptual Paper
A theoretical framework for consolidation in humanitarian logistics
(pp. 2 – 23)
Alain Vaillancourt
Abstract
Purpose
– The purpose of this paper is to develop a theoretical framework to better understand incentives and obstacles to consolidation of materials in humanitarian logistics.
Design/methodology/approach
– This study uses a content analysis for its literature review method to code 87 articles related to supply chain and logistics and understand what are the incentives and obstacles to consolidation. It then discusses these issues from the point of view of humanitarian logistics.
Findings
– Through the combination of a literature review and discussion, the framework developed in this conceptual paper identifies specific sources of delays and impediments to cooperation present in disaster response and development activities. These issues can be related to disaster type, the focus of the organization and the stakeholders as well as the resources required for consolidation themselves.
Research limitations/implications
– There are limitations to a conceptual paper, one being the lack of empirical proof for the findings. Another limitation is the use of coding; even though the coding grid was iterative to take into account the findings in the literature, there might still be shortcomings inherent to the categories.
Originality/value
– This study offers a comprehensive review of consolidation activities in the last decades and offers an abstract model to further investigate consolidation in the context of humanitarian logistics.

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Research paper
Developing organisational capabilities to support agility in humanitarian logistics: An exploratory study
(pp. 72 – 99)
Cécile L’Hermitte , Peter Tatham , Marcus Bowles , Ben Brooks
Abstract:
Purpose
– The purpose of this paper is to explore the underlying strategic mechanisms of agility in a humanitarian logistics context. Based on the research conducted in business disciplines, the paper empirically examines a set of four strategic dimensions (being purposeful, being action-focused, being collaborative, and being learning-oriented) and identifies an emergent relationship between these capabilities and agile humanitarian logistics operations.
Design/methodology/approach
– Leadership and management actions perceived to support the four capabilities were identified and used as a basis to complete the exploratory research. Specifically, a case study with the United Nations World Food Programme (WFP) was undertaken and, in this context, a qualitative analysis of 29 face-to-face interviews with humanitarian logistics experts working for WFP was conducted.
Findings
– The research corroborates the relevance of the four strategic-level capabilities to the humanitarian logistics context and confirms that these capabilities play a role in the development of agility in humanitarian operations. The work also identifies a set of key strategic decision-making areas that relate to the building of agility.
Research limitations/implications
– Additional research is needed to further investigate and measure the strategic-level capabilities and to quantify their impact on operational agility. Further research should also be undertaken to extend this study to a wider range of humanitarian organisations.
Originality/value
– This paper is the first empirical research that takes a strategic approach to the concept of agility in humanitarian logistics. It highlights that the leaders and managers of humanitarian organisations have a significant role to play in the building of an agile system.

Symptomatic Dengue in Children in 10 Asian and Latin American Countries

New England Journal of Medicine
March 24, 2016 Vol. 374 No. 12
http://www.nejm.org/toc/nejm/medical-journal

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Original Article
Symptomatic Dengue in Children in 10 Asian and Latin American Countries
Maïna L’Azou, M.Sc., Annick Moureau, M.Sc., Elsa Sarti, Ph.D., Joshua Nealon, M.Sc., Betzana Zambrano, M.D., T. Anh Wartel, M.D., Luis Villar, M.D., Maria R.Z. Capeding, M.D., and R. Leon Ochiai, Ph.D., for the CYD14 and CYD15 Primary Study Groups*
N Engl J Med 2016; 374:1155-1166 March 24, 2016
DOI: 10.1056/NEJMoa1503877
Abstract
Background
The control groups in two phase 3 trials of dengue vaccine efficacy included two large regional cohorts that were followed up for dengue infection. These cohorts provided a sample for epidemiologic analyses of symptomatic dengue in children across 10 countries in Southeast Asia and Latin America in which dengue is endemic.
Methods
We monitored acute febrile illness and virologically confirmed dengue (VCD) in 3424 healthy children, 2 to 16 years of age, in Asia (Indonesia, Malaysia, the Philippines, Thailand, and Vietnam) from June 2011 through December 2013 and in 6939 children, 9 to 18 years of age, in Latin America (Brazil, Colombia, Honduras, Mexico, and Puerto Rico) from June 2011 through April 2014. Acute febrile episodes were determined to be VCD by means of a nonstructural protein 1 antigen immunoassay and reverse-transcriptase–polymerase-chain-reaction assays. Dengue hemorrhagic fever was defined according to 1997 World Health Organization criteria.
Results
Approximately 10% of the febrile episodes in each cohort were confirmed to be VCD, with 319 VCD episodes (4.6 episodes per 100 person-years) occurring in the Asian cohort and 389 VCD episodes (2.9 episodes per 100 person-years) occurring in the Latin American cohort; no trend according to age group was observed. The incidence of dengue hemorrhagic fever was less than 0.3 episodes per 100 person-years in each cohort. The percentage of VCD episodes requiring hospitalization was 19.1% in the Asian cohort and 11.1% in the Latin American cohort. In comparable age groups (9 to 12 years and 13 to 16 years), the burden of dengue was higher in Asia than in Latin America.
Conclusions
The burdens of dengue were substantial in the two regions and in all age groups. Burdens varied widely according to country, but the rates were generally higher and the disease more frequently severe in Asian countries than in Latin American countries. (Funded by Sanofi Pasteur; CYD14 and CYD15 ClinicalTrials.gov numbers, NCT01373281 and NCT01374516.)

