Zika Virus Associated with Microcephaly

New England Journal of Medicine
March 10, 2016 Vol. 374 No. 10
http://www.nejm.org/toc/nejm/medical-journal

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Brief Report
Zika Virus Associated with Microcephaly
Jernej Mlakar, M.D., Misa Korva, Ph.D., Nataša Tul, M.D., Ph.D., Mara Popović, M.D., Ph.D., Mateja Poljšak-Prijatelj, Ph.D., Jerica Mraz, M.Sc., Marko Kolenc, M.Sc., Katarina Resman Rus, M.Sc., Tina Vesnaver Vipotnik, M.D., Vesna Fabjan Vodušek, M.D., Alenka Vizjak, Ph.D., Joze Pizem, M.D., Ph.D., Miroslav Petrovec, M.D., Ph.D., and Tatjana Avsic Zupanc, Ph.D.
Abstract
A widespread epidemic of Zika virus (ZIKV) infection was reported in 2015 in South and Central America and the Caribbean. A major concern associated with this infection is the apparent increased incidence of microcephaly in fetuses born to mothers infected with ZIKV. In this report, we describe the case of an expectant mother who had a febrile illness with rash at the end of the first trimester of pregnancy while she was living in Brazil. Ultrasonography performed at 29 weeks of gestation revealed microcephaly with calcifications in the fetal brain and placenta. After the mother requested termination of the pregnancy, a fetal autopsy was performed. Micrencephaly (an abnormally small brain) was observed, with almost complete agyria, hydrocephalus, and multifocal dystrophic calcifications in the cortex and subcortical white matter, with associated cortical displacement and mild focal inflammation. ZIKV was found in the fetal brain tissue on reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay, with consistent findings on electron microscopy. The complete genome of ZIKV was recovered from the fetal brain.

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Editorial
Zika Virus and Microcephaly
Eric J. Rubin, M.D., Ph.D., Michael F. Greene, M.D., and Lindsey R. Baden, M.D.
DOI: 10.1056/NEJMe1601862
[Extract]
…Zika virus has spread explosively since its introduction into South America and has now been found throughout Central America and the Caribbean. The full extent of disease is not clear — most infections are asymptomatic and many are associated with only mild disease.6 But the apparent risk of microcephaly was enough for the World Health Organization to declare a public health emergency of international concern on February 1.

What more do we need to know to help us manage and control this outbreak? Certainly, understanding the disease better could have long-term benefits, including the development of protective vaccines. However, it is the information that we do not yet have that has potential immediate applications.

Although many authorities are counseling women who are pregnant or could become pregnant to avoid travel to affected areas, the millions of women who live in these places are faced with enormous uncertainty, and as the virus spreads, many more will be affected. For example, assuming the association between Zika virus and microcephaly exists, we do not know whether the timing of the infection during pregnancy has an effect on the risk of fetal abnormalities, nor do we have any idea of the magnitude of that risk. The development of rapid, scalable diagnostic tests is needed, since the current polymerase-chain-reaction assay detects viral RNA and thus should be positive only during the period of viremia, which may be relatively short.

Current serologic assays have considerable cross-reactivity with other flaviviruses, including those that are endemic in the same areas (as in the case now being reported), and serologic assays specific for Zika virus are not easily available. Thus, it may be difficult to determine retrospectively whether a woman has been infected. This will be particularly difficult in areas where dengue virus and other pathogens can cause symptoms similar to those of the Zika virus.
In addition, it is unclear whether asymptomatic or minimally symptomatic disease poses a risk to the fetus. It is possible that as is the case with mumps, early infection could result in fetal loss rather than malformations. And, as in this case report, ultrasonography may detect severe fetal abnormalities only very late in gestation — in many cases, too late to terminate the pregnancy. Is there a sensitive test that can be applied earlier? And is previous infection protective?

Although we need a good deal of research to define critical aspects of infection, there is much to do immediately. A vulnerable point for Zika virus transmission is the mosquito vector. Unfortunately, mosquito-control efforts have failed to curtail the spread of many similar pathogens, including dengue and chikungunya viruses, which are carried by the same aedes species and are spreading in the same communities currently affected by the Zika virus. Perhaps this new threat will help boost such control efforts with the use of both old and new approaches. Women need to have access to relevant health care services, including contraception, diagnostics, and pregnancy-termination services. And the many affected children need to have care. Coming shortly after the global response to the Ebola virus, the rapid spread of the Zika virus reminds us how connected we all are.7 Once again, an outbreak is going to challenge our public health infrastructure and require a substantial response.

Nonprofit and Voluntary Sector Quarterly April 2016

Nonprofit and Voluntary Sector Quarterly
April 2016; 45 (2)
http://nvs.sagepub.com/content/current

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Articles
Tip of the Iceberg: The Nonprofit Underpinnings of For-Profit Social Enterprise
Curtis Child
Nonprofit and Voluntary Sector Quarterly April 2016 45: 217-237, first published on March 8, 2015 doi:10.1177/0899764015572901
Abstract
Market-based solutions to social and environmental problems in the form of for-profit social enterprise ventures have attracted considerable attention in recent years. According to popular discourse, the reason for their appeal is that they are not dependent on government grants or charitable support and are therefore more efficient and sustainable than existing alternatives. Using data collected from two social enterprise industries, this article challenges that discourse. It concludes that even though the recent focus on market-based ventures crowds out the importance of philanthropic ones, social enterprises rely substantially on civil society to accomplish their prosocial missions. By shifting attention away from the nonprofit–government relationship and toward the nonprofit–business one, these findings have implications for theorizing in nonprofit studies.

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High-Stakes Volunteer Commitment – A Qualitative Analysis
Lacy G. McNamee1, Brittany L. Peterson2
1Baylor University, Waco, TX, USA
2Ohio University, Athens, OH, USA
Abstract
This study examines the social network ties, motivations, and experiences of high-stakes volunteers (HSVs): individuals who fulfill long-term, consistent, and intense time commitments providing medical, social, and/or psychological assistance. Interview, focus group, and observational data from three settings (volunteer firefighting, victims’ services/advocacy, outreach for at-risk youth) were analyzed using qualitative methods. Accordingly, five types of HSVs (stable lifer, imbalanced lifer, conventionalist, professional, crusader) are presented and discussed. These findings advance theoretical insight into the variety of individuals who take on HSV roles and contribute to growing scholarship on diversified approaches to volunteer management.

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Managed Morality – The Rise of Professional Codes of Conduct in the U.S. Nonprofit Sector
Patricia Bromley1, Charlene D. Orchard1
1University of Utah, Salt Lake City, USA
Abstract
Calls for accountability in the nonprofit sector have never been stronger, and the rise of various forms of self-regulation represents a profound shift for nonprofits. Existing studies tend to focus on effective design and implementation of accountability policies, with an eye toward improving nonprofit efficiency and reducing instances of misconduct. Against this backdrop, we draw on sociological institutionalism to theorize an alternative view of one form of self-regulation, formal codes of conduct or ethical codes. In this view, formal policies, such as codes, are assumed to be adopted as a response to pressures in an organization’s institutional environment, beyond their purported instrumental value. Using a quantitative analysis of code adoption by 24 of 45 state nonprofit associations over the period 1994 to 2011, we provide evidence that codes arise due to general environmental conditions, particularly related to the influences of neoliberalism and professionalization, net of the functional demands of any particular context.

