Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 10 July 2019
:: A circulating vaccine-derived poliovirus type 2 (cVDPV2) has been confirmed in China. It is genetically linked to a VDPV2 isolated from an environmental sample from Xinjiang province, collected on 18 April 2018.  WHO is continuing to evaluate the situation and stands ready to support the ongoing investigation and risk assessment by national authorities.

Summary of new viruses this week:
:: Pakistan — nine wild poliovirus type 1 (WPV1) cases and 3 WPV1-positive environmental samples;
:: Angola —  one circulating vaccine-derived poliovirus  (cVDPV2) case;
:: China – one cVDPV2 case. See country sections below for more details.

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.
WHO Grade 3 Emergencies [to 13 Jul 2019]

Democratic Republic of the Congo
:: 49: Situation report on the Ebola outbreak in North Kivu 9 July 2019
:: Disease Outbreak News (DONs} Ebola virus disease – Democratic Republic of the Congo
11 July 2019
[See DRC Ebola+ above for detail]

Yemen
:: Outbreak update – Cholera in Yemen, 30 June 2019
8 July 2019 – The Ministry of Public Health and Population of Yemen reported 21,865 suspected cases of cholera with 13 associated deaths during epidemiological week 26 (24 to 30 June) of 2019. Thirteen percent of cases were severe. The cumulative total number of suspected cholera cases from 1 January 2018 to 30 June 2019 is 823,221, with 1210 associated deaths (CFR 0.13%). Children under five represent 23.0% of total suspected cases during 2019. The outbreak has affected 22 of 23 governorates and 299 of 333 districts in Yemen…

Nigeria
:: Nigeria intensifies cross border immunization, with special focus on nomadic populations 
Kano, 8 July, 2019 – In renewed efforts to vaccinate children traversing in and out of Nigeria, the World Health Organization (WHO) is supporting the government in an initiative to improve supplemental and routine immunization activities in the North Western region, which has a significant nomadic population.
Nomadic pastoralists live beyond the reach of established health care programs that are designed to serve sedentary populations. As a result, these groups are often under-immunized and out of the reach of existing disease surveillance activities.
Speaking on the intervention, Mallam Gwanda Mairakuma of Maiadua local government in Niger Republic said that, “with this intensified commitment, vaccination activities have reduced the number of complications associated with Measles infection on our children”…

Mozambique floods – No new digest announcements identified
Myanmar – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified

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WHO Grade 2 Emergencies [to 13 Jul 2019]

Libya
:: Medical aid accelerated as Libya crisis intensifies 6 July 2019

MERS-CoV
:: Worldwide reduction in MERS cases and deaths since 2016 8 July 2019
The World Health Organization and colleagues from the University of Oxford, Imperial College London and Institut Pasteur* have estimated that, since 2016, 1 465 cases of Middle East Respiratory syndrome coronavirus (MERS-CoV) and between 300 and 500 deaths may have been averted due to accelerated global efforts to detect infections early and reduce transmission.
In 2012, a novel virus that had not previously been seen in humans was identified for the first time in a resident from Saudi Arabia. The virus, now known as MERS-CoV, has, as of 31 May 2019, infected more than 2 442 people worldwide. MERS-CoV is a respiratory virus that can cause severe disease and has been fatal in approximately 35% of patients to date. MERS is zoonotic and people are infected from direct or indirect contact with dromedary camels. While the virus has demonstrated limited ability to transmit between people outside of hospitals, it has repeatedly caused large scale outbreaks in health care facilities with severe health, security and economic impacts, most notably in Saudi Arabia in 2014-2016 and the Republic of Korea in 2015. The outbreak in the Republic of Korea in 2015 involved 186 cases and 38 deaths, and had an estimated economic impact of US$12 billion.
In a research letter published in the journal Emerging Infectious Diseases on 8 July 2019, the researchers analyze case-based data on laboratory-confirmed MERS-CoV infections reported to WHO since 2012…

Afghanistan – No new digest announcements identified
Bangladesh – Rakhine conflict – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Cyclone Idai – No new digest announcements identified
Ethiopia – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Malawi floods – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 13 Jul 2019]

Angola – No new digest announcements identified
Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018 – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syrian Arab Republic: Recent Developments in Northwestern Syria Situation Report No. 7 – as of 12 July 2019
HIGHLIGHTS
:: …Humanitarian response is ongoing with hundreds of thousands of people receiving critical assistance essential for their survival. Violence in areas directly affected by conflict is driving displacement into denselypopulated areas, putting a strain on service delivery for humanitarian actors. A joint assessment is currently being finalized that will provide an overview of needs in the most affected areas.
:: Civilian infrastructure, including humanitarian facilities, continues to be damaged or destroyed in the violence. In the last two weeks, at least four medical facilities have been impacted by the violence, with several other unconfirmed reports, as well as a water station serving over 80,000 people, and several schools, IDP settlements, markets and bakeries.

Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth
:: Southern Africa: Cyclones Idai and Kenneth Snapshot, as of 10 July 2019.

EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 6 July 2019

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
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

PDF-The Sentinel_ period ending 6 Jul 2019

Contents
:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals  [see PDF]

Libya

Secretary-General Condemns Killing of Migrants, Refugees in Libya Air Strikes, Noting United Nations Gave Warring Parties Detention Centre’s Coordinates
3 July 2019 SG/SM/19652
The following statement was issued today by the Spokesman for UN Secretary-General António Guterres:

The Secretary-General is outraged by reports that at least 44 migrants and refugees, including women and children, have been killed and more than 130 injured following air strikes at the Tajoura migrant detention centre, east of Tripoli. He condemns this horrendous incident in the strongest terms. He expresses his deepest condolences to the families of the victims and wishes a quick recovery to those injured.

The Secretary-General calls for an independent investigation of the circumstances of this incident, to ensure that the perpetrators are brought to justice, noting that the United Nations had provided exact coordinates of the detention centre to the parties. The Secretary-General further reminds all parties of their obligations under international humanitarian law to take all feasible precautions to avoid, and in any event to minimize, incidental loss of civilian life, injury to civilians and damage to civilian objects, and to refrain from directing attacks against civilians. This incident underscores the urgency to provide all refugees and migrants with safe shelter until their asylum claims can be processed or they can be safely repatriated.