Leveraging Social Computing for Personalized Crisis Communication using Social Media

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 26 March 2016]

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Review
Leveraging Social Computing for Personalized Crisis Communication using Social Media
March 24, 2016 ·
Introduction: The extensive use of social media in modern life redefines social interaction and communication. Communication plays an important role in mitigating, or exacerbating, the psychological and behavioral responses to critical incidents and disasters. As recent disasters demonstrated, people tend to converge to social media during and following emergencies. Authorities can then use this media and other computational methods to gain insights from the public, mainly to enhance situational awareness, but also to improve their communication with the public and public adherence to instructions.
Methods: The current review presents a conceptual framework for studying psychological aspects of crisis and risk communication using the social media through social computing.
Results: Advanced analytical tools can be integrated in the processes and objectives of crisis communication. The availability of the computational techniques can improve communication with the public by a process of Hyper-Targeted Crisis Communication.
Discussion: The review suggests that using advanced computational tools for target-audience profiling and linguistic matching in social media, can facilitate more sensitive and personalized emergency communication.

Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982–2012: A Systematic Analysis

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 26 March 2016)

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Research Article |
Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982–2012: A Systematic Analysis
Kathryn E. Lafond, Harish Nair, Mohammad Hafiz Rasooly, Fátima Valente, Robert Booy, Mahmudur Rahman, Paul Kitsutani, Hongjie Yu, Guiselle Guzman, Daouda Coulibaly, Julio Armero, Daddi Jima, Stephen R. C. Howie, William Ampofo, Ricardo Mena, Mandeep Chadha, Ondri Dwi Sampurno, Gideon O. Emukule, Zuridin Nurmatov, Andrew Corwin, Jean Michel Heraud, Daniel E. Noyola, Radu Cojocaru, Pagbajabyn Nymadawa, Amal Barakat, Adebayo Adedeji, Marta von Horoch, Remigio Olveda, Thierry Nyatanyi, Marietjie Venter, Vida Mmbaga, Malinee Chittaganpitch, Tran Hien Nguyen, Andros Theo, Melissa Whaley, Eduardo Azziz-Baumgartner, Joseph Bresee, Harry Campbell, Marc-Alain Widdowson, Global Respiratory Hospitalizations—Influenza Proportion Positive (GRIPP) Working Group
Research Article | published 24 Mar 2016 | PLOS Medicine
10.1371/journal.pmed.1001977
Abstract
Background
The global burden of pediatric severe respiratory illness is substantial, and influenza viruses contribute to this burden. Systematic surveillance and testing for influenza among hospitalized children has expanded globally over the past decade. However, only a fraction of the data has been used to estimate influenza burden. In this analysis, we use surveillance data to provide an estimate of influenza-associated hospitalizations among children worldwide.
Methods and Findings
We aggregated data from a systematic review (n = 108) and surveillance platforms (n = 37) to calculate a pooled estimate of the proportion of samples collected from children hospitalized with respiratory illnesses and positive for influenza by age group ( Influenza was associated with 10% (95% CI 8%–11%) of respiratory hospitalizations in children Conclusions
Influenza is an important contributor to respiratory hospitalizations among young children worldwide. Increasing influenza vaccination coverage among young children and pregnant women could reduce this burden and protect infants

Willingness to Pay for Dog Rabies Vaccine and Registration in Ilocos Norte, Philippines (2012)

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 26 March 2016)

