International Journal of Epidemiology
Volume 43 Issue 5 October 2014
http://ije.oxfordjournals.org/content/current

Data protection and epidemiological research: a new EU regulation is in the pipeline
Jørn Olsen
Author Affiliations
Department of Public Health-Epidemiology, University of Aarhus, Bartholins Alle 2 – Building 1260, DK-8000 Aarhus C, Denmark.
Extract
Since the days of the Helsinki Declaration (www.wma.net), informed consent has been a cornerstone in all medical research. That is probably how it should be if you do experimental research on humans that carries a risk for the participants or collect new data, but in non-experimental research based on existing data it is not so clear cut. The Helsinki Declaration states that ‘the health of my patient will be my first consideration’ and ‘while the goal of the primary purpose of medical research is to generate new knowledge, this goal can never take precedence over the rights and interests of individual research subjects’. Most will agree on these general principles. However, if the principle of informed consent is required when using existing data, where the only risk is related to unwanted disclosure of personal data, they go too far and the term ‘research subject’ is misleading. If we are using data that already exist and the research can be done with no risk for the people under study, there may well more ethical problems in not doing the research than in doing it. We lack an ethics committee for important missed research opportunities!
Using the Helsinki Declaration uncritically to fit all types of research has not been without problems, including ethical problems. Important data collections have been destroyed because no informed consent had been given at the time of data collection. Useful information has not been used to benefit the public, sometimes because the data could have revealed unpleasant facts for those in charge of health service and medical treatment…

JAMA
October 8, 2014, Vol 312, No. 14
http://jama.jamanetwork.com/issue.aspx

Viewpoint | October 8, 2014
Global Tuberculosis: Perspectives, Prospects, and Priorities
Thomas R. Frieden, MD, MPH1; Karen F. Brudney, MD2; Anthony D. Harries, MD, FRCP3,4
Author Affiliations
JAMA. 2014;312(14):1393-1394. doi:10.1001/jama.2014.11450.
This Viewpoint discusses the importance of innovation and persistence in tuburculosis control programs.
Despite being nearly 100% curable, tuberculosis remains a major public health problem, representing the second leading cause of death from infectious diseases globally, with drug-resistant tuberculosis increasingly common. In 2012, an estimated 8.6 million people developed tuberculosis worldwide—a global incidence rate of 122 persons per 100 000 population—and 1.3 million people died. Incidence rates vary from high in southern Africa (550/100 000 population in Mozambique and Zimbabwe and 1000/100 000 population in South Africa) to fewer than 10/100 000 population in the United States, Canada, and most of Western Europe.1 Although the global prevalence of multidrug-resistant tuberculosis was estimated at 3.6% of newly diagnosed and 20.2% of previously treated patients, these rates were 20% to 35% for newly diagnosed cases and 50% to 69% for retreatment cases in the Russian Federation and some other former Soviet republics….

The Lancet
Oct 11, 2014 Volume 384 Number 9951 p1321 – 1400 e49 – 51
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Ebola: what lessons for the International Health Regulations?
The Lancet
With more than 3000 deaths since the first case was confirmed in March, 2014, and after months of slow, fragmented responses, the international community has recognised Ebola as a public health emergency of international concern and a clear threat to global health security. It is the subject of a high-level UN Security Council resolution, and has triggered the creation of a UN Mission for Ebola Emergency Response. Despite these efforts, Ebola is staying ahead of efforts to contain it. In such a situation, although it is understandable to focus on urgent actions, it would be a mistake not to reflect on how we arrived at this situation and what we need to do to prevent it from happening again.

The International Health Regulations (IHR) represent the system designed to prevent national public health emergencies from becoming international crises. WHO’s historic responsibility has been to control the spread of disease. The IHR were adopted in 1969 (IHR 1969) and focused on smallpox, plague, cholera, and yellow fever. In 1995, in the wake of plague in India and Ebola in DR Congo, a resolution was passed in the World Health Assembly (WHA) to revise and update the IHR. In the late 1990s a new way of working within WHO was created to detect and respond to infectious disease outbreaks using sources of information other than countries as prescribed under the IHR, and creating a network of over 120 partners to respond—called the Global Outbreak Alert and Response Network. The severe acute respiratory syndrome epidemic in 2003 gave great impetus to the revision process. In 2005, a revised IHR (IHR 2005) was adopted by the WHA, to come into force in 2007. The IHR 2005 are not limited to any specific diseases and they oblige countries to notify WHO of “events that may constitute a public health emergency of international concern” and to develop “core public health capacities”. They also offered flexibility to countries to develop core capacities by 2012, with a possible 2-year extension. Although all WHO member states have agreed to the IHR principles, countries were left to self-report their progress on core capacity development, such as surveillance, diagnostic, and containment demands.

