Global & Disaster Medicine

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WHO Humanitarian Crisis Response Plans: 2018. How successful was it and what about 2019?

WHO

The WHO Humanitarian Response Plans for 2018 are based on rigorous assessment and analysis of need in 26 countries. The plans include an overview of the situation, WHO’s objectives to address the health aspects of the crisis, and the funds that will be required to do so. They form part of the overall humanitarian response plans developed by partners in the wider humanitarian response.

Reviewing 2017 • In 2017, humanitarian agencies reached more people in need than ever before: tens of millions of them, saving millions of lives; • Donors provided record levels of funding to Humanitarian Response Plans—nearly $13 billion by the end of November; • Humanitarian agencies helped stave off famines in South Sudan, Somalia, north-east Nigeria and Yemen, through effective scale-up and the rapid release of funds by donors; • Agencies stepped up to provide rapid assistance to refugees fleeing violence in Myanmar; and • Mobilized to support countries in the Caribbean to prepare for and respond to successive hurricanes of a ferocity rarely seen before. • Despite conflict and other constraints complicating the provision of assistance, plans were implemented effectively, with costs averaging approximately $230 a year per person for essential needs.

In 2018 • Conflict will continue to be the main driver of humanitarian needs. • Protracted violence will force people to flee from their homes, deny them access to enough food, and rob them of their means of making a living. • Droughts, floods, hurricanes and other natural disasters will also create humanitarian needs. Although the risk of El Niño or La Niña is low next year, some scientists forecast an increased risk of earthquakes in 2018. • In a number of countries, humanitarian needs will fall, but still remain significant, including Afghanistan, Ethiopia, Iraq, Mali, and Ukraine. • However, needs are rising substantially in Burundi, Cameroon, Central African Republic, the Democratic Republic of the Congo, Libya, Somalia and Sudan. • And needs will remain at exceptionally high levels in Nigeria, South Sudan, the Syria region, and Yemen, which is likely to remain the world’s worst humanitarian crisis. • Overall, 136 million people across the world will need humanitarian assistance and protection. • UN-coordinated response plans costed at $22.5 billion can help 91 million. • The overall number of people in need is more than 5% higher than in the 2017 GHO. The cost of the response plans sets a new record, about 1% higher than at the start of 2017. • Humanitarian agencies will become more effective, efficient and cost-effective. They will respond faster to crises, in a way more attuned to the needs of those they are trying to help. They will undertake more comprehensive, cross-sectoral and impartial needs assessments. They will also contribute more to long-term solutions by working more closely with development agencies. • Larger country-based pooled funds will improve the agility and prioritised use of funds in the places where they operate. An expanded Central Emergency Response Fund will better support the least-funded major crises.
PEOPLE IN NEED PEOPLE TO RECEIVE AID 135.7M 90.9M
FINANCIAL REQUIREMENTS $22.5B


Scurvy Outbreak Among South Sudanese Adolescents and Young Men

MMWR

The figure is a bar chart showing the percentage of South Sudanese refugees with suspected scurvy (N = 45) who were living in the Kakuma Refugee Camp in Kenya during 2017–2018, by selected reported symptoms.

Ververs M, Muriithi JW, Burton A, Burton JW, Lawi AO. Scurvy Outbreak Among South Sudanese Adolescents and Young Men — Kakuma Refugee Camp, Kenya, 2017–2018. MMWR Morb Mortal Wkly Rep 2019;68:72–75. DOI: http://dx.doi.org/10.15585/mmwr.mm6803a4.\

“…..Severe vitamin C deficiency causes scurvy, a disease that is mainly associated with long sea voyages and naval expeditions until the 19th century. Scurvy manifests itself 2-3 months after consuming a diet lacking of vitamin c; it is characterized by multiple haemorrhages and, left untreated, is fatal. In the past decade, several refugee populations that were wholly dependent on food aid have developed scurvy…..”

“……A disease caused by prolonged severe dietary deficiency of ascorbic acid, in which the breakdown of intercellular cement substances leads to capillary haemorrhages and defective growth of fibroblasts, osteoblasts, and odontoblasts results in impaired synthesis of collagen, osteoid, and dentine; it is characterized by haemorrhagic gingivitis affecting especially the interdental papillae (in the absence of teeth, the gums are normal), subperiosteal haemorrhages, bone lesions (including the corner fraction sign, a ground-glass appearance, and trabecular atrophy) seen on radiography, perifollicular haemorrhages, and frequently petechial haemorrhages (especially on the feet). Sudden death may occur as a result of cerebral or myocardial haemorrhage. Megaloblastic anaemia, usually due to concomitant iron and/or folate deficiency, is usual. The early manifestations include weakness, lethargy, myalgia, and arthralgia. In the infantile form (in which onset usually occurs in the second 6 months of life), gingival involvement is minimal and the infant assumes a ‘frog-like’ position and does not move its legs (owing to the intense pain of subperiosteal haemorrhages). In the adult form there are intraarticular and intramuscular haemorrhages, and osteoporosis may occur. The disorder may occur in infants born to mothers who are consuming large doses of ascorbic acid, and in adults following the abrupt discontinuation of large supplemental doses (despite relatively normal dietary intake of ascorbic acid).
Source: International nomenclature of diseases. Vol. IV Metabolic, nutritional, and endocrine disorders. Geneva, World Health Organization, 1991, p. 283……”

