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By Bjørn Smestad

A New Focus on Peaceful Conflict Resolution at the UNSC?

United Nations Secretary-General Ban Ki Moon, UN High Commissioner for Human Rights Navi Pillay  and other senior United Nations officials have once more exhorted the UN Security Council to “heed early warning indications of potential conflict”, during a day-long meeting on conflict prevention at the United Nations on August 21. In response, the UNSC adopted Resolution 2171, resolving to better utilize available early detection and conflict prevention strategies and tools, specifically noting that Chapter VI mechanisms “have not been fully utilized.” 

During her final briefing to the UNSC in her role as High Commissioner for Human Rights, Navi Pillay was forthright and pulled no punches. Today’s conflicts “hammer home the full cost of the international community’s failure to prevent conflict”, she said. The narrow, short-term political interests of the member states have too often prevailed over the shared responsibility of maintaining peace and security, Pillay explained, preventing the Council from greater responsiveness and saving thousands of lives. This indictment of the UNSC is nothing new; any time the five permanent members of the Council even raise the possibility of a veto, resolutions are weakened and watered-down, and what is politically acceptable fails to have the desired impact on the situation. 

Indeed, as reiterated in Resolution 2171, there is a persistent, Westphalian notion that States are primarily responsible for peace and security (“the prevention of conflicts remains a primary responsibility of States and actions undertaken within the framework of conflict prevention by the United Nations should support and complement, as appropriate, the conflict prevention roles of national Governments”). As the most powerful nations in the world continue to affirm their right to place their national self-interest above the global interest in peace and security, the UNSC will always be somewhat limited in its ability to truly, and wholly, maintain international peace and security.

The new Resolution, however, is somewhat encouraging, suggesting that some of these structural weaknesses can be overcome in an effort to increase the UNSC’s effectiveness. The recognition that non-military solutions have not been fully utilized, and the UNSC’s new determination “to make and call for the greater and more effective use of such tools”, offers some measure of hope that the UNSC will be more creative in the deployment of the vast array of tools at their disposal to help prevent conflict from metastasizing using peaceful means. The UNSC, in this new Resolution, promises to make better use of tools “including negotiation, enquiry, mediation, conciliation, arbitration, judicial settlement and resort to regional and subregional organizations and arrangements.” 

As Navi Pillay pointed out, none of the crises the world is facing today were unpredictable. The UNSC has a a stong early warning system at its fingertips, with the UN Human Rights Council (among many other UN agencies of the UN and other organizations) monitoring the state of human rights protection and the health of democracy and societies around the world. Unfortunately, all too often, the political will to act has eluded the UNSC. Perhaps focusing on the use of “soft power” and the Chapter VI tools enumerated above will provide the UNSC a new, maybe more effective avenue to carry out their role.  

Photo Credit: Bjørn Smestad’s Flickr Photostream

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Manilla Bay at sunset

A Bold New Way of Measuring A Country’s REAL Wealth

Ed note. This piece appears in Project Syndicate and is reprinted with permission. The author, Mahmoud Mohieldin, is Corporate Secretary and the President’s special envoy at the World Bank

When the Millennium Development Goals (MDG) deadline expires next year, the world will be able to point to several important achievements since their launch in 2000. Extreme poverty has been halved during this period; an estimated 100 million slum-dwellers have gained access to safe drinking water, and millions to health care; and large numbers of girls are now receiving an education. But considerable unfinished business and significant performance discrepancies remain.

The post-2015 development agenda will continue where the MDGs left off, while adding further objectives relating to inclusion, sustainability, jobs, growth, and governance. The success of the coming Sustainable Development Goals (SDGs) will depend on how new programs are developed, implemented, and measured.

Strong economic growth enables people to improve their lives and creates space for new ideas to thrive. But such growth is often accompanied by environmental degradation, which diminishes human health and quality of life, threatens water supplies, and compromises ecosystems, impeding growth for future generations. Moreover, short-term growth that erodes natural capital is vulnerable to boom-and-bust cycles, and can cause people who live close to the poverty line to fall far below it.