With no additional financing in place and no proper accountability mechanism to ensure independent monitoring, this laudable vision has become a huge missed opportunity. Today, every person newly infected with Ebola reminds us of this lost opportunity. Whereas most developed countries certainly have the capacities to implement such a framework, many low-income and middle-income countries, and especially fragile states, do not. It was only on Aug 8, after a meeting of the International Health Regulations Emergency Committee, that WHO declared the outbreak a “public health emergency of international concern”. Such delays have probably enabled the outbreak to spread rapidly.

Several commentators have questioned the capability of WHO to address international threats, such as Ebola. Acknowledging gaps in global governance, and with its distinctive interest in global security, the USA has taken the lead and launched its Global Health Security Agenda earlier this year “to accelerate progress toward a world safe and secure from infectious disease threats and to promote global health security as an international security priority”. On Sept 26, a meeting took place in the White House to discuss the implementation of this new security agenda, together with the delivery of commitments to assist west Africa.

In view of the seriousness of the crisis, US leadership should be welcomed. However, the US Government is not a multilateral health agency. The final responsibility to prevent the international spread of disease rests with WHO and its IHR. But WHO has been poorly served by its member states and governing bodies. Member states have failed to invest in WHO to ensure the agency has full capacity to address its global mandate. And WHO’s Executive Board and WHA failed utterly to keep the promise they made in 2005 to scale-up attention and investment in crucial surveillance and reporting systems so necessary to prevent the kind of epidemic that is Ebola today.

Two priorities stand out. First, an urgent donor conference must be convened to discuss the implications of the Ebola epidemic and the international community’s failure to invest in the IHR. That conference must end with substantial financial commitments to strengthen delivery of core IHR public health capacities. Second, a robust mechanism must be put in place to guarantee independent monitoring and review of country implementation of the IHR. Self-reporting is an unreliable way to protect the world’s peoples from new and dangerous epidemics.

Comment
Ebola: a crisis in global health leadership
Lawrence O Gostin, Eric A Friedman
Preview |
The Ebola epidemic will take hundreds of thousands of lives if the current trajectory is not reversed.1 Fear has gripped the most affected countries: Sierra Leone instituted a national lockdown,2 Liberia cordoned off swathes of territory,3 and in Guinea, panicked residents in one village killed a team that had come to raise awareness about the disease.4 WHO, with its budget and capacity to respond diminished, has largely been sidelined in the response to Ebola. In a leadership vacuum, high-income countries sent in military assets, the UN Security Council declared Ebola a threat to international peace and security, and UN Secretary-General Ban Ki-moon created a special UN mission.

Ebola: towards an International Health Systems Fund
Lawrence O Gostin
Preview |
The international response to the current outbreak of Ebola virus in west Africa, which is projected to infect about 20 000 people with a case fatality rate of more than 50%,1,2 has been fractured and delayed. The index case (a 2-year-old boy from Guinea) died in December, 2013, followed by confirmed Ebola clusters on March 22, 2014, which quickly spread to Liberia and then Sierra Leone. The disease jumped to Nigeria through air travel, and, recently, to Senegal. Yet WHO did not declare a Public Health Emergency of International Concern (PHEIC) until Aug 8, 2014, and only released an Ebola response roadmap on Aug 28—5 months after international spread.

The Lancet
Oct 11, 2014 Volume 384 Number 9951 p1321 – 1400 e49 – 51
http://www.thelancet.com/journals/lancet/issue/current

Current status of rabies and prospects for elimination
Prof Anthony R Fooks PhD a b c d, Ashley C Banyard PhD a b, Daniel L Horton PhD a b, Nicholas Johnson PhD a b, Lorraine M McElhinney PhD a b d, Prof Alan C Jackson MD e
Summary
Rabies is one of the most deadly infectious diseases, with a case-fatality rate approaching 100%. The disease is established on all continents apart from Antarctica; most cases are reported in Africa and Asia, with thousands of deaths recorded annually. However, the estimated annual figure of almost 60 000 human rabies fatalities is probably an underestimate. Almost all cases of human rabies result from bites from infected dogs. Therefore, the most cost-effective approach to elimination of the global burden of human rabies is to control canine rabies rather than expansion of the availability of human prophylaxis. Mass vaccination campaigns with parenteral vaccines, and advances in oral vaccines for wildlife, have allowed the elimination of rabies in terrestrial carnivores in several countries worldwide. The subsequent reduction in cases of human rabies in such regions advocates the multidisciplinary One Health approach to rabies control through the mass vaccination of dogs and control of canine populations.