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Research Article
Willingness to Pay for Dog Rabies Vaccine and Registration in Ilocos Norte, Philippines (2012)
Meseret G. Birhane, Mary Elizabeth G. Miranda, Jessie L. Dyer, Jesse D. Blanton, Sergio Recuenco
Research Article | published 21 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004486
Abstract
Background
The Philippines is one of the developing countries highly affected by rabies. Dog vaccination campaigns implemented through collaborative effort between the government and NGOs have played an important role in successfully reducing the burden of disease within the country. Nevertheless, rabies vaccination of the domestic animal population requires continuous commitment not only from governments and NGOs, but also from local communities that are directly affected by such efforts. To create such long-term sustained programs, the introduction of affordable dog vaccination and registration fees is essential and has been shown to be an important strategy in Bohol, Philippines. The aim of this study, therefore, was to estimate the average amount of money that individuals were willing to pay for dog vaccination and registration in Ilocos Norte, Philippines. This study also investigated some of the determinants of individuals’ willingness to pay (WTP).
Methods
A cross-sectional questionnaire was administered to 300 households in 17 municipalities (out of a total of 21) selected through a multi-stage cluster survey technique. At the time of the survey, Ilocos Norte had a population of approximately 568,017 and was predominantly rural. The Contingent Valuation Method was used to elicit WTP for dog rabies vaccination and registration. A ‘bidding game’ elicitation strategy that aims to find the maximum amount of money individuals were willing to pay was also employed. Data were collected using paper-based questionnaires. Linear regression was used to examine factors influencing participants’ WTP for dog rabies vaccination and registration.
Key Results
On average, Ilocos Norte residents were willing to pay 69.65 Philippine Pesos (PHP) (equivalent to 1.67 USD in 2012) for dog vaccination and 29.13PHP (0.70 USD) for dog registration. Eighty-six per cent of respondents were willing to pay the stated amount to vaccinate each of their dogs, annually. This study also found that WTP was influenced by demographic and knowledge factors. Among these, we found that age, income, participants’ willingness to commit to pay each year, municipality of residency, knowledge of the signs of rabies in dogs, and number of dogs owed significantly predicted WTP.

Analysis and valuation of the health and climate change cobenefits of dietary change

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 26 March 2016)

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Biological Sciences – Medical Sciences – Social Sciences – Sustainability Science:
Analysis and valuation of the health and climate change cobenefits of dietary change
Marco Springmann, H. Charles J. Godfray, Mike Rayner, and Peter Scarborough
PNAS 2016 ; published ahead of print March 21, 2016, doi:10.1073/pnas.1523119113
Significance
The food system is responsible for more than a quarter of all greenhouse gas emissions while unhealthy diets and high body weight are among the greatest contributors to premature mortality. Our study provides a comparative analysis of the health and climate change benefits of global dietary changes for all major world regions. We project that health and climate change benefits will both be greater the lower the fraction of animal-sourced foods in our diets. Three quarters of all benefits occur in developing countries although the per capita impacts of dietary change would be greatest in developed countries. The monetized value of health improvements could be comparable with, and possibly larger than, the environmental benefits of the avoided damages from climate change.
Abstract
What we eat greatly influences our personal health and the environment we all share. Recent analyses have highlighted the likely dual health and environmental benefits of reducing the fraction of animal-sourced foods in our diets. Here, we couple for the first time, to our knowledge, a region-specific global health model based on dietary and weight-related risk factors with emissions accounting and economic valuation modules to quantify the linked health and environmental consequences of dietary changes. We find that the impacts of dietary changes toward less meat and more plant-based diets vary greatly among regions. The largest absolute environmental and health benefits result from diet shifts in developing countries whereas Western high-income and middle-income countries gain most in per capita terms. Transitioning toward more plant-based diets that are in line with standard dietary guidelines could reduce global mortality by 6–10% and food-related greenhouse gas emissions by 29–70% compared with a reference scenario in 2050. We find that the monetized value of the improvements in health would be comparable with, or exceed, the value of the environmental benefits although the exact valuation method used considerably affects the estimated amounts. Overall, we estimate the economic benefits of improving diets to be 1–31 trillion US dollars, which is equivalent to 0.4–13% of global gross domestic product (GDP) in 2050. However, significant changes in the global food system would be necessary for regional diets to match the dietary patterns studied here.

Reducing the global burden of Preterm Birth through knowledge transfer and exchange: a research agenda for engaging effectively with policymakers

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 26 March 2016]

