Ivory Coast: The Deteriorating Humanitarian Situation (Report)

Fighting in Abidjan, photo courtesy of Africasia(HN, March 17, 2011) --  Life for the people of the Ivory Coast is getting increasingly worse. The three-month campaign of organized violence by security forces under the control of Laurent Gbagbo and militias that support him gives every indication of amounting to crimes against humanity, Human Rights Watch said on Tuesday.

The crisis has escalated since the end of February 2011, with clashes between armed forces loyal to Gbagbo and Ouattara in the western and central regions of the country, as well as in Abidjan, the financial capital.

With around 400,000 displaced persons and the deaths of almost 400 civilians documented by the United Nations the vast majority killed by pro-Gbagbo forces in circumstances not connected with the armed conflict and with no apparent provocation - the attacks appear to be widespread.

On the Ouattara side, armed fighters have begun a pattern of extrajudicial executions against alleged pro-Gbagbo combatants detained in Ouattara territory since the Forces Nouvelles ("New Forces" or FN) gained effective control of the Abobo neighborhood and Anyama village around February 26.

"The time is long overdue for the UN Security Council to impose sanctions against Gbagbo and his allies directly implicated in the grave abuses of the post-election period," said Daniel Bekele, Africa director at Human Rights Watch. "The international community should also send a clear message to Ouattara's camp that reprisal killings will place them next on the list."

Armed fighters loyal to Alassane Ouattara clashed with the pro-Gbagbo security forces yesterday in several areas including Yopougon and Attecoube, while foreigners and ethnic groups viewed as pro-Ouattara are repeatedly harassed.

Fierce fighting and gun battles in the cities of Abobo, Abidjan and Williamsville have seen the most bloodshed. 

Although there is no reference whatsoever on state TV of the ongoing battles in the streets life for much of the population has become very bleak.

Many shops in these cities have been looted and those that have not have been closed as well as most banks.

Man wounded by gunshot in district of Adjame, photo courtesy of AfricasiaDoctors without Borders is reporting that in the city of Abobo only one hospital remains open and in the last two weeks doctors there have treated 129 patients 89 of which have come in with either knife or gun shot wounds.

UNICEF has said that the nation is on the verge of collapse with 1.5 million people at risk from epidemics. Reports of cholera have begun in Abidjan as rubbish lies uncollected and there have been 10’s of deaths reported in rural areas as a result of yellow fever.

In the north schools are closed leaving 800,000 children out of school and although the situation is better in the southern part of the country there are schools closed there as well.

Crime levels are up and armed youth roam the streets with impunity.

As the situation in the Ivory Cost continues to intensify and the country plunges further into economic decay there is real worry that shortages of basic needs will not be able to be met – electricity blackouts and water cuts are among the things people are most concerned about.

Attacks on Foreigners

According to Human Rights Watch residents from Mali, Burkina Faso, Nigeria, and Niger have given detailed accounts of daily attacks by pro-Gbagbo security forces and armed militias, who beat foreign residents to death with bricks, clubs, and sticks, or doused them with gas and burned them alive.

A Malian man interviewed by Human Rights Watch described how he and six other West Africans were forced into two vehicles by armed militiamen and taken into the basement of an abandoned building. More youths were waiting, who then executed five of the captured West Africans at point-blank range. The homes, stores, and mosques of hundreds of other West Africans have been burned, or they have been chased out of their neighborhoods en masse under threat of death at the hands of pro-Gbagbo militias.

The brunt of these attacks came immediately after Gbagbo's "youth minister," Charles Blé Goudé, called publicly on February 25 for "real" Ivoirians to set up roadblocks in their neighborhoods and "denounce" foreigners.

The situation threatens to worsen further, as a March 7 letter addressed to the Burkina Faso ambassador by a militant pro-Gbagbo group warned. The letter threatened to "cut the umbilical cord" of the Burkina Faso nationals in Côte d'Ivoire unless they left the country by March 22.

Refugees 

U.N. officials say the political crisis has also driven more than 75,000 Ivorian civilians across the border into Liberia, with half that total arriving in just the last two weeks. Aid officials in Liberia's Toe Town say they are struggling to keep up. Augustine Nugba is the local program coordinator for the Catholic charity Caritas.

"As soon as the place is given and we receive the government's okay, we will start to construct a camp and to remove everyone from here," said Nugba.

