For Immediate Release ***To view report: http://watchlist.org/about/report/afghanistan/ ***Link to live press conference March 6, 2017, 10:00am EST: http://www.un.org/webcast/ TARGETED ATTACKS ON MEDICAL FACILITIES AND STAFF IN AFGHANISTAN LEAD TO DEATH AND DISEASE AMONG CHILDREN

New Report Calls for Afghan Government Forces to be Cited as Responsible for Attacks for First Time

NEW YORK, March 6, 2017 – Afghan government forces, the Taliban and other parties to the country’s conflict have repeatedly targeted medical facilities and staff, negatively impacting children’s health, Watchlist on Children and Armed Conflict said in a new report today. For the first time, Watchlist called on the UN Secretary General to list the Afghan National Defense and Security Forces (ANDSF) as one of the parties responsible for these attacks. Watchlist’s 27-page report, which focuses on 2015 and 2016, details how parties to the conflict, through more than 240 attacks, have temporarily or permanently closed medical facilities throughout Afghanistan, damaged or destroyed facilities, looted medical supplies, stolen ambulances, and threatened, intimidated, extorted, detained and killed medical personnel. They have restricted and sometimes blocked access to health care and used medical facilities for military purposes, which is in violation of international humanitarian law. While the Taliban and other anti-government groups were responsible for the majority of attacks, the ANDSF carried out at least 35 attacks on medical facilities and personnel between 2015 and 2016. “Targeted attacks on medical facilities have decimated Afghanistan’s fragile health system, preventing many civilians from accessing lifesaving care,” said Christine Monaghan, research officer at Watchlist who traveled to Afghanistan in November 2016 and wrote the report. “Children suffer as a result — we are seeing more deaths, injuries and the spread of disease.”

Attacks on hospitals have compounded challenges to children’s health, already exacerbated by two years of escalating armed conflict, according to the report. In Afghanistan, 4.6 million people, including more than 2.3 million children, are in critical need of health care, according to the World Health Organization (WHO). More than 1 million children suffer from acute malnutrition, an increase of more than 40 percent since the beginning of the reporting period in January 2015, according to WHO. Communicable diseases are also up; WHO reported 169 measles outbreaks in 2015, an increase of 141 percent from 2014. The United Nations Assistance Mission in Afghanistan (UNAMA) furthermore reported that child casualties increased by 24 percent from 2015 to 2016.

Watchlist’s report includes stories from individuals impacted by the damaged health care system. One father discussed how his 15-year-old son lost both feet after stepping on a mine. He could not get proper care in Kunduz City, where the only trauma center had been bombed and many medical professionals had been killed or had fled. He eventually took a taxi to Kabul, more than 200 miles away, where he was told his son needed to get treatment earlier. “Now, both of his legs must get cut off from just below the waist, because the bones are ruined and he has a serious infection,” the father told Watchlist. “For a week he was OK, but then from the infection he went into a coma. Ten days later, he died in the hospital.”

The report calls on all parties to immediately stop attacks on medical facilities and personnel, which are protected during times of conflict under international humanitarian and human rights laws. It calls on the UN Secretary-General to list the ANDSF in its 2017 annual report on children and armed conflict, which is expected to come out before the summer. While previous UN reports included incidents by Afghan forces, the SecretaryGeneral only listed the Taliban in his annual report as responsible for attacks on hospitals. Watchlist also recommends the Afghan government establish an independent and permanent body to investigate these attacks.

About the report “Every Clinic is Now on the Frontline” The Impact on Children of Attacks on Health Care in Afghanistan Watchlist conducted a research trip in Afghanistan in November and December 2016 and interviewed more than 80 people, including humanitarian actors, health workers, health “shura” members, and patients.

Watchlist visited five hospitals and focused its research on four provinces: Helmand, Kunduz, Nangarhar and Maidan Wardak. To read the report: http://watchlist.org/about/report/afghanistan/ About Watchlist on Children and Armed Conflict Watchlist on Children and Armed Conflict is a New York-based global coalition that serves to end violations against children in armed conflict and to guarantee their rights.

For more information: http://watchlist.org/ Press Contacts: Vesna Jaksic Lowe vesnajaksic@gmail.com + 1 917.374.2273 Bonnie Berry bonnie@watchlist.org +1 212.972.0695

WHO

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

Background

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

Overview

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.

VOA

“…..air pollution is the biggest killer and is responsible for 6.5 million premature deaths every year, including nearly 600,000 deaths among children under age five……”

Reuters

CDC

Diphtheria once was a major cause of illness and death among children. The United States recorded 206,000 cases of diphtheria in 1921, resulting in 15,520 deaths. Starting in the 1920s, diphtheria rates dropped quickly due to the widespread use of vaccines. Between 2004 and 2015, 2 cases of diphtheria were recorded in the United States. However, the disease continues to cause illness globally. In 2014, 7,321 cases of diphtheria were reported worldwide to the World Health Organization, but many more cases likely go unreported.

The case-fatality rate for diphtheria has changed very little during the last 50 years. The overall case-fatality rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among persons younger than 5 and older than 40 years of age. Before there was treatment for diphtheria, the disease was fatal in up to half of cases.

Clinical Features

The incubation period of diphtheria is 2–5 days (range: 1–10 days). Diphtheria can involve almost any mucous membrane. For clinical purposes, it is convenient to classify diphtheria into a number of manifestations, depending on the site of disease:

• Respiratory diphtheria
  • Nasal diphtheria
  • Pharyngeal and tonsillar diphtheria
  • Laryngeal diphtheria
• Cutaneous diphtheria

Medical Management

After the provisional clinical diagnosis is made and appropriate cultures are obtained, persons with suspected diphtheria should be given antitoxin and antibiotics in adequate dosage and placed in isolation. Respiratory support and airway maintenance should also be administered as needed.