Taking a longer-term view of growth and accounting for social, economic, and environmental equity must be a top priority for the post-2015 development agenda. Discussion of the SDGs is now taking into consideration the need to incorporate food, water, and energy security, together with urban planning and biodiversity. But translating prospective goals into actions at the country level will not be feasible without measurable and meaningful indicators to guide policy and measure progress.

One method of measurement is “natural capital accounting,” which assesses the value of natural resources in development planning and national accounts, just as a family would account for their home’s value – and the cost of maintaining it – when deciding how much of their regular income to consume. A recent World Economic Forum report proposes a “dashboard” for inclusive and sustainable growth. This model brings together natural capital accounting, a human-opportunity index, a gender-gap index, measures of public investment as a percentage of GDP, a competitiveness index, indicators of shared prosperity, and disaggregated unemployment data.

A World Bank-led partnership, Wealth Accounting and the Valuation of Ecosystem Services (WAVES), shows governments how certain behavior depletes natural assets, and how natural capital accounting can help to establish more sustainable development policies. Following a campaign at the 2012 Rio+20 Summit, 70 governments, including those representing 40 middle- and low-income countries, endorsed natural capital accounting.

The method has already been put to good use around the world. “Forest accounts,” for example, have revealed that Guatemala has the fastest deforestation rate in Central and South America, with most uncontrolled logging being carried by households for their cooking needs. This information has spurred the Guatemalan government to review the country’s forestry law, and to fund new strategies to control firewood use, prevent unauthorized logging, and encourage families to use alternative energy sources.

Botswana’s attempts to diversify its economy are constrained by water shortages; but “water accounts” are helping the government to identify sectors – including agriculture, mining, and tourism – that can grow with minimal water consumption.

In the Philippines, where 60% of GDP is generated by industries and associated services in the Laguna Lake region of Metro Manila, pollution and siltation has already reduced the lake’s depth by one third. “Ecosystem accounts” have become instrumental in determining how better to manage this resource. These accounts are also being used to improve forest management in the Indian state of Himachal Pradesh, where forests are a vital resource for two major growth sectors, tourism and hydropower generation.

These experiences are vital in shaping the post-2015 development agenda. Incorporating sustainability forces governments and businesses to consider the environmental impact of their decisions. A UN report calls on all governments to adopt natural capital accounting so that their sustainability efforts can be consistent, accurate, and comparable over the long term. Institutionalizing sustainability in this way will make it an intrinsic part of day-to-day governance.

Only by shifting to a broader understanding of growth and development can the world address the pressing problems of inequality and sustainability. Placing that understanding at the heart of the SDGs will help to improve the health and wellbeing of all societies long into the future.

Mahmoud Mohieldin, is Corporate Secretary and the President’s special envoy at the World Bank

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Syria map

Will the USA Target ISIS in Syria?

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The Obama administration is sending strong signals that it may expand its air assault against ISIS to Syria, despite the fact that such a move would probably contravene international law. First, National Security Council advisor Ben Rhodes tells NPR that the USA is not ruling out hitting ISIS in Syria. Then, the Chair of the Joint Chiefs of Staff Martin Dempsey says this: “This is an organization that has an apocalyptic end-of-days strategic vision that will eventually have to be defeated. Can they be defeated without addressing that part of the organization that resides in Syria? The answer is no.” (NYT http://nyti.ms/1roTeo3)

Navi Pillay’s Parting Shot to the Security Council…Outgoing U.N. Human Rights Commissioner Navi Pillay  gave her final briefing to the UN Security Council. Her tenure ends at the end of the month, where she will be replaced by Prince Zeid of Jordan–who just happens to currently serve on the Council. Pillay was rather unsparing in her criticism of the ways in which divisions in the council prevented adequete responses to urgent human rights catastrophes. Money quote: “I firmly believe that greater responsiveness by this council would have saved hundreds of thousands of lives” (VOA http://bit.ly/1s5wZiA)

Ebola

The two U.S. patients who were treated for Ebola have been discharged from Emory University Hospital in Atlanta, where they had been in an isolation ward since returning from Liberia early this month. They are the first patients treated for Ebola on American soil. (NPR http://n.pr/1wdDjLp)