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Review
Reducing the global burden of Preterm Birth through knowledge transfer and exchange: a research agenda for engaging effectively with policymakers
Gavin Yamey, Hacsi Horváth, Laura Schmidt, Janet Myers and Claire D. Brindis
Published on: 18 March 2016
Abstract
Preterm birth (PTB) is the world’s leading cause of death in children under 5 years. In 2013, over one million out of six million child deaths were due to complications of PTB. The rate of decline in child death overall has far outpaced the rate of decline attributable to PTB. Three key reasons for this slow progress in reducing PTB mortality are: (a) the underlying etiology and biological mechanisms remain unknown, presenting a challenge to discovering ways to prevent and treat the condition; (ii) while there are several evidence-based interventions that can reduce the risk of PTB and associated infant mortality, the coverage rates of these interventions in low- and middle-income countries remain very low; and (c) the gap between knowledge and action on PTB—the “know-do gap”—has been a major obstacle to progress in scaling up the use of existing evidence-based child health interventions, including those to prevent and treat PTB.
In this review, we focus on the know-do gap in PTB as it applies to policymakers. The evidence-based approaches to narrowing this gap have become known as knowledge transfer and exchange (KTE). In our paper, we propose a research agenda for promoting KTE with policymakers, with an ambitious but realistic goal of reducing the global burden of PTB. We hope that our proposed research agenda stimulates further debate and discussion on research priorities to soon bend the curve of PTB mortality.

Ethics review for international data-intensive research

Science
25 March 2016 Vol 351, Issue 6280
http://www.sciencemag.org/current.dtl

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Policy Forum
Ethics review for international data-intensive research
By Edward S. Dove, David Townend, Eric M. Meslin, Martin Bobrow, Katherine Littler, Dianne Nicol, Jantina de Vries, Anne Junker, Chiara Garattini, Jasper Bovenberg, Mahsa Shabani, Emmanuelle Lévesque, Bartha M. Knoppers
Science25 Mar 2016 : 1399-1400
Summary
Historically, research ethics committees (RECs) have been guided by ethical principles regarding human experimentation intended to protect participants from physical harms and to provide assurance as to their interests and welfare. But research that analyzes large aggregate data sets, possibly including detailed clinical and genomic information of individuals, may require different assessment. At the same time, growth in international data-sharing collaborations adds stress to a system already under fire for subjecting multisite research to replicate ethics reviews, which can inhibit research without improving the quality of human subjects’ protections (1, 2). “Top-down” national regulatory approaches exist for ethics review across multiple sites in domestic research projects [e.g., United States (3, 4), Canada (5), United Kingdom, (6), Australia (7)], but their applicability for data-intensive international research has not been considered. Stakeholders around the world have thus been developing “bottom-up” solutions. We scrutinize five such ef orts involving multiple countries around the world, including resource-poor settings (table S1), to identify models that could inform a framework for mutual recognition of international ethics review (i.e., the acceptance by RECs of the outcome of each other’s review).

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 19 March 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 19 March 2016

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

EU-Turkey Agreement: Questions and Answers

Editor’s Note:
The “EU-Turkey Agreement” reached yesterday is quickly generating a high volume of analysis and challenges from across media, human rights groups, governments and more. Since the agreement is complex and raises a number of questions about its compliance with refugee conventions and international law, we include the Q&A published by the EU today, and selected additional comment on the Plan below.

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EU-Turkey Agreement: Questions and Answers
Brussels, 19 March 2016
Factsheet on the EU-Turkey Agreement
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What has been agreed?
On 18 March, following on from the EU-Turkey Joint Action Plan activated on 29 November 2015 and the 7 March EU-Turkey statement, the European Union and Turkey decided to end the irregular migration from Turkey to the EU. Yesterday’s agreement targets the people smugglers’ business model and removes the incentive to seek irregular routes to the EU, in full accordance with EU and international law.

The EU and Turkey agreed that:
1) All new irregular migrants crossing from Turkey to the Greek islands as of 20 March 2016 will be returned to Turkey;
2) For every Syrian being returned to Turkey from the Greek islands, another Syrian will be resettled to the EU;
3) Turkey will take any necessary measures to prevent new sea or land routes for irregular migration opening from Turkey to the EU;
4) Once irregular crossings between Turkey and the EU are ending or have been substantially reduced, a Voluntary Humanitarian Admission Scheme will be activated;
5) The fulfilment of the visa liberalisation roadmap will be accelerated with a view to lifting the visa requirements for Turkish citizens at the latest by the end of June 2016. Turkey will take all the necessary steps to fulfil the remaining requirements;
6) The EU will, in close cooperation with Turkey, further speed up the disbursement of the initially allocated €3 billion under the Facility for Refugees in Turkey. Once these resources are about to be used in full, the EU will mobilise additional funding for the Facility up to an additional €3 billion to the end of 2018;
7) The EU and Turkey welcomed the ongoing work on the upgrading of the Customs Union.
8) The accession process will be re-energised, with Chapter 33 to be opened during the Dutch Presidency of the Council of the European Union and preparatory work on the opening of other chapters to continue at an accelerated pace;
9) The EU and Turkey will work to improve humanitarian conditions inside Syria.

