MSF scales up patient care activities in DRC amid growing tensions and decreased access

Source: Médecins Sans Frontières
Country: Democratic Republic of the Congo

Reaching communities has become even more difficult as tension after the postponement of elections in Beni and Butembo increased the distance between the people and EVD response.
Almost six months after the declaration of the Ebola epidemic in north-eastern DRC, response teams on the ground, including Médecins Sans Frontières (MSF), are still struggling to gain control of the outbreak. So far, 619 people have been infected with the virus and 361 of them have died in what is the second-largest Ebola outbreak on record since the virus was discovered in this country in 1976.

As the number of new confirmed Ebola cases keeps growing, a heightened climate of unrest linked to the presidential elections has further restricted the population’s access health care in and around the city of Beni, where several health centres were damaged during protests. This is making the prompt identification of new Ebola cases more challenging, as remaining health centres become overloaded.

“In this situation people might have no other choice than to seek medical help in health facilities that do not have adequate triage or infection prevention and control measures in place, which makes the risk of contamination higher,” says Laurence Sailly, MSF emergency coordinator in Beni. “We are talking about a population that has endured many years of conflict. On top of that, they are now faced with the deadliest Ebola outbreak the country has ever seen. The unrest of these past weeks adds even more to their plight by limiting their chances of finding adequate medical care.”

Since the outbreak was declared on 1 August, MSF has been steadily scaling up patient care activities to tackle the increasing number of confirmed Ebola cases, most recently in the Butembo, Katwa and Komanda health zones. This includes the expansion of the Ebola treatment centre (ETC) in Butembo from 64 to 96 beds, the opening of a new ETC in Katwa – east of Butembo – and the opening of a transit centre in Bwana Sura in Komanda, Ituri province, where new hotspots have been identified.

“With more and more cases coming from the city of Butembo, which has a population of almost a million people, it was necessary to set up a second treatment centre very rapidly,” says Emmanuel Massart, MSF project coordinator in Katwa. “We are also addressing the need to gain the trust of the affected communities. We designed the Katwa treatment centre with the aim of offering greater capacity for patient care. Large windows allow our patients to see the faces of the doctors and nurses treating them and make family visits easier, reestablishing some of the human contact that is so hard to maintain in Ebola treatment centers”.

Raising awareness among communities about measures to control the spread of Ebola remains one of the main challenges of the outbreak response and has become largely the responsibility of those actors of the intervention. Reaching communities has become even more difficult as the tension that followed the postponement of the elections in Beni and Butembo increased the distance between the population and Ebola response activities. People are now even more reluctant to accept infection prevention and control practices such as safe and dignified burials or the decontamination of health centres and households.

“With Ebola, treatment centers alone are not enough. Connecting with the communities and building mutual trust is key to get the outbreak under control”, says Roberto Wright, MSF anthropologist is Katwa. “We need to increase our efforts to engage the population as active participants in the fight against the outbreak. This includes listening to their broader needs. For instance, at the end of December, we distributed trauma kits to local health centres to help their response to potential outbursts of violence. Likewise our transit centres are not only there to identify Ebola patients and refer them for treatment, but also to ensure adequate care for other health issues, which is a clear need for this population. Visiting communities to present our activities before we actually launch them can go a long way in terms of improving mutual understanding and facilitating better collaboration in the long run.”

MSF teams have been responding to the Ebola epidemic in North Kivu and neighbouring Ituri province since it was declared on 1 August 2018. MSF is running Ebola treatment centres in the towns of Butembo and Katwa, transit centres in Beni and Bwana Sura (Komanda health zone), and an isolation centre in Bunia. MSF also helped with the vaccination of frontline health workers and it carries out infection prevention and control activities and awareness-raising activities among health workers and affected communities.

MSF maintains complete independence from all political, religious or military powers and observes impartiality in its actions, based on an assessment of medical needs. The independence of the association is ensured by funding, 96% of which comes from private donors.


The invisible burden of antibiotic resistance in Mosul

Source: Médecins Sans Frontières
Country: Iraq

Almost 40 per cent of patients admitted to MSF’s post-operative care facility in East Mosul arrive with multidrug-resistant infections, and antibiotic resistance is a problem throughout the country.
Saad[1] sits in his bed and stares at the window, enjoying for a moment the pale light that filters through. He is alone in his isolation room, the doctors having just finished their daily medical consultation. They told him that he would be having surgery again soon – his fourth surgical intervention since the accident.

