Global & Disaster Medicine

Archive for the ‘Documents’ Category

Famine: South Sudan

Famine-SouthSudan_Lancet-2017: Document (   Vol 389   May 20, 2017)

“South Sudan, together with Yemen, Somalia, and Nigeria pose what the UN calls the biggest humanitarian crisis since 1945 as millions flee conflict and drought…”


NYC’s Unified Victim Identification System (UVIS)


Unified Victim Identification System (UVIS) document:  UVIS Information Guide-NYC

“…..In concert with the City’s 311-call center, UVIS enables a centralized communications and data collection processes to support the family assistance center (FAC). This coordinated system is essential to developing an accurate manifest of potential victims – a critical step in victim identification. Most importantly, the coordinated UVIS-311 call center system keeps the lines of communication open to the families, friends and associates of possible victims.  Such a resource is invaluable in the chaos that follows any tragic event…..

UVIS is designed to handle multiple types of scenarios, and can manage up to 156 simultaneous events if needed.  For example a terrorist operation may target different discrete areas of a large city (multiple incidents), as was the case on July 7th 2005 when a series of coordinated bomb blasts hit London’s public transport system during the morning rush hour resulting in more that 121,000 call center reports.

Most importantly, UVIS enables the OCME to meet its primary objectives following a catastrophic incident.  They include:

• Investigate, Recover & Process Decedents in a Dignified and Respectful Manner

• Accurately Determine Cause & Manner of Death

• Perform Accurate & Efficient Identification of Victims

• Provide Families with Factual & Timely Information in a Compassionate Manner

• Conduct Rapid Return of Victims to their Legal Next of Kin ……..”

Helping hands across a war-torn border: the Israeli medical effort treating casualties of the Syrian Civil War


TreatingSyrianWarCasualties: Published article in Lancet

Tourism vs. Child Protection: A Compilation of Good Practices

15 Years of the UNWTO World Tourism Network on Child Protection: A Compilation of Good Practices

Copyright © 2014, World Tourism Organization (UNWTO)
15 Years of the UNWTO World Tourism Network on Child Protection: A Compilation of Good Practices
Published by the World Tourism Organization (UNWTO) First printing: February 2014 All rights reserved.


4th case of Yellow Fever reported in Europeans who had recently traveled to South America in the past 8 months.

Yellow Fever in Europe

A travel-associated case of yellow fever has been reported by the Netherlands in March 2017 after travel to Suriname. During the past eight months, four travel-associated cases of yellow fever have been identified among EU travellers returning from South America. This represents a significant increase on four travel-associated cases of yellow fever among EU travellers during the last 27 years (1999 to July 2016).

Brazil has been experiencing a yellow fever outbreak since January 2017 and travel recommendations have been updated accordingly [1,2]. Therefore, EU travellers travelling to areas at risk of yellow fever in South America should be informed of the potential exposure to yellow fever virus and an individual risk benefit analysis should be conducted during pre-travel medical consultation. The ongoing yellow fever outbreak in Brazil should be carefully monitored, as the establishment of an urban cycle of yellow fever would have the potential to rapidly affect a significant number of people. The risk of introduction and further transmission of the yellow fever virus in the EU is currently considered very low.

Advice to travellers EU citizens who travel to, or live in areas where there is evidence of periodic or persistent yellow fever virus transmission, especially those in outbreak-affected regions, are advised to:

• Be aware of the risk of yellow fever in endemic areas throughout South America, including recently affected States in Brazil. WHO publishes a list of countries, territories and areas with yellow fever vaccination requirements and recommendations [1-3].

• Check vaccination status and get vaccinated if necessary. Vaccination against yellow fever is recommended from nine months of age for people visiting or living in yellow fever risk areas. An individual risk benefit analysis should be conducted prior to vaccination, taking into account the period, destination, duration of travel and the likelihood of exposure to mosquitoes (e.g. rural areas, forests) as  well as individual risk factors for adverse events following yellow fever vaccination.

• Take measures to prevent mosquito bites indoors and outdoors, especially between sunrise and sunset when Aedes and sylvatic yellow fever mosquito vectors are most active [4]. These measures include: − the use of mosquito repellent in accordance with the instructions indicated on the product label; − wearing long-sleeved shirts and long trousers; − sleeping or resting in screened/air-conditioned rooms, or using mosquito nets at night and during the day.