Food shortages, overcrowding, and inadequate sanitation have brought cases of diarrhea and malaria for refugees, including Victorine Tohogninon.

Tohogninon says that since the refugees came to Liberia, the children and the elderly are getting sick.

If the political crisis is not resolved soon, refugee Charles-Camille Kpehia says there will be no one left in Ivory Coast to govern.

- HUMNews Staff

Update on Thursday, March 17, 2011 at 12:34PM by HUMNEWS

South Africa backs the African Union in recognizing Alassane Ouattara as the winner of Ivory Coast's disputed presidential election, President Jacob Zuma said on Thursday.

Zuma said in reply to a question in parliament that South Africa backed the AU's position.

"South Africa fully supports the position taken by the African Union on the 10th of March, namely that Mr. Ouattara is recognised as the winner, which is a reaffirmation of the position of ECOWAS," Zuma said, referring to the West African regional grouping.

He said South Africa supported the AU's attempts to find a peaceful solution to the Ivory Coast crisis. Zuma and officials in his foreign ministry had previously given the impression they thought there were doubts over the vote, suggesting they did not back the tougher line taken by West African leaders on Gbagbo.

"We are all of one mind on the way forward towards a sustainable political solution."

Update on Thursday, March 17, 2011 at 12:38PM by HUMNEWS

According to the BBC, shells have been fired at a district of Abidjan opposed to disputed Ivory Coast President Laurent Gbagbo, with reports of at least 10 dead.

Two shell landed in a busy market in the Abobo area, residents said.

Some 370,000 people have fled recent clashes in Abidjan - many from Abobo, which backs the man widely recognised as the winner of last year's elections.

The African Union has given Mr Gbagbo until 24 March to organise a handover of power but he shows no signs of stepping down.

(News Brief) Cholera in Haiti and Nigeria

Photo UNICEF – A baby in Haiti suffers from diarrhea (HN, October 27, 2010) --- Over 3000 cases of cholera have been reported in Haiti this week resulting in over 250 deaths so far. More than 1,500 people have been hospitalized with a variety of diarrhea-related side effects, including dehydration, vomiting and abdominal pain. The confirmed cases are clustered around the Artibonite River in a region two hours north of the capital, Port-au-Prince. Additional cases of watery diarrhea in Port-au-Prince are worrying health officials who are working to prevent the spread of the disease into the crowded camps of displaced.

The United Nations Children’s Fund (UNICEF)  Haiti's Chief of Health, Dr. Jean-Claude Mubalama, said the situation was hectic and the local hospital in Saint-Marc was overwhelmed with sick people.

"The people here—the medical [staff] and the nurses—are not very familiar with this kind of disease," said Mr. Mubalama. As a result, UNICEF is managing the available resources, as well as coordinating with government and local partners, to try to treat people as quickly as possible, he added.

North of St. Marc, additional cases have appeared in the small community of Dessalines.

Photo: An MSF staff member attends to patients receiving treatment at the St. Nicholas Hospital in St. Marc"We have 35 hospitals beds, but we now have 61 patients spread throughout the hospital," says Dr. John Fequier, director of Claire Heureuse in Dessalines. Only 5 years out of medical school, Dr. Fequier is quick to admit he has never seen anything like this.

Dr. David Olson of Doctors without Borders/ Médecins Sans Frontières (MSF) medical advisor and cholera specialist in Haiti says “The best way to contain the spread of cholera is through prevention, and ensuring people have access to clean drinking water” . He adds that “ in refugee settings in conflict areas, people are forced to seek water wherever they can find it. By contrast, in many of the displacement camps in Port-au-Prince, people are provided with water that is less likely to be contaminated. This will hopefully mitigate the threat."

Nigeria
In Nigeria a cholera outbreak has led to 40,000 cases and resulted in 1,555 deaths, the United Nations confirmed yesterday.

According to the United Nations Children’s Fund (UNICEF) the number of cases is three times higher than last year and seven times higher and in 2008. The disease’s spread seems to be largely contained in Nigeria, where new cases are still being reported in the country, particularly in the northeast.

Women and children account for 80 percent of the cases, according to the UN report.

Two-thirds of rural Nigerians do not have access to safe drinking water or proper sanitation.