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A Cross-Cultural Study of Explicit and Implicit Motivation for Long-Term Volunteering
Arzu Aydinli1,2 Michael Bender1, Athanasios Chasiotis1, Fons J. R. van de Vijver1,3,4, Zeynep Cemalcilar2, Alice Chong5, Xiaodong Yue5
1Tilburg University, The Netherlands
2Koç University, İstanbul, Turkey
3North-West University, Potchefstroom, South Africa
4University of Queensland, Brisbane, Australia
5City University of Hong Kong, People’s Republic of China
Abstract
We propose a model of volunteering and test its validity across four cultural groups. We hypothesize that individuals’ explicit prosocial motivation relates positively to sustained volunteering, which is conceptualized as a latent factor comprising activity as a volunteer, service length, service frequency, and hours of volunteering. Moreover, we introduced implicit prosocial motivation and hypothesized that the relationship between explicit prosocial motivation and sustained volunteering would be amplified by implicit prosocial motivation. Data were collected from samples in China, Germany, Turkey, and the United States. Results confirmed our expectation that, across cultures, sustained volunteering was associated with explicit prosocial motivation and that the relationship between explicit prosocial motivation and sustained volunteering was strongest when implicit prosocial motivation was also high. By including implicit prosocial motivation, our study offers a novel approach to identifying sustained volunteer involvement, which can be of particular relevance for recruitment activities of voluntary organizations across various cultural contexts.

Parental Vaccine Hesitancy in Quebec (Canada)

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 12 March 2016)

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Parental Vaccine Hesitancy in Quebec (Canada)
March 7, 2016 · Research Article
Abstract
Introduction: “Vaccine hesitancy” is a concept frequently used in the discourse around vaccine acceptance. This study aims to contribute to the ongoing reflections on tools and indicators of vaccine hesitancy by providing results of a knowledge, attitudes and beliefs (KAB) survey conducted among parents.
Methods: Data were collected in 2014 through a computer-assisted telephone interview survey administered to a sample of parents of children aged between 2 months and 17 years of age.
Results: The majority of the 589 parents included in the analyses agreed on the importance of vaccination to protect their children’s health and to prevent the spread of diseases in the community. The majority of the parents (81%) reported that their child had received all doses of recommended vaccines and 40% of parents indicated having hesitated to have their child vaccinated. Fear of adverse events and low perceived vulnerability of the child or severity of the disease were the most frequent reasons mentioned by these vaccine-hesitant parents. In multivariate analyses, KAB items remaining significantly associated both with an incomplete vaccination status of the child and parents’ vaccine hesitancy were: not thinking that it is important to have the child vaccinated to prevent the spreading of diseases in the community; not trusting the received vaccination information and having felt pressure to have the child vaccinated.
Discussion: Further researches will be needed to better understand when, how and why these beliefs are formed in order to prevent the onset of vaccine hesitancy.

PLoS Medicine (Accessed 12 March 2016)

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 12 March 2016)

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Trans-Pacific Partnership Provisions in Intellectual Property, Transparency, and Investment Chapters Threaten Access to Medicines in the US and Elsewhere
Brook K. Baker
Essay | published 08 Mar 2016 | PLOS Medicine
10.1371/journal.pmed.1001970
Summary Points
:: The recently negotiated Trans Pacific Partnership Agreement (TPP) contains provisions that would dramatically and negatively impact access to affordable medicines in the United States and elsewhere if it is ratified.
:: Provisions in the Intellectual Property (IP) Chapter of TPP lengthen, broaden, and strengthen patent-related monopolies on medicine and erect new monopoly protections on regulatory data as well. IP Chapter enforcement provisions also mandate injunctions preventing medicines sales, increase damage awards, and expand confiscation of medicines at the border.
:: IP rightholders gain new powers in the Investment Chapter to bring private, IP-related investor-state-dispute-settlement (ISDS) damage claims directly against foreign governments before unreviewable, three-person arbitration panels. Unrestricted IP-investor damage claims deter countries’ willingness to render adverse IP decisions and to adopt IP policy flexibilities designed to increase access to affordable medicines.
:: The Transparency Chapter contains provisions that allow pharmaceutical companies more access to government decisions listing medicines and medical devices for reimbursement.
At the very least, these multiple TPP provisions that extend pharmaceutical powers should be scaled back to the minimum consensus standards reached in the 1994 World Trade Organization (WTO) Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Health advocates should convince the US Congress and opponents in other countries to reject an agreement that could so adversely impact access to medicines.

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Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys
Oona M. R. Campbell, Luca Cegolon, David Macleod, Lenka Benova
Research Article | published 08 Mar 2016 | PLOS Medicine
10.1371/journal.pmed.1001972
Abstract
Background
Following childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants.
Methods and Findings
We described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” ( Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries.
Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation.
Conclusions
Length of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough to benefit from these. The challenge is to commit to achieving adequate lengths of stay in low- and middle-income countries, while ensuring any additional time is used to provide high-quality and respectful care.

Editors’ Summary
Background
The general recommendation to women, especially to women in resource-poor settings (where more than 95% of all maternal and newborn deaths occur), is to give birth in a health facility. How long women and infants should stay after birth, i.e., the appropriate time to discharge, depends on many factors, but it is known that during the first 24 hours after birth mothers and children are at the highest risk of complications and death. During the postpartum stay, the objectives are to monitor maternal and newborn health, and to provide education on breastfeeding and signs for health problems in mothers and infants. WHO recommends that, in resource-poor settings, mothers and newborns stay for a minimum of 24 hours after vaginal birth.
Why Was This Study Done?
Considerable effort has gone into getting women to give birth in health facilities, and some countries have even made it illegal to give birth at home. However, some reports have suggested that women and infants often spend less than the recommended minimum time after birth in the facility. Actual data on duration of postpartum stays are limited, especially for low- and middle-income countries. This study was done to provide an overview of the reality in all countries for which current data exist, and to explore factors that influence the postpartum length of stay…
What Do these Findings Mean?
For many countries, the researchers were unable to find information on postpartum length of stay, and additional research seems warranted. Moreover, in the 30 DHS countries included in the analysis here, the percentage of births in health facilities ranged from 25.1% to 99.2%, suggesting that many countries still need to increase facility births. The postpartum lengths of stay reported vary widely between countries and are likely influenced by national norms and health system features in addition to specific needs of mothers and newborns. The reasons why women leave or are discharged early appear complex and are not well understood. Nonetheless, it seems that many women stay too short to receive adequate postnatal care. This is alarming, especially in low-income settings, where access to care after discharge is often limited. Countries in which staying too short is common should examine the reasons, clearly define appropriate care in health facilities during and after birth, and ensure both that such care is offered and that mothers and newborns stay long enough to receive it.

Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 12 March 2016)

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Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone
Kamalini Lokuge, Grazia Caleo, Jane Greig, Jennifer Duncombe, Nicholas McWilliam, James Squire, Manjo Lamin, Emily Veltus, Anja Wolz, Gary Kobinger, Marc-Antoine de la Vega, Osman Gbabai, Sao Nabieu, Mohammed Lamin, Ronald Kremer, Kostas Danis, Emily Banks, Kathryn Glass
Research Article | published 09 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004498
Abstract
Introduction
The scale and geographical distribution of the current outbreak in West Africa raised doubts as to the effectiveness of established methods of control. Ebola Virus Disease (EVD) was first detected in Sierra Leone in May 2014 in Kailahun district. Despite high case numbers elsewhere in the country, transmission was eliminated in the district by December 2014. We describe interventions underpinning successful EVD control in Kailahun and implications for EVD control in other areas.
Methods
Internal service data and published reports from response agencies were analysed to describe the structure and type of response activities, EVD case numbers and epidemic characteristics. This included daily national situation reports and District-level data and reports of the Sierra Leone Ministry of Health and Sanitation, and Médecins Sans Frontières (MSF) patient data and internal epidemiological reports. We used EVD case definitions provided by the World Health Organisation over the course of the outbreak. Characteristics assessed included level of response activities and epidemiological features such as reported exposure (funeral-related or not), time interval between onset of illness and admission to the EVD Management Centre (EMC), work-related exposures (health worker or not) and mortality. We compared these characteristics between two time periods—June to July (the early period of response), and August to December (when coverage and quality of response had improved). A stochastic model was used to predict case numbers per generation with different numbers of beds and a varying percentage of community cases detected.
Results
There were 652 probable/confirmed EVD cases from June-December 2014 in Kailahun. An EMC providing patient care opened in June. By August 2014 an integrated detection, treatment, and prevention strategy was in place across the district catchment zone. From June-July to August-December 2014 surveillance and contact tracing staff increased from 1.0 to 8.8 per confirmed EVD case, EMC capacity increased from 32 to 100 beds, the number of burial teams doubled, and health promotion activities increased in coverage. These improvements in response were associated with the following changes between the same periods: the proportion of confirmed/probable cases admitted to the EMC increased from 35% to 83% (χ2 p-value<0·001), the proportion of confirmed patients admitted to the EMC
Discussion
Our findings demonstrate that control of EVD can be achieved using established interventions based on identification and appropriate management of those who are at risk of and develop EVD, including in the context of ongoing transmission in surrounding regions. Key attributes in achieving control were sufficient patient care capacity (including admission to specialist facilities of suspect and probable cases for assessment), integrated with adequate staffing and resourcing of community-based case detection and prevention activities. The response structure and coverage targets we present are of value in informing effective control in current and future EVD outbreaks.

Author Summary
Ebola Virus Disease (EVD) is a severe illness that is usually spread from person to person through caring for someone who is sick, or if they die, contact with their body during their funeral. The recent EVD outbreak in West Africa caused illness and death in many thousands in Guinea, Sierra Leone and Liberia. It has been the largest and most difficult to control of any EVD outbreak in history, and this led to doubts as to the effectiveness of established control measures. Our study describes the successful control of EVD in a rural district of Sierra Leone. As in previous outbreaks, we found that control was achieved by working with communities to identify people who may have been exposed to EVD; if they then became sick, their early admission for testing and care to specialised centres that have equipment and procedures to prevent EVD passing on to staff or other patients, and safe burial of those who die of EVD by trained workers with appropriate protective equipment. We describe the resources and response structure needed to implement such measures effectively, information that will assist in controlling future outbreaks.

PLoS One [Accessed 12 March 2016]

PLoS One
http://www.plosone.org/
[Accessed 12 March 2016]

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Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review
Emilia Vynnycky, Elisabeth J. Adams, Felicity T. Cutts, Susan E. Reef, Ann Marie Navar, Emily Simons, Lay-Myint Yoshida, David W. J. Brown, Charlotte Jackson, Peter M. Strebel, Alya J. Dabbagh
Research Article | published 10 Mar 2016 | PLOS ONE
10.1371/journal.pone.0149160

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Factors Associated with Nursing Activities in Humanitarian Aid and Disaster Relief
Norihito Noguchi, Satoshi Inoue, Chisato Shimanoe, Kaoru Shibayama, Koichi Shinchi
Research Article | published 09 Mar 2016 | PLOS ONE
10.1371/journal.pone.0151170
Abstract
Background
Although nurses play an important role in humanitarian aid and disaster relief (HA/DR), little is known about the nursing activities that are performed in HA/DR. We aimed to clarify the nursing activities performed by Japanese nurses in HA/DR and to examine the factors associated with the frequency of nursing activities.
Methods
A self-administered questionnaire survey was completed by 147 nurses with HA/DR experience. The survey extracted information on demographic characteristics, past experience (e.g., disaster medical training experience, HA/DR experience), circumstances surrounding their dispatched to HA/DR (e.g., team size, disaster type, post-disaster phase, mission term), and the frequency of nursing activities performed under HA/DR. The frequency of nursing activities was rated on a 5-point Likert scale. Evaluation of nursing activities was conducted based on the “nursing activity score”, which represents the frequency of each nursing activity. Factors related to the nursing activity score were evaluated by multiple logistic regression analysis.
Results
Nurses were involved in 27 nursing activities in HA/DR, 10 of which were performed frequently. On analysis, factors significantly associated with nursing activity score were nursing license as a registered nurse (OR 7.79, 95% CI 2.95–20.57), two or more experiences with disaster medical training (OR 2.90 95%, CI 1.12–7.49) and a post-disaster phase of three weeks or longer (OR 8.77, 95% CI 2.59–29.67).
Conclusions
These results will contribute to the design of evidence-based disaster medical training that improves the quality of nursing activities.

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Crippling Violence: Conflict and Incident Polio in Afghanistan
Alison Norris, Kevin Hachey, Andrew Curtis, Margaret Bourdeaux
Research Article | published 09 Mar 2016 | PLOS ONE
10.1371/journal.pone.0149074
Abstract
Background
Designing effective public health campaigns in areas of armed conflict requires a nuanced understanding of how violence impacts the epidemiology of the disease in question.
Methods
We examine the geographical relationship between violence (represented by the location of detonated Improvised Explosive Devices) and polio incidence by generating maps of IEDs and polio incidence during 2010, and by comparing the mean number of IED detonations in polio high-risk districts with non polio high-risk districts during 2004–2009.
Results
We demonstrate a geographic relationship between IED violence and incident polio. Districts that have high-risk for polio have highly statistically significantly greater mean numbers of IEDs than non polio high-risk districts (p-values 0.0010–0.0404).
Conclusions
The geographic relationship between armed conflict and polio incidence provides valuable insights as to how to plan a vaccination campaign in violent contexts, and allows us to anticipate incident polio in the regions of armed conflict. Such information permits vaccination planners to engage interested armed combatants to co-develop strategies to mitigate the effects of violence on polio.