Advice to health professionals: Physicians, health professionals and travel health clinics should be provided with or have access to regularly updated information about areas with ongoing yellow fever transmission and should consider yellow fever in the differential diagnoses for illnesses in relation to travellers returning from affected areas.  To reduce the risk of adverse events following immunisation, healthcare practitioners should be aware of contraindications and comply with the manufacturers’ precautionary advice before administering yellow fever vaccine [5].

	Map: South America showing areas at risk for Yellow Fever Transmision in Columbia, Venezuela, Guyana, Suriname, French Guiana, Brazil, Paraguay, and parts of Ecuador, Peru, Bolivia, Argentina, and Uruguay

WHO: Don’t pollute my future! The impact of the environment on children’s health


Don’t pollute my future! The impact of the environment on children’s health

Cover: Don’t pollute my future! The impact of the environment on children’s health


In 2015, 5.9 million children under age five died. The major causes of child deaths globally are pneumonia, prematurity, intrapartum-related complications, neonatal sepsis, congenital anomalies, diarrhoea, injuries and malaria. Most of these diseases and conditions are at least partially caused by the environment. It was estimated in 2012 that 26% of childhood deaths and 25% of the total disease burden in children under five could be prevented through the reduction of environmental risks such as air pollution, unsafe water, sanitation and inadequate hygiene or chemicals.

Children are especially vulnerable to environmental threats due to their developing organs and immune systems, smaller bodies and airways. Harmful exposures can start as early as in utero. Furthermore, breastfeeding can be an important source of exposure to certain chemicals in infants; this should, however, not discourage breastfeeding which carries numerous positive health and developmental effects (4). Proportionate to their size, children ingest more food, drink more water and breathe more air than adults. Additionally, certain modes of behaviour, such as putting hands and objects into the mouth and playing outdoors can increase children’s exposure to environmental contaminants.


WHO: Inheriting a sustainable world: Atlas on children’s health and the environment



More than a decade after WHO published Inheriting the world: The atlas of children’s health and the environment in 2004, this new publication presents the continuing and emerging challenges to children’s environmental health.

This new edition is not simply an update but a more detailed review; we take into account changes in the major environmental hazards to children’s health over the last 13 years, due to increasing urbanization, industrialization, globalization and climate change, as well as efforts in the health sector to reduce children’s environmental exposures. Inheriting a sustainable world? Atlas on children’s health and the environment aligns with the Global Strategy for Women’s, Children’s and Adolescents’ Health, launched in 2015, in stressing that every child deserves the opportunity to thrive, in safe and healthy settings.

This book seeks to promote the importance of creating sustainable environments and reducing the exposure of children to modifiable environmental hazards. The wide scope of the SDGs offers a framework within which to work and improve the lives of all children. To this end, we encourage further data collection and tracking of progress on the SDGs, to show the current range of global environmental hazards to children’s health and identify necessary action to ensure that no one is left behind.

Report of the Independent International Commission of Inquiry on the Syrian Arab Republic

Report of the Independent International Commission of Inquiry on the Syrian Arab Republic

The Independent International Commission of Inquiry on the Syrian Arab Republic was established on 22 August 2011 by the Human Rights Council through resolution S-17/1 adopted at its 17th special session with a mandate to investigate all alleged violations of international human rights law since March 2011 in the Syrian Arab Republic.

The Commission was also tasked to establish the facts and circumstances that may amount to such violations and of the crimes perpetrated and, where possible, to identify those responsible with a view of ensuring that perpetrators of violations, including those that may constitute crimes against humanity, are held accountable.


Aleppo aerial campaign deliberately targeted hospitals and humanitarian convoy amounting to war crimes, while armed groups’ indiscriminate shelling terrorised civilians – UN Commission

Independent International Commission of Inquiry on the Syrian Arab Republic


GENEVA (1 March 2017) – The brutal tactics used by the parties to the conflict in Syria as they engaged in the decisive battle for Aleppo city between July and December 2016 resulted in unparalleled suffering for  Syrian men, women and children and amount to war crimes, according to a UN report released today.