The Secretary-General reiterates his call for an immediate ceasefire in Libya and a return to political dialogue.

Poverty – Development

The Poverty Alleviation Coalition
In 2019 an unprecedented 71.4 million people worldwide have been forced from their homes. To compound matters, 85% of 25.1 million refugees globally are hosted in developing countries. 25% live in the least developed countries. Here, refugees and host communities alike often find themselves enduring extreme poverty and scarce economic opportunities. Further, the majority of refugees worldwide live in protracted situations for five years or more, making most refugees less suited for emergency relief than for longer term solutions.

With an average of 30 persons being forcibly displaced every minute of every day, both refugees, nationals in host communities, and host country governments experience increasing social and economic pressure. In addition to new and protracted conflicts, climate change impacts will significantly add to the numbers of the forcibly displaced in coming years. Refugees and nationals in host communities are often forced into informal employment without regular earnings and social protection, thus, leaving many with little resilience to shocks and highly dependent on humanitarian aid. In locations where the level of poverty of refugees and host communities is on par, disparities in access to relief, resources and infrastructure often create pressure on refugees and nationals alike. This in turn puts fiscal and political pressures on hosting governments and social services, particularly in low-income countries.

Enabling refugees to work in their host country has received renewed attention in the past years as a way to combine development needs of host communities and countries with the humanitarian needs of refugees. When refugees are able to work, their self-reliance is enhanced, and they are able to provide for themselves and their families, increase resilience, regain dignity, and build independent and meaningful future. Ultimately, access to livelihoods and jobs enables the impoverished to meet their needs for protection, food security, health, housing, and other essential services in a safe, sustainable, and dignified manner. A growing body of evidence suggests that including refugees in local economies contributes to economic growth, and can thus be mutually beneficial for refugees and host communities. Overall, access to work reduces pressure on refugees and hosts locally, contributes to economic growth, and therefore eases pressure on the host country as a whole.

In December 2018 the United Nations adopted the Global Compact on Refugees (GCR) in which member states committed to the objectives of reducing pressure on host countries and enhancing refugee self-reliance. This is to be achieved by increased international burden and responsibility sharing, and by mobilizing the international community and stakeholders as a whole. In line with the 2030 Agenda’s Sustainable Development Goals, the Compact calls for alleviating poverty which is itself a significant root cause of large refugee populations.

In response to the global poverty situation among refugees and nationals in host communities, and in line with the GCR spirit, a coalition between the UNHCR, The World Bank Partnership for Economic Inclusion (PEI) and 11 NGOs has been formed with the goal of alleviating poverty for refugees and host communities in selected countries.

The partners are:
World Vision
Mercy Corps
Concern Worldwide
BOMA Project
Caritas Suisse
GOAL
BRAC
HIAS
Trickle Up
Village Enterprise
Norwegian Refugee Council (NRC).

,

The Poverty Alleviation Coalition
Vision
A coalition of UNHCR, The World Bank Partnership for Economic Inclusion (PEI) and 11 NGOs will work towards the common vision of increasing self-reliance, economic and social inclusion of refugees & host communities by sustainably increasing income-earning opportunities.

500,000 households
Alleviating poverty of half a million households consisting of refugees and host communities as an objective within 5 years. The Coalition will run two cohorts from 2020-2025. This is a direct response to the high levels of poverty among refugees and host communities in low income countries.

The Graduation Approach
The Graduation Approach will guide the coalition’s response. The approach combines humanitarian and development assistance and helps the extremely poor refugees and host communities to become self-reliant. The methodology is developed by BRAC and show impressive results with 95% of participants graduating out of poverty. A programme is typically 18-36 months.

35 countries
The Coalition has a target of reaching 35 countries across Africa, Asia, Europe and Latin America from 2020-2025. Target households are in areas where both refugees and nationals live in poverty and close proximity. Fundraising is ongoing.

Parallel funding
Parallel funding where donors fund implementing NGOs directly is the Coalition’s modality. UNHCR and PEI will be the main conveners by facilitating access to populations, supporting programming and fundraising, as well as monitoring and evaluation of the Coalition’s programmes.

US$ 1,400/household
The approximate cost of alleviating a household of extreme poverty is on average US$ 1,400. To meet the coalition’s goal of alleviating 500,000 households, the annual need is an average of USD 140 million annually for 5 years (totaling US$ 700 million).

SDGs – Health Financing

High-Performance Health-Financing for Universal Health Coverage: Driving Sustainable, Inclusive Growth in the 21st Century
World Bank
Publication June 27, 2019 :: 82 pages
PDF: http://documents.worldbank.org/curated/en/641451561043585615/
Overview
Just over a decade out from the SDG deadline of 2030, many developing countries are not on track to meet Universal Health Coverage (UHC) targets to ensure access to quality, affordable health services to all. People in developing countries pay over half a trillion dollars annually out-of-pocket for health services, which is pushing about 100 million people into extreme poverty each year. The evidence is strong that progress towards UHC would spur not just better health but also inclusive and sustainable economic growth, yet this report estimates that in 2030 there will be a UHC financing gap of $176 billion in the 54 poorest countries. This threatens decades-long progress on health, endangers countries’ long-term economic prospects, and makes them more vulnerable to pandemic risks. This report, launched to inform the first-ever G20 Finance and Health Ministers session in Osaka, Japan in June 2019, lays out an action agenda for countries and development partners to bridge the UHC financing gap, and makes a strong case for a focus on innovation in health financing over the next decade.

Education

World Bank, UNESCO Institute for Statistics Join Forces to Help Countries Measure Student Learning
PARIS July 4, 2019 – The World Bank and UNESCO Institute for Statistics (UIS) today announced a new partnership to help countries strengthen their learning assessment systems, better monitor what students are learning in internationally-comparable ways and improve the breadth and quality of global data on education.