Diphtheria Antitoxin

In the United States, diphtheria antitoxin can be obtained from CDC on request.

Antibiotics

The recommended antibiotic treatment for diphtheria is erythromycin orally or by injection (40 mg/kg/day; maximum, 2 gm/day) for 14 days, or procaine penicillin G daily, intramuscularly (300,000 units every 12 hours for those weighing 10 kg or less, and 600,000 units every 12 hours for those weighing more than 10 kg) for 14 days. Oral penicillin V 250 mg 4 times daily is given instead of injections to persons who can swallow. The disease is usually not contagious 48 hours after antibiotics are instituted. Elimination of the organism should be documented by two consecutive negative cultures after therapy is completed.

Preventive Measures

For close contacts, especially household contacts, a diphtheria toxoid booster, appropriate for age, should be given. Contacts should also receive antibiotics—a 7- to 10-day course of oral erythromycin (40 mg/kg/day for children and 1 g/day for adults). For compliance reasons, if surveillance of contacts cannot be maintained, they should receive benzathine penicillin (600,000 units for persons younger than 6 years old and 1,200,000 units for those 6 years and older). Identified carriers in the community should also receive antibiotics. Contacts should be closely monitored and antitoxin given at the first sign(s) of illness.

Contacts of cutaneous diphtheria should be treated as described above; however, if the strain is shown to be nontoxigenic, investigation of contacts can be discontinued.

Challenges

Circulation of the bacteria appears to continue in some settings, even in populations with more than 80% childhood immunization rates. An asymptomatic carrier state can exist even among immune individuals.

Immunity wanes over time and a booster dose of vaccine should be administered every 10 years to maintain protective antibody levels. Large populations of older adults may be susceptible to diphtheria, in both developed as well as in developing countries.

In countries with low disease incidence, the diagnosis may not be considered by clinicians and laboratory scientists. Prior antibiotic treatment can prevent recovery of the organism. Because the disease is rarely seen in developed countries, most physicians will never have seen a case of diphtheria in their lifetime. There is limited epidemiologic, clinical, and laboratory expertise on diphtheria.

Surveillance

National surveillance is conducted through the National Notifiable Diseases Surveillance System. Cases are also identified by requests for diphtheria antitoxin (DAT); since 1997, DAT is available for U.S. healthcare professionals only through CDC.

NY Times

“…..In 2016, 3,498 civilians were killed and 7,920 others wounded — an increase of 3 percent over the previous year….”

WHO

Kabul 30 January 2017 – The Ministry of Public Health, WHO and UNICEF launched today the first polio subnational immunization days campaign of 2017. Over 5.6 million children will be vaccinated against polio in all provinces in the southern and south-eastern regions, most districts in the eastern region, as well as selected high-risk districts across the country, including Kabul city.

“The campaign will build on strong progress seen in 2016. Last year Afghanistan had only 13 cases of polio nationwide, down from 20 in 2015. This was made possible through hard work by thousands of frontline health workers and a renewed emphasis on monitoring and oversight,” said Dr Maiwand Ahmadzai, Director of the National Emergency Operations Centre for Polio Eradication at the Ministry of Public Health, speaking at a joint press conference held in Kabul.

This week’s campaign is carried out by over 31 000 trained polio workers and it runs until 3 February when vaccinators revisit children who were missed when the vaccinators first visited. These vaccinators and other polio workers are trusted members of the community and they have been chosen because they care about children.

“We have seen significant progress in our polio eradication efforts over the past year. Most of Afghanistan is now polio-free, the circulation of the poliovirus is restricted to small areas in the eastern, southern and southeastern parts of the country and we have seen huge improvements in vaccination campaign quality,” said Dr Hemant Shukla, director of the polio programme at WHO. “Our focus is now on reaching every single child during every vaccination campaign to stop the transmission of polio.”

“With our collective efforts, we will be able to eradicate polio from the world. Vaccines are the right of every child and no child should be missed during polio campaigns,” said Ms Melissa Corkum, UNICEF Polio director in Afghanistan. “Thousands of frontline workers visit every house in the country during campaigns. That’s not an easy task. Due to the hard work of these dedicated frontline workers, we are closer to polio eradication than ever.”

In 2016, new initiatives have been implemented to strengthen the polio eradication programme in Afghanistan. All polio eradication activities have been brought under one leadership as Emergency Operations Centres have been established at the national and subnational level. The surveillance system has been strengthened and the circulation of wild poliovirus is unlikely to be missed in Afghanistan. The quality of campaigns, routine immunization and rapid response to polio cases have improved tremendously over the past year.

In 2016, 13 polio cases were registered: 7 cases in Paktika, 4 cases in Kunar, one case in Kandahar and one in Helmand province. Afghanistan remains one of 3 polio-endemic countries together with Pakistan and Nigeria.

litchii-encephalopathy_lancet-2017

NY Times

https://www.youtube.com/watch?v=uAubUZ6pdoE

comment-litchi

NY Times

“The worst affected by the cash crunch are the country’s hundreds of millions of farmers, produce vendors, small shop owners and daily-wage laborers who are usually paid in cash at the end of a day’s work.”        

“A sense of desperation and helplessness is emerging……This currency ban is not helpful for poor people.”

https://nyti.ms/2cWw9Uk