In the African nations of Cameroon, Chad and Niger there have been far more cases of cholera than usual this year according to the United Nations

The statistics from the World Health Organization (WHO) are that the disease kills about 120,000 people per year.

Causes

Cholera is caused by a bacterial infection of the intestine and, in severe cases, is characterized by diarrhea, vomiting and leg cramps, according to the Centers for Disease Control (CDC) . In such cases, rapid loss of body fluids can lead to dehydration and shock. Without treatment death can occur within hours.

A person can get cholera by drinking water or eating food contaminated with the bacteria. During epidemics, the source of the contamination is often the feces of an infected person, and infections can spread rapidly in areas where there is poor sewage treatment and a lack of clean drinking water.

Treatment

According to the World Health Organization (WHO) Cholera is an easily treatable disease. The prompt administration of oral rehydration salts to replace lost fluids nearly always results in cure. In especially severe cases, intravenous administration of fluids may be required to save the patient's life.

- HUM News Staff

Starved for Attention - US: The U.S. Standard and a Double Standard

In the documentary above, Doctors Without Borders/Médecins Sans Frontières (MSF) and VII photographers Antonin Kratochvil and Jessica Dimmock take a closer look at the US Special Supplemental Nutrition Program for Women, Infants and Children (WIC) that provides vouchers to low-income young mothers for the purchase of nutritious staple foods such as milk, fruit, eggs, cereal and rice.  The documentary also takes a look at the sub-standard foods the US, as the world's largest food aid donor, sends to other countries.

Starved for Attention - India: Invisible

One in every three malnourished children in the world are in India. In this documentary focusing on the state of Bihar, India Doctors Without Borders/Médecins Sans Frontières (MSF) and VII Photographer Stephanie Sinclair bring to our attention the magnitude of malnutrition in the world and the challenges of addressing the problem of malnutrition in a place like India where the problem is so large and more often than not goes unnoticed.

The “Starved for Attention” series produced by Doctors Without Borders/Médecins Sans Frontières (MSF) and VII Photography captures frontline stories of malnutrition from Bangladesh, Burkina Faso, Democratic Republic of Congo, Djibouti, India, Mexico, and the United States.

Starved for Attention - Djibouti: Frustration

The “Starved for Attention” Campaign: In June of this year Doctors Without Borders/Médecins Sans Frontières (MSF) and VII Photography co-produced and presented “Starved for Attention,” a multimedia campaign exposing the neglected and largely invisible crisis of childhood malnutrition.  “Starved for Attention” captures frontline stories of malnutrition from Bangladesh, Burkina Faso, Democratic Republic of Congo, Djibouti, India, Mexico, and the United States.  You can show your support for the millions of malnourished children around the world and demand that food aid meets the nutritional needs of young children by signing the “Starved for Attention” petition, here.

Former Canadian PM Martin Blasts Donor Nations for Cutting Africa Aid

(HN, September 21, 2010) --- A former Canadian Prime Minister has blasted major donor nations for not honouring pledging commitments made five years ago to boost progress towards the Millennium Development Goals (MDGs).

“One of the worst things you can do to a developing country is build up expectations and then not meet them.” Paul Martin told the Globe and Mail newspaper. “The effect on government budgets, on morale, on people who believe they are about to receive help, and then don’t, is in many ways worse than if it had never been promised.”

The MDGs were forged by world leaders 10 years ago to help lift the world’s poor out of misery by 2015. This week world leaders are in New York to review progress. Martin attended the G8 Summit in Gleneagles, Scotland in 2005 where leaders pledged to boost aid to meet the MDGs. At the time Canada pledged to double its annual aid contribution to Africa to $2.8 billion but the current government of Prime Minister Stephen Harper slashed the annual pledge to just $2.1 billion.

In the Globe interview, Martin doesn’t conceal his bitterness. “I set out a number and said its not subject to revision. When the Canadian numbers were revised down, that was reneging on our commitment. The ‘reclarifying’ of numbers, which Canada, Italy and France engaged in, is exactly the kind of thing that must not happen in the future.”

Many donor nations, including the United Kingdom, are blaming the ongoing world economic crisis for slashing aid budgets.

Earlier this year, the respected NGO, Medecins Sans Frontieres (MSF), harshly criticized major donor nations for cutting back funding on HIV AIDS prevention programmes in Sub-Saharan Africa. MSF said the situation has gotten so bad that so-called stock-outs in anti-retroviral medicines are occurring in some of the countries in which it operates.