On what legal basis will irregular migrants be returned from the Greek islands to Turkey?
People who do not have a right to international protection will be immediately returned to Turkey. The legal framework for these returns is the bilateral readmission agreement between Greece and Turkey. From 1 June 2016, this will be succeeded by the EU-Turkey Readmission Agreement, following the entry into force of the provisions on readmission of third country nationals of this agreement.

On what legal basis will asylum seekers be returned from the Greek islands of Turkey?
People who apply for asylum in Greece will have their applications treated on a case by case basis, in line with EU and international law requirements and the principle of non-refoulement. There will be individual interviews, individual assessments and rights of appeal. There will be no blanket and no automatic returns of asylum seekers.

The EU asylum rules allow Member States in certain clearly defined circumstances to declare an application “inadmissible”, that is to say, to reject the application without examining the substance.

There are two legal possibilities that could be envisaged for declaring asylum applications inadmissible, in relation to Turkey:
1) first country of asylum (Article 35 of the Asylum Procedures Directive): where the person has been already recognised as a refugee in that country or otherwise enjoys sufficient protection there;
2) safe third country (Article 38 of the Asylum Procedures Directive): where the person has not already received protection in the third country but the third country can guarantee effective access to protection to the readmitted person.

What safeguards exist for asylum seekers?
All applications need to be treated individually and due account must be paid to the situation of vulnerable groups, in particular unaccompanied minors for whom all decisions must be in their best interests.
Moreover, specific attention should be given also to persons who have members of their close family in other Member States and for whom the Dublin rules should be applied.
All applicants will also be able to appeal their decision.

Will asylum seekers remain in Greece during the appeal procedure?
When applying the “safe third country” concept, any return decision is suspended automatically while the appeal is being treated.
When applying the “first country of asylum” concept, there is a possibility to make a request to suspend the transfer while the appeal is being treated.

Where will migrants be accommodated whilst they await return?
Irregular migrants may be held in closed reception centres on the Greek islands, subject to EU legislation – in particular the EU Return Directive. Asylum seekers will be accommodated in open reception centres on the Greek islands.

How can you be sure that people will be given protection in Turkey?
Only asylum seekers that will be protected in accordance with the relevant international standards and in respect of the principle of non-refoulement will be returned to Turkey.
The EU will speed up the disbursement of funds from the €3 billion Facility for Refugees in Turkey. This funding will support Syrians in Turkey by providing access to food, shelter, education and healthcare. An additional €3 billion will be made available after this money is used to the full, up to the end of 2018. The UNHCR will be a key actor in the readmission and resettlement processes to provide additional support and supervision.

What operational support will Greece need in order to implement the scheme?
The implementation of the agreement will require huge operational efforts from all involved, and most of all from Greece. EU Member States agreed to provide Greece at short notice with the necessary means, including border guards, asylum experts and interpreters.

The Commission estimates that Greece will need:
Around 4,000 staff from Greece, Member States, the European Asylum Support Office (EASO) and FRONTEX
:: For the asylum process: 200 Greek asylum service case workers, 400 asylum experts from other Member States deployed by EASO and 400 interpreters
:: For the appeals process: 10 Appeals Committees made up of 30 members from Greece as well as 30 judges with expertise in asylum law from other Member States and 30 interpreters
:: For the return process: 25 Greek readmission officers, 250 Greek police officers as well as 50 return experts deployed by Frontex. 1,500 police officers seconded on the basis of bilateral police cooperation arrangements (costs covered by FRONTEX)
:: Security: 1,000 security staff/army
Material assistance:
:: Transport: return from the islands: 8 FRONTEX vessels with a capacity of 300-400 passengers per vessel) and 28 buses
:: Accommodation: 20,000 short-term capacity on the Greek islands (of which 6,000 already exist)
:: Administration: 190 containers, including 130 for EASO case workers

Who will coordinate this support?
Heads of State or Government meeting in the European Council on 18-19 March 2016 agreed that “the Commission will coordinate and organise together with Member States and Agencies the necessary support structures to implement it effectively.”
President Juncker has appointed Maarten Verwey to act as the EU coordinator to implement the EU-Turkey statement. Maarten Verwey is the Director-General of the European Commission’s Structural Reform Support Service. He leads a team which has already been on the ground in Greece since October 2015, working hand in hand with the Greek authorities to address the refugee crisis, by accelerating access to emergency funding, improving the coordination between the various actors, addressing administrative bottlenecks and facilitating knowledge sharing on border management and relocation. The EU coordinator has at his disposal significant resources from relevant European Commission services in Brussels (in particular DG HOME) and EU agencies (FRONTEX, EASO, Europol).
The EU coordinator will organise the work and coordinate the dispatching of the 4,000 staff that will be needed from Greece, Member States, the European Asylum Support Office (EASO) and FRONTEX. Staff needed include case workers, interpreters, judges, return officers and security officers.