This partnership is part of a collaborative effort to tackle the global learning crisis marked by the slowdown in the improvement of access to education in recent years – leaving over 262 million children, adolescents and youth out of school— and hundreds of millions who are in school but not learning enough.

“Over half of the world’s children cannot read and understand a simple story by the age of 10 – this is unacceptable. Reading and numeracy are rights and must be tackled, urgently, to ensure children can develop the fundamental skills necessary for building the strong and resilient economies of the future,” said Jaime Saavedra, World Bank Global Director for Education. “Many countries do not undertake the systematic measurement of learning needed to track progress and inform education policies. Without this data, policymakers are flying blind. This partnership will help ensure that countries have the right tools to measure learning and to close the data gaps underpinning the global learning crisis,” said Saavedra.

“Our focus is on supporting developing countries to strengthen their national assessments and on working with other international partners and countries to generate the necessary consensus to produce the best education statistics necessary for an evidence-based policymaking process,” said Stefania Giannini, Assistant Director-General for Education of UNESCO. “This partnership will allow us to collaborate on supporting countries with the tools and technical support they need to track progress towards the Sustainable Development Goal 4 (SDG 4), to see what is working, what challenges remain, and where improvements can be made.”

Both the Sustainable Development Goal on inclusive, equitable and quality Education and the education-related component of the World Bank’s Human Capital Index (HCI) released last year provide an impetus for measuring learning outcomes in internationally comparable ways, and over time.

The partnership will harness key global initiatives of the two institutions to strengthen countries’ national capacity for the design, administration and analysis of large-scale national learning assessments. The UIS is leading global efforts to expand internationally comparable data on learning outcomes, leveraging countries’ national measurement efforts. The World Bank is developing a Global Education Policy Dashboard to enable countries to monitor how well their education systems are oriented toward improving learning and educational attainment for all children…

Health – Medicines Quality/Safety

WHO launches five-year plan to improve the quality and safety of health products
1 July 2019 | News release
…Despite global progress, serious problems with health product quality and safety persist, particularly in lower- and middle-income countries. These problems threaten the health of people every day and waste resources. Quality and safety of medicines, vaccines and other products are compromised when manufacturers, whether by accident or intent, produce substandard products, when the supply chain allows unsafe medical products through, and when systems (usually due to lack of resources) are too slow to respond to adverse events.

Current regulatory capacity and enforcement are insufficient in most developing countries. WHO estimates that only 3 out of 10 regulatory authorities globally function according to acceptable standards. To compound that, manufacturing of health products has become increasingly globalized, with products and the materials that go into them crossing several borders before they reach patients, requiring even greater global vigilance. And with the rise of non-communicable diseases, such as cancer, cardiovascular conditions and diabetes, regulatory authorities in developing countries are facing greater workloads and new demands to regulate innovative products.

Universal health coverage will bring about greater access to medical products, but we must ensure that those products are quality-assured, safe and effective so that they do what they are supposed to do – prevent illness and improve people’s health. That is why today’s launch of WHO’s five-year plan ‘Delivering Quality-assured Medical Products for All 2019–2023’ is important.

The plan outlines work and activities to reach four main objectives:
[1] Strengthen country and regional regulatory systems – improving the functioning of regulatory authorities but also speeding up product registration timelines so that patients can get the product sooner, and facilitating cross-border collaboration;
[2] Increase regulatory preparedness for public health emergencies – equipping regulators with the knowhow to deal with emergencies, including by fast-tracking product approval processes and improving crisis communication;
[3] Strengthen and expand WHO prequalification – WHO prequalification of priority health products has contributed to treating millions of people with quality, cost-effective HIV medicines, as well as to the vaccination of millions of children through Gavi, the Vaccine Alliance. It is now expanding to include cancer medicines as the cancer burden grows in low- and middle-income countries;
[4] Increase the impact of WHO’s Regulatory Support activities – by aligning work across all levels of the organization, with particular attention given to countries’ needs.

Providing oversight of health products throughout their lifecycle – from laboratory to health facility – is the linchpin of effective prevention, diagnosis and treatment and an essential part of WHO’s drive towards universal health coverage. While WHO has worked to improve the quality and safety of health products for many years, this is the first time we are aligning goals and activities with global partners (Bill and Melinda Gates Foundation, UNITAID, The Global Fund to Fight AIDS, TB and Malaria, GAVI and UNICEF) to ensure full coordination and work towards a common goal – to deliver a safe and quality-assured supply of medicines, vaccines, medical devices and other health products for all populations.

External assessment report of the programmes, prequalification and regulatory supporting activities
WHO makes available the outcomes of an external assessment report of the programmes, prequalification and regulatory supporting activities. The review aims to increase a fact-based understanding of the impact and value of WHO’s work on prequalification of medicines, vaccines and in-vitro diagnostics and supporting regulatory activities, including norms and standards setting, regulatory systems strengthening, safety monitoring and vigilance.

Key findings:
:: WHO Prequalification (PQ) programme enables a core market of approximately US$3.5 billion with the majority coming from vaccines
:: WHO PQ has a Return on Investment of 30-40 to 1 for the PQ-enabled donor-funded market (US$ million)
:: Most donors and procurers and implementing partners view PQ approval as equivalent to approvals by stringent regulatory authorities
:: 340-400 million more patients have access thanks to resources freed up by PQ
:: National regulatory authorities (NRAs) relying on Collaborative Registration Procedure (CRP) have achieved significant acceleration of approval timelines vs pre-CRP registrations

Impact on countries:
:: Since 1997, WHO trained more than 8’000 NRA staff worldwide and number of functional NRAs increased by 70%
:: Four types of inspection-related capacity building activities are held to support local NRAs
:: A positive correlation is observed between the number of substandard and falsified medical products reported and the number of trained focal points
:: Number of reports on adverse events in medicines has increased in regions with extensive training activities
:: Number of countries with basic vaccine safety monitoring system has increased with workshops held in the regions

Opportunities for improvement:
:: Improve external communication and operational efficiency
:: Strengthen cross-functional collaboration and communication
:: Increase cooperation with entities outside of the department, e.g. emergencies, procurement
:: Continue efforts to expand existing PQ-product list with a more end-to-end lifecycle view
:: Increase awareness of WHO support provided during the early development phase of a product