Saad, aged 46, is from Mosul; his family has lived there for generations. But the life he knew changed dramatically when a bomb went off in his neighbourhood, just as Saad was walking towards his car to go to work. “It was an incredibly hot, overcast morning, like lots of days,” he remembers. “But suddenly an explosion knocked me over and I fell unconscious.”

The blast was not close enough to kill Saad, but his leg was badly injured, fracturing his tibia and fibula. Saad was taken to hospital for surgery. “The first surgery I had consisted of inserting an internal fixation into my leg to enable me to walk again,” he says. “But the recovery was excruciating and there were complications.”

When MSF opened a post-operative care facility in East Mosul in April 2018 for people injured by violent or accidental trauma, Saad was admitted there. A biopsy showed that his internal fixation needed to be removed and replaced by an external one, and that he had developed a multidrug-resistant infection.

Multidrug-resistant infections: a major public health challenge

Saad’s case is not an isolated one. Almost 40 per cent of patients admitted to MSF’s post-operative care facility in East Mosul arrive with multidrug-resistant infections, and antibiotic resistance is a problem throughout the country[2]. While the incidence of antibiotic resistance is particularly high in Iraq and across the Middle East, it also occurs in many other countries around the world where MSF works.

Antibiotic resistance is not new, but it urgently needs to be addressed to prevent it becoming one of this century’s major public health challenges.

When a person has a bacterial infection, they are generally treated with antibiotics – the only available drugs that are effective against bacteria. But the bacteria can adapt to the drugs to ensure their survival.

This ability to adapt and survive is called antibiotic resistance and can be caused by the overuse or misuse of antibiotics. In many low and middle-income countries, antibiotics are frequently available over-the-counter, rather than solely on prescription by a doctor, so their overuse and misuse is a common problem.

In the long run, antibiotic resistance has a tremendous impact on people’s health. If antibiotics lose their effectiveness, essential medical procedures can become too risky to carry out. Antibiotic resistance also complicates the recovery of patients injured by violent or accidental trauma, such as the ones that MSF treats in East Mosul.

Tackling antibiotic resistance in East Mosul

When its post-operative care facility opened last year, MSF put in place antibiotic stewardship and infection prevention and control measures to limit the impact of drug-resistant infections.

“It’s crucial to avoid the transmission of multidrug-resistant infections between patients in the facility,” says An Caluwaerts, MSF’s advisor on infection prevention and control. These measures can be as simple as making sure that people wash their hands properly.

“Hand hygiene in healthcare facilities is one of the most important infection prevention and control measures to prevent this transmission,” says Caluwaerts. “Undertaken at the right time, hand hygiene can prevent the spread of resistant or sensitive organisms present in our environment and in our body.”

‘Contact precautions’ are also fundamental: patients with multidrug-resistant infections are given single rooms, rather than staying in open-plan wards, to avoid the spread of infection to other patients and medical staff.

Contact precautions also include the use of personal protective equipment, such as gloves and gowns; limiting the transport and movement of patients; using dedicated patient-care equipment; and making sure that patients’ rooms are thoroughly cleaned and disinfected regularly.

The importance of mental healthcare and health promotion services

Because of their physical isolation within the hospital, patients with drug-resistant infections are more likely to experience psychological difficulties related to what they have experienced and the challenges of their treatment.

“People who are in ‘contact isolation’ experience higher levels of anxiety, depression and anger than other patients,” says Olivera Novakovic, a psychologist in MSF’s East Mosul project. “Many of our patients experienced traumatic events, and they have more time to think about it when they are in isolation rooms.”

MSF mental health staff are on hand to help them cope. “We’re developing individual psychological programmes according to the age and the level of education of our patients,” says Novakovic. “Psycho-education is a crucial phase, because if the patient understands why he’s in contact isolation and what drug resistance is, naturally he will become more compliant with the treatment.”

At the same time, MSF’s health promoters raise awareness about multidrug-resistant infections among patients and caretakers. “Antibiotic resistance represents a severe threat to public health and it shouldn’t be underestimated,” says health promoter Karam Yaseen, bringing to an end an awareness session in the hospital.

Data suggests that antibiotic resistance rates in Middle Eastern countries, including Iraq, are alarmingly high[3]. We recommend that all medical and paramedical professionals avoid the unnecessary use of antibiotics. We also strongly recommend that the Iraqi Ministry of Health take all necessary measures to make the population of Iraq aware of the severe impact on their health of the misuse or overuse of antibiotics.