What financial support will be provided to Greece?
The Commission estimates the costs of the practical implementation of the agreement to be around €280 million euro over the next six months.
The EU will support Greece to put in place the necessary human resources, infrastructure and reception capacity in order to carry out registrations appeals processes and large scale return operations. In particular, the hotspots in the islands in Greece will need to be adapted – with the current focus on registration and screening before swift transfer to the mainland replaced by the objective of implementing returns to Turkey.

Emergency assistance
Since the beginning of 2015, Greece has been awarded €181 million in emergency assistance. For 2016, the Commission has significantly increased the emergency assistance budget under the Asylum Migration and Integration Fund (AMIF) and the Internal Security Fund (ISF) – the total amount of emergency funding available in 2016 for the refugee crisis now stands at €464 million. €267 million has been earmarked for Greece, out of which €193,7 million is still available to support the Greek authorities and International Organisations operating in Greece in managing the refugee and humanitarian crisis, provided requests for financing are submitted to the Commission. This funding can be made available for the funding of reception centres on the islands, as well as support for return operations (transport and accompanying measures). This funding can also be used for the temporary deployment of additional Greek staff or Member States’ experts deployed to Greece. Yesterday, the Commission awarded an additional €30.5 million from the available emergency funding for Greece to support the Greek Ministry of Defence in providing shelter, accommodation, food and health care to refugees.

Funding available under the Greek multiannual National Programmes
The emergency funding comes on top of the €509 million already allocated to Greece under the national programmes for 2014-2020 (€294.5 million from AMIF and €214.7 million from ISF).

Frontex funding
€60 million euro is available in funding for return operations, including the reimbursement of the costs of Frontex return experts, the reimbursement of transport costs (including vessels made available through Frontex) and the reimbursement of police officers for return escorts (including police officers seconded by other Member States on the basis of bilateral police cooperation agreements).

EASO funding
Under the budget of the European Asylum Support Office, €1,9 million (additional allocations are foreseen) is available to support Member States under particular pressure in 2016 with the funding of for example case worker and judges and part of the mobile containers.
Emergency Assistance mechanism
On 2 March, the Commission proposed an Emergency Assistance instrument, providing €700 million over the next three years, to be used within the European Union to provide a faster, more targeted response to major crises, including helping Member States cope with large numbers of refugees. The estimated needs for 2016 are €300 million with a further €200 million each for use in 2017 and 2018, respectively.

When will the new agreement take effect?
The agreement will take effect from 20 March 2016. What this means in practice is that anyone arriving in the Greek islands from this date will be returned directly to Turkey if they have no right to international protection or do not claim asylum. Those who claim asylum will have their application processed, in an expedited fashion, with a view to their immediate return to Turkey if the claim is declared inadmissible.

When will resettlements from Turkey start?
Resettlements of Syrians under the 1:1 scheme will commence as of the beginning of April.
What happens to migrants who are already in Greece?
The Greek authorities, EU Member States and EU Agencies will accelerate relocations from Greece and provide rapid humanitarian assistance to Greece. In view of the emergency situation on the ground, 6,000 relocations should be achieved within the next month and at least 20,000 relocations completed by mid-May 2016.

UNHCR on EU-Turkey deal: Asylum safeguards must prevail in implementation

UNHCR on EU-Turkey deal: Asylum safeguards must prevail in implementation
Press Release
18 March 2016
UNHCR notes today’s agreement between the European Union and Turkey on the situation of refugees and migrants seeking to make their way to Europe.

We recognize the shared need of countries to find properly managed solutions to this situation. Indeed UNHCR has on several occasions in recent months offered its own specific recommendations to Europe in this regard. The chaos that has prevailed in 2015 and till now in 2016 serves neither the interests of people fleeing war and needing safety, nor of Europe itself.

Today’s agreement clarifies a number of elements. Importantly, it is explicit that any modalities of implementation of the agreement will respect international and European law. In UNHCR’s understanding, in light of relevant jurisprudence, this means that people seeking international protection will have an individual interview on whether their claim can be assessed in Greece, and the right to appeal before any readmission to Turkey. This would also entail that once returned, people in need of international protection will be given the chance to seek and effectively access protection in Turkey. We now need to see how this will be worked out in practice, in keeping with the safeguards set out in the agreement – many of which at present are not in place.

How this plan is to be implemented is thus going to be crucial. Ultimately, the response must be about addressing the compelling needs of individuals fleeing war and persecution. Refugees need protection, not rejection.