South Africa said on Thursday that due to fears over the spread of the Ebola virus it was banning travellers from Guinea, Liberia and Sierra Leone from entering the country, apart from its own citizens. (Reuters http://bit.ly/1s4VFrr

Up to 30,000 people could have used experimental treatments or vaccines so far in the world’s worst outbreak of Ebola currently plaguing West Africa, British scientists said. (Reuters http://bit.ly/1s4W4u4)

While the Ebola epidemic continues to claim lives in West Africa, information technology specialists, together with radio and TV reporters, are battling misinformation and prejudice about the disease – using social media to educate the public about the deadly virus. (VOA http://bit.ly/1wdHWF4)

Hundreds of residents of a Liberian slum lined up to receive rice and water from government officials Thursday in their neighborhood which was sealed off from the rest of the capital in an attempt to halt the spread of Ebola. (AP http://yhoo.it/1we7vWy)

An emergency research call has been launched to help fight the world’s worst Ebola outbreak in West Africa, with the British government and the Wellcome Trust medical charity pledging a combined $10.8 million. (VOA http://bit.ly/1wdIlaI)

Africa

Children accused of being members of armed groups in the conflict in Mali are languishing in adult jails while human rights abuses continue, said Amnesty International. (ReliefWeb http://bit.ly/1wdC5jc)

A cash transfer scheme in Zambia provides a bi-monthly cash allowance of $25 and $50 respectively for vulnerable households and households where there are people with disabilities, to help people deal with shocks created by climate. (IPS http://bit.ly/1wdDTZq)

Uganda has been hailed as a success story in fighting HIV/AIDS, with prevalence rates dropping from 18 percent in 1992 to 6.4 percent in 2005. But activists fear a new HIV Bill will lead to lead to people shunning testing and treatment. (IPS http://bit.ly/1s4URmz)

The 40,000 people sheltering from South Sudan’s civil war in a flooded and crowded UN camp are enduring conditions “barely compatible with life and incompatible with human dignity”, and must be helped before disease and danger force them back into the conflict zone, MSF has warned. (Guardian http://bit.ly/1s4X0yA)

Fighting erupted in the Central African Republic capital Bangui, killing a humanitarian worker and injuring dozens of civilians hours after the UN said it would dispatch thousands of peacekeepers to quell religious violence. (Guardian http://bit.ly/1wdH2sh)

Human Rights Watch says South Sudan’s army used child soldiers during recent fighting against opposition forces in violation of international law. (VOA http://bit.ly/1wdIdI7)

The UN refugee agency called for East African countries hosting Somali refugees to make voluntary repatriation possible and sustainable. (VOA http://bit.ly/1wdIw5L)

West Africa must openly confront its political and governance weaknesses to curb the growing drug trade in the region, former Nigerian President Olusegun Obasanjo said. http://yhoo.it/1wdIYkq

Former child soldiers in war-torn Somalia are being held in prison conditions in foreign-funded camps, “punishing” rather than rehabilitating them, the top UN children’s envoy said Thursday. http://yhoo.it/1s5wcOw

MENA

America has returned to war, of a sort, in Iraq with airstrikes that have intensified in recent days against Islamic State militants. But details about the execution of this limited campaign, which so far includes no reported U.S. ground combat, are thin. (AP http://yhoo.it/1we896t)

About 10,000 mourners on Thursday buried three senior commanders of the armed wing of Hamas who were killed in a predawn airstrike by Israel, the most significant blow to the group’s leadership since Israel’s operation in Gaza began more than six weeks ago.(NYT  http://nyti.ms/1roUoQi)

Asia

Sri Lanka’s government is scrambling to ease the impact of record harvest losses on millions of farmers as the country enters its tenth month of an acute dry spell. (IRIN http://bit.ly/1s4SLTu)

Thousands of rescuers combed through the wreckage of homes engulfed by landslides in western Japan on Thursday in the slim hope of finding survivors, a day after a wall of mud claimed at least 39 lives. http://yhoo.it/1wdJuyZ

Flooding in Cambodia has killed at least 45 people since last month, officials said Thursday. (AP http://yhoo.it/1we7lyA)

The Americas

Brazil expands labor rights for domestic workers through new legislation. (AP http://yhoo.it/1s50Jfy)