WHO-Scurvy Primer:  Document

“……Manifest scurvy in adults is preceded by a period of latent scurvy whose early symptoms include lassitude, weakness and irritability; vague, dull aching pains in the muscles or joints of the legs and feet; and weight loss. Shortness of breath may also occur and the skin can become dry and rough. The principal signs and symptoms of manifest scurvy in adults consist of follicular hyperkeratosis, haemorrhagic manifestations, swollen joints, swollen bleeding gums, and peripheral oedema (Hodges et al., 1971). Anaemia of a variable degree occurs with scurvy in a certain percentage of adults and infants, which is considered to be due in part to undernutrition and intercurrent infection. However, it is due chiefly to the effect of vitamin C on blood formation, folic acid metabolism, and bleeding.

In children the syndrome is called Moeller-Barlow disease, and is seen in non-breast-fed infants usually at about 5-6 months of age when maternally derived stores of vitamin C have been exhausted. No single symptom predominates, but the majority of infants with scurvy eventually show signs of irritability, tenderness of the legs, and pseudo paralysis, usually involving the lower extremities. The “pithed-frog” position—legs flexed at the knees and hips partially flexed—is assumed by approximately half the sufferers. Involvement of the costochondral junctions is very common, and costochondral beading is found in 80% of infants with scurvy. Haemorrhage around erupting teeth is consistently present. Petechial haemorrhages in the skin may occur (10 -15% of infants with scurvy). Left untreated, scurvy in any age group can lead to death……”


North Korea: “advanced, underestimated and highly lethal” bioweapons program.

NYT

“…..But today, analysts say, the gene revolution could be making germ weapons more attractive. They see the possibility of designer pathogens that spread faster, infect more people, resist treatment, and offer better targeting and containment. If so, North Korea may be in the forefront.

South Korean military white papers have identified at least ten facilities in the North that could be involved in the research and production of more than a dozen biological agents, including those that cause the plague and hemorrhagic fevers…..”

North Korea Biological Weapons Program


The Marjory Stoneman Douglas High School Public Safety Commission criticizes the response of school staff and the Broward County Sheriff’s Office and recommends arming teachers

Parkland Stoneman Douglas Commission Report

“….The commission’s 15 members issued a unanimously approved, 439-page preliminary report Wednesday aimed at preventing similar attacks and improving the response should they occur. …..”

In memory of:

Alyssa Alhadeff          Scott Beigel                Martin Duque

Nicholas Dworet        Aaron Feis                  Jaime Guttenberg

Chris Hixon                Luke Hoyer                 Cara Loughran

Gina Montalto            Joaquin Oliver           Alaina Petty
Meadow Pollack         Helena Ramsay         Alex Schachter
Carmen Schentrup     Peter Wang


Rift Valley Fever: It’s even more dangerous to fetuses than Zika.

NYT

“…….Testing on human placental tissue revealed that, unlike the Zika virus, Rift Valley fever virus has a unique ability to infect a specialized layer of cells that supports the region of the placenta where nutrients flow in.

Zika must take the “side roads” into the placenta to infect a fetus, while the Rift Valley fever virus can take the “expressway,” Dr. Hartman said.

“The fetus is protected from hundreds of thousands of dangers that could affect it,” she added. “Only a few microbes can get past, and this is one of them.”…….”

Rift Valley Fever Distribution MapRift Valley Fever Distribution Map

Rift Valley Fever:  Document

Rift Valley fever virus induces fetal demise in Sprague-Dawley rats through direct placental infection

WHO: Psychological first aid: Guide for field workers

WHO

Overview

This guide (2011) covers psychological first aid which involves humane, supportive and practical help to fellow human beings suffering serious crisis events. It is written for people in a position to help others who have experienced an extremely distressing event. It gives a framework for supporting people in ways that respect their dignity, culture and abilities.

Endorsed by many international agencies, the guide reflects the emerging science and international consensus on how to support people in the immediate aftermath of extremely stressful events.

 


Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies.

World Health Organization and United Nations High Commissioner for Refugees. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies. Geneva: WHO, 2015.

The target group for WHO work on mental health and psychosocial support in emergencies is any population exposed to extreme stressors, such as refugees, internally displaced persons, disaster survivors and terrorism-, war- or genocide-exposed populations.