In their report based on 291 interviews, including with residents of Aleppo city, and the review of satellite imagery, photographs, videos and medical records, the Independent International Commission of Inquiry on the Syrian Arab Republic documents daily Syrian and Russian airstrikes against eastern Aleppo over several months which steadily destroyed vital civilian infrastructure resulting in disastrous consequences for the civilian population.

By using brutal siege tactics reminiscent of medieval warfare to force surrender, Government forces and their allies prevented the civilian population of eastern Aleppo city from accessing food and basic supplies while relentless airstrikes pounded the city for months, deliberately targeting hospitals and clinics, killing and maiming civilians, and reducing eastern Aleppo to rubble, the report states.

By late November 2016 when pro-Government forces on the ground took control over eastern Aleppo, no functioning hospitals or other medical facilities remained. The intentional targeting of these medical facilities amounts to war crimes, the Commission concludes.

In the report, mandated by the Human Rights Council at its 25th special session in October 2016, the three-person Commission also notes how armed groups indiscriminately shelled civilian-inhabited areas of western Aleppo city with improvised weapons, causing many civilian casualties. A number of these attacks were carried out without a clear military target and had no other purpose than to terrorise the civilian population.

“The violence in Aleppo documented in our report should focus the international community on the continued, cynical disregard for the laws of war by the warring parties in Syria. The deliberate targeting of civilians has resulted in the immense loss of human life, including hundreds of children”, said Commission Chair Paulo Pinheiro.

In one of the most horrific attacks investigated by the Commission, Syrian Air Force deliberately targeted a United Nations/Syrian Arab Red Crescent humanitarian convoy in Orum al-Kubra, Aleppo countryside. The attack killed 14 aid workers, destroyed 17 trucks carrying aid supplies, and led to the suspension of all humanitarian aid in the Syrian Arab Republic, further aggravating the unspeakable suffering of Syrian civilians.

“Under no circumstances can humanitarian aid workers be targeted. A deliberate attack against them such as the one that took place in Orum al-Kubra amounts to war crimes and those responsible must be held accountable for their actions”, said Commissioner Carla del Ponte.

The repeated bombardments, which also destroyed schools, orphanages, markets, and residential homes, effectively made civilian life impossible and precipitated surrender. The report further stresses that Syrian aircraft used chlorine – a chemical agent prohibited under international law – against the civilian population of eastern Aleppo, causing significant physical and psychological harm to hundreds of civilians.

As it became clear that eastern Aleppo would be taken by pro-Government forces, all parties continued to commit brutal and widespread violations, the report states. In some districts, armed groups shot at civilians to prevent them from leaving, effectively using them as human shields. Pro-government forces on the ground, composed mostly of Syrian and foreign militias, executed hors de combat fighters and perceived opposition supporters, including family members of fighters. Others were arrested and their whereabouts remain unknown.

The report also notes that the eastern Aleppo evacuation agreement forced thousands of civilians – despite a lack of military necessity or deference to the choice of affected individuals – to move to Government-controlled western Aleppo whilst others were taken to Idlib where they are once more living under bombardments. In line with the precedents of Moadamyia and Darayya, this agreement confirms the regrettable trend whereby parties to the conflict in Syria use civilian populations as bargaining chips for political purposes.

“Some of these agreements amount to forced displacement. It is imperative that the parties refrain from similar future agreements and provide the conditions for the safe return of those who wish to go back to their homes in eastern Aleppo”, said Commissioner Karen AbuZayd.

The Independent International Commission of Inquiry on the Syrian Arab Republic, which comprises Mr. Paulo Sérgio Pinheiro (Chair), Ms. Carla Del Ponte, and Ms. Karen Koning AbuZayd has been mandated by the United Nations Human Rights Council to investigate and record all violations of international law since March 2011 in the Syrian Arab Republic.

The full report and supporting documentation can be found on the Human Rights Council web page dedicated to the Independent International Commission of Inquiry on the Syrian Arab Republic:

The report is scheduled to be presented on 14 March during an interactive dialogue at the 34th session of the Human Rights Council.

– See more at:


Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014


NY Times


SOFA Score: What it is and How to Use it in Triage


“….Though SOFA was developed for sepsis research and has been validated in additional settings, there is concern that it does not accurately predict mortality when used for patients with isolated respiratory failure as demonstrated during the 2009 H1N1 pandemic. …”


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