The Challenge of Asylum Detention to Refugee Protection

Refugee Survey Quarterly
Volume 35 Issue 1 March 2016
http://rsq.oxfordjournals.org/content/current

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Special Issue: The Challenge of Asylum Detention to Refugee Protection
Guest Editors: Philippe De Bruycker and Evangelia (Lilian) Tsourdi

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The Challenge of Asylum Detention to Refugee Protection
Philippe De Bruycker* and Evangelia (Lilian) Tsourdi**
Abstract
Detention poses a specific challenge to refugee protection; detained asylum-seekers risk not being able to file and meaningfully pursue their claim and benefit only from restrained social and economic rights. They pay a steep human cost. Courts, the legislature, and the United Nations High Commissioner for Refugees have made efforts to rationalise its use, with the aim to render it a truly exceptional measure of last resort. However, challenges remain and there are pitfalls in asylum detention regulation. One major challenge is non-implementation of legal guarantees in practice and insufficient control by the judge. This can nullify legal guarantees, especially in a highly sophisticated framework like European Union law, where individualisation and the necessity and proportionality requirements, are the elements that rationalise otherwise broadly phrased detention grounds. The misuse of alternatives to detention that have been established to rationalise the use of asylum detention is another, as they may paradoxically be used to enhance control over asylum-seekers instead. Finally, migration management imperatives pose distinct challenges to refugee protection, where asylum detention is used arbitrarily as a means to their end.
[Six articles in this Special Issue]

Reproductive Health [Accessed 12 March 2016]

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 12 March 2016]

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Research
Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda
Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, h…
Emmanueil Benon Turinawe, Jude T. Rwemisisi, Laban K. Musinguzi, Marije de Groot, Denis Muhangi, Daniel H. de Vries, David K. Mafigiri, Achilles Katamba, Nadine Parker and Robert Pool
Reproductive Health 2016 13:24
Published on: 12 March 2016

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Study protocol
PREventing Maternal And Neonatal Deaths (PREMAND): a study protocol for examining social and cultural factors contributing to infant and maternal deaths and near-misses in rural northern Ghana
The Preventing Maternal And Neonatal Deaths (PREMAND) project works to understand the social and cultural factors that may contribute to the deaths and near-misses (people who almost die but end up surviving) …
Cheryl A. Moyer, Raymond A. Aborigo, Elizabeth B. Kaselitz, Mira L. Gupta, Abraham Oduro and John Williams
Reproductive Health 2016 13:20
Published on: 9 March 2016

The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literatur

Tropical Medicine & International Health
March 2016 Volume 21, Issue 3 Pages 293–453
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2016.21.issue-3/issuetoc

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Reviews
The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature (pages 294–311)
Dawn M. Becker, Chelsea A. Tafoya, Sören L. Becker, Grant H. Kruger, Matthew J. Tafoya and Torben K. Becker
Article first published online: 10 JAN 2016 | DOI: 10.1111/tmi.12657
Abstract
Objectives
To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low- and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used.
Methods
The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions.
Results
A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials).
Conclusions
Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.

Nepal Digest – Evidence for Action

__________________________________________________
February 2016

In support of building evidence-based practice, this digest aggregates selected research, analysis and insight about Nepal from UN agencies, INGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. A key resource for this digest is the peer-reviewed journal literature, attempting to better connect academic and other primary and secondary researchers to field practice leaders and practitioners.

pdf version and earlier editions available here: https://ge2p2-center.net/country-digests/

Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
– email: david.r.curry@ge2p2center.net
– twitter: @ge2p2
– skype: davidrcurry1

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 5 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 5 March 2016

blog edition: comprised of the 35+ entries  posted below on 29 February through 6 March 2016

Statement of the UN High Commissioner for Human Rights, Zeid Ra’ad Al Hussein, at the 31st session of the Human Rights Council in Geneva, 29 February 2016

United Nations Human Rights Council
31st regular session of the Human Rights Council
Geneva 29 February to 24 March 2016)\
Website for agenda and documentations: http://www.ohchr.org/EN/HRBodies/HRC/RegularSessions/Session31/Pages/31RegularSession.aspx

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Opening Session – 29 February 2016
Video: Zeid Ra’ad Al Hussein, High-Level Segment – 1st Meeting, 31st Regular Session Human Rights Council
29 Feb 2016
[Video: 00:21:10]
Mr. Zeid Ra’ad Al Hussein, United Nations High Commissioner for Human Rights – Opening of Session and High-Level Segment

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Statement of the UN High Commissioner for Human Rights, Zeid Ra’ad Al Hussein, at the 31st session of the Human Rights Council in Geneva, 29 February 2016
…I am honoured to address this Council on the eve of its second decade. This is an anniversary that calls for more than rhetoric: it cries out for action, and decisive and cooperative leadership in defence of vital principles.

Human rights violations are like a signal, the sharp zig-zag lines of a seismograph flashing out warnings of a coming earthquake. Today, these jagged red lines are shuddering faster and higher. They signal increasing, and severe, violations of fundamental rights and principles.

These shocks are being generated by poor decisions, unprincipled and often criminal actions, and narrow, short-term, over-simplified approaches to complex questions. All now crushing the hopes and lives of countless people. So the compression begins, once again. This resurgent broad-based malice, irresponsibility and sometimes eye-watering stupidity, altogether acting like steam at high pressure being fed into the closed chamber of world events. And unless it is released gradually and soon, through wiser policy making – where the interests of all humans override this strengthening pursuit of the narrowest, purely national, or ideological, agenda. Otherwise – as the reading of human history informs us – its release, when it comes, will be as a colossus of violence and death.

Mr. President,
When the key drafters, representing States, wrote the UN Charter and drew up the protective fortress of treaties and laws making up our international system, they did not do so because they were idealists only. They did it for security, and because they were pragmatists. They had experienced global warfare, dispossession and the oppression of imperialism. They had lived “balance-of-power” politics, and its consequences – thrown violently into imbalance as it was by the feral nationalisms and ideologies of the extreme left and right. They knew, from bitter experience, human rights, the respect for them, the defence of them, would not menace national security – but build more durable nations, and contribute (in their words) to “a final peace”. And so, after the cataclysm of global war and the development of nuclear weapons, they created the UN, and wrote international laws, to ward off those threats.

Today we meet against a backdrop of accumulating departures from that body of institutions and laws which States built to codify their behaviour. Gross violations of international human rights law – which clearly will lead to disastrous outcomes – are being greeted with indifference. More and more States appear to believe that the legal architecture of the international system is a menu from which they can pick and choose – trashing what appears to be inconvenient in the short term.

This piecemeal dismantling of a system of law and values that States themselves set up to ward off global threats is deeply alarming. Instead of taking a reasoned and cooperative approach to settling challenges – including the rise of violent extremism, the growing number of armed conflicts, and the movement of people seeking safety – many leaders are pandering to a simplistic nationalism, which mirrors the simplified and destructive ‘us’ versus ‘them’ mind-set of the extremists, and fans a rising wind of prejudice and fear. This bid to find unilateral quick fixes for issues that have broad roots is not only unprincipled, it is illusory – and it contributes to great suffering and escalating disarray.

Mr President,
The protection of human life and dignity is crucial at all times. Warfare does not put a stop to these and other fundamental obligations of international human rights law. During armed conflict or occupation, a complementary body of law – international humanitarian law – provides additional protection, to safeguard the rights of those fighting, as well as civilians, the sick and wounded, and people who have laid down their weapons. It must be applied by all parties: States – including all foreign forces, in the case of external intervention – and non-State armed groups.

These two great bodies of law are being violated shockingly, in multiple conflicts, with complete impunity. In Syria, previous to the temporary cessation of hostilities which began last weekend, this has been the case for five long years. Neighbourhoods, schools, and packed marketplaces have been hit by tens of thousands of airstrikes. Thousands of barrel bombs have been thrown out of helicopters onto streets and homes. Mortar and artillery fire, and IEDs, have been used without regard for civilian life.