MSF has been working in and around Mosul since 2017 to provide lifesaving services for people caught up in the violence. Throughout 2017 and 2018, MSF ran a number of trauma stabilisation posts in East and West Mosul and worked in four hospitals, providing a range of services including emergency and intensive care, surgery and maternal healthcare. In April 2018, MSF opened a comprehensive post-operative care facility in East Mosul for people injured by violent or accidental trauma.

With more than 1,500 staff, MSF in Iraq delivers primary and secondary healthcare, services for expectant and new mothers, treatment for chronic diseases, surgery and rehabilitation for war-wounded, mental health support and health education activities. MSF currently works in the governorates of Erbil, Diyala, Ninewa, Kirkuk, Anbar and Baghdad.

[1] The name of the patient has been changed to protect his identity.

[2] 40 per cent of patients among the total patients admitted in the period (April-mid November 2018) had a microbiologically confirmed infection. Among those 40 per cent, over 90 per cent had an multi-drug resistant infection. 60% of the admitted patients did not have a confirmed infection (either did not have any clinical signs of infection or they had some signs compatible with infection but this was not confirmed).

[3] https://www.reactgroup.org/uploads/news/2014-MSF-Conference-on-ABR-in-the-Middle-East.pdf


Displaced people at Niger-Mali border fear being attacked at any time - MSF

Source: Médecins Sans Frontières
Country: Mali, Niger

These people were forced to leave their homes, their fields and often their animals to escape the violence orchestrated by armed groups and other opportunists. Basic services are closed.
After increased insecurity in the Tillabéry region of Niger caused large numbers of people to flee their homes, MSF carried out an emergency response in early January 2019.

MSF deputy head of mission Boulama Elhadji Gori describes the situation.

Why did MSF carry out an emergency response in the rural area of Dessa in the Tillabéry region last week?

A state of emergency was declared recently in the department of Tillabéry, in the region of the same name. Like many other departments in the region, Tillabéry faces many security challenges.

The people living in this border area between Mali and Niger find themselves trapped in violence that comes from two directions: on one side, the community conflict; on the other, the activities of non-state armed groups.

After receiving information about people being displaced in the region, an MSF team visited the immediate area, where they saw first-hand the precarious situation in which the displaced people were living.

We are talking about a total of 1,287 people at three sites within a five-kilometre radius. These people were already vulnerable, having been displaced several times already.

What were people’s main needs?

These people had been forced to leave their homes, their fields and often their animals in order to escape the violence orchestrated by armed groups and other opportunists. Because of the hostilities in the area, basic services such as schools and health centres have been closed.

The displaced people lack shelter, food, healthcare and protection. They are also drinking untreated river water, which brings the risk of various diseases.

Given the urgency of their needs, and in the absence of other humanitarian organisations, the MSF team decided to launch a response.

What did MSF’s response involve?

Our medical team conducted 170 medical consultations, mainly for respiratory infections, malaria, dermatitis and severe malnutrition, as well as 20 antenatal consultations.

We also assessed the nutritional status of children and vaccinated nearly 130 children against measles. Five mental health promotion sessions were organised for approximately 160 people.

Several patients were referred to the health centre for follow-up care, which MSF was also involved in. Our team distributed essential relief items to 220 families, including blankets, cooking utensils, washing kits, mosquito nets and jerry cans.

To make sure that people have safe drinking water, the teams distributed 4,000 water purification tablets, and ran sessions on how to use them.

Who are the displaced people?

“Most of the people who fled the violence are women, children and the elderly, of different ethnicities, living in the border area between Mali and Niger. There are also a number of young people who reject violence and want to settle in places that are considered more secure.

The displaced include refugees from Mali and internally displaced people from Niger.

The majority of the displaced people live in fear of being attacked at any time, because of what they have already experienced – their villages being attacked, assassinations, their markets burned down, their animals stolen, and living with the threat of death.

Other than this emergency response, what is MSF doing in Tillabéry region?

MSF has been working in Niger’s Bani-Bangou department, near the border with Mali, since November 2018. Long before the state of emergency was declared, schools, health centres and other social infrastructure were not functioning because of the violence.

MSF is working in the area to ensure access to free quality medical care for displaced people and local communities. We support two health centres and five health posts.

We are also monitoring the situation in other areas which could potentially receive newly displaced people, or where there are needs not covered by other organisations, particularly in the area around Innates. MSF also supports medical services, from health posts to hospitals, in Bani-Bangou and Ouallam.