Featured Journal Content

BMC Medical Ethics
13 June 2019; 20(40)
Research Article
Mention of ethical review and informed consent in the reports of research undertaken during the armed conflict in Darfur : a systematic review
Ghaiath Hussein, Khalifa Elmusharaf
Abstract
Background
Armed conflict in Darfur, west Sudan since 2003 has led to the influx of about 100 international humanitarian UN and non-governmental organizations to help the affected population. Many of their humanitarian interventions included the collection of human personal data and/or biosamples, and these activities are often associated with ethical issues. A systematic review was conducted to assess the proportion of publicly available online reports of the research activities undertaken on humans in Darfur between 2004 and 2012 that mention obtaining ethical approval and/or informed consent.
Methods
This systematic review is based on a systematic literature search of Complex Emergency Database, ReliefWeb, PubMed), followed by a hand search for the hardcopies of the eligible reports archived in the Centre for Research on the Epidemiology of Disasters (CRED) in Brussels.
Results
The online search showed that out of the 68 eligible studies, 13.2% (9) reported gaining ethical approval and 42.6% (29) that an informed consent was obtained from the participants. The CRED search included 138 eligible reports. None of these reports mentioned gaining ethical approval and 17 (12.3%) mentioned obtaining informed consent from their participants.
Conclusions
The proportion of studies reporting ethical review and informed consent was smaller than might be expected, so we suggest five possible explanations for these findings. This review provides empirical evidence that can help in planning ethical conduct of research in humanitarian settings.

DRC – Cholera

More than a million people to be vaccinated in phase 2 of a huge cholera vaccination campaign in the Democratic Republic of the Congo
MBUJI-MAYI / GENEVA, 3 JULY 2019 — Phase 2 of the biggest ever oral vaccination campaign against cholera is scheduled to take place from 3-8 July 2019 in 15 health districts in the four central provinces of the Democratic Republic of the Congo (DRC) – Kasaï, Kasaï Oriental, Lomami et Sankuru. The second dose of vaccine confers lasting immunity against cholera, and is being targeted at 1,235,972 people over 1 year of age. The 5-day, door-to-door campaign will involve 2632 vaccinators recruited mainly from local communities, whose job it is to administer the oral cholera vaccine, fill in vaccination cards and tally sheets, and compile a daily summary of the teams’ progress.

In parallel, 583 community mobilizers have been selected – 1 mobilizer for every 3 teams in urban areas and 1 mobilizer for every 2 teams in rural districts. Their job is to alert local people that vaccinators will visit their homes. They will use loudspeakers to spread the message, particularly in the early evening. The campaign is organized by the Ministry of Health with technical, logistic and financial support from WHO, Gavi, the Vaccine Alliance and the Global Task Force on Cholera Control (GTFCC). It is the second such campaign in this central region of the DRC. 1,224,331 people over 1 year of age were vaccinated during the first round in late December 2018. The purpose of the vaccination campaign is to contain the serious epidemic which resulted in 9154 presumed cases and 458 deaths (case-fatality rate of 5%) in the 5 affected provinces in Kasaï region between January and December 2018.

This cholera vaccination campaign marks the intensification of our response in the DRC,” said Dr Matshidiso Moeti, WHO Regional Director for Africa, “WHO and our partners are working with national authorities to rollout the vaccine, which comes in addition to multiple interventions introduced since the beginning of the cholera epidemic, including sanitation and water quality control in the affected areas, many of which have little access to a safe water supply.”

Right now, with the second dose, the preventive campaign for which 1,235,972 doses of oral vaccine have been laid in will ensure coverage of all at-risk areas in this central region of the DRC. The vaccines have been provided from global cholera vaccine stocks managed by Gavi, the Vaccine Alliance. “This vaccination campaign will play a key role in bringing this cholera outbreak under control,” said Dr Seth Berkley, CEO of Gavi. “The DRC is currently going through an unprecedented combination of deadly epidemics, with Ebola and measles outbreaks also causing untold misery across the country. It is vital that the global effort to control these outbreaks continues to receive support: we cannot allow this needless suffering to continue.”…

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 3 July 2019
:: G20 Leaders met on 28-29 June 2019 in Osaka, Japan, and discussed major challenges facing the world and the importance of eradicating polio. The G20 declaration states, “We reaffirm our commitment to eradicate polio as well as to end the epidemics of AIDS, tuberculosis and malaria and look forward to the success of the sixth replenishment of the Global Fund to fight AIDS, Tuberculosis, and Malaria.” Read more here.
:: A second cVDPV2 outbreak has been reported in Angola this year; the earlier outbreak was detected in Lunda Norte province; for which an outbreak response is in progress (in close coordination with DRC). The Global Polio Eradication Initiative (GPEI) Outbreak Preparedness and Response Task Team (OPRTT) is also supporting the Angola polio eradication team on planning the response to the new outbreak in Huila.
:: The World Health Organization is seeking Expressions of Interest from public- and private-sector vaccine manufacturers and other institutions on development and manufacture of affordable poliovirus virus-like-particle vaccine.  Read more here

Summary of new viruses this week:
:: Afghanistan —two wild poliovirus type 1 (WPV1)-positive environmental samples;
:: Pakistan — five WPV1 cases and 18 WPV1-positive environmental samples;
:: Nigeria — five circulating vaccine-derived poliovirus type 2 (cVDPV2)-positive environmental samples case;
:: DR Congo —  one cVDPV2 case;
:: Angola—  one cVDPV2 case and four cVDPV2 isolated from healthy community contacts.

