Since 4 May intercommunal clashes between armed groups affiliated to Banyamulenge and Bafuliri ethnicities have triggered large-scale displacement across three bordering territories (Fizi, Uvira and Mwenga) in Sud Kivu province. Some 125,000 people from 100 villages fled to safer neighbouring villages and to the surrounding forests. Armed groups looted and burnt villages, causing severe damages to shelter and critical infrastructure including health and sanitation facilities. Displaced people are in need of food, shelter and NFIs, WASH and health assistance.

Anticipated scope and scale

Congolese forces (FARDC) have stepped up their operations, which translated in to a slight improvement in the security situation in some areas since 20 May. As return movements have commenced it is unclear how many people remain displaced. Shelter, NFIs, WASH, food and health needs are anticipated to persist upon return.

WASHINGTON, May 28, 2019 – The World Bank Board of Executive Directors approved today a total financing of $502 million for the Multisectoral Nutrition and Health project in the Democratic Republic of Congo (DRC). This funding comprises a $246 million credit and a $246 grant from the International Development Association (IDA)* and a $10 million grant from the Global Financing Facility (GFF)**.

Child malnutrition is an underlying cause of up to 45 percent of under five deaths and a major challenge in the DRC. The project will help reduce the prevalence of stunting in the country and provide community and primary health care and nutrition, and family planning services in the provinces of Kwilu, Kasai Central, Kasai and Sud Kivu.

“_This operation, which targets regions where the needs are the greatest, is the largest and most ambitious World Bank-financed nutrition project to date. In a country like the DRC where 6 million children currently suffer from malnutrition, tackling stunting is a long-term commitment but also the best investment this country can make_,” said Jean-Christophe Carret, the World Bank Country Director for the Democratic Republic of Congo.

The Multisectoral Nutrition and Health project is expected to benefit 1.5 million pregnant and lactating women and 2.5 million children over five years. Over 200,000 women of reproductive age will also be covered by family planning services. The project will support the government in establishing and scaling up a community health and nutrition platform to deliver an essential package of services, support community mobilization, and strengthen the demand for nutrition-specific and nutrition-sensitive services. It will also strengthen the supply of evidence-based public services.

“The project would lead to improvements in the nutrition status and physical and cognitive development in the children who benefit from it. In the long term, it would help increase productivity when children grow up, generate higher wages and incomes for individuals and households, and faster economic growth at the national level,” said Hadia Samaha and Jakub Jan Kakietek, World BankTask Team Leaders of the project.

The project is aligned with the Government’s priority of building a comprehensive nutrition agenda. Recognizing the impact of malnutrition on human development and economic growth, DRC identified the fight against malnutrition and, more broadly, investments in the early years as priorities in the national strategy for poverty reduction and economic development.

*The World Bank’s International Development Association (IDA), established in 1960, helps the world’s poorest countries by providing grants and low to zero-interest loans for projects and programs that boost economic growth, reduce poverty, and improve poor people’s lives. IDA is one of the largest sources of assistance for the world’s 75 poorest countries, 39 of which are in Africa. Resources from IDA bring positive change to the 1.5 billion people who live in IDA countries. Since 1960, IDA has supported development work in 113 countries. Annual commitments have averaged about $18 billion over the last three years, with about 54 percent going to Africa.

**The Global Financing Facility for Women, Children and Adolescents (GFF) is a multi-stakeholder partnership that is helping countries tackle the greatest health and nutrition issues affecting women, children and adolescents. The GFF Trust Fund acts as a catalyst for financing, with countries using modest GFF Trust Fund grants to significantly increase their domestic resources alongside the World Bank’s IDA and IBRD financing, aligned external financing, and private sector resources. Each relatively small external investment is multiplied by countries’ own commitments—generating a large return on investment, ultimately saving and improving lives.

PRESS RELEASE NO: 2019/090/AFR

Contacts
Kinshasa
Louise Mekonda Engulu
(243) 999 949015
lengulu@worldbank.org

ABSTRACT

The objective of Multisectoral Nutrition and Health Project for Democratic Republic of Congo is to increase the utilization of nutrition-specific and nutrition-sensitive interventions targeting children 0-23 months of age and pregnant and lactating women in the project regions and to respond to an eligible crisis or emergency. The project has 4 components. (1) Improving the delivery of community interventions and social and behavioral change component will support the government in implementing the NAC approach - a standardized community-level delivery platform and package of services whose scale-up could be financed by the Government and development partners either individually or through pooled financing mechanisms. (2) Improving service supply and strategic purchasing component will focus on improving the supply (quantity and quality) of key nutrition-specific and nutrition-sensitive interventions delivered through primary health care facilities and facilitate access to FP counseling and methods through nonstate actors, such as NGO. (3) Convergence demonstration project component will demonstrate the added value of multisectoral convergence to improve nutrition outcomes. The demonstration project will provide unconditional cash transfers to pregnant women and mothers of children 0-23 months of age to improve access to adequate quantity and quality of foods. Targeted cash transfers are a strategy recommended in the most recent DRC SCD (2018) to improve social safety nets. To restore the productive capacity of the households of vulnerable women and children and prevent their relapse into food insecurity and malnutrition, the demonstration project will complement the cash transfers with food production kits for households with food production capacity. The demonstration pilot will also finance the scale-up of the locally-developed biofortified varieties of key crops

View the project documents

The twenty-first meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director-General on 14 May 2019 at WHO headquarters with members, advisers and invited Member States attending via teleconference, supported by the WHO secretariat.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties provided an update on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 19 February 2019: Afghanistan, DR Congo, Indonesia, Nigeria, Pakistan and Somalia.

The committee commended all countries that presented on the quality of information provided, and the transparency with which countries discussed their challenges.

Wild poliovirus

The Committee is gravely concerned by the significant further increase in WPV1 cases globally in 2019, particularly in Pakistan where 15 cases have already been reported. In Pakistan transmission continues to be widespread, as indicated by the number of positive environmental isolates in many areas of the country, and the proportion of samples that detect WPV1 is rising. The recent cluster of cases in Lahore also indicates that vulnerabilities still exist outside the high-risk corridors. Notably, the increased rate of infection during what is usually the low season may herald even higher rates of infection in the coming high season unless urgent remedial steps are taken. The committee was very concerned about attacks on vaccinators and on the police protecting them. The increasing refusal by individuals and communities to accept vaccination also needs to be actively addressed. While the committee understood that the recent elections and political transition may have adversely affected delivery of the polio program, it is now essential that the new government renews its efforts, noting that the eradication program in the country is no longer on-track.

