Global & Disaster Medicine

Archive for the ‘Humanitarian’ Category

Puerto Rico: The USNS Comfort, a 70,000-metric-ton ship staffed with roughly 800 medical and support personnel and 250 beds, has treated only about 150 people since it arrived on Oct. 3

WSJ

  • “….Hurricane Maria, a Category 4 storm, slammed into the U.S. Commonwealth of 3.4 million people on Sept. 20 with sustained winds of 155 miles an hour, killing nearly 50 residents and leaving 250,000 without homes…..”
  • “….Patients who show up at the Comfort aren’t turned away. But the normal path is through San Juan’s Centro Medico hospital, where doctors evaluate requests for transfer from other hospitals, contact a medical-operation center which in turn dials the ship. Patients are flown to the vessel via helicopter from other hospitals. …”

Image result for USNS Comfort

  • “……officials recently changed the protocol to allow regional hospitals to contact the operation center directly….”
  • “….The DoD…stationed personnel outside of hospitals around the island with satellite phones to relay information about hospitals’ power, water and patient count, in case there was need to evacuate or transfer patients…..”
  • “…..Four U.S. Army crews were recently certified to land on the ship during daytime…”
  • “…..Ryder Memorial Hospital….The Oct. 4 power failure prompted the evacuation of 29 patients by helicopter to San Juan, where five were transferred to the Comfort…..”
  • “….Two days later, the Comfort took in four patients after generators failed at Hospital Menonita in Caguas….”
  • “….As it has moved along Puerto Rico’s north coast, the ship has also supplied hospitals with more than 10 tons of food and water, plus 29,100 liters of oxygen…….”

 


Globally, some 61 million people suffer serious physical and psychological suffering and pain each year. Of this total, some 83 percent live in low- and middle-income countries where access to low-cost, off-patent morphine is rare or completely unavailable.

University of Miami

The Lancet

“…..Impediments to [opiate analgesic] use included an absence of training and awareness in medical professionals, fear of dependence, restricted financial resources, issues in sourcing, cultural attitudes, fear of diversion, international trade controls, and onerous regulation….Use of opioid analgesics has increased, but remains low in Africa, Asia, Central America, the Caribbean, South America, and eastern and southeastern Europe. Identified impediments to use urgently need to be addressed by governments and international agencies…….”

 


NEJM: The View from Puerto Rico — Hurricane Maria and Its Aftermath

NEJM

The View from Puerto Rico — Hurricane Maria and Its Aftermath

Carmen D. Zorrilla, M.D.

DOI: 10.1056/NEJMp1713196

“…..As of 16 days after the hurricane, 25 hospitals were working, only 9.2% of people had power, 54% had water, 45% had cell phone service, and the Federal Emergency Management Agency had distributed 433,000 food packages and 42,000 gallons of water…….”

Puerto Rico Goes Dark

 

Puerto Rico Goes Dark

Late on September 21, 2016, a fire at a power plant substation in southern Puerto Rico triggered a cascade of problems across the island’s aging electrical grid. The event knocked out power to nearly 1.5 million customers.

From space, the effects appeared dramatic. The Visible Infrared Imaging Radiometer Suite (VIIRS) on the Suomi NPP satellite captured these nighttime images of Puerto Rico before and after the outage. The upper image was acquired at 2:50 a.m. local time (06:50 Universal Time) on September 21, 2016; the lower image shows the island at 2:31 a.m. local time (06:31 Universal Time) on September 22, 2016.

Both images were captured by the VIIRS “day-night band,” which detects light in a range of wavelengths from green to near-infrared and uses filtering techniques to observe signals such as gas flares, city lights, and reflected moonlight. Note that the brightness of the ocean surface varies between the images due to slightly different angles of moonlight on the water. Use the slider tool to compare the images.

The widespread loss of electricity appears across Puerto Rico in all areas outside of the San Juan metropolitan area. Ponce, Humacao, Aguadilla, Arecibo, and Mayagüez all had large numbers of customers losing power.

The fire occurred at the Aguirre power plant in Salinas after a power switch overheated. This caused a 2,000-gallon (8,000 liter) mineral oil tank to explode and trigger a fire across a 3-acre (1 hectare) area. According to news reports, the collapse of the power system has caused widespread losses of water and air conditioning, traffic jams, and business and school closures.

“With something of this scale, we’re not just seeing an outage. We are seeing a complete stoppage in the rhythms of daily life,” said Miguel Román, a scientist at NASA Goddard Space Flight Center and member of the Suomi NPP science team.

“These nighttime satellite images help bring a level of situational awareness so we can clearly identify the extent of the impacts into key lifelines of a city’s infrastructure,” added David Green, the program manager for NASA’s Disaster Response Program. “We hope that power, civil, and health authorities can use imagery and data like this to map the extent of affected areas and prioritize their personnel and resources to restore critical infrastructure.”