Our teams work in collaboration with the Ministry of Health. In December 2018, we treated 4,599 people, provided 452 antenatal consultations and assisted 22 births. In addition, 588 children under the age of two received routine immunisations, and 34 women of childbearing age were vaccinated against tetanus. We also referred to hospital seven patients in need of emergency treatment.

What are people’s main needs in this region? And what are the challenges of assisting them?

People in this region need food, essential relief items, physical and mental healthcare, clean water, good sanitation and hygiene, and protection.

The main challenge we face is the climate of insecurity in the region, which can make it difficult to reach the people who need assistance.


Nearly 36 million children in Ethiopia lack access to basic social services

Source: Government of Ethiopia, UN Children's Fund
Country: Ethiopia

Rates of child poverty range from 18% in Addis Ababa to 91% in Afar, Amhara, and SNNPR. Poverty rates are equally high in Oromia and Somali (90% each) and Benishangul-Gumuz (89%).
Nearly 36 million children in Ethiopia are poor and lack access to basic social services, a new report reveals

An estimated 36 million of a total population of 41 million children under the age of 18 in Ethiopia are multi-dimensionally poor, meaning they are deprived of basic goods and services in at least three dimensions, says a new report released today by the Central Statistical Agency and UNICEF.

Titled “Multi-dimensional Child Deprivation in Ethiopia - First National Estimates,” the report studied child poverty in nine dimensions – development/stunting, nutrition, health, water, sanitation, and housing. Other dimensions included education, health related knowledge, and information and participation.

”We need to frequently measure the rates of child poverty as part of the general poverty measures and use different approaches for measuring poverty. This requires all stakeholders from government, international development partners and academic institutions to work together to measure, design policies and programmes to reduce child poverty in Ethiopia,’’ said Mr Biratu Yigezu, Director General of Central Statistical Agency.

The report adapted the global Multi-Dimensional Overlapping Deprivation Analysis (MODA) methodology and used information available from national data sets such as the Ethiopian Demographic and Health Surveys of 2011 and 2016. MODA has been widely used by 32 countries in Africa to analyze child well-being. The methodology defines multi-dimensional child poverty as non-fulfilment of basic rights contained in the UN Convention on the Rights of the Child and concludes that a child is poor if he or she is deprived in three to six age-specific dimensions. The report’s findings have been validated through an extensive consultative process involving the Ministry of Women, Children and Youth, National Planning Commission, the Ministry of Labour and Social Affairs together with the Economic Policy Research Institute, among others.

The study finds that 88 per cent of children in Ethiopia under the age of 18 (36 million) lack access to basic services in at least three basic dimensions of the nine studied, with lack of access to housing and sanitation being the most acute. The study reveals that there are large geographical inequalities: 94 per cent children in rural areas are multi-dimensionally deprived compared to 42 per cent of children in urban areas. Across Ethiopia’s regions, rates of child poverty range from 18 per cent in Addis Ababa to 91 per cent in Afar, Amhara, and SNNPR. Poverty rates are equally high in Oromia and Somali (90 per cent each) and Benishangul-Gumuz (89 per cent).

Additional key findings from the report indicate:

  • High disparities across areas and regions of residence in terms of average number deprivations in basic rights or services. For example, the differences in deprivation intensity (average number of deprivations in basic rights and services that each child is experiencing) between rural and urban areas are significant; multi-dimensionally deprived children residing in rural areas experienced 4.5 deprivations in accessing basic rights and needs on average compared to 3.2 among their peers in urban areas;
  • Given their large population sizes, Oromia, Amhara, and SNNPR regions are the largest contributors to multi-dimensional child deprivation in Ethiopia. These three regions jointly account for 34 of the 36 million deprived children in Ethiopia, with Oromia having the highest number at 16.7 million, SNNPR at 8.8 million, and Amhara at 8.5 million. Regions with the lowest number of poor children are Harar at 90,000, Dire Dawa at 156,000, and Gambella at 170,000.
  • Although there has been progress in reducing child deprivation, much more remains to be done. The percentage of children deprived in three to six dimensions decreased from 90 per cent to 88 per cent between 2011 and 2016 and the average number of deprivations that each child is experiencing decreased from 4.7 to 4.5 dimensions during the same period.
  • Most children in Ethiopia face multiple and overlapping deprivations. Ninety-five per cent of children in Ethiopia are deprived of two to six basic needs and services, while only one per cent have access to all services. Deprivation overlaps between dimensions are very high in rural areas and among children in the poorest wealth quintiles.