Highlighting these concerns, the committee noted the recent detection of WPV1 in sewage in Iran in an area close to the international border with Pakistan. Based on genetic sequencing, the virus is most closely linked to viruses found recently in Karachi, Pakistan. While there is no evidence currently that transmission has occurred in Iran and routine immunization coverage is high there, this finding together with the resumption of WPV1 international spread between Pakistan and Afghanistan suggests that rising transmission in Pakistan correlates with increasing risk of WPV1 exportation beyond the single epidemiological block formed by the two countries. The Iran event is the first such exportation detected since 2014 and signals that the hard fought gains of recent years can easily be reversed.

In Afghanistan, the critical issue of access is seriously hampering progress towards global eradication and needs to be resolved. Inaccessible and missed children particularly in the Southern Region mean there is a large cohort of susceptible children in this part of Afghanistan. Environmental surveillance has found an increased proportion of positive samples in 2019. The security situation and access will need to significantly improve for eradication efforts to progress.

The Committee noted the continued high degree of cooperation and coordination between Afghanistan and Pakistan, particularly in reaching high risk mobile populations that frequently cross the international border and welcomed the all age vaccination now being taken at key border points between the two countries. In Nigeria, there has been no WPV1 detected for over two and a half years, and it is possible that the African Region may be certified WPV free in early 2020. However, this will require careful assessment of the risk of missed transmission in inaccessible areas of Borno, and in other countries in the region where confidence in surveillance is lacking. The Committee commended the strong efforts to reach inaccessible and trapped children in Borno, Nigeria, even in the face of increased insecurity, and noted that the inaccessible target population was now down to around 60 000 children, scattered across Borno State in smaller pockets. The committee noted the delays between case investigation and final laboratory results in Nigeria and suggested an analysis be undertaken to understand the reasons for this.

**Vaccine derived poliovirus **

The multiple cVDPV2 outbreaks on the continent of Africa are as concerning as the WPV1 situation in Asia. The emergence of new strains of cVDPV2 in areas where mOPV2 has been used, the recent spread of cVDPV2 into southern Nigeria, including the densely populated Lagos region, and evidence of missed transmission in Nigeria and Somalia suggests that the situation continues to deteriorate. Insufficient coverage with IPV exacerbates the growing vulnerability on the continent to cVDPV2 transmission. Early detection of any international spread from the five currently infected countries and prioritized use of mOPV2 is essential to mitigate further depletion of the limited mOPV2 supply. Repeatedly, cases have occurred in border districts (in Nigeria, close to Benin, in DR Congo close to Angola, in Somalia, close to Ethiopia, and in Mozambique, close to Malawi).

The cVDPV1 outbreaks in PNG and Indonesia and cVDPV3 in Somalia highlight the gaps in population immunity due to pockets of persistently low routine immunization coverage in many parts of the world. However, these outbreaks seem to pose a lesser risk of international spread, as bOPV vaccine is already available in the country, and available for traveler vaccination, and global population immunity is far higher than for type 2. It appears likely there has been missed transmission of cVDPV1 in Indonesia although no evidence so far that the virus has spread beyond Papua. Large inaccessible areas of Somalia are a significant constraint on achieving interruption of transmission, exacerbated by large nomadic population movements.

The committee noted that in all infected countries, routine immunization was weak, and coverage remains very poor in many areas of these countries.

Inaccessibility is a major risk to interruption of transmission in Nigeria, Niger, Somalia and Afghanistan, and conflict in these countries and DR Congo makes control of these outbreaks even more challenging.

Conclusion

The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:

Rising risk of WPV1 international spread: The progress made in recent years appears to be reversing, with the committee’s assessed risk of international spread the highest since 2014 when the PHEIC was declared. This risk assessment is based on the following: - the first WPV1 exportation outside of the single epidemiological block of Afghanistan and Pakistan since 2014;
- rising number of WPV1 cases in Pakistan; o rising proportion of environmental samples that are positive for WPV1 in Afghanistan and Pakistan; - widespread detection of WPV1 in Pakistan in environmental samples; o clusters of cases in areas not considered high risk such as Lahore;
- the fact that all of these observations have been made during the part of the year normally considered as low transmission season;
- Increasing community and individual resistance to the polio program.

Rising risk of cVDPV spread: The newly emerged strains of cVDPV2 in Nigeria and DR Congo, and the increased number of infected states / provinces in these two countries, together with evidence of missed transmission in Nigeria, Somalia and Indonesia also suggests the risk of international spread of cVDPV, especially type 2, is rising.

Falling PV2 immunity: Global population immunity to type 2 polioviruses (PV2) continues to fall, as the cohort of children born after OPV2 withdrawal grows, exacerbated by poor coverage with IPV particularly in some of the cVDPV infected countries. Protracted outbreaks: The difficulty in rapidly controlling cVDPV outbreaks in Nigeria and DR Congo is another risk.

Weak routine immunization: Many countries have weak immunization systems that can be further impacted by various humanitarian emergencies, and the number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies poses a growing risk, leaving populations in these fragile states vulnerable to outbreaks of polio. Surveillance gaps: The appearance of highly diverged VDPVs in Somalia and Indonesia are examples of inadequate polio surveillance, heightening concerns that transmission could be missed in various countries. Similar gaps exist in Lake Chad countries and around the Horn of Africa.

Lack of access: Inaccessibility continues to be a major risk, particularly in several countries currently infected with WPV or cVDPV, i.e. Afghanistan, Nigeria, Niger, Somalia and Papua, Indonesia, which all have sizable populations that have been unreached with polio vaccine for prolonged periods.

Population movement: The risk is amplified by population movement, whether for family, social, economic or cultural reasons, or in the context of populations displaced by insecurity and returning refugees. There is a need for international coordination to address these risks. A regional approach and strong cross-border cooperation is required to respond to these risks, as much international spread of polio occurs over land borders.

Risk categories

The Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of WPV1 and cVDPVs, based on the risk stratification as follows:

States infected with WPV1, cVDPV1 or cVDPV3, with potential risk of international spread.
States infected with cVDPV2, with potential risk of international spread.
States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV.

Criteria to assess States as no longer infected by WPV1 or cVDPV:

• Poliovirus Case: 12 months after the onset date of the most recent case PLUS one month to account for case detection, investigation, laboratory testing and reporting period OR when all reported AFP cases with onset within 12 months of last case have been tested for polio and excluded for WPV1 or cVDPV, and environmental or other samples collected within 12 months of the last case have also tested negative, whichever is the longer.
  
• Environmental or other isolation of WPV1 or cVDPV (no poliovirus case): 12 months after collection of the most recent positive environmental or other sample (such as from a healthy child) PLUS one month to account for the laboratory testing and reporting period.
  