NASA Earth Observatory image by Jesse Allen, using VIIRS day-night band data from the Suomi National Polar-orbiting Partnership provided by Miguel Roman (NASA/GSFC). Suomi NPP is the result of a partnership between NASA, the National Oceanic and Atmospheric Administration, and the Department of Defense. Caption by Adam Voiland.

Instrument(s):
Suomi NPP – VIIRS

 


World Vision: More than 800,000 children risk death by starvation in East Africa and aid agencies have just weeks – months at most – to save them

Thomson Reuters

  • World Vision – the world’s largest international children’s charity
  • “We’re seeing emaciated children, nearly skeletons, lying in pain in hospital beds … We’re seeing mothers unable to breastfeed because they are malnourished themselves.”
  • “The hunger crisis is wreaking havoc on 24 million people (in East Africa) – more than the population of Berlin, London, Chicago and Bangkok combined.”

 


U.N. High Commissioner for Refugees said after a visit to Cox’s Bazar this week that the most urgent needs were shelter, clean water and sanitation.

Reuters

  • About 480,000 men, women and children have arrived in Cox’s Bazar since the end of August.  Most came with nothing more than the clothes they wore.
  • Nearly 200 of the women have given birth since they arrived and another 20,000 are pregnant.
  • The authorities made 22 decisions to remove logistical hurdles.  These included building 14 storage warehouses, regulating aid distribution, protecting orphans, building roads and power infrastructure, and setting up shelters for more than 500,000 people.
  • 475 tonnes of aid have arrived at Chittagong airport north of Cox’s Bazar
  • U.S. Ambassador to the United Nations Nikki Haley on Thursday called on countries to suspend providing weapons to Myanmar over violence against Rohingya Muslims until the military puts sufficient accountability measures in place.

 


European Commission wants new refugee resettlement scheme, with 50,000 target

European Commission

European Commission – Press release

Brussels, 27 September 2017

State of the Union 2017 – Commission presents next steps towards a stronger, more effective and fairer EU migration and asylum policy

1

On 13 September, in his annual State of the Union address, President Jean-Claude Juncker said: “In spite of the debate and controversy around this topic, we have managed to make solid progress (…) We now need to redouble our efforts. Before the end of the month, the Commission will present a new set of proposals with an emphasis on returns, solidarity with Africa and opening legal pathways.”

The Commission is today reviewing progress on the 2015 European Agenda on Migration and setting out the next steps to put in place the missing elements of a stronger, fairer and more effective EU migration and asylum policy. Building on the progress achieved so far, the Commission is today presenting a series of new initiatives in key areas: a new resettlement scheme for at least 50,000 refugees, pilot projects for legal migration which the Commission can help finance and coordinate, and new measures to make the EU’s return policy more effective. The Commission also calls on Member States to urgently make progress on the reform of the Common European Asylum System and make further efforts to work with countries of origin and transit of migration, in particular by providing additional contributions to the EU Trust Fund for Africa.

First Vice-President Frans Timmermans said: “Our joint efforts to respond to the migration and refugee crisis have led to tangible results, with irregular arrivals significantly down in both the Eastern and the Central Mediterranean. However, we’re not there yet, so we must stay the course and further consolidate our comprehensive migration approach by putting in place the remaining building blocks.”

High Representative/ Vice-President Federica Mogherini said: “Over the last two years, we finally built an EU policy on migration, which is starting to deliver. It is about managing one of the most complex, structural phenomena of our times, not a temporary emergency. Our cooperation with our partners in Africa, but also with the UN, has started to bear fruits by ensuring a better protection of migrants, making traffickers and smugglers’ business less profitable, and offering alternatives and legal avenues. We will keep working on the same track: We’ll only succeed by working in a united and consistent manner.”

Commissioner for Migration, Home Affairs and Citizenship Dimitris Avramopoulos said: “Now is the moment to take the next steps to achieve a fair, robust and realistic EU migration policy. This means continuing to show solidarity with the most affected Member States, but also finding quickly the right compromise on the reform of the Common European Asylum system. It also means improving returns and today we propose to create a true operational EU return hub within the European Border and Coast Guard Agency. And we need to open real alternatives to taking perilous irregular journeys. Investing in more legal pathways, both for protection but also for study or work, is therefore essential. “

The Mid-term review of the European Agenda on Migration shows the positive impact of EU migration management over the past two years on reducing the incentives for irregular migration, strengthening the protection of our external borders, upholding our duty to assist refugees and enhancing legal pathways to Europe. Building on these results, it is now essential to maintain the current efforts, step up the work towards more stable and structural solutions and remain ready to respond to unforeseen situations, as the migratory pressure on Europe remains high. That is why the Commission proposes to take the following next steps:

Continuing to ensure solidarity

With over 29,000 persons relocated so far, the first ever large-scale EU-coordinated relocation mechanism has contributed to significantly reducing the pressure on the asylum systems of Italy and Greece. The immediate priority is now to ensure that all the remaining eligible persons who have arrived to Greece and Italy until September 26 are relocated swiftly. In total, around 37,000 people are expected to be effectively relocated under the scheme.