Police on Mexico’s Caribbean coast arrested 13 activists during a demonstration by Maya Indians against water rate hikes. (NYT http://nyti.ms/1roUtna)

Opinion/Blogs

South Sudan’s Looming Famine (UN Dispatch http://bit.ly/1nfAQq7)

How Uganda Stopped Previous Ebola Outbreaks (DW http://bit.ly/1s5yayk)

Microfinance in Jordan isn’t helping to empower women (Guardian http://bit.ly/1s5yvRI)

Can alternative economic indicators ever be any good if they are devised solely by experts? (From Poverty to Power http://bit.ly/1piMipH)

Shouldn’t “anti-poverty” and “pro-middle class” be synonyms? (Campaign for Boring Development http://bit.ly/1piMG7Q)

There always needs to be a product: ‘Self-reflection’, volunteering & the emerging development entertainment industrial complex (Aidnography http://bit.ly/1nfB7tn)

150 million bank accounts – is that enough? (IPA http://bit.ly/1piN32i)

Research/Reports

A new study finds cancer affects even simple, ancient multicellular organisms — which means the disease and the deaths it causes may simply be a part of life. (NPR http://n.pr/1wdDd6u)

The international community needs to stop looking at neglected tropical diseases as a sub-Saharan African problem and realize that the G20 countries are now home to the “lion’s share” of the dangerous, debilitating, yet low-profile illnesses, a US expert has warned. (Guardian http://bit.ly/1s4Yf0v)

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South Sudan is on the verge of famine

South Sudan’s Looming Famine

South Sudan is quite possibly on the verge of famine. The conflict that erupted in December shows little signs of abating. The peace process is halting and in the meantime the humanitarian situation is growing precipitously worse. Mark speaks with Tariq Riebl, Oxfam’s South Sudan country director about the humanitarian situation in South Sudan and what can be done to avert a possible famine.

 

 

Previous Episodes

Episode 30: Jeff Sachs, economist

Sex Slaves in Iraq, an interview with Zainab Hawa Bangura, the UN Special Representative for Sexual Violence in Armed Conflict

Episode 29: Chris Hill, former Ambassador to Iraq and North Korea nuke negotiator

Kevin Jon Heller discusses the  International Criminal Court’s Palestine Problem

Episode 28: Nancy Birsdall, founder of the Center for Global Development

The WHO explains Why this Ebola Outbreak is So Hard to Contain

Episode 27: Daniel Drezner, counter-intuitive wonk

Michael W. Hanna on How to Negotiate a Gaza Ceasefire

Episode 25: Helene Gayle, CEO of CARE, USA. Long-time AIDS-Fighter

One Campaign’s Erin Hofhelder How Humanity is Winning the Fight Against AIDS

Episode 24: Joseph Cirincione, Nuclear Policy Wonk 

A Migrant’s Story: Why are So Many Children Fleeing to the USA?

Episode 23: Live from the UN 2014 (Volume 2); A special edition with a slew of UN officials.

Inside the Iran Nuke Talks

Episode 23: Jillian York, Digital Free Speech defender

Turkey’s Strategic Interests in Iraq

Episode 22: Live from the UN, 2014 (Vol 1); A special edition, featuring the President of the General Assembly,  the UN Ambassadors from Vietnam and Jamaica, the head of the UN Association, and more!

The UN’s View of the Iraq Crisis

Episode 21: Thomas Pickering, former Ambassador to the UN, Israel, Jordan, Russia, India and more.

Dying for the World Cup

Episode 20: Jessica Tuchman Matthews, foreign policy trendsetter

Egypt After the Counter Revolution 

Episode 19: Louise Arbour, human rights pioneer.

What Obama Left Out of His Big Foreign Policy Speech

Episode 18: Zalmay Khalizad, former US Ambassador to Afghanistan, Iraq and the UN.

Why Libya is Suddenly on the Verge of a Civil War 

Episode 17: Gov Bill Richardson, he frees hostages.

The Foreign Policy Implications of India’s Elections

Episode 16: Carolyn Miles, CEO of Save the Children

What Boko Haram Wants

Episode: 15 Laura Turner Seydel, philanthropist

Episode 14: Douglas Ollivant, Iraq expert

Episode 13: Gary Bass, historian

Episode 12: Mark Montgomery, demographer

Episode 11: Kenneth Roth, Human Rights Watcher

Episode 10: Live from the UN, Volume 2.