Hospitals, medical units and healthcare personnel are afforded special protection under international humanitarian law. But at least ten hospitals and other medical units have been damaged or destroyed in Syria since the beginning of January ¬– more than one every week – and on several occasions a second strike has hit rescue operations. The repetition of these murderous attacks suggests that some parties to the conflict are targeting medical units deliberately, or with reckless disregard. They deprive huge numbers of people, many already suffering the effects of intense bombardment, of their right to health, and endanger their right to life.

Similarly, the deliberate starvation of people is unequivocally forbidden as a weapon of warfare. By extension, so are sieges, which deprive civilians of essential goods such as food. And yet over 450,000 people are currently trapped in besieged towns and villages in Syria – and have been, in some cases, for years. Food, medicine and other desperately-needed humanitarian aid is repeatedly obstructed. Thousands risk starving to death.

And yet Syria is far from the only armed conflict in which civilians have endured frightful attacks. Multiple medical facilities, religious sites and schools have been repeatedly attacked and bombed in Afghanistan, Iraq, Libya, South Sudan, and Yemen. Mindful as we all are of the attack against the Khaleq market in Nahem which left scores of civilians dead only two days ago. The damage done by these violations – in bloodshed, and needless suffering and deaths from treatable illnesses and wounds – is dreadful. I add my voice to that of the distinguished President of Médecins Sans Frontières: the normalization of such attacks is intolerable.

It is extremely alarming that so many conflicts, crises and humanitarian emergencies are currently raging, with repeated violations of the norms that protect people’s rights and lives. In Afghanistan, Burundi, the east of the Democratic Republic of Congo; the countries around Lake Chad which have suffered the attacks of Boko Haram; in Iraq; Libya; Mali; the Occupied Palestinian Territory; Somalia; South Sudan; Sudan; Syria; Ukraine and Yemen, millions of lives are threatened, and millions of homes are destroyed. Survivors, particularly the most vulnerable, are forced to flee, and become exposed to further violations. Economies are being broken. Health systems and infrastructure are being destroyed. Children go hungry, unschooled, and many suffer multiple forms of violence.

The effects of these prolonged conflicts and emergencies will be endured for generations. And yet they continue – and even cease, apparently, to shock.

Whether they are the result of deliberate targeting or systemic incompetence, every single attack on civilians and protected civilian objects must be fully, transparently and independently investigated.

Mr President,
Conflicts in Syria, Iraq and elsewhere have unleashed a toxic brew of malevolent forces, including the commission of sickening crimes and atrocities, and the emergence of human trafficking gangs. These are the circumstances that migrants are increasingly fleeing. The trauma they have suffered is appalling; they deserve the international community’s sympathy and compassion. To keep building higher walls against the flight of these desperate people is an act of cruelty and a delusion.

Migration is a basic fact of human history, and it requires global sharing of responsibility. The welcome of millions of displaced people after the Second World War was clearly a positive, as well as a principled, move for the States which opened their doors. Agreements to resettle and integrate the refugees and migrants of Cambodia, Laos and Viet Nam, and people fleeing war in the former Yugoslavia: these decisions not only brought net benefit to the host States, but also displayed moral leadership and international cooperation.

Today, instead, we see hostility, disarray, and a rising roar of xenophobia.

Mr. President,
Anti-immigrant and anti-minority rhetoric scar societies. They might offer instant political gratification in some quarters, but they result in divisions that cut deep. Racist, discriminatory and xenophobic rhetoric makes it even harder for minorities and outsiders to access equal opportunities and basic goods. And so our societies are cleaved. Communities grow further apart.

“Ignorance leads to fear, fear leads to hate, and hate leads to violence. That is the equation,” wrote Abu al-Walid Mohammad ibn Ahmed ibn Rushd, the great Islamic and European philosopher of Spain, 850 years ago. When leaders express, or ignite, waves of hate speech, as we have seen in recent months – hate speech against migrants, and specific ethnic and religious groups – they are setting off shock-waves, whose impact will lead to violence.

Similarly, when Governments clamp down against grassroots activists, journalists and political opponents – or scrap the guarantees of an independent judiciary – they are not acting to halt violent extremism. They are dismantling the integrity of their societies and the people’s trust and respect for fundamental institutions. Crushing human freedoms will not protect us from terrorism. It creates dangerous divisions and grievances that will lead to more violence.

We must not throw our principles and our reason overboard because we are petrified by the grotesque abuses of a few thousand fanatics. So-called ISIL is a powerful force for ill. But its behaviour and its mindset are so inhuman that it can only thrive in an atmosphere of deprivation and hate. This is a threat that can be overcome, and indeed our societies have done so in the past.

The ancient Chinese philosopher Lao Tzu is said to have observed, “We join spokes together in a wheel, but it is the centre space that makes the wagon move.” That central space is our values. Our principles are the force that create resilience, the capacity to resist threats.

I urge policy-makers to deploy those central values as they work to uproot the underpinning factors of violent extremism. Persistent discrimination, which creates bitter grievances and daily humiliations. Corruption, which stokes resentment, and is at the root of so much poor governance. Inadequate schools, and economic structures which deprive young people of opportunities.

Failures to establish a sense of belonging in a society that is benevolent and respectful.

Restrictions that hamper the full participation of the people in decision-making – so that they no longer believe in their own societies.

Measures which ensure respect for human rights will extinguish violent extremism more effectively, and more sustainably, than any crackdown. Justice and human rights are the essential foundation of loyalty. They are what is needed.

Similarly, sound policies cannot be built on a distorted image of so-called invasion by people who are manifestly fleeing countries no longer safe for human life. Their movement is a search for hope, out of despair. And while I do not belittle the logistical difficulties it may create, they are a threat to no society. A disorderly race to the bottom of policies by States is creating massive and unsustainable strain on countries neighbouring conflict, which cannot continue to manage this task alone. These policies are compounding human suffering, driving increasingly unprincipled decisions, and creating chaos.

We need a new, concerted set of policies which establish the hope that people will be able to live in fair and just societies in their own homes. Meanwhile, there must be a sane, principled and compassionate welcome given to people who are fleeing for their lives. I urge Member States to rise above the crescendo of xenophobia and gather lessons from the great integrative forces of history. Cities and civilizations have been irrigated by diversity, and have welcomed far greater movements of people in the past.

Mr President,
If global climate change can teach us one thing, it is that on this planet, there is no “them”. There is only us.

And yet structural injustice and discrimination continue to deprive millions of people of their right to development. A shocking number of women are denied their fundamental equality, including their reproductive rights. Far too many people are excluded from vital resources by prejudice and by the force of crushing inequalities.

On these and other topics, I and my Office speak out, and act, to the full extent of our capacity – and here I would like to pay tribute to the Secretary-General for his Human Rights Up Front initiative, promoted also by the Deputy Secretary-General, which has given new impetus to the whole system to speak up on human rights. We do this work boldly, although we are dependent on States for resources, because the inherent dignity and worth of the human person; equality between all men and women; the economic and social advancement of all peoples – these human rights principles are the basis of peace.

The combined influence of 47 States is assembled here. We speak with the weight of the United Nations. Both individually and as the representatives of States, I urge you to act with courage and on principle, and to take a strong stand regarding the protection of civilians. The perpetrators of severe violations of this order must know that they will, at the first occasion, be sanctioned to the full extent of the law. I urge you to rise above national self-interest and heal divisions instead of fuelling them. To abide by and protect international humanitarian and human rights law. I urge you to deploy your diplomatic power to uphold peace and advance the protection of human rights for all people, in other States and within your own.