• These criteria may be varied for the endemic countries, where more rigorous assessment is needed in reference to surveillance gaps (e.g. Borno).
  

Once a country meets these criteria as no longer infected, the country will be considered vulnerable for a further 12 months. After this period, the country will no longer be subject to Temporary Recommendations, unless the Committee has concerns based on the final report.

Temporary recommendations

States infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread

WPV1

Afghanistan (most recent detection 3 April 2019)

Pakistan (most recent detection 26 April 2019)

Nigeria (most recent detection 27 Sept 2016)

cVDPV1

Papua New Guinea (most recent detection 7 November 2018)

Indonesia (most recent detection 13 February 2019)

cVDPV3

Somalia (most recent detection 7 Sept 2018)

These countries should:

• Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained as long as the response is required.
  
• Ensure that all residents and long-term visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.
  
• Ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers.
  
• Ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the IHR to record their polio vaccination and serve as proof of vaccination.
  
• Restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travelers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea).
  
• Further intensify cross-border efforts by significantly improving coordination at the national, regional and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk cross-border populations. Improved coordination of cross-border efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.
  
• Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
  
• Maintain these measures until the following criteria have been met: (i) at least six months have passed without new infections and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the above assessment criteria for being no longer infected.
  
• Provide to the Director-General a regular report on the implementation of the Temporary Recommendations on international travel.

States infected with cVDPV2s, with potential risk of international spread

DR Congo (most recent detection 8 February 2019)

Mozambique (most recent detection 17 December 2018)

Niger (most recent detection 16 March 2019)

Nigeria (most recent detection 16 April 2019)

Somalia (most recent detection 15 March 2019)

These countries should:

• Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained.
  
• Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, consider requesting vaccines from the global mOPV2 stockpile based on the recommendations of the Advisory Group on mOPV2.
  
• Encourage residents and long-term visitors to receive a dose of IPV (if available in country) four weeks to 12 months prior to international travel; those undertaking urgent travel (i.e. within four weeks) should be encouraged to receive a dose at least by the time of departure.
  
• Ensure that travelers who receive such vaccination have access to an appropriate document to record their polio vaccination status.
  
• Intensify regional cooperation and cross-border coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travelers and cross-border populations, according to the advice of the Advisory Group.
  
• Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
  
• Maintain these measures until the following criteria have been met: (i) at least six months have passed without the detection of circulation of VDPV2 in the country from any source, and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the criteria of a state no longer infected.
  
• At the end of 12 months without evidence of transmission, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.

States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV

WPV1

Cameroon (last case 9 Jul 2014)

Central African Republic (last case 8 Dec 2011)

Chad (last case 14 Jun 2012)

cVDPV

Syria (last case 21 Sept 2017)

Kenya (last env positive specimen 21 March 2018)

These countries should:

• Urgently strengthen routine immunization to boost population immunity.
  
• Enhance surveillance quality, including considering introducing supplementary methods such as environmental surveillance, to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high risk mobile and vulnerable populations.
  
• Intensify efforts to ensure vaccination of mobile and cross-border populations, Internally Displaced Persons, refugees and other vulnerable groups.
  
• Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high risk population groups.
  
• Maintain these measures with documentation of full application of high quality surveillance and vaccination activities.
  
• At the end of 12 months* without evidence of reintroduction of WPV1 or new emergence and circulation of cVDPV, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.
  

**For the Lake Chad countries, this will be linked to when Nigeria is considered no longer infected by WPV1 or cVDPV2.*

Additional considerations

The committee suggested a thorough analysis of the situation in Pakistan be urgently undertaken, to understand what factors have led to the recent but most serious deterioration in polio eradication seen since 2014. Government, program and community factors need to be all included in such a review. Similarly, in Afghanistan there needs to be an analysis of why anti-government elements have withdrawn cooperation with the polio program. These analyses should be used to tailor programmatic responses to the current situation, as current methods appear to be failing. The committee felt that due to the serious risk of failure of eradication, the GPEI leadership including the Director-General of WHO should engage at the level of head of State in polio affected countries, to advocate for greater levels of government ownership of eradication. Noting the environmental detection of WPV1 in Iran, the committee recommended that Iran review its surveillance and immunisation coverage in the affected region, and further requested Iran and Pakistan to consider whether further measures are required on their borders to prevent exportation.

Recognizing the limited tools available to prevent cVDPV2 exportation through traveler vaccination with respect to these outbreaks, the committee urged that all countries neighboring cVDPV2 infected countries urgently review surveillance and immunity indicators, particularly in border zones and other high risk population groups. Early detection of importation events is essential in the current situation, and every effort is needed to avoid missed transmission. Countries at highest risk currently are Benin, Ethiopia, Malawi, and Angola. Other countries in the vicinity must also act quickly to enhance surveillance and preparedness level to be ready to mount effective and timely response in case of any evidence of geographic expansion of outbreak transmission. Ongoing efforts are needed also in Lake Chad basin countries and the Central African Republic.

The heightened risk of international spread of polioviruses should be communicated clearly, including engaging infected and high risk countries at the upcoming WHA.

The situation in Iran needs to be closely monitored, and the committee be updated at the next meeting, or alerted sooner if the situation suggests transmission is occurring there.

Based on the current situation regarding WPV1 and cVDPV, and the reports provided by Afghanistan, DR Congo, Indonesia, Nigeria, Pakistan and Somalia, the Director-General accepted the Committee’s assessment and on 21 May 2019 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 21 May 2019.

2,384,240* South Sudanese refugees in the region as of 30 April 2019 (pre- and post-Dec 2013 caseload).

9,414* South Sudanese refugee arrivals in April 2019.

297,321 Refugees in South Sudan and 1.91 million IDPs including 178,923 in UNMISS Protection of Civilians sites.

KEY INDICATORS

4.4 million - persons of concern (South Sudanese refugees in the region;
South Sudanese IDPs and refugees in South Sudan)

63% of the South Sudanese refugee population are children (under the age of 18 years old)

2,795,827 2019 Regional RRP Planning figure for the total South Sudanese refugees projected in the region by 31 December

Regional Highlights

• On 2 April, the Food and Agriculture Organization (FAO), the World Food Programme (WFP) and European Union released the “Global Report on Food Crises 2019”, revealing that South Sudan is expected to remain among the world’s most severe food crises in 2019 with some 6 million people already affected. The report has also identified conflict as the key driver of food insecurity for the majority of the 113 million acutely food-insecure people globally.

• In April, African Union released the report of the roundtable on root causes and solutions for forced displacement held on 9 February 2019 at United Nations Economic Commission for Africa in Addis Ababa, Ethiopia. While the Global Compact on Refugees and CRRF, and their potential to ensure the socio-economic inclusion of refugees in host communities and enable self-reliance have been highlighted it was also raised that durable solutions for refugees and the internally displaced require the establishment of conditions of normality and inclusion of refugees, IDPs and stateless persons in national development plans to harness their potential.