Episode 9: Mia Farrow, humanitarian activist and Goodwill Ambassador

Episode 8: Suzanne Nossel, Big Thinker

Episode 7: Live from the UN, Volume 1. 

Episode 6: PJ Crowley, former State Department Spokesperson

Episode 5: Octavia Nasr, reporter

Episode 4: Arsalan Iftikhar, “The Muslim Guy”

Episode 3: Dodge Billingsley, filmmaker.

Episode 2: Laura Seay,  @TexasinAfrica

Episode 1: Heather Hurlburt, national security wonk

 

Podcast | | Leave a comment
the city of Lagos

Africa’s Booming Middle Class

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This news is a couple days old, but worth highlighting. Standard Bank issued a report showing that Africa’s middle class has tripled in size since 2000.  “The study analyzed 11 of the biggest economies in the region, accounting for about half of sub-Saharan Africa’s population and GDP. Those economies have grown tenfold since 2000, reaching a collective GDP of more than $1-trillion today, compared with a growth of just 25 per cent between 1990 and 2000. Using a more rigorous definition of “middle class,” the study concludes that earlier estimates were much exaggerated. But it still finds dramatic growth, from about 4.6 million households in 2000 to almost 15 million households today in the 11 focal countries, if the middle class and lower-middle-class categories are both included.” (Globe and Mail http://bit.ly/1rng1AA)

Liberia Neighborhood Under Quarantine. Violent Clashes Ensue…Monrovia’s West Point neighborhood has become a scene of mayhem. ”Soldiers and police officers in riot gear blocked the roads. Even the waterfront was cordoned off, with the coast guard stopping residents from setting out in canoes. The entire neighborhood, a sprawling slum with tens of thousands of people, awoke Wednesday morning to find that it was under strict quarantine in the government’s halting fight against Ebola. The reaction was swift and violent. Angry young men hurled rocks and stormed barbed-wire barricades, trying to break out. Soldiers repelled the surging crowd with live rounds, driving back hundreds of young men.” (NYT http://nyti.ms/1rngcvH)

Ebola

The Ebola outbreak in West Africa is putting off thousands of tourists who had planned trips to Africa this year, especially Asians, including to destinations thousands of miles from the nearest infected community such as Kenya and South Africa. (Reuters http://bit.ly/1pfmURV)

Democratic Republic of Congo has sent its health minister and a team of experts to the remote northern Equateur province after several people died there from a disease with Ebola-like symptoms, a local official and a professor said on Wednesday. (Reuters http://bit.ly/1pfmXwY)

The World Health Organization says the death toll from the Ebola outbreak in West Africa is now at least 1,350 people. (AP http://yhoo.it/1pfojrJ)

Health officials in Juba have stepped up efforts to ensure the deadly Ebola virus does not spread to South Sudan. (VOA http://bit.ly/1rmSDDj)

The senior United Nations coordinator on the Ebola virus says he will travel to Africa later this week. Dr. David Nabarro in New York said he met with U.N. Secretary-General Ban Ki-moon and is headed to Washington for meetings with officials from the Centers for Disease Control and the World Bank. He left for Senegal last night. (VOA http://bit.ly/1s0kftp)

Africa

Ethiopia has overtaken Kenya to become the largest refugee-hosting country in Africa, sheltering 629,718 refugees as of the end of July. Kenya, in comparison, is host to 575,334 registered refugees and asylum-seekers. (UN http://bit.ly/1pfh3Mc)

Over 171,000 people across 12 states in Sudan have been affected by heavy rains and floods that started in late July 2014. (OCHA http://bit.ly/1nb7TM3)

South African inflation ticked down to 6.3 percent in July, government data showed on Wednesday, easing pressure slightly on consumers. (AP http://yhoo.it/1nbcoGl)

People are lining up as early as 4 AM in Zimbabwe, 4 hours before the passport office opens, to be able to leave the country and get work elsewhere. (AP http://yhoo.it/1nbdmCG)