The report makes the following recommendations:

  1. Speed up investments to reduce child poverty by four per cent each year for the next decade if Ethiopia is to achieve the Sustainable Development Goal on poverty reduction;
  2. Accelerate investments in social sectors prioritizing child-sensitive budgeting at the national and regional levels to enhance equality and equity; and
  3. Improve collaboration among different social sectors to ensure that the multiple needs of children are met.

Media Contacts

Esayas Muleta
Central Statistical Agency
Tel: +251 911 733295
Email: esayasmuleta@gmail.com

Wossen Mulatu
Communication Officer
UNICEF Ethiopia
Tel: +251 115 184028
Email: wmulatu@unicef.org


Nigeria: Thousands fleeing Rann attack seek refuge in Cameroon

Source: Médecins Sans Frontières
Country: Cameroon, Nigeria

Following a violent attack on the town on 14 January, MSF estimates that some 8,000 people arrived yesterday to Bodo and is preparing to assist 15,000 people with food, water and medical care over the coming days.
Several thousand people have fled Rann in northeast Nigeria following a violent attack on the town on 14 January. Yesterday, they started arriving by foot in Bodo, Cameroon, some seven kilometres across the border from Rann. Médecins Sans Frontières (MSF) staff have started providing assistance in Bodo. A team consisting of medical and logistical staff have been distributing food and water, and are providing emergency medical care.

People left in a state of shock – and with nothing

“Our team in Bodo estimates that some 8,000 people arrived yesterday and we expect several thousand more may come today,” said Hugues Robert, MSF Programme Manager for Nigeria. “We are preparing to assist 15,000 people with food, water and medical care over the coming days. Many people were in a state of shock and were clearly distressed by what they had witnessed. Now they have lost all that they have and need absolutely everything.”

Near Bodo, people have spent one night outdoors as there are no shelters. There are children and many breastfeeding and pregnant women among them.

Rann destroyed – once again

In Rann, many parts of the town were burnt, including houses and shelters. The market and food stores were also destroyed. The MSF warehouse, office and pharmacy were looted and burnt to the ground. Empty boxes of medical supplies were lying scattered on the ground outside.

MSF was able to evacuate one injured man on site, but most others fled to nearby Cameroon.

“This is truly devastating for the people in Rann”, says Robert, “They suffer endless violence. And now they have to get back on their feet once more. How many more times is this possible? The people of Borno continue to pay the price for this merciless conflict. All the warring parties must respect the safety of civilians.”


UNICEF and partners providing urgent support to protect 40,000 children at risk due to latest winter storms in Lebanon

Source: UN Children's Fund
Country: Lebanon, Syrian Arab Republic

UNICEF pre-positioned response includes distribution of winter cash assistance, water and sanitation interventions, distribution of more than 7,000 blankets and 5,500 winter clothes.
BEIRUT, 16 January 2019 – Devastation generated by the latest storms across Lebanon have left vulnerable children relocated and in need of protection and warmth, with refugee children especially affected. UNICEF, working with partners, and in close coordination with UNHCR, other UN agencies and the government of Lebanon, started immediate response last week to meet the needs of the affected children and their families. UNICEF pre-positioned response includes distribution of winter cash assistance, water and sanitation interventions such as water pumping and dislodging, distribution of more than 7,000 blankets and 5,500 winter clothes for children, 1,500 family hygiene and dignity kits.
Strong winds, snow and torrential rains battered more than 570 sites all over the country, including floods in more than 11 informal settlements. According to the inter-agency report, more than 11,300 people, over half of them girls and boys, have been affected by the storm.
UNICEF is particularly concerned about children and families who were already displaced and living in precarious conditions before the severe weather struck. In the Bekaa valley alone, at least 847 Syrian refugees had to relocate due to floods or severe damages to their shelters. In the North, over 700 relocations are reported so far.
“The sad reality is these children have now been hit by double humanitarian crises,” said Violet Speek Warnery, UNICEF Deputy Representative to Lebanon. “We assisted more than 6,000 refugee children in urgent need of assistance across Lebanon following the severe weather over the past 10 days and we are working closely with our NGO partners to protect children as best as we can and keep them warm and dry”.
UNICEF, workign with with partners on the ground, continue to respond to the increasing needs of children and their families. To date, UNICEF was able to dewater and dislodge more than 60 affected sites and distribute life-saving supplies in the Bekaa, North, Beirut and Mount Lebanon and the South areas. UNICEF’s partners on the ground are also monitoring health, nutrition and sanitation needs to prevent an outbreak of diseases.