• On 17th April UNHCR issued an update to its 2015 Position on Returns to South Sudan. The position calls on states to uphold that the bar on forcible return as a minimum standard until such time as the security, rule of law, and the human rights situation in South Sudan significantly improve to permit a safe and dignified return of those determined not to be in need of international protection. Under the current circumstances, UNHCR current stance is that it cannot facilitate, promote or otherwise organize returns to South Sudan.

Ce rapport a été produit par OCHA Nord-Kivu en collaboration avec les partenaires humanitaires. Il est publié par OCHA et couvre la période du 20 au 27 mai 2019.

FAITS SAILLANTS

• Plus de 25 000 déplacés dans le Territoire de Masisi en raison des conflits

• Environ 21 000 déplacés de la Province de la Tshopo installés entre Walikale et Province du Maniema

APERÇU DE LA SITUATION

Depuis fin avril 2019, les affrontements entre groupes armés se sont amplifiés dans le Territoire de Masisi. Selon la Commission nationale pour les Réfugiés (CNR), environ 25 000 personnes fuyant ces violences dans les groupements de Biiri, Banyungu, Buabo et Bapfuna, auraient trouvé refuge dans des familles d’accueil à Masisi (40%), Mulamba (26%) et Nyabiondo (22%). Le reste serait à Kaanja et Lushebere, tandis que 3% des déplacés se seraient installés dans les sites de Kalinga et Bukombo, dans les alentours de Nyabiondo.

La société civile de Nyanzale confirme l’arrivée dans la ville de plus de 4 000 déplacés vivant dans des familles d’accueil depuis le 14 mai 2019. Ces déplacés ont fui les récents affrontements entre les groupes armés dans le Groupement de Kihondo. Selon le point focal de veille humanitaire dans la Zone de santé de Pinga, près de 600 déplacés originaires de la même zone se seraient réfugiés à Rusamambo, à l’est du Territoire de Walikale.

Par ailleurs, la localité voisine de Buleusa a rapporté le retour d’environ 7 700 personnes entre février et mars 2019, suite à l’accalmie sécuritaire. Ces retournés sont venus de Kayna et Kanyabayonga, où ils s’étaient réfugiés en fin 2018 suite aux affrontements récurrents entre les groupes armés. Ni les retournés ni les déplacés n’auraient encore bénéficié d’une quelconque assistance.

Depuis le 20 mai 2019, un climat d’incertitude règne au sein des habitants des localités du nord du Territoire de Beni suite aux activités grandissantes des individus armés. Le 23 mai 2019, Samboko Tsanitsani, une localité située dans le secteur de Beni-Mbau (Territoire de Beni) s’est presque vidée de ses habitants, en raison d’une incursion d’individus armés ; environ 7 300 personnes auraient quitté leurs maisons pour se refugier soit dans les forêts environnantes soit à Mayimoya. Les assaillants auraient pillé plusieurs maisons, boutiques et biens de la population et emporté des produits pharmaceutiques avant d’incendier la formation sanitaire locale. Environ 50 personnes seraient portées disparues.

The Ebola crisis in eastern Democratic Republic of the Congo (DRC) is worsening, and it poses a serious threat to the ongoing humanitarian response on which nearly 13 million people depend for lifesaving aid. As of May 27, 2019, over 1,832 confirmed cases of Ebola have been identified in eastern DRC, and there have been 1,193 confirmed deaths. Substantial community resistance to the response in many communities remains a serious obstacle, as indicated by persistent reports of individuals refusing the vaccine and avoiding treatment centers. In addition, since March there have been nearly 30 violent attacks on Ebola treatment centers and hand washing stations, including the April 19 murder of a WHO doctor during an attack on a hospital in Butembo. As a result of these dynamics, efforts to slow the spread of new infections have been seriously hampered, and there is a severe risk that the disease will spread further south along the main road towards Goma.

The purpose of this brief is to provide donors, NGOs and technical agencies such as the WHO, UNICEF, and OCHA with a snapshot of what the evidence says about why and how to deploy community mobilization in public health emergencies, using a synthesis of the existing literature and a reflection on Mercy Corps’s evidence from a 2015 community mobilization campaign in Liberia. Taking stock of the evidence about what works for community mobilization in Ebola response is crucial at this point in the outbreak, as decisive investments in community mobilization will be necessary to effectively reduce resistance and increase trust and community ownership of the response.

Key Implications

…*for Donors:* Direct funding in 24-month cycles should be targeted to agile partners who are already on the ground in eastern DRC and in at-risk areas of neighboring countries such as South Sudan, Rwanda, and Uganda.

…*for Technical Agencies (WHO, UNICEF, OCHA):* There should be a senior community engagement lead appointed at the highest strategic level to ensure that effective community ownership is being achieved across the response.

…*for NGOs:* Fostering community ownership in a conflict setting will require the commitment of substantial personnel and resources that allow for ongoing learning and adaptation to local perceptions and politics.

Overview and Context

While several previous Ebola outbreaks have taken place in fragile and post-conflict settings, this outbreak in North Kivu and Ituri is different in that it coincides with an active conflict zone with nearly 120 different armed groups that are fighting with each other and with the government. Battles between armed groups and acts of violence against civilians were common in the region before the start of the current Ebola outbreak. These types of violence have continued alongside the spread of the disease and the rise in attacks against the Ebola response. In the month of April 2019 alone, 9 battles between armed groups and 14 acts of violence against civilians were reported in or near the health zones where the outbreak is active.

The current outbreak is also different from other past outbreaks in that it has coincided with a highly disputed election campaign, which was marked by delays in voting, reports of electoral malfeasance that impacted the outcome, and a suspension of voting in areas affected by Ebola. The ongoing violence and contentious political environment have shaped community resistance by encouraging a lack of trust between communities, the government, and responders. Recently published research from the Harvard Humanitarian Initiative shows that in September 2018, 45.9% of surveyed individuals believed at least one incorrect rumor about Ebola, and 60% reported not trusting the government for Ebola response. The March 2019 Social Science in Humanitarian Response compilation of behavioral data confirms that many of the rumors that are based on political conspiracy theories, such as “The Ebola Virus disease was sent here by the Kabila government to take revenge on the people of the great North Kivu, because he understood that he is not welcome here.”

Summary

Democratic Republic of Congo (DRC) declared their tenth outbreak of Ebola in 40 years on 1 August 2018. The outbreak is centred in the northeast of the country. With the number of cases passing 1,000, it is now by far the country's largest-ever Ebola outbreak. It is also the second-biggest Ebola epidemic ever recorded, behind the West Africa outbreak of 2014-2016.