Nigerian soldiers say they defied orders to launch an operation against Boko Haram militants because the soldiers were not adequately armed. (VOA http://bit.ly/1s0jL6M)

MSF says at least 31 people were injured Wednesday in the Central African Republic when a local militia clashed with international peacekeepers. (VOA http://bit.ly/1s0jUah)

MENA

Four beheaded corpses were found by residents of a town in Egypt’s Sinai Peninsula on Wednesday, security sources said, blaming Islamist militants waging an insurgency against Cairo. (Reuters http://bit.ly/1pfn1wG)

A humanitarian airlift to northern Iraq began on Wednesday, kicking off a 10-day operation to provide tents and other aid to half a million displaced people who are struggling for survival, the United Nations’ refugee agency UNHCR said. http://yhoo.it/1nbcNZC

Asia

Thailand’s coup leader is expected to be picked as prime minister by the kingdom’s new army-dominated national assembly, junta sources said Wednesday, cementing the military’s hold on power in the politically turbulent nation. (AP http://yhoo.it/1nbcygZ)

A recent United Nations report found that, despite the existence of a stringent anti-child marriage law, India ranks sixth among countries with the highest prevalence of child marriages across the globe. In India, 27 percent of women aged 20-49 claim to have tied the knot before turning 15, the survey states. (IPS http://bit.ly/1nb8FbZ)

Afghanistan has given New York Times reporter Matthew Rosenberg 24 hours to leave the country for not cooperating with an investigation, a statement from the attorney general’s office said on Wednesday. (AP http://yhoo.it/1pfpQxU)

An Indian woman who has staged a 14-year hunger strike against rights abuses in the country’s northeast broke down in tears on Wednesday as she was finally released from a hospital jail. http://yhoo.it/1pfqLyf

Almost a decade after a devastating tsunami hit the coast of Banda Aceh, Indonesia, one family believes they have been reunited with two of their children who have been missing since the disaster struck. (VOA http://bit.ly/1rmSQGp)

The Americas

Analysis of a video showing American journalists James Foley and Steven Sotloff indicates that the video is authentic, a U.S. National Security Council spokeswoman said. Intelligence Community has analyzed the recently released video showing U.S. “We have reached the judgment that this video is authentic.  http://yhoo.it/1nbdEJE

An estimated 104,000 people remain internally displaced in Haiti in 172 camps almost five years after the 2010 earthquake. Basic services in camps, including WASH and health, have declined faster than the pace of return or relocation of the displaced. (OCHA http://bit.ly/1nb875V)

The people of Patagonia in southern Chile are working to make the Aysén region a “life reserve”. Neighbouring Argentina, across the border, is a historic ally in this remote wilderness area which is struggling to achieve sustainable development and boost growth by making use of its natural assets. (IPS http://bit.ly/1pfmjzE)

The burden of caretaking traditionally falls to women, in Cuba, which sustains gender inequalities and makes women vulnerable to the reforms undertaken by the government of Raúl Castro since 2008, aimed at boosting productivity and the efficiency of the economy, but without parallel wage hikes. (IPS http://bit.ly/1nb8Vb2)

An emotional President de Kirchner says proposed legislation will return control of its debt to the government. (BBC http://bbc.in/1s0jhxk)

Opinion/Blogs

Violations of International Law Degenerate UN (IPS http://bit.ly/1pfmydV)

If Maliki Can Go, Why Not Assad? (VOA http://bit.ly/1s0lloZ)

Humans give malaria to mosquitoes  we need a vaccine to stop this (Guardian http://bit.ly/1rmSsI1)

Six key findings on the use of Theories of Change in international development (ODI http://bit.ly/1s0jAYX)

Ebola Drug Poses Question of Ethics in Treatment (VOA http://bit.ly/1rmSGyT)

Research/Reports

Ukraine wants the International Monetary Fund to combine the expected third and fourth tranches of a $17 billion dollar bailout package for a total of around $2.2 billion, Interfax quoted Finance Minister Oleksander Shlapak as saying on Wednesday. http://yhoo.it/1nbcIF4

Amid increasing documentation of attacks on people engaged in environmental activism, experts are calling for a global protection regime to defend and support campaigners subjected to harassment and abuse. (IRIN http://bit.ly/1s0jy3o)

Top of the Morning | Leave a comment
A hospital in Liberia

Some Encouraging News on Ebola

First the bad news. Ebola is still an out of control international epidemic. The death toll surpassed 1,000 last week. And it’s becoming increasingly clear that fear of ebola may end up being deadlier than ebola itself. Hospitals are shut. And already fragile health systems are extended beyond capacity.