::::::
::::::

Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 6 Jul 2019]

Democratic Republic of the Congo
:: More than a million people to be vaccinated in phase 2 of a huge cholera vaccination campaign in the Democratic Republic of the Congo 3 July 2019
:: 48: Situation report on the Ebola outbreak in North Kivu 2 July 2019
:: Disease Outbreak News (DONs} Ebola virus disease – Democratic Republic of the Congo
4 July 2019
[See DRC Ebola+ above for detail]

Syrian Arab Republic
:: WHO delivers healthcare to displaced people in north-west Syrian Arab Republic
2 July 2019

Yemen
:: WHO supports emergency medical care in Al Thawra Hospital, Sana’a, Yemen
2 July 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Myanmar – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified

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WHO Grade 2 Emergencies [to 6 Jul 2019]

Ethiopia
:: Ethiopia sets new standards for the management of acute malnutrition 26 June 2019

Afghanistan – No new digest announcements identified
Bangladesh – Rakhine conflict – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Cyclone Idai – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

::::::

WHO Grade 1 Emergencies [to 6 Jul 2019]

Angola – No new digest announcements identified
Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018 – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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::::::

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syria: Humanitarian Response in Al Hol camp, Situation Report No. 5 – As of 5 July 2019
Published on 05 Jul 2019
HIGHLIGHTS
:: The camp population is at 70,097 individuals or 19,824 households, as of 26 June; more than 90% are children and women. The decrease in numbers from 73,782 four weeks ago, is the result of updated distribution figures, a slight increase in repatriation of 3rd country nationals and the return of hundreds of internally displaced Syrians to Raqqa governorate.
:: A total of 35 humanitarian partners; UN agencies and other humanitarian organisations, are delivering a range of services and activities in the camp. Needs remain considerable across all sectors; such as in protection, health, water, sanitation and hygiene, shelter and education. Water quantity and quality, poor hygiene conditions, inadequate feeding habits and limited health services pose challenges.
:: Past month has seen a slight increase in acute malnutrition, and a sharp increase in acute diarrhea. However, overall emergency thresholds have not been breached and assistance efforts remain within SPHERE standards…
:: Humanitarian access to the annexes hosting some 11,000 foreign nationals, who are not Iraqi nor Syrian, has slightly improved although it remains restricted, particularly in the evening and during night time – and continues to impact and prevent delivery of services 24/7. More approvals are being granted to humanitarian actors to access the annexes and one INGO already has a static health center in an annex.

Yemen – No new digest announcements identified

::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 29 June 2019

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
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

PDF-The Sentinel_ period ending 29 Jun 2019

Contents
:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals  [see PDF]

Syria

Syria: Humanitarian leaders, standing with civilians under fire in Idlib, send a message that ‘The World Is Watching’ [EN/AR]
(New York/Geneva 27 June 2019) – Eleven chiefs of global humanitarian organizations today spearhead the launch of a worldwide campaign in solidarity with civilians under fire in northwestern Syria.

Three million civilians, among them one million children, are in imminent and mortal danger from the escalating violence in Idlib governorate and surrounding areas.

In a direct video address, the humanitarian leaders stress that civilians face the constant threat of violence and armed conflict and desperately need protection. Stressing that “too many have died already” and that “even wars have laws”, they deplore the devastating impact of the fighting on hospitals, schools and markets.

“Idlib is on the brink of a humanitarian nightmare unlike anything we have seen this century,” they warn.

“Our worst fears are now materializing,” added UN humanitarian chief Mark Lowcock. “Yet again, innocent civilians are paying the price for the political failure to stop the violence and do what is demanded under international law – to protect all civilians. For the women, children and men in Idlib, it can be a death sentence. Our campaign expresses solidarity with the families under attack and tell everyone that we are watching and witnessing what is happening.”

A huge influx of displaced people from other parts of Syria since 2015 has doubled the size of the population in Idlib. At least 330,000 people have been displaced internally in the region during the last two month’s surge of violence. They have nowhere left to flee to. The UN Secretary-General has warned about the violence for months, but it hasn’t stopped, or even slowed.

The campaign video will be posted on Twitter and other online platforms and global leaders and the public are encouraged to share it with their own networks to show solidarity and to emphasize that they are witnesses to what is happening in Idlib.

We see you
We stand with you
You are not forgotten
You are #NotATarget
#TheWorldIsWatching

#TheWorldIsWatching campaign is supported by:
Henrietta Fore, UNICEF
Mark Lowcock, UN OCHA
Jan Egeland, Norwegian Refugee Council
Carolyn Miles, Save the Children
Abby Maxman, Oxfam America
Justin Byworth, World Vision
Phumzile Mlambo-Ngcuka, UN Women
Caroline Kende Robb, CARE International
David Miliband, International Rescue Committee
Neil Keny-Guyer, Mercy Corps
António Vitorino, International Organization for Migration
Dominic MacSorley, Concern Worldwide
David Beasley, World Food Programme

Children’s Rights

Six leading NGOs call for a ‘second revolution’ for children’s rights
Joining Forces – June 26 2019
The ‘Joining Forces Alliance’ — an alliance of the six leading child-focused organisations – launched its report, “A Second Revolution: 30 years of child rights, and the unfinished agenda”, during an event today at the United Nations.

The report, presented to UN representatives, notes achievements made since the adoption of the United Nations Convention on the Rights of the Child 30 years ago, but also highlights major shortcomings in reaching all children.

“It is the most vulnerable children the world overlooks – those facing extreme poverty, the young living in fragile states, refugees, and children with disabilities,” said Meg Gardinier, Chair of the Joining Forces CEO Oversight Committee.

“When it comes to translating commitments into lasting change, we have fallen short and we must do better. This is a moral, legal and economic failure that the world can ill afford,” Ms Gardinier continued.

Each year, over five million children die from preventable causes, and nearly half of these deaths are attributable to undernutrition, the report finds. Discrimination and social exclusion are other key factors why children countinue to suffer.

The Joining Forces Alliance calls on governments to implement legislation, policies, budgets, and programmes that are inclusive of all children; to promote the rights of all marginalised children and champion gender equality, and to support children’s participation and uphold their rights to freedom of expression and opinion.

‘Joining Forces’ is a collaboration between the six leading NGOs working with and for children under the age of 18 (ChildFund Alliance, Plan International, Save the Children International, SOS Children’s Villages International, Terre des Hommes International Federation, and World Vision International). Joining Forces currently focuses on two work streams: Child Rights Now! of which this report is a part, and Ending Violence Against Children.