Latest figures - information as of 29 May 2019; figures provided by DRC Ministry of Health.

1,945
TOTAL CASES
1,851
CONFIRMED CASES
1,208
CONFIRMED DEATHS

Retrospective investigations point to a possible start of the outbreak back in May 2018 – around the same time as the Equateur outbreak earlier in the year. There is no connection or link between the two outbreaks.

The delay in the alert and subsequent response can be attributed to several factors, including a breakdown of the surveillance system due to the security context (there are limitations on movement, and access is difficult) and a strike by the health workers of the area which began in May, due to non-payment of salaries.

A person died at home after presenting symptoms of haemorrhagic fever. Family members of that person developed the same symptoms and also died. A joint Ministry of Health/World Health Organization (WHO) investigation on site found six more suspect cases, of which four tested positive. This result led to the declaration of the outbreak.

The national laboratory (INRB) confirmed on 7 August that the current outbreak is of the Zaire Ebola virus, the most deadly strain and the same one that affected West Africa during the 2014-2016 outbreak. Zaire Ebola was also the virus found in the outbreak in Equateur province, in western DRC earlier in 2018, although a different strain than is affecting the current outbreak.

Malaria | The number of health districts that have passed the epidemic threshold has increased and the upward trend is set to continue according to the WHO. As of week 18 (starting 29 April), 13 health districts are above the alert threshold and 24 are above the epidemic threshold. The number of cases recorded since the start of the year now exceeds two and a half million. Returnees | Between January and March, over 5,000 Burundians have been voluntarily repatriated mainly from Tanzania. In addition to this, 4 individuals from Zambia have been repatriated. According to UNHCR’s planning figures, an estimated 116,000 will be repatriated in 2019. Refugees | Since the start of this year an average of 642 people per month continue to seek refuge in neighbouring countries. Tanzania is hosting around 192,000 refugees, Rwanda 71,000, DRC 43,000, and Uganda 40,000. In total there are now 347,000 refugees in neighbouring countries. Natural Disasters | Strong winds and torrential rain in April have led to a six per cent increase in the number of people affected by natural disasters and a similar increase in the number of people displaced.

Paludisme | Le nombre de districts sanitaires qui ont dépassé le seuil épidémique a augmenté et la tendance à la hausse va se maintenir selon l'OMS. A la semaine 18 (à partir du 29 avril), 13 districts sanitaires sont au-dessus du seuil d'alerte et 24 sont au-dessus du seuil épidémique. Le nombre de cas enregistrés depuis le début de l'année dépasse maintenant les deux millions et demi. Les rapatriés | Entre janvier et mars, plus de 5 000 burundais ont été rapatriés volontairement, principalement de Tanzanie. En outre, quatre personnes originaires de Zambie ont été rapatriées. Selon les chiffres de planification du UNHCR, on estime que 116 000 personnes seront rapatriées en 2019. Réfugiés | Depuis le début de cette année, 642 personnes en moyenne par mois continuent de chercher refuge dans les pays voisins. La Tanzanie accueille environ 192 000 réfugiés, le Rwanda 71 000, la RDC 43 000 et l'Ouganda 40 000. Au total, il y a maintenant 347 000 réfugiés dans les pays voisins. Catastrophes naturelles | Les vents violents et les pluies torrentielles d'avril ont entraîné une augmentation de six pour cent du nombre de personnes touchées par les catastrophes naturelles et une augmentation similaire du nombre de personnes déplacées.

A decline in the number of confirmed Ebola virus disease (EVD) cases has been reported this week (22 to 28 May). Over the past seven days, a total of 73 new confirmed cases were reported compared to the previous where 127 new confirmed cases were reported. This should be interpreted with caution given the complex operating environment and fragility of the security situation. Katwa, one of the epicenters of the outbreak, reported fewer cases this week and other health zones such as Mabalako, Kalunguta and Mandima have also seen a decline in case reporting. Active transmission was reported in 14 of the 22 health zones that have been affected to date. Other initial encouraging findings such as a lower proportion of reported nosocomial infections, a lower proportion of community deaths and a higher proportion of registered contacts at case detection have also been reported. Weekly fluctuations in these indicators have been reported in the past and uncertainties remain with regards to the ability of the surveillance system to identify all new cases in areas faced with ongoing insecurity. Operations are still regularly hampered by security issues, and the risk of national and regional spread remains very high.

Mabalako reported 24% (73/309) of the new confirmed cases in the past 21 days. Nine out of the 12 Mabalako health areas have reported new confirmed cases during this period. In the 21 days between 8 to 28 May 2019, 83 health areas within 14 health zones reported new cases, representing 46% of the 180 health areas affected to date (Table 1 and Figure 2). During this period, a total of 309 confirmed cases were reported, the majority of which were from the Mabalako (24%, n=73), Butembo (21%, n=64), Katwa (14%, n=42), Beni (11%, n=34), Kalunguta (10%, n=31), Musienene (7%, n=23) and Mandima (6%, n=20) health zones.

As of 28 May 2019, a total of 1945 EVD cases, including 1851 confirmed and 94 probable cases, were reported. A total of 1302 deaths were reported (overall case fatality ratio 67%), including 1208 deaths among confirmed cases. Of the 1945 confirmed and probable cases with known age and sex, 58% (1122) were female, and 29% (572) were children aged less than 18 years. The number of healthcare workers affected has risen to 108 (6% of total cases).

All alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries continue to be monitored and investigated. To date, EVD has been ruled out in all alerts outside the outbreak affected areas. On 3 June, a pilgrimage is planned to Namugongo, Uganda to commemorate the death of Catholics and Anglican martyrs. Preparedness activities surrounding the pilgrimage are ongoing.

EVD Cases in Under Five-Year Olds

WHO periodically conducts in-depth epidemiological analyses so that data can help reveal any gaps and drive evidence-based response improvements. An in-depth analysis of EVD cases in children under five-years of age demonstrated some noteworthy trends. As of 28 May, children under the age of five accounted for 15% (300/1949) of EVD cases reported, with children under one year of age accounting for 6% (118/1949). Of the 300 cases in children under the age of five, 19 were probable cases (19/94, 20% of all probable cases).