This Council has become an important institution within the United Nations, with growing influence and respect. I believe that the increasing integration of human rights concerns, within development and all other UN activities, makes it essential that the Council develop stronger ties to the Security Council and other bodies. In its second decade, the Human Rights Council must have important impact on world events – and help to ensure that the frightful human rights violations which we are seeing today are not the prologue to even greater suffering and chaos, tomorrow.

Special measures for protection from sexual exploitation and sexual abuse – Report of the Secretary-General

Atul Khare (DFS) on the Secretary-General’s report on special measures for protection from sexual exploitation and sexual abuse – Press Conference
4 Mar 2016
Video: 42.34
Press Conference by Mr. Atul Khare, Under-Secretary-General for Field Support (Department of Peacekeeping Operations, DPKO) on the Secretary-General’s report on special measures for protection from sexual exploitation and sexual abuse.

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Special measures for protection from sexual exploitation and sexual abuse
Report of the Secretary-General
General Assembly
A/70/729 :: 41 pages
16 February 2016
Summary
Pursuant to General Assembly resolution 57/306, the present report provides data on allegations of sexual exploitation and abuse in the United Nations system for the period from 1 January to 31 December 2015 and information on measures being taken to strengthen the Organization’s response to sexual exploitation and abuse in the areas of prevention, enforcement and remedial action.

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[Excerpt]
VI. Action to be taken by the General Assembly
98. The General Assembly is requested to take note of progress made in advancing the Secretary-General’s initiatives set out in his previous report (A/69/779) and of new proposals in the present report.

99. The General Assembly is requested to:
(a) Request that Member States assess existing national legislation to determine its applicability to sex crimes committed by nationals while in the service of United Nations peace operations and, if necessary, assess whether new legislative action is required, including allowing nationality-based extraterritorial jurisdiction;

(b) Encourage Member States to provide information, to be included in future reports, on compliance with the United Nations request to amend national administrative frameworks governing police and military contingents to explicitly include sexual exploitation and abuse as a type of misconduct where this is not the case and to ensure that such cases attract the harshest possible sanctions;

(c) Request that Member States adopt a six-month timeline for completing investigations into alleged sexual exploitation and abuse;

(d) Expand the scope of action open to the United Nations in cases of alleged sexual exploitation and abuse by contingent members in order to allow OIOS and Immediate Response Teams to interview witnesses, including contingent members, where no National Investigation Officer is available;

(e) Request that Member States establish on-site court martial proceedings, supported by any judicial infrastructure necessary, when allegations amount to sex crimes under national legislation;

(f) Request that Member States obtain DNA samples of members of military contingents and formed police units who are alleged to have committed sexual exploitation and abuse;

(g) Approve the transfer of payments withheld in substantiated cases of sexual exploitation and abuse by any United Nations personnel to the trust fund for victims;

(h) Encourage Member States to contribute to the trust fund for victims on a voluntary basis;

[i] Urge Member States to receive claims from victims and consider the required mechanisms for doing so, and advise the Secretariat on this process;

(j) Request that Member States appoint paternity focal points for troop-contributing and police-contributing countries, and notify the Secretariat accordingly;

(k) Request that Member States suspend payments in relation to the unit with which the implicated individual was deployed, or a corresponding replacement unit, where an investigation is not completed within one year of the date of notification and agree that, following consultation with the concerned Member State, all further deployments will be suspended pending notification of completion of the investigation.

UNHCR: 6 steps towards solving the refugee situation in Europe

UNHCR: 6 steps towards solving the refugee situation in Europe
Press Releases, 4 March 2016
Ahead of a meeting of heads of state or government of the European Union (EU) with Turkey on 7 March in Brussels, UNHCR, the UN Refugee Agency, has today issued recommendations aimed at helping States solve the refugee situation in Europe.

“We are running out of time, and strong leadership and vision are urgently needed from European leaders to deal with what is, in our view, a situation that can still be managed if properly addressed,” said UN High Commissioner for Refugees Filippo Grandi. “This is as much a crisis of European solidarity as it is a refugee crisis. The collective failure to implement the measures agreed by EU Member States in the past has led to the current escalation in the crisis,” he added.

The situation is quickly deteriorating with some 30,000 people now in Greece, almost a third of whom are in Idomeni just near the border with the former Yugoslav Republic of Macedonia. Although the Greek authorities and military have ramped up their response, thousands are sleeping in the open without adequate reception, services, aid or information. With tensions mounting, the situation could escalate quickly into a full-blown crisis. UNHCR is supporting the Greek Government’s efforts by deploying staff, helping coordinate the response and providing emergency shelter, technical support and information to refugees and migrants.

“The participation of all EU Member States in a solution is critical to managing it effectively,” Mr. Grandi said. “It should not just be left to the entry countries of Greece and Italy, and those such as Austria, Germany and Sweden, who welcomed so many.”

High Commissioner Grandi has proposed a plan to EU Member States to manage and stabilize the refugee situation. The plan includes six key points, intended as broad guidance:
1. Implement fully the so-called “hot spot” approach and relocation of asylum seekers out of Greece and Italy and, at the same time, return individuals who don’t qualify for refugee protection, including under existing readmission agreements.
2. Step up support to Greece to handle the humanitarian emergency, including for refugee status determination, relocation, and return or readmission.
3. Ensure compliance with all the EU laws and directives on asylum among Member States.
4. Make available more safe, legal ways for refugees to travel to Europe under managed programmes – for example humanitarian admission programmes, private sponsorships, family reunion, student scholarships and labour mobility schemes – so that refugees do not resort to smugglers and traffickers to find safety
5. Safe-guard individuals at risk, including systems to protect unaccompanied and separated children, measures to prevent and respond to sexual and gender-based violence, enhancing search and rescue operations at sea, saving lives by cracking down on smuggling, and countering xenophobia and racism targeted at refugees and migrants.
6. Develop Europe-wide systems of responsibility for asylum-seekers, including the creation of registration centres in main countries of arrival, and setting up a system for asylum requests to be distributed in an equitable way across EU Member States.

UNHCR’s proposals make clear that equitable sharing of responsibility is key to bringing about a managed and orderly solution, and that EU Member States would need to agree a system of percentages of asylum-seekers for each Member State to take.

“Europe has successfully dealt with large-scale refugee movements in the past, during the Balkans Wars for example, and can deal with this one, provided it acts in a spirit of solidarity and responsibility sharing,” said High Commissioner Grandi. “There is really no other option than working together to solve this.”

UNHCR’s paper “Stabilizing the situation of refugees and migrants in Europe Proposals to the Meeting of EU Heads of State or Government and Turkey on 7 March 2016”, 3 March 2016, can be downloaded here: http://www.unhcr.org/56d94f7e9.html

Joint NGO Statement on the Western Balkan migration route

Joint NGO Statement on the Western Balkan migration route
3 March 2016
[Text bolding from statement original]

To European Leaders:
As national and international organizations working along the Western Balkan migration route in Greece, the Former Yugoslav Republic of Macedonia, Serbia, and Croatia, we strongly condemn the latest discriminatory and dangerous measures adopted by European countries as part of a broader package of deterrence policies intended to stem the flow of vulnerable people seeking safety.