Nature
Volume 514 Number 7521 pp139-266 9 October 2014
http://www.nature.com/nature/current_issue.html

Nature | Editorial
Out of Africa
The Ebola outbreak in West Africa must be shut down now, or the disease will continue to spread.
07 October 2014
…The world is fiddling as West Africa burns, and unless it acts much faster, the outbreak risks spreading to surrounding regions. Sparks from it could lead to exports to more far-flung places, perhaps even to major cities that lack decent public-health infrastructure. But countries and the public must also realize that although action is needed urgently, the commitments must be sustained until the outbreak has been stamped out, which could take many months. The relatively low threat to developed countries must not distract or detract from the pressing need to tackle the outbreak at its source.

PLoS One
[Accessed 11 October 2014]
http://www.plosone.org/

Research Article
More Evidence on the Impact of India’s Conditional Cash Transfer Program, Janani Suraksha Yojana: Quasi-Experimental Evaluation of the Effects on Childhood Immunization and Other Reproductive and Child Health Outcomes
Natalie Carvalho mail, Naveen Thacker, Subodh S. Gupta, Joshua A. Salomon
Published: October 10, 2014
DOI: 10.1371/journal.pone.0109311
Abstract
Background
In 2005, India established a conditional cash transfer program called Janani Suraksha Yojana (JSY), to increase institutional delivery and encourage the use of reproductive and child health-related services.
Objective
To assess the effect of maternal receipt of financial assistance from JSY on childhood immunizations, post-partum care, breastfeeding practices, and care-seeking behaviors.
Methods
We use data from the latest district-level household survey (2007–2008) to conduct a propensity score matching analysis with logistic regression. We conduct the analyses at the national level as well as separately across groups of states classified as high-focus and non-high-focus. We carry out several sensitivity analyses including a subgroup analysis stratified by possession of an immunization card.
Results
Receipt of financial assistance from JSY led to an increase in immunization rates ranging from 3.1 (95%CI 2.2–4.0) percentage points for one dose of polio vaccine to 9.1 (95%CI 7.5–10.7) percentage points in the proportion of fully vaccinated children. Our findings also indicate JSY led to increased post-partum check-up rates and healthy early breastfeeding practices around the time of childbirth. No effect of JSY was found on exclusive breastfeeding practices and care-seeking behaviors. Effect sizes were consistently larger in states identified as being a key focus for the program. In an analysis stratified by possession of an immunization card, there was little to no effect of JSY among those with vaccination cards, while the effect size was much larger than the base case results for those missing vaccination cards, across nearly all immunization outcomes.
Conclusions
Early results suggest the JSY program led to a significant increase in childhood immunization rates and some healthy reproductive health behaviors, but the structuring of financial incentives to pregnant women and health workers warrants further review. Causal interpretation of our results relies on the assumption that propensity scores balance unobservable characteristics.

Determinants of Acceptance and Subsequent Uptake of the HPV Vaccine in a Cohort in Eldoret, Kenya
Heleen Vermandere, Violet Naanyu, Hillary Mabeya, Davy Vanden Broeck, Kristien Michielsen, Olivier Degomme
Research Article | published 09 Oct 2014 | PLOS ONE 10.1371/journal.pone.0109353