Data indicate that children under the age of five are being brought into healthcare facilities sooner than cases over the age of five (2.4 days vs. 3.2 days respectively), but most of these cases are not being referred to ETCs, and instead attend multiple local healthcare facilities. These cases visited on average 1.5 healthcare facilities, compared to 1.2 healthcare facilities for cases aged over five-years of age. These observations show that in general, parents are willing to seek medical attention for their children at healthcare facilities but are reluctant to bringing their children to ETCs, perhaps out of fear of being far from home and without the support of family members. More work needs to be done to reduce fear and misunderstanding of ETCs and to reduce any other barriers to access, with a special focus on this age group. All cases that may not be adequately isolated including children under five-years of age may pose a considerable transmission risk to healthcare workers, patients, and members of the community.

With regards to contact-tracing, 28% of EVD cases under five-years of age are registered as contacts, compared to 41% in cases over five-years of age. Although EVD cases under five years of age are less frequently listed as contacts, proportions of cases both below and over five-years of age are under surveillance remain similar (18% vs. 20% respectively). The reasons underlying these low figures are unclear at this time and further investigations are ongoing.

As of 28 May, the overall case fatality rate (CFR) of EVD cases in children under the age of five stands at 77%. This CFR was notably higher than that of EVD cases over five-years of age at 57%. These figures are in line with those observed in the 2014 West Africa EVD outbreak1 . There are a number of possible explanations for the higher CFR in this vulnerable population: the lower proportion of cases that present to ETCs, higher baseline mortalities in this population in general, and the inability to vaccinate cases who were not listed as contacts. Community deaths (i.e. any EVD deaths occurring outside of Ebola treatment centres/Transit centres (ETCs/TCs) account for 76% of deaths due to EVD in children under the age of five and 65% above the age of five. Of the community deaths of children under the age of five, 54% died in a healthcare facility.

As expected, the CFRs of EVD cases both younger and older than five-years of age (50% and 39% respectively) who sought treatment at ETCs is markedly lower than those who did not (86% and 68% respectively). The relative difference in CFRs between the two groups reduces upon admission into an ETC. This again reinforces the need to continue strengthening efforts to work with communities to encourage all affected populations, and in particular parents of young children, to seek treatment at ETCs as early as possible in order to give them the best chance of survival. Overall, the fact that these observed trends indicate that while it is promising to see lower CFRs in young children treated in ETCs, and to see that parents are willing to seek medical attention for their children at healthcare facilities, much emphasis needs to be made at improving contact listing of children under five years of age and encouraging parents to bring their children to be treated in ETCs. It must also be stressed that the proportions and resultant associations described above must be interpreted with caution given the often-limited demographic information available and are subject to change due to the fluid nature of the ongoing EVD outbreak.

Efforts are ongoing to encourage community-based facilities to refer suspected cases to ETCs/TCs, however these activities can be further strengthened. Children of all ages, including infants, that have suspected or confirmed EVD, are cared for at ETUs with specific optimized, supportive care protocols. Paediatric-specific equipment, medicines and trained specialists are available to provide clinical support at ETCs for this age group. All confirmed children are also rapidly enrolled in investigational therapeutic protocols after informed consent is obtained. Children receive nutritional care and psychosocial support from psychologists while at the ETC and are cared for 24/7 by care providers from survivors so they are not alone. As with all age groups, infants and young children are offered support via a specialized programme of care for Ebola survivors. In addition, pregnant women that have survived EVD are followed closely in the survivor program and return to ETCs for delivery by a multi-disciplinary team that has obstetric and paediatric expertise.

In light of these findings, UNICEF and WHO are working with partners in supporting activities related to nutritional care and psychosocial support of EVD patients, particularly for parents and children. These include supporting and providing information related to infant feeding for children separated from their parents or orphaned. UNICEF is working with EVD survivors and creating infant and young child feeding (IYCF) counselling support groups. They are also supporting the screening of malnourished children under two years old and their referral to Nutritional Units for assistance. Psychosocial support and material assistance are being conducted in outbreak areas where nurseries for children who have been separated from their mothers are set up and psychosocial support is provided to family members accompanying EVD affected persons and their contacts.

Public health response

For further detailed information about the public health response actions by the MoH, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:

• Ebola situation reports: Democratic Republic of the Congo

WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last assessment concluded that the national and regional risk levels remain very high, while global risk levels remain low. Weekly increases in the number of new cases has been ongoing since late February 2019. A general deterioration of the security situation, and the persistence of pockets of community mistrust exacerbated by political tensions and insecurity, have resulted in recurrent temporary suspension and delays of case investigation and response activities in affected areas, reducing the overall effectiveness of interventions. However, recent community dialogue, outreach initiatives, and restoration of access to certain hotspot areas have resulted in some improvements in community acceptance of response activities and case investigation efforts. The high proportion of community deaths reported among confirmed cases, relatively low proportion of new cases who were known contacts under surveillance, existence of transmission chains linked to nosocomial infection, persistent delays in detection and isolation in ETCs, and challenges in the timely reporting and response to probable cases, are all factors increasing the likelihood of further chains of transmission in affected communities and increasing the risk of geographical spread both within the Democratic Republic of the Congo and to neighbouring countries. The high rates of population movement occurring from outbreak affected areas to other areas of the Democratic Republic of the Congo and across porous borders to neighbouring countries during periods of heightened insecurity further compounds these risks. Additional risks are posed by the long duration of the current outbreak, fatigue amongst response staff, and ongoing strain on limited resources. Conversely, substantive operational readiness and preparedness activities in a number of neighbouring countries have likely increased capacity to rapidly detect cases and mitigated local spread. However, these efforts must continue to be scaled-up at this time.

WHO advice

WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

For more information, please see:

• The Ongoing Ebola Epidemic in the Democratic Republic of Congo, 2018–2019
• WHO resources and updates on Ebola virus disease
• Highlights from the April 2019 meeting of the IHR Emergency Committee on the EVD outbreak in the Democratic Republic of the Congo
• WHO Interim recommendation Ebola vaccines
• WHO recommendations for international travellers related to the Ebola Virus Disease outbreak in the Democratic Republic of the Congo
• UNICEF Ebola crisis
• Ebola virus disease in the Democratic Republic of the Congo – Operational readiness and preparedness in neighbouring countries
• Ebola virus disease fact sheet

Polio this week as of 29 May 2019

• Health leaders at the World Health Assembly last week in Geneva, Switzerland, welcomed the new Polio Endgame Strategy 2019-2023, and acknowledged that while a lot had been accomplished, more efforts were needed in order to achieve a lasting polio-free world by 2023. More.
• Following the group’s meeting earlier this month, the latest report of the International Health Regulations (IHR) Emergency Committee is available. The Committee evaluated the latest global poliovirus epidemiology and concluded that the effort to eradicate polio remained a Public Health Emergency of International Concern (PHEIC). More.
• In Cameroon, a circulating vaccine-derived poliovirus type 2 (cVDPV2) was detected from an environmental sample collected on 20 April 2019 in Extreme Nord. The virus was detected in an environmental sample only – no associated cases of paralysis have been detected. See ‘Lake Chad Basin’ section below, for more details.
• Summary of new viruses this week: Pakistan – two wild poliovirus type 1 (WPV1) cases and six WPV1-positive environmental samples; Afghanistan – one WPV1-positive environmental sample; Nigeria – two circulating vaccine-derived poliovirus type 2 (cVDPV2)-positive environmental samples; Somalia – one cVDPV2 case; Cameroon – one cVDPV2-positive environmental sample; and, Iran – one WPV1-positive environmental sample. See country sections below, for more details.