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About UNICEF
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EU increases aid budget to record €1.6 billion in 2019

Source: European Commission
Country: Afghanistan, Bangladesh, Central African Republic, Colombia, Democratic Republic of the Congo, Myanmar, South Sudan, Syrian Arab Republic, Ukraine, Venezuela (Bolivarian Republic of), World, Yemen

"With this new budget, the EU remains a leading humanitarian donor in the face of crises such as Syria and Yemen. Humanitarian aid alone cannot solve all problems but we must do everything in our power to help the most vulnerable."
Brussels, 16 January 2019

As more and more people face humanitarian crises worldwide, the EU has adopted its highest ever initial annual humanitarian budget of €1.6 billion for 2019.

From long-lasting conflicts in the Middle East and Africa, to the growing impact of climate change worldwide, humanitarian crises are worsening and conflict threatens aid delivery to those most in need.

"With this new budget, the EU remains a leading humanitarian donor in the face of crises such as Syria and Yemen. Humanitarian aid alone cannot solve all problems but we must do everything in our power to help the most vulnerable. This is our humanitarian duty. We must also think about the impact of these many crises on children, on the next generation. That's why a record 10% of the new budget, 10 times more than in 2015, is dedicated to education in emergencies, so we can give children the tools to build a better future," said Christos Stylianides, Commissioner for Humanitarian Aid and Crisis Management.

The biggest bulk of the budget will address the crisis in Syria, refugees in neighbouring countries and the extremely critical situation in Yemen. In Africa, EU aid will support people in regions affected by crisis in South Sudan, Central African Republic, Lake Chad basin, the Democratic republic of Congo suffering from an Ebola outbreak and in regions suffering food and nutrition crises, such as Sahel.

In Latin America, EU funding will help the most vulnerable populations affected by the crisis in Venezuela and protracted conflict in Colombia. The European Union will also continue to provide assistance in Afghanistan and help Rohingya populations in both Myanmar and Bangladesh. In Europe, the EU's humanitarian efforts will focus on people affected by the conflict in Ukraine.

In view of the growing effects of climate change, the funding will help vulnerable communities in disaster prone countries to prepare better to various climatic shocks, such as droughts, floods and cyclones.

Background

EU humanitarian aid is impartial and independent, and is based only on needs, delivered in accordance with humanitarian principles of humanity, neutrality, impartiality and independence. The EU's humanitarian assistance helps millions of people in need across the world. EU assistance is implemented via humanitarian partner organisations, including UN agencies, non-governmental organisations and the Red Cross family, who have signed partnership agreements with the European Commission. The Commission closely monitors the use of EU funds via its global network of humanitarian experts and has strict rules in place to ensure funding is well spent.

IP/19/426


Más de 5.1 millones de personas con necesidades humanitarias en Colombia

Source: UN Office for the Coordination of Humanitarian Affairs
Country: Colombia, Venezuela (Bolivarian Republic of)

A este escenario se suman 1.9 millones de personas con necesidades, incluyendo refugiados y migrantes venezolanos, colombianos retornados y comunidades de acogida.
PERSONAS CON NECESIDADES HUMANITARIAS

En los últimos cinco años y como parte del ciclo programático humanitario, se han identificado las personas con necesidades en Colombia (anual) en un esfuerzo conjunto de los socios del Equipo Humanitario de País, en coordinación con otras contrapartes del Estado. La afectación histórica de millones de personas por diferentes emergencias humanitarias, como consecuencia del conflicto, la violencia y eventos de desastres naturales, ha requerido la presencia e intervención complementaria al Estado, por parte de organizaciones humanitarias tanto nacionales como internacionales.

Después de cuatro años de Diálogos de Paz entre el Gobierno y las FARC-EP se dio la firma de un Acuerdo, el cual debía también representar el alivio humanitario en muchas regiones golpeadas; no obstante, el deterioro de la situación humanitaria interna en Colombia, se refleja en más de 5.1 millones de personas con necesidades, como lo podremos evidenciar en este documento.

A este escenario se suman 1.9 millones de personas con necesidades, incluyendo refugiados y migrantes venezolanos, colombianos retornados y comunidades de acogida, quienes llegan al país con necesidades existentes y adicionalmente se exponen a riesgos y al impacto del contexto en Colombia.