I visited a number of hospitals in Liberia a couple years ago when I tagged along with UNITAID chairman Phillippe Douste-Blazy as he visited UNITAID grantees. The country was about 9 years past its brutal civil war and in the process of rebuilding state institutions, including its health system.

We visited the crowded maternity ward of one hospital. The doctor on site admitted that one woman dies from childbirth complications every few weeks. That was in the hospital. For women who can’t reach basic medical services, the rate is undoubtedly higher.

Hospitals in Liberia are being closed down. Over 30 health workers have died from Ebola and many more are staying away out of legitimate concern for their health. Women are still giving birth. And many of those women will have complications that require medical attention. This story by Jina Moore of Buzzfeed offers some important context of this awful ebola-maternal mortality complex.

Barh works in the maternity ward at Redemption Hospital — a hospital that was closed when Fatuma Fofana went there to deliver her baby. The facility shut its doors after a pregnant woman, possibly Ebola-infected, died there in late July. The community blamed the health workers for the death and attacked the hospital, Barh said.

“They said the hospital killed her, and they stormed the hospital,” she said. “The police had to come to our rescue. Then we had to close the hospital for two weeks.”

Redemption re-opened on Monday, after a youth leader pled that the community needed a functioning health facility. This week, Barh and a much-reduced staff delivered five babies — an incredibly low number in a facility that usually sees 300 births a month.

Sheriff, whose sister died in childbirth, sees the closure of the health facilities as a betrayal. “We never imagined they could close the clinics, the small community clinics,” Sheriff said. The order to shut the government hospitals, he said, “scares the other community [clinics, which think] ‘If they closed, what are we doing?’

A UNFPA report from 2011 found  3 obstetricians in all of Liberia; and about 650 people with some training in midwifery. The population of Liberia is over 4 million. The fertility rate is 5.1 births/woman. A woman has about a one in 20 chance of dying in childbirth.

Even before hospitals were open to pregnant women the math was not good. It’s undoubtedly much worse now.

So that is the bad news.

The good news is that there are some signs that the outbreak is starting to come under control in Nigeria and Guinea. How? In Nigeria ebola was imported by a single person, and a thorough monitoring and investigation of the people who came in contact with that one person. In all, twelve people in nigeria have been infected. But the WHO seems to think that the infections will stop there:

Intensive contact tracing, conducted by Nigerian health officials and staff from the US Centers for Disease Control and Prevention, has not, so far, identified any further confirmed cases outside the initial transmission chain.

The index case arrived in Lagos on 20 July and died on 25 July. The 21-day incubation period has lapsed. All 12 cases were confirmed in a WHO-approved laboratory.

The intensity of the search and monitoring effort raises cautious optimism that further spread of the virus in Nigeria can be stopped. The search for additional cases continues, as does the current high level of vigilance.

And in Guinea, where the outbreak began, public awareness about the basic facts of Ebola (that it is transmitted through contact with bodily fluids–and transmission can occur during traditional burial rituals) has helped contain its spread. From the WHO

Public awareness of the facts about Ebola is higher there than in the other affected countries. Innovative solutions are being found. For example, respected community leaders have been used to secure the cooperation of 26 villages that were highly resistant to outside help.

The opening of these villages has resulted in a surge of reported cases. These are cases that were previously concealed; their reporting should not be interpreted as a sudden upsurge in Guinea’s outbreak.

Of course, the outbreak is far from over in Guinea and Nigeria–let alone in Liberia and Sierra Leone. But these encouraging signs goes to show that the outbreak can be stopped.

The key question going forward is whether or not the outbreak can be stopped before the health systems of countries like Liberia and Sierra Leone are destroyed by the fear of ebola.

 

 

Health | | Leave a comment

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