La crise alimentaire qui sévit en République démocratique du Congo (RDC) est la deuxième crise alimentaire dans le monde en termes de gravité après celle au Yémen, a déploré jeudi le Programme alimentaire mondial (PAM) lors d’un entretien avec ONU Info.

Selon le Représentant du PAM en RDC, Claude Jibidar, les nombreux conflits qui secouent le pays depuis plus de deux décennies et qui ont connu une intensification depuis 2016, notamment dans l’Est et le Sud-Est, ont provoqué un déplacement dramatique de populations rurales qui vivent de l'agriculture.

« Les paysans en RDC mangent parce qu’ils peuvent cultiver et récolter, mais comme nous avons eu jusqu’à 4,5 millions de personnes déplacées dans ces zones rurales. Ce sont des gens qui n’ont pas pu continuer à cultiver. Cela a continué pendant plusieurs saisons agricoles et la situation s’est détériorée avec le temps », a expliqué M. Jibidar lors de cet entretien avec ONU Info.

Environ 13 millions de Congolais vivent dans une insécurité alimentaire extrême, dont 5 millions d’enfants, et les évaluations en cours montrent que la tendance à l’aggravation de l'insécurité alimentaire se poursuit, a averti le PAM.

Une action axée sur les déplacements et le retour

Pour répondre à cette crise, le PAM continue de renforcer son aide alimentaire et nutritionnelle en ciblant 5,1 millions de personnes cette année, dont 1,5 million reçoivent une assistance nutritionnelle.

L’agence se concentre notamment sur l’aide aux personnes déplacées en visant les sites de déplacés mais aussi les sites de retour.

« Les déplacements en RDC sont fréquents mais ils ne sont pas nécessairement de longue durée. Ce sont des conflits spontanés qui font que les gens vont fuir leur village. Alors on essaie d’aider les gens à retourner chez eux », a expliqué le Représentant du PAM. « En RDC, on peut voir deux ou trois récoltes par an, donc si vous aidez les gens à planter dans l’espace de quelques mois vous leur donnez la capacité de pouvoir se prendre en charge en termes de nourriture ».

Sauver et changer des vies

Malgré la complexité de la crise en RDC, le PAM ne sauve pas seulement des vies, mais aussi s'efforce de les changer.

L’agence travaille sur le lien « aide humanitaire-développement-paix » en soutenant la sécurité alimentaire et la nutrition par l’agriculture, l’autonomisation des femmes et la consolidation de la paix.

Elle essaie de lier l’aide à des actions à plus long terme pour aider les populations à faire face aux chocs, que ce soient les chocs liés aux problématiques climatiques, aux conflits et aux déplacements, dont ceux provoqués par l’arrivée de populations déplacées dans des communautés d’accueil.

« Vous avez souvent des situations ou une famille de 6 ou 7 personnes accueille une douzaine d’autres personnes, et bien sûr ils vont partager leurs ressources ce qui fait que la famille hôte réduit ses propres ressources très rapidement et se retrouve elle-même en situation d’insécurité alimentaire », a souligné M. Jibidar.

« Donc, aider ces gens à produire plus et à produire mieux, à avoir un peu plus de ressources pour prendre en charge ces personnes déplacées, ça permet de ne pas avoir une situation humanitaire catastrophique au bout de quelques mois », a-t-il ajouté.

En partenariat avec l'Organisation des Nations Unies pour l'alimentation et l'agriculture (FAO), le PAM a intensifié ses interventions en matière de résilience afin de toucher 450.000 petits exploitants et leurs familles cette année. Selon le PAM, la RDC pourrait produire toute la nourriture dont elle a besoin et devenir un exportateur de denrées alimentaires.

Le Représentant du PAM souligne aussi l’importance d’investir dans la résilience. Apporter une assistance alimentaire à plus de 5 millions de personnes par an en RDC « n’est pas viable » pour le PAM.

« Ce que l’on voudrait, c'est faire en sorte que ces gens arrivent à se prendre en charge et que l’on puisse se tourner vers d’autres priorités que de donner à manger aux gens dans un pays qui peut produire plus que sa population ne peut manger », a-t-il conclu.

SITUATION

• Nearly one million people in southern Malawi were affected by Tropical Cyclone Idai, which made landfall in early March and resulted in heavy rainfall and flooding, destroying houses, crops, and infrastructure. As a result, households in flood-affected areas are expected to face Stressed (IPC 2) and Crisis (IPC 3) levels of food insecurity through September, due to a loss of crops, livestock, and livelihoods, according to the Famine Early Warning Systems Network (FEWS NET).* Despite an estimated loss of 175,000 acres of crops due to flooding, the overall 2019 crop harvest is projected to be well above 2018 production, sustaining Minimal (IPC 1) levels of food insecurity across areas of the country less-affected by flooding.

• Malawi also hosts more than 38,000 refugees, primarily from Burundi, the Democratic Republic of the Congo, and Rwanda, the majority of whom are dependent on humanitarian assistance to meet their daily food needs.

RESPONSE

• USAID’s Office of Food for Peace (FFP) partners with the UN World Food Program (WFP) in Malawi to provide cyclone-affected populations with cash transfers for food, with which recipients can purchase urgently-needed supplies in local markets. FFP also supports WFP to strengthen the technical capacity of the Government of Malawi to coordinate and provide emergency assistance, including the distribution of maize from the national grain reserve to food-insecure communities across the country.

• Additionally, WFP carries out food-for-asset activities. In exchange for participation in creating or rehabilitating community assets that support resilience from recurrent shocks, households receive assistance to meet basic household food and nutrition needs.

• FFP also partners with the UN Children’s Fund (UNICEF) to provide specialized nutritious products to children experiencing severe acute malnutrition.

• Through its partnership with Catholic Relief Services (CRS) and Project Concern International, FFP supports long-term development activities that reduce chronic malnutrition and food insecurity, as well as build resilience to environmental shocks in food-insecure and disaster-prone districts of southern Malawi. Furthermore, the FFP partnership with CRS supports the USAID Feed the Future initiative to help smallholder farmers improve productivity and increase income, in coordination with the Government of Malawi.