Firstly, Greece’s reception conditions and its systems for assessing asylum claims and dealing with people accepted as refugees must be rapidly strengthened. The safeguards in the agreement have to be established and implemented. This will be an enormous challenge needing urgent addressing.

Secondly, people being returned to Turkey and needing international protection must have a fair and proper determination of their claims, and within a reasonable time. Assurances against refoulement, or forced return, must be in place. Reception and other arrangements need to be readied in Turkey before anyone is returned from Greece. People determined to be needing international protection need to be able to enjoy asylum, without discrimination, in accordance with accepted international standards, including effective access to work, health care, education for children, and, as necessary, social assistance.

Thirdly, while UNHCR has noted the commitment in this agreement to increase resettlement opportunities for Syrian refugees out of Turkey, it is crucial that such commitments are meaningful and predictable. Increased EU resettlement from Turkey should not be at the expense of the resettlement of other refugee populations around the world who also have great needs – especially in today’s context of record forced displacement worldwide.

Leaders Launch New Humanitarian-Development Partnership to Respond To Forced Displacement and Global Crises

Leaders Launch New Humanitarian-Development Partnership to Respond To Forced Displacement and Global Crises
WASHINGTON, March 16, 2016 — Signaling a great urgency to address the crisis of millions of people forcibly displaced from their homes, leaders of multilateral development banks, UN agencies and major NGOs today agreed to strengthen collective action and to work together more effectively.

At an unprecedented meeting on humanitarian-development collaboration — co-chaired by United Nations Secretary General Ban Ki-moon and World Bank Group President Jim Yong Kim — about 30 leaders of the international organizations called for a new action-oriented humanitarian-development partnership. The meeting focused on forced displacement as an example of a humanitarian emergency that also presents a significant development challenge, emphasizing the need for more work to address the drivers of fragility and prevention.

The leaders expressed their commitment to build on comparative advantages in three key areas for joint action:
:: Data and evidence:
Work together to launch initiatives such as joint risk assessments, to strengthen and harmonize the data and evidence base to inform policies and programs, and to develop a clear action plan with specific deliverables and milestones.

:: Joint engagements:
Work together and with national counterparts to develop a set of multi-year joint initiatives in select groups of countries facing protracted and recurring crises. This could include the development of joint assessments and planning based on synergies and complementarities that reflect respective comparative advantages.

:: Financing instruments:
Commit to developing innovative financing instruments that “follow the need,” including concessional financing, and in particular leverage private sector resources.
Partners agreed to further develop this agenda and to establish a set of concrete proposals by the time of the World Humanitarian Summit in May 2016.

The meeting, held at World Bank Group headquarters, came in response to the Secretary General’s call for action in the report “One Humanity: Shared Responsibility,” and the Agenda for Humanity. It launched an agenda for collective action leading up to the World Humanitarian Summit and the Summit on Addressing Large Movements of Refugees and Migrants, to be held by the UN General Assembly on September 19, 2016.

“We need to shift from a disproportionate focus on crisis management to investing in crisis prevention and building up community resilience. Our planning and financing tools need to identify how to strengthen local capacity and resilience, including through increased cash-based programming. We should set ambitious targets and use the Summit and its follow-up process to monitor and measure achievement,” said UN Secretary General Ban Ki-moon.

“These humanitarian crises are among the biggest challenges of our time – we must safeguard the lives and livelihoods of millions of people who are driven from their homes because of conflict or natural disasters,” said World Bank Group President Jim Yong Kim. “In this meeting, we identified steps for urgent action, which we will set in motion immediately. We have a collective responsibility to work together to build a secure and stable foundation for sustainable development.”

Humanitarian development action is already under way: one example is the World Bank Group and UNHCR are rapidly expanding collaboration, deepened through joint analytics and operations in several regions in Africa and in the response to the Syrian crisis.

Organizations represented at this high-level meeting included:
United Nations High Commissioner for Refugees, Islamic Development Bank, United Nations Development Programme, International Monetary Fund, World Food Programme, International Finance Corporation, International Organization for Migration, European Investment Bank, Food and Agriculture Organization, United Nations Educational, Scientific and Cultural Organization, World Health Organization, United Nations Office for the Coordination of Humanitarian Affairs, United Nations Children’s Emergency Fund, Results, European Bank for Reconstruction and Development, Inter-American Development Bank, International Rescue Committee, Islamic Relief Worldwide, International Committee of the Red Cross, International Federation of the Red Cross, International Council of Voluntary Agencies, Save the Children, OXFAM America, InterAction, Catholic Relief Services

More than 100 humanitarian agencies call for immediate and sustained access in Syria

More than 100 humanitarian agencies call for immediate and sustained access in Syria
GENEVA/NEW YORK, 15 March 2016 – Today, 102 humanitarian agencies urged sustained and unconditional humanitarian access to all Syrians. The appeal was made on the fifth anniversary of the start of the conflict in Syria. The appeal and signatories below.