Según la Plataforma Regional coordinada por ACNUR y OIM, desde la situación en Venezuela ha obligado a la salida de más de 3 millones de personas desde el año 2015, siendo Colombia el principal país de acogida y transito.

Con el ánimo de priorizar, planificar y gestionar recursos para la respuesta humanitaria adecuada de manera integral, intersectorial, el HNO 2019 incluye un capítulo especial el cual describe las necesidades en muchas ocasiones, e identifica los lugares donde se superponen las diferentes afectaciones externas e internas del país, que configuran una doble y hasta triple afectación .
Uno de los mayores desafíos hoy en día es poder informar sistemáticamente sobre los resultados y logros colectivos, con la evidencia de referencia (HNO) y un marco de planificación con objetivos, metas e indicadores (HRP); vale la pena mencionar que estos logros dependen de un monitoreo riguroso y sistemático de los cambios en la línea de base y los resultados de las intervenciones planteadas.

NECESIDADES HUMANITARIAS & CIFRAS CLAVE

El aumento y persistencia de las necesidades humanitarias; los riesgos en protección, las violaciones de Derechos Humanos -DDHH- e infracciones al Derecho Internacional Humanitario -DIH-, son motivo de preocupación para la comunidad internacional, diferentes sectores de la sociedad civil y el Gobierno de Colombia. Comunidades vulnerables sufren el impacto de las nuevas dinámicas del conflicto, el incremento de la violencia, eventos de desastres naturales y migración, donde los problemas estructurales de desigualdad, exclusión y pobreza extrema agudizan aún más sus condiciones de vida, y en otros casos representan una amenaza contra su vida y la dignidad.
En 2018, a diferencia de años anteriores, el impacto humanitario por la convergencia de emergencias relacionadas al conflicto, el incremento de la violencia armada, y la ocurrencia de eventos de desastres naturales y antrópicos, ha propiciado que alrededor de 5.1 millones de personas vivan con necesidades humanitarias

sectoriales en varias regiones de Colombia. Las regiones con mayor concentración del impacto humanitario son Nororiente-Frontera con Venezuela, Sur-Frontera con Ecuador, Pacífico-Frontera con Panamá y Noroccidente. Se destaca la priorización de 268 municipios, dejando ver la necesidad de asistencia y fortalecimiento de la presencia de actores humanitarios y de protección en los territorios, manteniendo sus espacios de coordinación activos en complementariedad a los del Estado.

La persistencia de acciones armadas y ataques contra civiles sigue dejando víctimas, violaciones a los DDHH, infracciones al DIH y consecuentes emergencias humanitarias. La confluencia de la creciente llegada de refugiados, migrantes y retornados provenientes de Venezuela desde el 2017, que se explora en el capítulo sobre refugiados y migrantes de este documento, se expone la necesidad urgente de analizar integralmente las posibles situaciones de sobreposición con la situación humanitaria preexistente, reflejando la urgente necesidad de garantizar los derechos de las víctimas y comunidades afectadas, considerando enfoques diferenciales (étnico, etario, género). Uno de los grandes retos del nuevo Gobierno es tomar medidas e implementar estrategias eficaces en términos de prevención, protección y soluciones duraderas por parte del Estado para la población vulnerable.


UN calls for access to all people in need in Hajin and Rukban

Source: United Nations
Country: Jordan, Syrian Arab Republic

Thousands of people are estimated to remain trapped by ongoing hostilities in ISIL-held areas of Hajin. At the Rukban makeshift settlement, more than 40,000 people in urgent need of assistance.
The United Nations in Syria is gravely concerned about the protection of thousands of people who are estimated to remain trapped by ongoing hostilities in ISIL-held areas of Hajin in south-eastern Deir-ez-Zor Governorate, as well as for some 11,000 thousand people who have fled these areas since the beginning of December. The United Nations is also deeply worried about the dire humanitarian situation at the Rukban makeshift settlement in southern Syria, where more than 40,000 people remain displaced in urgent need of assistance.

The ongoing fighting in Hajin is taking a heavy toll on civilians. Those leaving the areas of active hostilities have reported many civilian casualties, including women and children, critical shortages of food and medical supplies, and large-scale destruction of civilian infrastructure. Due to ongoing insecurity, humanitarian access to civilians who remain in the Hajin area and to people on the move remains severely restricted.