Martin applauded the aid and other investments in the developing world made by the new economic powers such as Brazil and Korea. However certain recipient countries have not done enough to reach MDG targets, for example in education, Martin said.

One of the eight MDGs is to ensure that all boys and   girls get a complete primary school education. However, UNESCO counts 69 million children out of school - down from 103 million in 2000.

---- Reporting by HUMNEWS’ Michael Bociurkiw in Toronto

A Plea From South Africa: Now is Not the Time to Retreat From the Global HIV Response (PERSPECTIVE)

By Roxy Marosa

(HN, July 21, 2010) -- In the run-up to the World Cup, Médecins Sans Frontières (MSF), the medical humanitarian organization, sounded a loud and worrisome alarm bell: major donors are starting to roll-back funding of HIV prevention and treatment programs that millions of people in Sub-Saharan Africa have come to depend on. 

Each time I interact with people both infected and affected by HIV, there is still a huge lack of knowledge around HIV and Aids. It goes without saying that so much more remains to be done, and what has been done is not enough.

A case in point: I recently learned that there are still people who have no idea what HIV or those who have the wrong idea of what HIV is. I am particularly referring to the remote rural areas of South Africa.

I ran a session in April this year with a group of faith denominations, where one of the priests said he discovered an area that’s challenging to reach by means of the usual transportation. Addressing the subject of HIV, he was almost in tears as he spoke about the people in this little village who had never heard of HIV - yet there were so many deaths and it is through learning about the deaths that he discovered the place. There is little civilization in the area and people live with just the basics. The priest asked himself, having taken so many years of HIV and Aids education to reach people in civilized societies, how long will it take for people in this isolated community to understand and practice safe sex? 

It has been drummed into people’s minds that the way to be safe with HIV and Aids is through prevention, testing and treatment. This method has taken years to reach people and it is taking years for people to get used to it and practice it.

We still have so many challenges to overcome, such as: 

1. Basic education for people who have not been exposed to HIV and Aids education
2. Reaching people who have never seen a female condom, let alone use it.
3. Helping women who stay in abusive relationships because they are reliant on their partners for day to day survival
4. Changing the mindsets of women who see sex as an obligation to their husbands
5. Dealing with men’s attitude towards safe sex - sex with a condom
6. Providing access to people not able to reach clinics for testing
7. Outreach to the street dwellers who get raped from time to time and are so used to it and no longer see it as rape

The people who are best able to address these challenges are the not-for-profit organisations. Without crucial funding, they are not able to execute their work. And a draw back on funding would throw tens of thousands of people out of work who have been endowed with skills to help millions of others.

What I think of a lot these days is, what will be the impact of of a withdrawal of funding on ordinary people. If you ask most people ‘How do you manage HIV and AIDS’?, the most common response is ‘by taking AIDS tablets.’ 

Some people - especially low-income earners - refuse to test because they are afraid of the outcome and say that the knowledge that they are positive will lead them to die sooner. Can we blame them for being afraid after seeing so many deaths due to this pandemic? To them the reality is that HIV and Aids leads to death.

Recently in South Africa - which has the highest case load of HIV Aids patients in the world - the government declared a 15 month war on AIDS;15 million people are to be tested by July 2011. Most of the tests are free and those who need treatment will receive it for free. The unemployed are to get the benefits government has made available. It has taken years to get us to this point, and to get the sceptical people to be open to testing, and have the hope and belief of life with HIV and AIDS. Now this possibility is threatened. 

It took many years for people in Africa to utter the words HIV and AIDS. And it is still taking tremendous work for people to relate to their neighbours living with the virus freely without prejudice or judgement. 

The way I see it is if major donors want to roll back funding for testing and treatment, they should propose a different approach to remedying the whole situation. People have to understand why they are vulnerable to this virus. They have to be educated in order to change their attitudes towards activities that will lead them to becoming infected with the virus and responsible for the choices they make.

The fact that we still have new cases of the virus should be sufficient proof that education about HIV and Aids is insufficient - and needs to be scaled up.

It has taken us years to get to the point where people are able to distinguish the difference between HIV and AIDS. People are only now warming up to the idea of getting tested, and are summoning the courage to deal with fear of the test outcome. 