PLoS Medicine
(Accessed 11 October 2014)
http://www.plosmedicine.org/

Open Access
Policy Forum
Global Financing and Long-Term Technical Assistance for Multidrug-Resistant Tuberculosis: Scaling Up Access to Treatment
Thomas J. Hwang, Salmaan Keshavjee mail
Published: September 30, 2014
DOI: 10.1371/journal.pmed.1001738
Summary Points
:: Multidrug-resistant tuberculosis (MDR-TB) is a leading public health concern, particularly in low- and middle-income countries, necessitating coordinated international action to prevent its spread and effectively treat the infected.
: The cost of treatment for MDR-TB is over 200 times the comparable cost for a drug-susceptible tuberculosis (TB) patient. Data show that prices for three of the currently most expensive drugs have increased dramatically since 2001, outpacing inflation.
:: Many of the high MDR-TB burden countries were ranked by WHO as being in the bottom 50% of health systems worldwide. Without sufficient technical, human, and organizational resources, weak health systems can pose a significant barrier to access to treatment.
:: In order to achieve the goal of eradicating MDR-TB, policymakers should implement a two-pronged intervention that pools donor resources for the coupling of market-oriented solutions to MDR-TB drug prices and targeted investments in health systems strengthening and innovative care delivery models. Innovative policy mechanisms piloted for other infectious diseases, such as pneumococcal vaccine, may offer lessons for the MDR-TB context.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
(Accessed 11 October 2014)
http://www.pnas.org/content/early/

Impact and cost-effectiveness of new tuberculosis vaccines in low- and middle-income countries
Gwenan M. Knighta, Ulla K. Griffithsb, Tom Sumnera, Yoko V. Laurenceb, Adrian Gheorgheb,
Anna Vassallb, Philippe Glaziouc, and Richard G. Whitea,1
Author Affiliations
Significance
To aid in prioritizing the development of tuberculosis (TB) vaccines most likely to reach the 2050 TB elimination goal, we estimated the impact and cost-effectiveness of a range of vaccine profiles in low- and middle-income countries. Using mathematical modeling, we show that vaccines targeted at adolescents/adults could have a much greater impact on the TB burden over a 2024–2050 time horizon than those vaccines targeted at infants. Such vaccines could also be cost-effective, even with relatively high vaccine prices. Our results suggest that to achieve the 2050 elimination goals, future TB vaccine development should focus on vaccines targeted at adolescents/adults, even if only relatively low efficacies and short durations of protection are technically feasible.
Abstract
To help reach the target of tuberculosis (TB) disease elimination by 2050, vaccine development needs to occur now. We estimated the impact and cost-effectiveness of potential TB vaccines in low- and middle-income countries using an age-structured transmission model. New vaccines were assumed to be available in 2024, to prevent active TB in all individuals, to have a 5-y to lifetime duration of protection, to have 40–80% efficacy, and to be targeted at “infants” or “adolescents/adults.” Vaccine prices were tiered by income group (US $1.50–$10 per dose), and cost-effectiveness was assessed using incremental cost per disability adjusted life year (DALY) averted compared against gross national income per capita. Our results suggest that over 2024–2050, a vaccine targeted to adolescents/adults could have a greater impact than one targeted at infants. In low-income countries, a vaccine with a 10-y duration and 60% efficacy targeted at adolescents/adults could prevent 17 (95% range: 11–24) million TB cases by 2050 and could be considered cost-effective at $149 (cost saving to $387) per DALY averted. If targeted at infants, 0.89 (0.42–1.58) million TB cases could be prevented at $1,692 ($634–$4,603) per DALY averted. This profile targeted at adolescents/adults could be cost-effective at $4, $9, and $20 per dose in low-, lower-middle–, and upper-middle–income countries, respectively. Increased investments in adult-targeted TB vaccines may be warranted, even if only short duration and low efficacy vaccines are likely to be feasible, and trials among adults should be powered to detect low efficacies.

Science
10 October 2014 vol 346, issue 6206, pages 137-276
http://www.sciencemag.org/current.dtl

World population stabilization unlikely this century
Patrick Gerland, Adrian E. Raftery, Hana Ševčíková, Nan Li, Danan Gu, Thomas Spoorenberg,
Leontine Alkema, Bailey K. Fosdick, Jennifer Chunn, Nevena Lalic, Guiomar Bay, Thomas Buettner, Gerhard K. Heilig, and John Wilmoth
Science 10 October 2014: 234-237.
Published online 18 September 2014 [DOI:10.1126/science.1257469]
The 21st century is unlikely to see the end of global population growth. [Also see Perspective by Smeeding]
Abstract
The United Nations (UN) recently released population projections based on data until 2012 and a Bayesian probabilistic methodology. Analysis of these data reveals that, contrary to previous literature, the world population is unlikely to stop growing this century. There is an 80% probability that world population, now 7.2 billion people, will increase to between 9.6 billion and 12.3 billion in 2100. This uncertainty is much smaller than the range from the traditional UN high and low variants. Much of the increase is expected to happen in Africa, in part due to higher fertility rates and a recent slowdown in the pace of fertility decline. Also, the ratio of working-age people to older people is likely to decline substantially in all countries, even those that currently have young populations.