Civilians leaving the Hajin area, the majority of whom are women, children and elderly people, undertake an arduous journey to escape the violence, with most of those displaced arriving at Al Hole camp in Al-Hasakeh Governorate. People fleeing face serious protection risks along the way, including exposure to hostilities, explosive hazard contamination and long waiting periods at screening points in harsh winter conditions.

Consequently, many of those arriving to Al Hole are extremely exhausted and seven young children have died shortly after arriving. According to the displaced persons, the movement to Al Hole camp is carried out without their consent and many would prefer to remain in Deir-ez-Zor areas.

At the Rukban settlement, conditions for displaced people, the majority of whom are women and children, are increasingly desperate and the situation is exacerbated by the winter cold. With limited access to food, medical care and other support and with the continued restrictions on humanitarian access, people are in urgent need of assistance and protection. The cold weather, lack of healthcare facilities and limited access to clean water greatly increase the risk of health concerns. Several young children have reportedly died at the site since the beginning of December. The last time the United Nations had access to Rukban was in November, where an inter-agency convoy, jointly with the Syrian Arab Red Crescent, delivered food, medical and other assistance.

The United Nations strongly calls upon all parties to the conflict, and those with influence over them, to take all measures to protect civilians and civilian infrastructure in line with their obligations under International Humanitarian and International Human Rights Law.

The United Nations further calls on all parties to facilitate unhindered and sustained humanitarian access to all people in need in Hajin and Rukban, and to minimize the distress and unnecessary suffering for the civilian population, both for those in transit from Hajin and those currently stranded in Rukban.

For more information, please contact UN Damascus, Office of the RC/HC:

Fadwa Abed Rabou Baroud, Email: Fadwa.baroud@one.un.org, Tel: +963 996 666 134

Dr. Khaled Al Masri, Email: khalid.al-masri@one.un.org, Tel: +963 991 206 555


Lack of access to medical care in Syria is putting children’s lives at risk

Source: UN Children's Fund
Country: Jordan, Syrian Arab Republic

Amid freezing temperatures and lack of medical care, at least eight children died in Rukban and seven after fleeing Hajin. Thirteen of these were younger than one-year-old.
Amid freezing temperatures and lack of medical care, at least eight children died in Rukban and seven after fleeing Hajin. 13 of them were under one-year-old.

Statement attributable to Geert Cappelaere, UNICEF Regional Director for the Middle East and North Africa

AMMAN, 15 January 2019 – “Freezing temperatures and harsh living conditions in Rukban, at the southwestern border of Syria with Jordan, are increasingly putting children’s lives at risk. In just one month, at least eight children - most of them under four months and the youngest only one hour old - have died.

“In Rukban, where 80 per cent of the estimated 45,000 population are women and children, extreme cold and the lack of medical care for mothers before and during birth, and for new infants, have exacerbated already dire conditions for children and their families.

“Meanwhile, in eastern Syria, heavy violence in the Hajin area of Deir-Ez-Zor has displaced an estimated 10,000 people since December. Families seeking safety face difficulties leaving the conflict zone and wait in the cold for days without shelter or basic supplies. The dangerous and difficult journey has reportedly killed seven children – most of them under one-year-old.

“The lives of babies continue to be cut short by health conditions that are preventable or treatable. There are no excuses for this in the 21st century. This tragic manmade loss of life must end now.

“Without reliable and accessible healthcare, protection and shelter, more children will die day in, day out in Rukban, Deir-Ez-Zor and elsewhere in Syria. History will judge us for these entirely avoidable deaths.

“UNICEF calls on all parties to the conflict and those with influence over them to provide safe passage for all families seeking safety out of the line of fire, and to facilitate access to lifesaving medical assistance for their children in Hajin and elsewhere in Syria.

“Needs for assistance in Rukban are beyond urgent. They are extremely acute and have become a matter of life and death.

“Once again, UNICEF calls on all sides to urgently facilitate a humanitarian convoy to Rukban, including mobile health clinics, so that lifesaving supplies and services can be delivered.

“Surely, this is not too much to ask when the lives of tens of thousands of children - children - depend on it.”

Media Contacts

Juliette Touma
Chief of Communication
UNICEF Middle East and North Africa Regional Office
Tel: 00962798674628
Email: jtouma@unicef.org

Tamara Kummer
Communications Specialist
UNICEF Middle East and North Africa
Tel: +962 797 588 550
Email: tkummer@unicef.org