On 21 February 2016, several countries in Europe closed their borders to Afghans resulting in a build-up of refugees in Greece and frantic scenes of chaos and confusion in the Western Balkans countries. Border restrictions on the basis of nationality deny each person’s right to an individual assessment of their international protection needs – which runs counter to international and European refugee and human rights law. These latest measures represent a further narrowing of a selective and arbitrary admissions policy which was already in place from late last year, when Europe shut its borders to all but those from the ‘war-torn’ countries of Syria, Iraq or Afghanistan.

This new policy is part of a package of restrictive measures that impact on the safety, well-being and rights of people on the move in Europe. At a meeting on 18 February 2016, the Heads of Police Services of the Republics of Austria, Slovenia, Croatia, Serbia and the Former Yugoslav Republic of Macedonia, issued a statement introducing new identification and registration measures that could amount to arbitrary and illegal restrictions on a person’s right to seek international protection.

For example, entry into these countries on humanitarian grounds will only be authorized to those fleeing “war-torn areas” that “are in need of international protection” on the basis of proven nationality. Such a policy involves a potential violation of the right to claim asylum[1], and the obligation of Council of Europe member states to non-discrimination in immigration controls, including on the basis of national or social origin[2]. Likewise, the Police Statement allows for other limitations taking into account ‘any other restrictions of destination countries’, such as the daily quotas Austria introduced on 20 February, which the European Commission has stated is clearly incompatible with European and international law. Family reunification is also among the reasons why a person might be refused entry, despite the right to family unity being a core tenet of international law[3], with States encouraged to facilitate the reunification of refugee families.

An announcement made on 20 February at a meeting of the Directors of the Police of Serbia and Bulgaria, stated that refugees would only be allowed to enter Serbia through Preševo (via the Former Yugoslav Republic of Macedonia) and that Serbia and Bulgaria would take joint measures to prevent the movement of people from Bulgaria to Serbia. Given Serbia’s obligation to allow refugees access to its territory at any border crossing,[4] and given the reports of abuse and unlawful treatment of refugees in Bulgaria[5], this development is particularly concerning.

Not only are these procedures out of line with existing international and European law to protect and uphold the rights of persons to seek asylum, they have also served to further exacerbate the level of human suffering on the ground and perpetuate the humanitarian crisis.

Sudden border closures or restrictions can leave people stranded in inadequate and inhumane conditions, as border areas often have insufficient reception capacity to host large numbers of people. Since the borders were closed to Afghans and new screening procedures introduced, thousands of people who had already exhausted their financial resources to make the costly journey into Europe were left stranded, often sleeping outdoors without access to even basic services. Returning home is not an option for many of them, who may instead turn to smugglers and traffickers to facilitate their onward journey – exposing already vulnerable people to increased risks of abuse, violence and exploitation. We are particularly concerned for vulnerable families, women and unaccompanied children travelling through Europe, many of whom are from Afghanistan, as the new measures will only push them further underground and further out of reach of humanitarian actors.

To that end, we call on European governments to take action in order to ensure that the immediate humanitarian needs of people on the move are met, and to live up to their obligations under international law. In particular, we are calling on European states to:

:: Put an end to the selective admission policy currently in place and fulfill legal obligations to ensure fair and thorough refugee status determination procedures for all nationalities. In addition, children seeking asylum have the right to a ‘best interest assessment’ and an individual screening for their specific protection needs.

:: Make immediate provisions to meet the needs of people no longer able to continue their journey, including urgently scaling up reception and support services which respect people’s dignity and human rights. Provisions should be made to find emergency accommodation for children and their families who are especially vulnerable.

:: Stop forceful and involuntary push-backs which deny individual rights to apply for asylum, particularly to countries where people might face persecution, and for those who are found not to be eligible for international protection, ensure the returns process respects their basic human rights.

:: Work together to ensure a co-ordinated approach to deal with the crisis based on information-sharing and collaboration, and avoid unilateral moves which can create dangerous ‘domino-effects’ that impact on vulnerable people. A collective response is needed immediately to ensure that affected states, particularly Greece, have adequate resources and funding to provide support and protection to people in their borders.

:: Create safe and legal routes into Europe for people seeking asylum, to avoid the loss of life on dangerous journeys and decrease the demand for irregular smuggling and trafficking networks. It is clear that deterrence policies based on razor-wire fences, intimidating police forces, and closed borders, will do little to stop desperate people searching for safety.

European states have a responsibility to protect the vulnerable and respect the rights and human dignity of all people arriving at their borders. Instead, the latest measures reveal the dangerous trajectory that Europe is following towards undermining the foundations of European and international refugee and human rights law. It is not too late for Europe to correct course and enact proper procedures outlined in existing law and take immediate action to protect vulnerable people in its territory.

ActionAid
Albanian Helsinki Committee
Atina Serbia
Belgrade Center for Human Rights
Center for Youth Integration Serbia
Civic Initiatives Belgrade
Civil Rights Program Kosovo
Doctors of the World Greece
European Council on Refugees and Exiles
Građanske inicijative – Civic Initiative
Greek Council of Refugees
Greek Forum of Refugees
Grupa 484
Helsinki Committee for Human Rights in Serbia
Humanitarni centar za integraciju i toleranciju (HCIT)
Hrvatski pravni centar
International Rescue Committee
Lawyers Committee for Human Rights
Macedonian Young Lawyers Association
Norwegian Refugee Council
Open Gate – La Strada
Oxfam
Practical Policy Centre Serbia
Praksis
Praxis Serbia
Save the Children
Solidarity Now
VluchtelingenWerk Nederland

Download pdf of joint statement here.
References
[1] Including on grounds of a well-founded fear of being persecuted because of his or her race, religion, nationality, membership of a particular social group or political opinion, according to the 1951 Geneva Convention relating to the Status of Refugees.
[2] See e.g. East African Asians v. the United Kingdom (Eur. Comm, 1973); Abdulaziz, Cabales and Balkandali v. the United Kingdom; Cyprus v. Turkey as well as Kiyutin v. Russia
[3] Inter alia : Bruxelles demande l’Autriche de revenir sur son quota de demandeurs d’asile » Le Monde, Feb.2016, « Austrian cap on asylum seekers infuriates Commission » Euractiv, 19 February 2016
[4] Article 22 of the Law on Asylum that says “An alien may, verbally or in writing, express his/her intention to seek asylum to an authorized police officer of the Ministry of the Interior, during a border check in the course of entering the Republic of Serbia, or inside its territory.”
[5] Belgrade Centre for Human Rights, ‘Safe Passage’ Testimony of people arriving in Dimitrovgrad, Serbia, 20-22 October 2015,

UNESCO and ICRC partner on the protection of culture heritage in the event of armed conflict

UNESCO and ICRC partner on the protection of culture heritage in the event of armed conflict
29.02.2016 –
UNESCO Director-General Irina Bokova and the President of the International Committee of the Red Cross (ICRC), Peter Maurer, signed a partnership agreement paving the way for the two organizations to undertake joint projects to enhance the protection of cultural heritage in the event of armed conflict.

“As the impartial, neutral and independent keeper of international humanitarian law, the International Committee of the Red Cross is a key partner for UNESCO in emergency situations during which it is of utmost importance to protect cultural heritage as the bearer of peoples’ identity, dignity and resilience”, said Ms Bokova. “This partnership is another testimony to the growing global awareness that protecting cultural heritage is not just a cultural emergency but indeed a humanitarian imperative”.