UN Chronicle
Vol.LI No. 2 2014 September 2014
http://unchronicle.un.org/

Illegal Wildlife Trade
This issue takes a closer look at poaching and illegal wildlife trade, with a focus on causes and possible solutions.

Strengthening Front-Line Action to Combat Wildlife and Forest Crimes
John E. Scanlon
With 180 States (called Parties) signatory to the Convention, CITES is the principal instrument in regulating international trade in wildlife. Over 35,000 species of wild plants and animals are listed in its three Appendices,5 each corresponding to differing levels of trade control to ensure that trade is not detrimental to the survival of species in the wild.

The Illegal Commercial Bushmeat Trade in Central and West Africa
Jane Goodall
All of the great apes of Africa, chimpanzees, bonobos and gorillas are endangered by human population growth, habitat destruction, illegal trafficking of apes for entertainment, private zoos and hunting.

Putting a Stop to Global Environmental Crime Has Become An Imperative
Achim Steiner
The illegal trade in wildlife and timber has escalated rapidly and globally, and now encompasses a wide range of flora and fauna across all continents, including terrestrial and aquatic animals, forests and other plants and their products.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 4 October 2014

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, consortiums 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 verion: The Sentinel_ week ending 4 October 2014

blog edition: comprised of the 35+ entries posted below on 5 October 2014

Joint NGO statement International Conference: Effective International Response to Defeat Ebola in Sierra Leone
01 Oct 2014 –
Delivered by Sanjayan Srikanthan, International Rescue Committee, on behalf of 34 NGOs

The world is facing an unprecedented crisis in West Africa. Infection rates are growing exponentially – the number of cases is doubling roughly every three weeks. In Sierra Leone the situation is critical: Ebola has spread throughout the country, infecting at least 2,300 people that we know of; the real number is probably much higher. Many health centres and hospitals have closed and those that are still open are full to capacity, with sick people being turned away.

The international community has a window of opportunity over the next four weeks to stop the crisis from spreading completely out of control. To do so, we must support national authorities, health workers, humanitarian agencies and community groups to break transmission rates and halt the exponential increase in cases.

As I speak, our agencies have hundreds of staff on the ground fighting the spread of the disease. We are involved in every aspect of response from treatment to provision of equipment to body disposal and prevention and awareness raising, as well as dealing with secondary impacts like food security. We also have dedicated teams working in neighbouring countries to prepare for the worst case scenario. Our staff say they are fighting for the very survival of their communities.

We welcome the strong commitment demonstrated by many Governments so far in responding to the crisis, and the leadership shown by the UK Government in supporting Sierra Leone and in convening today’s conference. But a further and massive increase in financial, human and material capacity is urgently needed to halt the spread of Ebola and mitigate its impacts on the hard earned development progress of Sierra Leone and other countries in the region. This is a matter of the utmost urgency.