To read the report and find out more about ‘Joining Forces’, go to: https://child-rights-now.org/

Featured Journal Content

The Lancet
Jun 29, 2019 Volume 393Number 10191p2563-2654, e45
https://www.thelancet.com/journals/lancet/issue/current
Editorial
Refugee health is a crisis of our own making
The Lancet
Another World Refugee Day has passed, and the number of displaced people around the world is at its highest ever. The wellbeing of those fleeing their homes because of persecution, poverty, and war to seek a better life elsewhere, although guaranteed by ratified international human rights standards and conventions, is still under attack. At last month’s World Health Assembly meeting, a report entitled Promoting the health of refugees and migrants: draft global action plan, 2019–2023 was discussed. By WHO estimates, 68 million people have been forcibly displaced across borders. Developing countries host 86% of the population of migrants who have suffered forced displacement and the UN estimates suggest 71 million people worldwide fled war in 2018 alone.

The WHO draft plan suggests six action points regarding the health of refugees, most of which cover advocacy and continuity of local health care. This guidance is, of course, welcome. Any greater visibility for the plight of refugees and migrants is a wholly worthwhile topic and WHO is right to focus its efforts on ensuring protection for one of the most vulnerable groups of people worldwide. Health is a right, not a privilege granted by circumstance of birthplace.

An action plan like this does not, however, cover the simple denial of the most basic human rights of individuals that is taking place in the USA. It used to be the case that America was able and proud to demonstrate its record on refugee resettlement. The USA marked World Refugee Day by highlighting the successes the country had in the integration of extremely vulnerable populations from around the world. That Canada, a country with a much smaller population, welcomed more refugees than the USA in 2018, with 28 100 refugees settled in Canada compared with 22 900 in the USA, does not tell the full story of what has happened since. This year, the USA marked World Refugee Day by the acting head of the US Citizenship and Immigration Services sending an email to asylum officers urging them to “stem the crisis and better secure the homeland”.

A leadership built on spiteful rhetoric towards those seeking a better life in a country of great opportunity and freedom has fallen further than anyone who brushed aside the xenophobia of the 2016 campaign trail could have thought. Even those who are only passingly familiar with the news will be aware of the perilous state of those detained in the so-called migrant camps, of the children separated from their parents at the border and lost in the system, and of migrants kept in solitary confinement and locked up without trial. A true illustration of the government’s mendacity in these matters came in front of the courts this week, when a government lawyer argued that detained migrant children were not entitled to soap or toothbrushes under a law requiring them to be kept in “safe and sanitary” conditions. Children recently lost access to legal aid, classes, and recreational activities for “budgetary reasons”. According to NBC, there are 50 000 people detained in Immigration and Customs Enforcement (ICE) facilities. 24 migrants have died under ICE custody so far.

The blatant nature of the Trump administration’s transgressions towards the vulnerable people it is required to protect is breathtaking. Let us instead focus on the positive results that immigration can bring to a nation. Former German president Christian Wulff said this week, regarding Germany’s resettlement of 900 000 migrants at the height of the crisis in 2015, that “the refugee move will be a stroke of luck in German history”. Wulff stated that, in a few years, Germany will look back on this decision with pride. The effect could be as pronounced as German reunification in the 1990s. He warned against blurring the line separating patriotism and nationalism.

Immigration strengthens a country, but even among immigration-positive politicians, the argument is lost in a flurry of caps on numbers and a tacit agreement that the argument for immigration is already lost. Accepting refugees and allowing them to live freely is itself lifesaving and of demonstrable economic and social benefit to a country. Forbidding them is damaging to us all.

The health, safety, and wellbeing of vulnerable populations must be uppermost in the mind of anyone who is a health professional. The prominence WHO has given to the health of refugees is welcome, and we can all do more to state the positive case for allowing migrants unfettered access to health care. The brutal treatment of refugees and migrants in many situations worldwide should be condemned in the strongest possible terms.

Featured Journal Content

The Lancet
Jun 29, 2019 Volume 393Number 10191p2563-2654, e45
https://www.thelancet.com/journals/lancet/issue/current

Editorial
Caring for patients who have been tortured in detention
The Lancet
People who have been tortured while in detention are among our most vulnerable patients. Clinicians who care for these patients might likewise feel vulnerable and ill-equipped to manage the complex health-care needs of victims. Torture and detention on their own have health impacts, but together exact a physical and psychological toll on individuals that can be long-lasting and profound. A third of asylum seekers and over 40% of refugees are estimated to be victims of torture. That health-care delivery can trigger memories of trauma, fear of officials, and mistrust of institutions compounds the challenges clinicians face in caring for people who have been tortured in detention.

International instruments exist, such as the so-called Mandela rules (UN Standard Minimum Rules for the Treatment of Prisoners) and a World Medical Association declaration, which lay out the basic principles to be applied in the health care of those in detention who have been tortured or subject to inhuman or degrading treatment. Now, a more specific set of quality standards has been developed by the Faculty of Forensic and Legal Medicine (FFLM) of the Royal College of Physicians. Their guidance is welcome.

The FFLM’s 12 quality standards are intended to help physicians, nurses, paramedics, and others establish good practice in the identification, documentation, and reporting of torture, and improve the treatment and quality of life for victims. The new standards also aim to empower health-care professionals to maintain their ethical obligations to patients if in conflict with the requirements of detention authorities. The standards are comprehensive, detailed, and direct, and cover areas such as sexual torture, children, mental capacity, and vicarious traumatisation.

These guidelines should be disseminated widely to enable clinicians everywhere to build the capacity, confidence, and compassion to manage the complex needs of patients who have been tortured. These standards should also be used to challenge detaining authorities to improve their standards of detention health care.