…The recent large-scale and systematic destruction and looting of cultural heritage sites have highlighted the strong connection between the cultural and humanitarian dimensions of cultural heritage protection. Attacks against cultural heritage and diversity are also attacks against people, their rights, and their security. Under the Rome Statute of the International Criminal Court, the deliberate destruction of cultural heritage is a war crime. In the face of these unprecedented challenges, there is a need for innovative approaches to build on the existing international legal standards – notably the 1954 Convention for the Protection of Cultural Property in the Event of Armed Conflict, so as to enhance their effective implementation.

Case Information Sheet:: ICC – The Prosecutor v. Ahmad Al Faqi Al Mahdi [Timbuktu]

Editor’s Note:
We understand that the confirmation of charges hearing detailed below represents a milestone in the prosecution of damage and destruction cultural heritage as a war crime. This actual prosecution of the case, involving destruction of various historically significant buildings in Timbuktu, will unfold in the months ahead and will provide a critically important precedent for future prosecution of similar war crimes involving destruction of cultural heritage.

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Case Information Sheet:: ICC – The Prosecutor v. Ahmad Al Faqi Al Mahdi
Situation in the Republic of Mali
Ahmad Al Faqi Al Mahdi
Age: Born approximately 1975
Place of birth: Agoune, 100 kilometers west of Timbuktu, Mali,
Warrant of arrest: 18 September 2015
Transferred to The Hague: 26 September 2015
First appearance: 30 September 2015
Confirmation of charges hearing:
1 March 2016
Charges
The Chamber found that the evidence establishes reasonable grounds to believe that Al Mahdi is criminally responsible for having committed, individually and jointly with others, facilitated or otherwise contributed to the commission of war crimes alleged by the Prosecutor regarding intentionally directing attacks against the following buildings: 1) the mausoleum Sidi Mahmoud Ben Omar Mohamed Aquit, 2) the mausoleum Sheikh Mohamed Mahmoud Al Arawani, 3) the mausoleum Sheikh Sidi Mokhtar Ben Sidi Muhammad Ben Sheikh Alkabir, 4) the mausoleum Alpha Moya, 5) the mausoleum Sheikh Sidi Ahmed Ben Amar Arragadi, 6) the
mausoleum Sheikh Muhammad El Micky, 7) the mausoleum Cheick Abdoul Kassim Attouaty, 8) the mausoleum Ahamed Fulane, 9) the mausoleum Bahaber Babadié, and 10) Sidi Yahia mosque.

It is alleged that Ahmad Al Faqi Al Mahdi, from the Ansar Tuareg tribe, was an active personality in the context of the occupation of Timbuktu. He allegedly was a member of Ansar Eddine, working closely with the leaders of the two armed groups and in the context of the structures and institutions established by them. It is alleged that, until September 2012, he was at the head of the “Hisbah” (body set up to uphold public morals and prevent vice), operational from May 2012. He was also associated with the work of the Islamic Court of Timbuktu and has participated in executing its decisions. Specifically, it is alleged that he was involved in the destruction of the buildings mentioned in the charges…

Non-proliferation and the Democratic People’s Republic of Korea – Security Council, 7638th meeting

Non-proliferation and the Democratic People’s Republic of Korea – Security Council, 7638th meeting (English)
2 Mar 2016
Video:: 01:16:34
The Security Council has adopted unanimously Resolution 2270 (2016) on additional sanctions against the Democratic People’s Republic of Korea (DPRK).

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Security Council Imposes Fresh Sanctions on Democratic People’s Republic of Korea, Unanimously Adopting Resolution 2270 (2016)
2 March 2016
SC/12267
The Security Council today condemned in the strongest terms the nuclear test conducted by the Democratic People’s Republic of Korea on 6 January 2016 “in violation and flagrant disregard” of the relevant resolutions, its actions thereby constituting a challenge to the Treaty on Non-Proliferation of Nuclear Weapons (NPT) and to peace and stability in the region and beyond…

Speaking after the adoption, the representative of the United States said the resolution went further than any other sanctions regime in two decades, emphasizing that multilateral pressure could be effective in bringing Pyongyang back to the table for serious and credible negotiations on denuclearization. Describing the Democratic People’s Republic of Korea as the only State that had conducted nuclear tests in the twenty-first century, routinely threatening other countries with nuclear annihilation, she noted that the chronic suffering of its people was the direct result of the choices made by their Government….

…The United Kingdom’s representative noted that the resolution contained some of the toughest measures ever taken by the Council, while emphasizing that it was not intended to have adverse humanitarian consequences, nor to affect those activities not prohibited by Council resolutions, nor to affect international relief efforts….

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Editor’s Note:
The full text of Resolution 2270(2016) is available at the link in the title above, but we include here paragraph 17 which may be unprecedented in terms of impacts on academic training and scholarly collaboration. Further, we observe that this sanction strategy may establish an unsettling precedent, or widened to apply beyond this sphere [for example, to bioterrorism and its supporting disciplines].

“17. Decides that all Member States shall prevent specialized teaching or training of DPRK nationals within their territories or by their nationals of disciplines which could contribute to the DPRK’s proliferation [of] sensitive nuclear activities or the development of nuclear weapon delivery systems, including teaching or training in advanced physics, advanced computer simulation and related computer sciences, geospatial navigation, nuclear engineering, aerospace engineering, aeronautical engineering and related disciplines;”

Secretary-General Appoints Commission on Health Employment and Economic Growth

Secretary-General Appoints Commission on Health Employment and Economic Growth
2 March 2016
Secretary-General SG/A/1639
Press Release
United Nations Secretary-General Ban Ki-moon today announced the appointment of a Commission on Health Employment and Economic Growth.

The global economy is projected to create around 40 million new health sector jobs by 2030, mostly in middle- and high-income countries. Despite this growth, there is a projected shortage of 18 million health workers in low- and lower-middle-income countries. The Commission is tasked with proposing actions to redress these inequities, and stimulate and guide the creation of health and social sector jobs for inclusive economic growth.

“Having a sufficient number of health workers responsive to population needs and well-distributed across the world will be critical to the achievement of the Sustainable Development Goals and to addressing the growing challenges to global public health security,” said Secretary-General Ban Ki-moon. “I expect this Commission to make an important contribution towards the achievement of Universal Health Coverage, the creation of decent jobs, and to inclusive and transformative economic growth.”

The Commission had been established following United Nations General Assembly resolution A/RES/70/183, which recognized that “investing in new health workforce employment opportunities may also add broader socioeconomic value to the economy and contribute to the implementation for the 2030 Agenda for Sustainable Development” and requested the Secretary-General to “explore steps to meet the global shortfall of trained health workers”.

The Commission will be co-chaired by François Hollande, President of France, and Jacob Zuma, President of South Africa.

Approximately 25 Commissioners will soon be appointed to provide a balance of policy, technical and geographical expertise, from the education, employment, health and foreign affairs sectors of government, as well as representation from international organizations, academia, health-care professional associations, civil society and trade unions.

The Commission will hold its first meeting on 23 March, and will deliver its final report in the margin of the seventy-first regular session of the United Nations General Assembly in September.

For more information about the Commission, please visit www.who.int/hrh/com-heeg/.