The WHO Department of Mental Health and Substance Abuse emphasizes that the number of persons exposed to extreme stressors is large and that exposure to extreme stressors is a risk factor for mental health and social problems. The Department’s work on mental health in emergencies focuses mostly on resource-poor countries, where most populations exposed to natural disasters and war live.

 

Management of physical health conditions in adults with severe mental disorders

Preventable physical health conditions lead to premature mortality in people with severe mental disorders, reducing their life span by 10-20 years. The majority of these premature deaths are due to physical health conditions.

The physical health of people with severe mental disorders is commonly overlooked, not only by themselves and people around them, but also by health systems, resulting in crucial physical health disparities and limited access to health services. Many lives can be saved by ensuring that people with severe mental disorders receive treatment.

WHO’s “Guidelines on management of physical health conditions in adults with severe mental disorders” provide evidence-based, up-to-date recommendations to practitioners on how to recognize and manage comorbid physical and mental health conditions.

 


WHO: Mental Health of Refugees and Migrants

WHO

Being a refugee or a migrant does not, in itself, make individuals significantly more vulnerable to mental disorders, but refugees and migrants can be exposed to various stress factors that influence their mental well-being.

Refugees and migrants have often faced war, persecution and hardship in their country of origin. Many will have experienced displacement and difficulties in transit countries and embarked on dangerous travels. Lack of information, uncertainty about immigration status, potential hostility, changing policies, and undignified and protracted detention all contribute to additional stress.

Furthermore, forced migration requires multiple adaptations in short periods of time, making them more vulnerable to abuse and neglect. Pre-existing social and mental health problems can thus be exacerbated.

Clinical Management of Mental, Neurological and Substance Use Conditions in Humanitarian Emergencies


WHO: Proposed Health Component in the Global Compact for Safe, Orderly and Regular Migration

WHO

Proposed Health Component in the Global Compact for Safe, Orderly and Regular Migration

Document

To achieve the vision of the 2030 Sustainable Development Goals – to leave no one behind – it is imperative that the health rights and needs of migrants be adequately addressed in the Global Compact for Safe, Orderly and Regular Migration (GCM). Despite health being a prerequisite for sustainable development, health is missing from the six thematic sessions of the modalities for development of the GCM, as well as from the 24 elements contained in Annex II of the New York Declaration for Refugees and Migrants. To address this, in its 140th session in January 2017, the WHO Executive Board requested that its Secretariat develop a framework of priorities and guiding principles to promote the health of refugees and migrants.

In May 2017, the World Health Assembly endorsed resolution 70.15 on ‘Promoting the health of refugees and migrants’. The resolution encourages Member States to use the Framework of priorities and guiding principles to promote the health of refugees and migrants at all levels and to ensure that health is adequately addressed both in the Global Compact for Refugees (GCR) and the GCM.

Based on the Framework, to further provide health resources for the development of the draft GCM, WHO in close cooperation with IOM, ILO, OHCHR, UNAIDS, and other stakeholders, developed the Proposed Health Component in the Global Compact for Safe, Orderly and Regular Migration. The document proposes eight actionable commitments and the means of implementation.


WHO: Addressing the health needs of refugees and migrants by 2030

WHO

Reports on situation analysis and practices in addressing the health needs of refugees and migrants

To achieve the vision of the 2030 Agenda and the Sustainable Development Goals, to leave no one behind, it is imperative that the health needs of refugees and migrants be adequately addressed. In its 140th session in January 2017, the Executive Board requested that its Secretariat develop a framework of priorities and guiding principles to promote the health of refugees and migrants. In May 2017, the World Health Assembly endorsed resolution 70.15 on Promoting the health of refugees and migrants. This resolution urges Member States to strengthen international cooperation regarding the health of refugees and migrants in line with the New York Declaration for Refugees and Migrants. It urged Member States to consider providing the necessary health-related assistance through bilateral and international cooperation to those countries hosting and receiving large populations of refugees and migrants, as well as using the Framework of priorities and guiding principles at all levels. In addition, the resolution requested the Director-General to conduct a situation analysis and identify best practices, experiences and lessons learned in order to contribute to the development of a global action plan for the Seventy-second World Health Assembly in 2019.

In alignment with World Health Assembly resolution 70.15, WHO made an online global call from August 2017 to January 2018 for contributions on evidence-based information, best practices, experiences and lessons learned in addressing the health needs of refugees and migrants. Between August 2017 and January 2018, 199 submissions were received, covering 85 countries, from 52 Member States and partners such as the Office of the United Nations High Commissioner for Refugees (UNHCR), the International Organization for Migration (IOM) and the International Labour Organization (ILO). The submissions included valuable information on the current situation of refugees and migrants, health challenges associated with migration and forced displacement, past and ongoing practices and interventions in promoting the health of refugees and migrants, legal frameworks in place for addressing the health needs of this population, lessons learned and recommendations for the future.

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