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Syria Humanitarian Appeal – 5th Anniversary of the Syrian Conflict
As the parties to the conflict in Syria resume talks to end a war that now enters its sixth horrific year, there is renewed hope for peace. For an end to the suffering of millions of the innocent.
Two months ago our organizations appealed for urgent access to all those in desperate need inside Syria: for the lifting of sieges; for the full protection of civilians. Today, there are some encouraging signs of progress.

The cessation of hostilities has allowed humanitarian organizations to rush more food and other relief to communities desperate for help.

But access has to go beyond a temporary lifting of seiges and checkpoints and allowing more aid convoys to move.

Humanitarian access and freedom of movement of civilians in Syria has to be sustained. It has to be unconditional. And it should include access to all people in need by whatever routes necessary.

The parties to this conflict and their international sponsors must from now on guarantee:
:: Full access for humanitarian and medical workers to assess the wellbeing of civilians in all communities and treat those who are sick and injured without obstacle or restriction.
:: Allowing all humanitarian aid, as required by international humanitarian law, to reach, unimpeded, those who urgently need it – including medical supplies, surgical equipment, and nutritional necessities.
:: Support for an urgently needed nationwide immunization campaign for children.

These are practical actions that would mean the difference between life and death. All parties to the conflict can agree on them, now.

And in doing so, they can take another step to peace. Peace for Syria. The peace that Syrians so desperately deserve.

[List of 102 signatories at UNICEF press release]

No Place for Children – The Impact of Five Years of War n Syria’s Children and Their Childhoods – UNICEF

No Place for Children – The Impact of Five Years of War n Syria’s Children and Their Childhoods
UNICEF
14 March 2016 :: 15 pages
PDF: http://www.unicef.org/media/files/SYRIA5Y_REPORT_12_MARCH.pdf

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Press Release
1 in 3 Syrian children has grown up knowing only crisis as conflict reaches 5 year point – UNICEF
AMMAN/NEW YORK, 14 March 2016 – An estimated 3.7 million Syrian children – 1 in 3 of all Syrian children – have been born since the conflict began five years ago, their lives shaped by violence, fear and displacement, according to a UNICEF report. This figure includes 306,000 children born as refugees since 2011.
In total, UNICEF estimates that some 8.4 million children – more than 80 per cent of Syria’s child population – are now affected by the conflict, either inside the country or as refugees in neighbouring countries.

“In Syria, violence has become commonplace, reaching homes, schools, hospitals, clinics, parks, playgrounds and places of worship,” said Dr. Peter Salama, UNICEF’s Regional Director for the Middle East and North Africa. “Nearly 7 million children live in poverty, making their childhood one of loss and deprivation.”

According to “No Place for Children”, UNICEF verified nearly 1,500 grave violations against children in 2015. More than 60 per cent of these violations were instances of killing and maiming as a result of explosive weapons used in populated areas. More than one-third of these children were killed while in school or on their way to or from school.

In Syria’s neighbouring countries, the number of refugees is nearly 10 times higher today than in 2012. Half of all refugees are children. More than 15,000 unaccompanied and separated children have crossed Syria’s borders.

“Five years into the war, millions of children have grown up too fast and way ahead of their time,” Salama said. “As the war continues, children are fighting an adult war, they are continuing to drop out of school, and many are forced into labour, while girls are marrying early.”…

…One of the most significant challenges to the conflict has been providing children with learning. School attendance rates inside Syria have hit rock bottom. UNICEF estimates that more than 2.1 million children inside Syria, and 700,000 in neighbouring countries, are out-of-school. In response, UNICEF and partners launched the “No Lost Generation Initiative”, which is committed to restoring learning and providing opportunities to young people.

“It’s not too late for Syria’s children. They continue to have hope for a life of dignity and possibility. They still cherish dreams of peace and have the chance to fulfill them,” Salama said.

The report calls on the global community to undertake five critical steps to protect a vital generation of children.
:: End violations of children’s rights;
:: Lift sieges and improve humanitarian access inside Syria;
:: Secure US$ 1.4 billion in 2016 to provide children with learning opportunities;
:: Restore children’s dignity and strengthen their psychological wellbeing; and
:: Turn funding pledges into commitments. UNICEF has received only 6 per cent of the funding required in 2016 to support Syrian children both inside the country and those living as refugees in neighbouring countries.