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Summary – Quality standards for healthcare professionals working with victims of torture in detention
The Faculty of Forensic & Legal Medicineof the Royal College of Physicians
The Faculty of Forensic and Legal Medicine of the Royal College of Physicians (FFLM), whose work focuses on the care of the vulnerable, has acknowledged expertise in setting clinical standards for police custody healthcare and sexual offence medicine. The healthcare professionals who work with Victims of Torture (HWVT) working group, established by the FFLM to produce these quality standards, has drawn on wider expertise from Freedom from Torture, Helen Bamber Foundation, Medical Justice, UK Association of Forensic Nurses, the Royal College of Psychiatrists, and the British Association for Sexual Health and HIV. The document has benefited from review by survivors of torture, an international expert in solitary confinement, Physicians for Human Rights, the International Rehabilitation Council for Torture Victims, Dignity Institute, the International Red Cross, the Royal College of General Practitioners Secure Environments Group, NHS England, the British Medical Association Ethics Committee. We are grateful for all the support offered by the above named to the HWVT working group of the FFLM.

PDF: Summary – Quality standards for healthcare professionals working with victims of torture in detention

“Liberalism”

Vladimir Putin says liberalism has ‘become obsolete’
In an exclusive interview with the FT, the Russian president trumpets growth of national populism
Financial Times, Lionel Barber and Henry Foy in Moscow and Alex Barker in Osaka
June 27, 2019

Vladimir Putin has trumpeted the growth of national populist movements in Europe and America, crowing that liberalism is spent as an ideological force.

In an FT interview in the Kremlin on the eve of the G20 summit in Osaka, Japan, the Russian president said “the liberal idea” had “outlived its purpose” as the public turned against immigration, open borders and multiculturalism.

Mr Putin’s evisceration of liberalism — the dominant western ideology since the end of the second world war in 1945 — chimes with anti-establishment leaders from US president Donald Trump to Hungary’s Viktor Orban, Matteo Salvini in Italy, and the Brexit insurgency in the UK.

“[Liberals] cannot simply dictate anything to anyone just like they have been attempting to do over the recent decades,” he said.

Mr Putin branded Chancellor Angela Merkel’s decision to admit more than 1m refugees to Germany, mainly from war-ravaged Syria, as a “cardinal mistake”. But he praised Donald Trump for trying to stop the flow of migrants and drugs from Mexico.

“This liberal idea presupposes that nothing needs to be done. That migrants can kill, plunder and rape with impunity because their rights as migrants have to be protected.”

He added: “Every crime must have its punishment. The liberal idea has become obsolete. It has come into conflict with the interests of the overwhelming majority of the population.”…

Editor’s Alert: Human Rights

Department of State Commission on Unalienable Rights [U.S.]
Federal Register – A Notice by the State Department on 05/30/2019
AGENCY: Department of State.
ACTION: Notice of intent to establish an advisory committee.
The Secretary of State announces an intent to establish the Department of State Commission on Unalienable Rights (the Commission), in accordance with the Federal Advisory Committee Act.

Nature and Purpose: The Commission will provide the Secretary of State advice and recommendations concerning international human rights matters. The Commission will provide fresh thinking about human rights discourse where such discourse has departed from our nation’s founding principles of natural law and natural rights.

Other information: It is anticipated that the Commission will meet at least once per month and at such other times and places as are required to fulfill the objectives of the Commission. The Department of State affirms that the advisory committee is necessary and in the public interest.

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A New Trump Battleground: Defining Human Rights
New York Times – Editorials, June 17, 2019
By Carol Giacomo
Ms. Giacomo is a member of the editorial board.
The State Department says the nation has departed from its founding principles, but won’t say how. Some fear a rollback of rights.

“…If the commission is another step toward narrowing or calling into question America’s commitment on human rights, it will further erode the country’s leadership and give the world’s repressive rulers more reasons to ignore complaints about their own abuses and atrocities.”

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Pompeo Tries to Rescue the Idea of Human Rights
Wall Street Journal, Opinion By Aaron Rhodes
June 10, 2019 7:03 pm ET
Unmoored from natural law, the ‘liberal world order’ generally hasn’t produced liberty.
“…The “liberal world order” has generally not produced liberty. The hope that participation in inclusive, rules-based multilateral human-rights organizations would pull oppressive states toward liberalism has proved illusory. And while oppressive regimes sabotage human rights at the highest level, civil-society campaigns have largely become passive, expecting that unfree societies can really be liberated by United Nations bureaucracies.

Can Americans get their act together to do something about this global disaster? Initial reactions to the Pompeo initiative are discouraging. The issue has been immediately folded into domestic preoccupations with sexual-identity politics. The mention of “natural law” and “natural rights”—which the State Department correctly named as the core foundational principles of human rights—has aroused charges that the government is becoming a theocracy, exactly what the American Founders, who risked everything to honor rights they knew were grounded in nature, sought to avoid.

The principle of natural rights has been all but forgotten on the international scene. Without any transcendent point of reference, human rights are seen as arbitrary “values,” no different from the laws of rulers and legislatures that authentic human-rights standards are there to constrain.

Confusions and clashes about the meaning of human rights are nothing new in American history. Since the early 19th century, proponents of slavery, nativism, progressivism and socialism have all sought to undermine the idea of unconditional, individual natural rights protected by the Constitution, because those rights stood in the way of their agendas.

Especially in America, a country founded to protect liberty, human rights should not be the focus of partisan squabbles and culture wars. They should be understood instead as the foundation of pluralism. Natural rights allow us to be different but live peacefully together. That’s the spirit that should animate the Unalienable Rights Commission.

Asylum – Human Rights – Litigation

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Asylum Officers’ Union Says Trump Migration Policy ‘Abandons’ American Tradition [U.S.]
New York Times, By Mihir Zaveri June 26, 2019

A union representing federal asylum officers said in a court filing Wednesday that the Trump administration’s policy forcing migrants to wait in Mexico while their asylum cases are decided risks violating international treaty obligations and “abandons our tradition of providing a safe haven to the persecuted.”

The union, which represents 2,500 Department of Homeland Security employees, including the asylum officers, said in its filing that the policy, the Migration Protection Protocols, puts migrants in danger because they could face persecution while being forced to wait in Mexico, undermining the purpose of asylum.

Citing a State Department report, the union said that “impunity for human rights abuses remained a problem” in Mexico. Migrants are at particular risk of being sexually assaulted, it said, and ethnic minorities could face “persecution similar to the persecution they face in their home countries.”