The migratory pressure on Italy and Greece however continues to remain high, due to the accumulated backlog from the arrivals in 2016 and first half of 2017. The Commission stands ready to provide financial support to Member States who sustain their relocation efforts beyond the current schemes. The assistance provided by EASO and other EU agencies to Italy and Greece should also continue and, when needed, be further reinforced.

At the same time, we cannot continue to rely on ad hoc measures. That is why the Commission calls on the co-legislators to make use of the current window of opportunity and achieve decisive progress on the reform of the Common European Asylum System and especially the Dublin Regulation.

Enhancing legal pathways: at least 50,000 new resettlement places

The Commission is recommending a new EU resettlement scheme to bring at least 50,000 of the most vulnerable persons in need of internatio­nal protection to Europe over the next two years. This is part of the Commission’s efforts to provide viable safe and legal alternatives for those who risk their lives at the hands of criminal smuggling networks. The new scheme will be in place until October 2019 and will build on the current successful resettlement schemes which, having provided new homes to over 23,000 persons in the EU, are now coming to an end.

The Commission has set aside €500 million to support Member States’ resettlement efforts. Whilst resettlement from Turkey and the Middle East must continue, increased focus should be put on resettling vulnerable persons from North Africa and the Horn of Africa; notably Libya, Egypt, Niger, Sudan, Chad and Ethiopia. This will contribute to further stabilising migration flows along the Central Mediterranean route and notably support the UNHCR in establishing an emergency evacuation mechanism from Libya. Today’s recommendation follows up and complements the resettlement pledging exercise launched on 4 July 2017 which has so far resulted in 14,000 pledges by 11 Member States. It will serve to bridge the period until the new permanent EU Resettlement Framework, proposed by the Commission in July 2016, is adopted.

In addition, the Commission encourages Member States to set up private sponsorship schemes allowing private groups or civil society organisations to organise and finance resettlements in accordance with national legislation. To this effect, the Commission has invited EASO to coordinate a pilot project on private sponsorship schemes with interested Member States.

To turn irregular flows into needs-based economic migration to EU Member States, the Commission is proposing to coordinate and financially support pilot projects for legal migration with third countries. They should focus initially on countries which have shown political engagement in finding joint solutions to tackle irregular migration and readmission of irregular migrants. The European Parliament and the Council should also swiftly come to an agreement and adopt the Commission proposal for a revised EU Blue Card which will improve the EU’s ability to attract and re­tain highly skilled workers and ensure that Member States can rely on the work force they need, when they need it.

The EU’s common visa policy is also an essential instrument for mobility, notably facilitating tourism and business, but also a key tool to prevent security risks or risks of irregular migration. The Commission will assess whether the current visa policy still matches present and future challenges, and will reflect on the need to modernise it.

A more effective EU policy on return

With return rates remaining unsatisfactory (around 36% in 2014-2015) and an estimated 1.5 million people to be returned from EU Member States in the near future, the Commission proposes to step up return efforts on all fronts. The Return Department will be significantly reinforced within the European Border and Coast Guard to ensure the Agency can implement a truly proactive return management approach and drive and coordinate the EU-wide management of returns.

Member States need to further streamline their return policies in line with the 2017 Commission Recommendation and the Renewed Action Plan on Returns and in close cooperation with the European Border and Coast Guard Agency. To this effect, the Commission is today publishing a revised Return Handbook that integrates all these recommendations to national authorities on returns. Member States at the external borders can, where appropriate, use the hotspot approach to ensure that return operations can be managed swiftly, in particular in situations of significant arrival surges.

To increase cooperation on readmission by countries of origin, all incentives and leverages available at EU and national level must be applied.

External dimension: Moving forward under the Partnership Framework

Significant results have been achieved in jointly managing migration flows with countries of origin and transit since the establishment of the Partnership Framework for Migration one year ago. While the progress made needs to be sustained, more work is needed on a number of key issues. This includes further strengthening the EU Trust Fund for Africa and in particular its North Africa window through additional Member State funding.

With arrivals and the number of deaths at sea down, the joint work along the Central Mediterranean route needs to be continued. Work which needs to be further stepped up includes improving the situation of stranded migrants in Libya in cooperation with UNHCR and IOM, in particular in detention centres, the promotion of socio-economic opportunities for local communities, stepping up work on assisted voluntary returns and strengthening the capacity of the Libyan authorities to control the southern borders. In addition, work must be continued along other migratory routes, especially in view of the increasing interconnectivity of such routes.