Let me discuss six key ways the international community must respond in the next four weeks.
1. Donors must act fast in committing and disbursing funds. Like chasing a ball down a hill, every day that we delay in disbursing resources to affected countries, the more impossible it becomes to contain the disease. Only a quarter of the total required funding for the region has been committed. We urge donors to increase and quickly disburse national pledges against the UN Appeal within a two-week timeframe. Donors should ensure that funding is flexible, allowing NGOs to respond appropriately to a rapidly changing situation.
2. Donors and governments must ensure that health care workers are trained and equipped. Health care workers are our most precious resource in this crisis, but hundreds have already been infected. Health centres in Sierra Leone lack crucial tools and supplies for diagnosing, isolating and treating patients with Ebola and for protecting health workers tending to those infected by Ebola. We call on donors and governments to ensure that health workers have training in Infection Prevention & Control, and consistent supplies of basic equipment including chlorine, gloves, personal protective equipment (or PPE).
3. Governments must rapidly identify and deploy military and civilian capacity. Financing and equipment alone will not stop this crisis. There is an urgent need for human resources: Aid agencies simply do not have the medical, WASH or logistical staff we need to scale up our response. As a measure of last resort, we are calling on governments to release military capacity to set up facilities and help manage them, in accordance with the Oslo Guidelines, and to expedite the deployment of volunteers from health services and agencies. Governments must also create an enabling environment for volunteers. More people are now volunteering, but to access this huge and priceless resource requires a guaranteed medevac system, and other logistical and financial support. We call on states to solve this obvious and critical problem here today, by agreeing to operationalise and fund a dedicated medevac system for all staff, regardless of their nationality or organizational affiliation.
4. Donors, governments and INGOs must support community mobilization efforts. Treatment will never be enough unless we use effective community mobilization, including support for local media, to reduce transmission and dispel rumours and misunderstanding about Ebola. This can be done far more effectively through the many community groups and associations who are active in treatment and messaging on Ebola. Donors should support these community mobilization efforts and provide logistical support to appropriate community-based activities. Governments and INGOs must work closely with local groups, consulting them before disseminating health promotion messaging, and ensuring that communities have access to accurate information about Ebola.
5. States must urgently support preparedness and contingency planning in neighbouring countries. The UN estimates that it will cost almost $1 billion to respond to Ebola and its secondary impacts, but this projection only covers the cost of the response in the three countries with confirmed cases. It is critical to work with governments in the region to strengthen preparedness and contingency planning so they are ready to quickly respond to any potential outbreak.
6. The international community must respond holistically to all impacts of the crisis. The hidden cost of this Ebola outbreak is huge. As national resources are diverted to responding to the outbreak, health systems have collapsed. Easily treatable and preventable illnesses such as malaria and diarrhoea are claiming hundreds of lives, while mothers are dying in childbirth due to treatable complications. Children are missing vital months of education as schools have been closed. Many who are orphaned when parents die of Ebola have no one willing to care for them due to the perceived fear of transmission. We are urging donors and governments to implement a holistic response to the crisis, addressing the gender impacts of Ebola, the impacts on the wider health system, food security, protection and education.
We can turn the tide on this outbreak today, in this room. As aid agencies and campaigning organisations, we are all scaling up our work, doing all we can to support the people affected by Ebola. But we need your help. The international community needs to move faster than it has ever moved before to prevent a catastrophe in West Africa with global implications. Every new case is a testament to how much more we still need to do, and we are running out of time.

The following NGOs endorse this statement:
ActionAid UK :: CAFOD :: CARE International :: Christian Aid :: Children in Crisis :: Concern Worldwide :: Deutsche Welthungerhilfe :: GOAL :: Handicap International :: Health Poverty Action (HPA) :: InterHealth Worldwide :: International Health Partners :: International Medical Corps UK :: The International Rescue Committee :: Internews Europe :: Islamic Relief Worldwide :: King’s Health Partners :: Médecins du Monde/Doctors of the World :: Mercy Corps :: Mission Aviation Fellowship :: Muslim Aid :: Norwegian Refugee Council :: The ONE Campaign :: Oxfam :: Plan UK :: RedR UK :: Royal Society for the Protection of Birds (RSPB) :: Samaritan’s Purse :: Save the Children :: Solidarités International :: Street Child :: Worldwide Hospice :: Palliative Care Alliance :: World Vision UK :: Womankind Worldwide

Guidelines on the Use of Foreign Military and Civil Defence Assets in Disaster Relief – “Oslo Guidelines” – Rev. 1.1 (November 2007) 40 pages
https://docs.unocha.org/sites/dms/Documents/Oslo%20Guidelines%20ENGLISH%20(November%202007).pdf

Overview
The “Oslo Guidelines” were originally prepared over a period of two years beginning in 1992. They were the result of a collaborative effort that culminated in an international conference
in Oslo, Norway, in January 1994 and were released in May 1994. The unprecedented deployment in 2005 of military forces and assets in support of humanitarian response to natural disasters, following an increasing trend over the past years, confirmed the need to update the 1994 “Oslo Guidelines” eventually resulting in the current version from November 2007.

[Excerpts]
Aim
9. The aim of the present Guidelines on the Use of Military and Civil Defence Assets in Disaster Relief (hereinafter referred to as «Oslo Guidelines») is to establish the basic framework for formalizing and improving the effectiveness and efficiency of the use of foreign military and civil defence assets in international disaster relief operations….