Let us not turn our backs on the millions of people in Sub-Saharan Africa and elsewhere who have embraced prevention and treatment.

As donor nations meet in Vienna this week at the XVIII International AIDS Conference, the message should be loud and clear: now is not the time for major donors to retreat from their commitments to the global HIV response that has saved the lives of millions.

Cape Town-based Roxy Marosa is host of the Roxy Marosa Show and runs several projects assisting people affected by HIV and Aids in South Africa. 

Funding Countries Guilty of "Moral Betrayal" in Fight Against HIV in Africa - MSF

(HN, June 6, 2010) - A severe drawback in pledges from major donors in the fight against HIV represents a "moral betrayal" of millions of infected people on the African continent, says the respected organization Medecins Sans Frontieres (MSF).

Donor governments, blaming the ongoing global economic crisis, are drawing back support of HIV treatment programmes, such as anti-retroviral treatment (ART). MSF claims that had the international community not provided financial support, about 4-million people on treatment in Africa would not be alive today. Its also helped the scaling up of preventative treatment, such as mother-to-child transmission.

The Global Fund Against AIDS, Tuberculosis and Malaria, and the countries that fund it, the U.S. bilateral PEPFAR program, UNITAID and the World Bank are all beginning to retreat from their commitments to the global HIV response, according to MSF. The Geneva-based organization is currently facing a major funding shortfall of about $5 billion.

The impact is already being felt by frontline organizations like MSF, which provides HIV/AIDS treatment to 140,000 patients in 30 countries. MSF says it is reaching into its emergency buffer stocks of medicines deeper and more frequently.

Africa is Ground Zero in the fight against HIV: two-thirds of the 9 million people in need of urgent treatment live in sub-Saharan Africa. Because of funding gaps, already in South Africa and Uganda, patients are being shuffled from one clinic to another because of limited treatment slots.

Said Dr. Eric Goemaere, medical coordinator for MSF in South Africa: Some years ago, messages to governments in the region were unambiguous. They were told... we want to see ambitious targets because we want to see a population-level impact on the HIV epidemic. We want you to show that you can have an impact to stop this epidemic. And today the message switched to, ‘let's see what you and [we] can afford together.

"If this trend is confirmed, I would call it a moral betrayal. A moral betrayal because we will have failed first our patients, who were told to get tested and all the ones who tested positive. We promised them we'd provide them treatment. We will fail our health staff, who managed to start 4 million people on treatment, an unprecedented effort for the health services in developing countries in such a short time, and who are today told that they cannot initiate patients. And finally we would fail regional governments, with some of them already contributing a substantial amount of their own resources. The economic crisis is happening here as well as in the United States and Europe, and we would fail them if we would tell them that we cannot any more support this effort."

Aside from longer waiting lists, doctors and nurses are now having to face the agonizing choice of whether to prioritize late-stage cases or new cases, where treatment may have more of an impact, MSF says.

Experts say that the importance of international donors cannot be over-estimated: in Kenya, for example, it covers about 95% of HIV programmes and ARVs.

"If the international donors decide to withdraw their funding, the HIV programs will not be sustainable according to the present funding levels by the government," said Jimmy Gideyi, an activist and person living with HIV in Kenya. "We already have so many problems to take on, such as stigma, beliefs,  misconceptions, cultural practices, which contribute to the spread of HIV in the community, without having to worry [about] where more money will be coming from to catch up on our treatment."

Most African governments had committed some years ago to allocate 15% of their national budgets to health, but that has not happened - making the contributions of the donor community even more crucial, MSF says. It adds that the debate on funding is complicated over whether to prioritize preventative (such as distribution of condoms) or treatment programmes.

"African governments need to keep their commitments, but the international community also needs to keep its commitment," said MSF's Emi McLean. He added that even the richest country on the continent, South Africa - which depends only 20% on external aid - will stil need funding to treat millions of AIDS patients.

MSF's comments were made recently with the release of a report called Titled “No time to quit: HIV/AIDS treatment gap widening in Africa." The report builds on analyses made in eight sub-Saharan countries to illustrate how major international funding institutions such as the U.S. President’s Plan for Emergency AIDS Relief (PEPFAR), the World Bank, UNITAID, and donors to the Global Fund, have decided to cap, reduce, or withdraw their spending on HIV treatment and antiretroviral drugs (ARVs) over the past year-and-a-half.