The EU and Member States must also work closely together to achieve an ambitious UN Global Compact for Safe, Orderly and Regular Migration and the development of the Global Compact for Refugees and the Comprehensive Refugee Response Framework with pilot countries.

Background

Upon taking office, European Commission President Jean-Claude Juncker entrusted a Commissioner with special responsibility for Migration, Dimitris Avramopoulos, to work together with the other Commissioners, under the coordination of First Vice-President Frans Timmermans, on a new policy on migration as one of the 10 priorities of the Political Guidelines of the Juncker Commission.

On 13 May 2015, the European Commission proposed a far-reaching strategy, through the European Agenda on Migration, to tackle the immediate challenges of the ongoing crisis, as well as to equip the EU with the tools to better manage migration in the medium and long term, in the areas of irregular migration, borders, asylum and legal migration.

Today’s Communication serves as a mid-term review of what has been achieved so far in delivering the European Agenda on Migration. It also sets out new initiatives from the Commission to address key areas, and identifies where further efforts are needed in the coming months.

For More Information

Communication on the delivery of the European Agenda on Migration

Recommendation on ensuring effective legal pathways to Europe

Recommendation establishing a common Return Handbook

Annex

Factsheet: Towards and efficient and credible EU return policy

Factsheet: Opening legal pathways to Europe

Factsheet: Relocation – sharing responsibility: September 2017

Press release: European Agenda on Migration: Good progress in managing migration flows needs to be sustained

The European Agenda on Migration

 


Thousands of cargo containers bearing millions of emergency meals and other relief supplies have been piling up on San Juan’s docks since Saturday.

Bloomberg

‘…..Distributors for big-box companies and smaller retailers are unloading 4,000 20-foot containers full of necessities like food, water and soap this week at a dock in Puerto Rico’s capital operated by Crowley Maritime Corp. In the past few days, Tote Maritime’s terminal has taken the equivalent of almost 3,000. The two facilities have become choke points in the effort to aid survivors of Hurricane Maria.

“There are plenty of ships and plenty of cargo to come into the island,” said Mark Miller, a spokesman for Crowley, based in Jacksonville, Florida. “From there, that’s where the supply chain breaks down — getting the goods from the port to the people on the island who need them.”……’

 


Adventure of the Seas was scheduled to arrive on Wednesday for humanitarian calls in San Juan, St. Thomas and St. Croix to aid in evacuation and to donate critical supplies. Evacuees on the ship are also scheduled to be ferried to Fort Lauderdale.

Royal Caribbean

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At Cox’s Bazar: Some 150,000 Rohingya children will be immunized over 7 days for measles, rubella and polio.

Washington Post

“…..Refugee camps were already beyond capacity and new arrivals were staying in schools or huddling in makeshift settlements with no toilets along roadsides and in open fields. Police were checking vehicles to prevent the Rohingya from spreading to nearby towns in an attempt to control the situation…..many children are suffering from flu and risk pneumonia……. Many are suffering from diarrhea, dehydration, skin diseases or worse……..”


Bangladeshi Prime Minister demands that Myanmar “take steps to take their nationals back,” and assures temporary aid until that happened.

FOX News

  • “We will not tolerate injustice.”
  • PM lambasted Buddhist-majority Myanmar for “atrocities”
  • PM had “no words to condemn Myanmar”
  • At least 313,000 Rohingya have flooded into Bangladesh since Aug. 25
  • The U.N. human rights chief said the violence and injustice faced by the ethnic Rohingya minority in Myanmar seems a textbook example of ethnic cleansing.”
  • Bangladesh has said it would free 2,000 acres (810 hectares) of land for a new camp in Cox’s Bazar district, to help shelter newly arrived Rohingya. The government was also fingerprinting and registering new arrivals.
  • Kutupalong and another pre-existing Rohingya camps were already beyond capacity.
  • Other new arrivals were staying in schools, or huddling in makeshift settlements with no toilets along roadsides and in open fields.  Basic resources were scarce, including food, clean water and medical aid.
  • Aid agencies have been overwhelmed by the influx of Rohingya, many of whom are arriving hungry and traumatized after walking days through jungles or being packed into rickety wooden boats in search of safety in Bangladesh.
  • In the last two weeks, the government hospital in Cox’s Bazar has been overwhelmed by Rohingya patients, with 80 arriving in the last two weeks suffering gunshot wounds as well as bad infections.
  • At least three Rohingya have been wounded in land mine blasts
  • Dozens have drowned when boats capsized during sea crossings.
  • Before Aug. 25, Bangladesh had already been housing more than 100,000 Rohingya who arrived after bloody anti-Muslim rioting in 2012 or amid earlier persecution drives in Myanmar.

 


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