Core Principles
20. As per UN General Assembly Resolution 46/182 humanitarian assistance must be provided in accordance with the principles of humanity, neutrality and impartiality.
:: Humanity: Human suffering must be addressed wherever it is found, with particular attention to the most vulnerable in the population, such as children, women and the elderly. The dignity and rights of all victims must be respected and protected.
:: Neutrality: Humanitarian assistance must be provided without engaging in hostilities or taking sides in controversies of a political, religious or ideological nature.
:: Impartiality: Humanitarian assistance must be provided without discriminating as to ethnic origin, gender, nationality, political opinions, race or religion. Relief of the suffering must be guided solely by needs and priority must be given to the most urgent cases of distress.
21. In addition to these three humanitarian principles, the United Nations seeks to provide humanitarian assistance with full respect for the sovereignty of States. As also stated in General Assembly Resolution 46/182:
“The sovereignty, territorial integrity and national unity of States must be fully respected in accordance with the Charter of the United Nations. In this context, humanitarian assistance should be provided with the consent of the affected country and in principle on the basis of an appeal by the affected country.”…

Key Concepts For Use Of Military and Civil Defence Assets (MCDA) by UN Agencies
32. In addition and in the framework of the above-mentioned principles, the use of MCDA by UN agencies in response to a natural disaster shall be guided by the six following standards:
i. Requests for MCDA to support UN agencies must be made by the Humanitarian
Coordinator/Resident Coordinator, with the consent of the Affected State, and based solely on humanitarian criteria.
ii. MCDA should be employed by UN humanitarian agencies as a last resort, i.e. only in the absence of any other available civilian alternative to support urgent humanitarian needs in the time required.
iii. A UN humanitarian operation using military assets must retain its civilian nature and character. While MCDA may remain under military control, the operation as a whole must remain under the overall authority and control of the responsible humanitarian organization. This does not infer any civilian command and control status over military assets.
iv. Humanitarian work should be performed by humanitarian organizations. Insofar as military organizations have a role to play in supporting humanitarian work, it should, to the extent possible, not encompass direct assistance, in order to retain a clear distinction between the normal functions and roles of humanitarian and military stakeholders.
v. Any use of MCDA should be, at its onset, clearly limited in time and scale and present an exit strategy element that defines clearly how the function it undertakes could, in the future, be undertaken by civilian personnel.
vi. Countries providing MCDA to support UN humanitarian operations should ensure that they respect the UN Codes of Conduct and the humanitarian principles.
33. Implementing and operational partners and members of international civil society, are expected to adhere to these core principles and have been encouraged to adopt the «Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief”…

HelpAge International launches Global AgeWatch Index 2014 ranking 96 countries according to the social and economic wellbeing of older people
1 October 2014
Norway tops the list, Latin America leads pension revolution, life expectancy continues to rise
HelpAge used the United Nations International Day of Older Persons to launch the Global AgeWatch Index 2014, representing 91 per cent or nine out of ten people over 60 across the world. It measures wellbeing in four key areas: income security, health, personal capability and an enabling environment.

Globally Norway (1) tops the Index this year, closely followed by Sweden. Apart from Japan (9) all the top 10 countries are again in Western Europe, North America and Australasia. Five new countries have been added – Bangladesh, Iraq, Mozambique, Uganda and Zambia.

The worst place for an older person is Afghanistan (96). Just above it come Mozambique (95), West Bank and Gaza (94) and Malawi (93).

All regions are represented in the lowest quarter, with African countries making up half of those with low income security rankings and poor health results. Venezuela (76), Serbia (78) and Turkey (77) are included in this section in similar position to countries in sub-Saharan Africa and Asia.

Chile (22) leads a cluster of Latin American countries including Uruguay (23), Panama (24), Costa Rica, (26) Mexico (30), Argentina (31), Ecuador (33) and Peru (42) which do well in the Index particularly on income security.

There are currently 868m people over 60 – nearly 12 per cent of the global population. By 2050, it’s predicted to rise to 21 per cent, nearly as many people aged 60 or over as those under 15 – 2.02 billion compared with 2.03 billion.

The Index tells us that economic growth alone will not improve older people’s wellbeing and specific policies need to be put in place to address the implications of ageing. More than one third of countries trail significantly behind the best-performing countries.

The report this year focuses on pension policy and how this is being managed across the globe. Only half the world’s population can expect to receive even a basic pension in old age and although policies supporting people in later life exist they need to be implemented faster and more systematically.

Full report: https://helpage.box.com/s/dns35q1ndbm561v1pum4

Florence Declaration emphasizes role of culture in post-2015 development agenda
UNESCO
04 October 2014

“Cultural vitality is synonymous with innovation and diversity. Culture creates jobs, generates revenues and stimulates creativity. It is a multifaceted vector of values and identity. Moreover, culture is a lever that promotes social inclusion and dialogue,” the Director-General of UNESCO, Irina Bokova, declared today at the close of UNESCO’s Third World Forum on Culture and Cultural Industries, which took place in Florence from 2 to 4 October.