“Asylum officers are duty bound to protect vulnerable asylum seekers from persecution,” the union said. “They should not be forced to honor departmental directives that are fundamentally contrary to the moral fabric of our nation and our international and domestic legal obligations.”

Muhammad Faridi, a lawyer representing the union, Local 1924 of the American Federation of Government Employees, said in an interview that the court filing was significant given the officers’ role in returning migrants to Mexico.

“These are people working in the background. These are not people opining or expressing their opinions on public policy or litigation matters,” Mr. Faridi said. “It takes something as egregious as the M.P.P., something that is so fundamentally contrary to the moral fabric of our country and international treaty obligations, it’s something like that that brings people to the litigation arena.”…

Migration – Children at U.S.- Mexico Border

Migrant children in the U.S. lack protection and services needed to ensure their wellbeing
Statement from UNICEF Executive Director Henrietta Fore
NEW YORK, 26 June 2019 – “I am deeply concerned for the wellbeing of migrant children at the U.S.-Mexico border. Having already faced perilous journeys, some children are now being sheltered at facilities that are not equipped to meet the needs of this vulnerable population.

“Recent reports coming from some of these facilities are grim. Children should not be in unsafe environments that can cause toxic stress and irreparable harm to their health and development. This is a dire situation requiring urgent action and funding to provide children and families with essential services and support.

“It’s hard to fathom this happening in a country with such a rich history as a champion for children in need around the world, particularly for those uprooted from their homes and communities by crisis. By any measure, these ARE children in need – I have met them.

“This past week, I visited with children and families from northern Central America at a migrant shelter in Tijuana, Mexico. None wanted to leave their countries, but all felt they had no choice because of the threat of gang violence or oppressive poverty.

“Some children had already been traumatized by experiences in their countries of origin or along the migration route.

“The heart-rending photo published just yesterday showing the lifeless bodies of Salvadoran toddler Valeria and her father Oscar on the bank of the Rio Grande is a stark reminder of the perils facing migrants trying to reach the U.S. It is a searing image that should shake each of us to our core.

“UNICEF is already working to expand access to protection, education and other services for migrant children wherever they may be in the region.

“But countries of origin, transit and destination must also act and implement a coordinated approach to ensure the rights, protection, wellbeing and dignity of migrant and refugee children.

“No one country can do it alone. Addressing the root causes of forced migration and the needs of uprooted children require serious commitment, resolve and resources.”

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 26 June 2019
:: Two new cVDPV2 emergences are reported this week in DR Congo; one from Sankuru province and one from Kasai province. Sankuru province is in the centre of the country and had previously not participated in mOPV2 outbreak response campaigns.  However, it is neighboring known infected provinces, where mOPV2 response continues to be implemented.  Kasai had already been participating in mOPV2 outbreak campaigns, as it had already been affected by a separate cVDPV2.  Currently, total six, genetically-distinct cVDPV2 outbreaks affecting the country.
:: One of the major factors that determines whether a child will receive vaccinations is the primary caregiver’s receptiveness to immunization.  The decision to vaccinate is a complex interplay of various socio-cultural, religious, and political factors. Read how everyday people in Pakistan are advocating for vaccinations.
:: Bayelsa State in the Niger Delta, Nigeria, is a riverine state with precarious transportation and rivers crisscrossing the land. Thanks to healthcare workers, community engagement and innovations in immunization practices, Bayelsa State jumped from one of the most poor-performing states in terms of routine immunization to be the second best in the country. Read more here.
Summary of new viruses this week:

Summary of new viruses this week:
:: Afghanistan — two wild poliovirus type 1 (WPV1) cases;
:: Pakistan — three WPV1 cases;
:: Nigeria — one circulating vaccine-derived poliovirus type 2 (cVDPV2) case;
:: DRC— four cVDPV2 cases;
:: Ethiopia— three cVDPV2 isolated from healthy community contacts.

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 29 Jun 2019]

Democratic Republic of the Congo
:: Winning the hearts of communities fearful of Ebola 24 June 2019
:: 47: Situation report on the Ebola outbreak in North Kivu 25 June 2019
:: Disease Outbreak News (DONs} Ebola virus disease – Democratic Republic of the Congo
27 June 2019
[See DRC Ebola above for detail]

Mozambique floods
:: 200 000 people lack access to health services in Mozambique 21 June 2019

Nigeria
:: States in Nigeria’s South West zone conclude second round of outbreak response
26 June 2019 All six States in the South West Zone have completed the ‘2nd Outbreak Response’ (OBR2) to the circulating Vaccine Derived Polio Virus (cVDPV2) with varying degrees of success. The exercise, implemented on 15 – 24 June, was in response to confirmed reports by the Lagos State Government of environmental strains of Polio Virus in Makoko, Itire and Maracana canals, as well as in Imeko Afon LGA of Ogun State.
Initial large-scale zonal supplementary immunization activities were coordinated across all States (Lagos, Ogun, Osun, Oyo, Ondo and Ekiti), during the OBR1 conducted on 18 -21 May, 2019. Polio eradication teams on the ground covered 89,841 settlements. The teams maximized the impact of available resources and ensured that oral polio vaccine be administered to 9,927,112 under-five year old children in all the States…

Somalia
:: WHO and UNICEF Somalia and partners call on all Somalis to vaccinate children against polio
25 June 2019

Myanmar – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 29 Jun 2019]

Bangladesh – Rakhine conflict
:: Bi‐weekly Situation Report 12 – 20 June 2019

Libya
:: Mental health support in a time of war 25 June 2019
:: Mental illness: training Libya’s health workers 24 June 2019

Afghanistan – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Cyclone Idai – No new digest announcements identified
Ethiopia – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Malawi floods – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 29 Jun 2019]

Angola – No new digest announcements identified
Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018 – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syrian Arab Republic: Recent Developments in Northwestern Syria Situation Report No. 6 – as of 28 June 2019

Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth
:: Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator, Ursula Mueller – Opening remarks at ECOSOC Humanitarian Affairs Segment Side Event “Cyclone Idai: The Ongoing Needs,” 26 June 2019

EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

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