At the end of the Forum, its 300 participants adopted the Florence Declaration that advocates the integration of culture in the post-2015 development agenda, which the United Nations is scheduled to adopt in the autumn of 2015.

The declaration reflects the findings of national consultations on culture and development conducted jointly in five countries—Bosnia and Herzegovina, Ecuador, Mali, Morocco and Serbia—by UNESCO, the United Nations Development Programme (UNDP), and the United Nations Population Fund (UNFPA)…

…The Florence Declaration notably calls on governments, civil society and the private sector to enhance:
:: human and institutional capacities;
:: legal and policy environments;
:: new partnership models and innovative investment strategies;
:: benchmarks and impact indicators to monitor and evaluate the contribution of culture to monitor and evaluate the contribution of culture to sustainable development.

FAO calls for “paradigm shift” towards sustainable agriculture and family farming
Director-General urges support for science-based options in pursuit of global food security
29 September 2014, Rome
Excerpt

Policy makers should support a broad array of approaches to overhauling global food systems, making them healthier and more sustainable while acknowledging that “we cannot rely on an input intensive model to increase production and that the solutions of the past have shown their limits,” FAO Director-General José Graziano da Silva said today in his opening remarks to the 24th session of the Committee on Agriculture (COAG).

Calling for a “paradigm shift,” he said that today’s main challenges are to lower the use of agricultural inputs, especially water and chemicals, in order to put agriculture, forestry and fisheries on a more sustainable and productive long-term path.

Options such as Agro-ecology and climate-smart agriculture should be explored, and so should biotechnology and the use of genetically modified organisms, FAO’s director-general said, noting that food production needs to grow by 60 percent by 2050 to meet the expected demand from an anticipated population of 9 billion people. “We need to explore these alternatives using an inclusive approach based on science and evidences, not on ideologies,” as well as to “respect local characteristics and context,” he said.

Graziano da Silva also asked the COAG, which will conclude its biannual meeting on Friday, Oct. 3, to consider the importance of family farming in all aspects of its agenda…

Emergency Economies: The Impact of Cash Assistance in Lebanon
IRC Evaluation
29 September 2014
Full report here.

In what it described as “the first ever scientifically rigorous evaluation of cash distribution for refugees in an emergency setting,” the IRC said it found “strikingly positive impacts for Syrian refugees in Lebanon.” The evaluation was conducted in partnership with Daniel Masterson of Yale University and Christian Lehmann of the University of Brasilia.

Last winter, 90,000 Syrian refugee families facing freezing conditions in the Lebanese mountains were given $100 a month through ATM cards by international aid agencies. Families living below 500 meters altitude were given e-vouchers for food, while those living in villages above 500 meters were also given e-vouchers for food, plus the cash to buy winter warmth materials, like blankets and sweaters.

Comparative research confirmed that refugees receiving the cash spent everything on meeting very basic needs ahead of winter. Despite the cash initially being intended by aid agencies for use buying materials to keep warm, the money allowed the refugees to invest in what they knew they most needed: food and water. There was no evidence of spending on alcohol or tobacco. Meals were more frequent and had bigger portions. For each dollar of cash assistance spent, the model calculated $2.13 was created in local markets, boosting the Lebanese economy. The research did not find an inflationary impact — instead, supply moved to meet new demand.

As well as economic impact, social impacts were also measured. Households receiving cash assistance were half as likely to send their children out to work. Cash also increased access to education, and there is evidence of reduced tensions within the household and between the refugee and host community.

A majority (80%) suggested that they would prefer to receive cash to other forms of assistance.

David Miliband, IRC president and CEO, said: “The spate of man-made and natural disasters enveloping innocent civilians raises profound questions not just for international politics, but for NGOs and the humanitarian sector, as well. If we keep doing ‘business as usual,’ the gap between need and provision will continue to grow. Cash distribution – alongside clear humanitarian ‘floor’ targets in the revised Millennium Development Goals, more sustainable local partnerships and better use of evidence overall — could be part of a vital renewal of the humanitarian sector. There will be a new disaster in the near future. And when the calls for donations go out, yes, let’s spend some of it on cash, but let’s also spend that fraction more evaluating it – the lessons are too expensive to miss.”