The following syndromes have been flagged:

• Acute Fever and Rash: Palau

• Dengue-like illness: Solomon Islands

• Influenza-like illness: Kiribati

Other updates:

Dengue

• Palau: dengue serotype-3 outbreak is ongoing. As of 26 May 2019 there have been 196 cases since 7 December 2019; there were 9 cases reported between 20 – 26 May. There have been no deaths reported. [Source: Palau Ministry of Health dengue SitRep posted on PacNet on 29 May 2019]

• On 27 May, a health alert on dengue was issued by the Wallis and Futuna Islands Territory Health Agency following reports of two new cases of dengue in Wallis. [Source: Government]

• Increase in Dengue-like illness cases reported by Solomon Islands for week ending 26 May 2019.

Influenza

• Flu cases and deaths in Western Australia are much higher this year, says the state health department. To date, it has recorded 3,013 cases and 10 deaths compared to compared to 1,151 cases and 4 deaths for the same period last year. [Source: Media]

Ebola Virus Disease (EVD)

• Democratic Republic of Congo: As of 28 May 2019, the cumulative number of cases is 1,945 cases (1,851 confirmed, 94 probable) including 1,302 deaths (CFR 66.9%) reported from 22 health zones in North Kivu and Ituri Provinces. On 7 May 2019, the Strategic Advisory Group of Experts (SAGE) issued new vaccination recommendations, including adjusting vaccine dosages, expanding vaccine eligibility, ring vaccination operational improvements, and strengthening training of local healthcare workers to aid in the EVD response. The full recommendations are available here. Latest updates are available in the DRC Ministry of Health situation report and AFRO EVD situation report. Regular updates are published in WHO’s Disease Outbreak News.

Kampala, 30th May 2019:- The government of Uganda and partners have so far invested over 18 million dollars in Ebola Virus Disease (EVD) preparedness and readiness. This was revealed at the just concluded Accountability Forum organized by the Ministry of Health at which partners shared information on their contribution in the EVD preparedness efforts in the country.

The funds have been utilized to implement various activities under the various pillars of the preparedness response and significant progress has been made. For instance, under case management, 526 health workers in 14 districts have been trained on the appropriate handling of suspected EVD patients while taking sufficient protection measures for themselves. These health workers are now available for rapid deployment to any part of the country where EVD may occur.

In addition, Ebola Treatment Units (ETUs) have been constructed in which the trained health workers can take care of patients. The centres are in Kasese (Bwera), Bundibugyo, Wakiso (Entebbe), Kabarole, Kabarole, Kikuube and Ntoroko districts. Two additional ETUs are under construction in Kanungu district and Naguru in Kampala city. Isolation units have also been established in Arua, Gulu and Mbarara districts.

The Accountability Forum was informed that presently, 9,806 health workers in 562 health units located in 11 high-risk districts of the Rwenzori sub-region have been trained and mentored on EVD Infection Prevention and Control (IPC). This is a critical aspect in the EVD response as many health workers are known to have acquired the infection, lost their lives and further perpetuated the disease through poor IPC practices. In efforts to ensure further health workers’ safety against EVD, 4,419 frontline health workers in 13 districts have been vaccinated against the Ebola-Zaire virus subtype that is currently circulating in DRC with a high possibility of spillover to Uganda given the proximity of the epicentre.

EVD preparatory efforts have also been augmented with the training of 404 health workers in 13 districts on Psychosocial support and in addition, 17 districts now have trained and fully equipped teams ready to conduct safe and dignified burials.

For community education and awareness, over two million people have been reached through interpersonal communication and house to house visits using trained Village Health Teams (VHTs), civic leaders, religious and cultural leaders and volunteers. In the high-risk districts, over 12,000 people in these categories have been trained and deployed for this purpose.

Radio talk shows, announcements and television messages have supplemented the awareness activities and currently, 21 FM radio stations in 30 districts are broadcasting EVD messages. Printed material such as posters, leaflets and fliers in English and local languages have been distributed as well.

Regarding logistics, the Accountability Forum was informed that partners have provided over 30 Viral Haemorraghic Fever (VHF) kits that are a requirement in EVD responses. In addition, all high-risk districts have been supplied with IPC materials to be able to prevent infections in health facilities or in communities while conducting investigations.

Border entry points and Entebbe International Airport have had their staff trained in EVD detection and equipped with infrared thermometers and thermo-scanners to do the job. Presently, three thermo-scanners- two at Entebbe airport and one at Mpondwe Customs post have been installed and are facilitating the quick screening of travellers for EVD. Over 100 EVD suspected people have been detected through these efforts, their samples collected, tested at the Uganda Virus Institute and fortunately, all have been found to be negative for the disease.

To facilitate evacuation and transfer of patients, surveillance and community engagement activities, partners have provided eight brand new ambulances, two pickups and forty motorcycles to the Ministry of Health and the high-risk districts.

Addressing the forum, Uganda’s Minister of Health, Dr Jane Ruth Aceng emphasized the need to now move from preparedness to readiness. “We need to ensure that Uganda is ready to respond to disease outbreaks, this way we shall have achieved all the dedication and time we have invested since August 2018, when the outbreak in DRC was announced,” she said.

Similarly, Dr Bayo Fatumbi who represented WHO at the forum commended the government for the leadership noting that “we have managed to keep the outbreak out of Uganda for this long and this is definitely due to the commitment of the government and partners. We, however, need to do more.”

Indeed despite the progress reported, the forum was informed that more work still needs to be done in areas such as waste management at lower health facilities, interactions with regular travellers to and from DRC as well as Congolese refugees resident in Kampala city and Wakiso district.

Strengthened cross border collaboration, community engagement and expansion of preparedness activities to other districts were also pointed out as critical. Vaccination of more frontline health workers was also highlighted as requiring urgent attention.

Partners commended for working closely with government on this endeavour include Center for Disease Control, United States Agency for International Development, Department for International Development, Irish AID, International Organization on Migration, Médecins Sans Frontières, Samaritan Purse, Save the Children, Uganda Red Cross Society, United Nations High Commissioner for Refugees, United Nations Children's Fund, World Food Program and the World Health Organization among others.

Messages clés

Selon les prévisions climatiques de la NOAA, les précipitations sur la RDC bimodale dans l’Est seront inférieures à la moyenne jusqu'à la fin de la saison B (janvier à juillet) en cours dans le Nord-est et Centre-est avec un cumul de 90 pourcents de la normale. Cette situation présage des récoltes moyennes spécialement pour les vivriers dans le Rutshuru et le Masisi au Nord Kivu.

Au cours des trois derniers mois, différents groupes armés multiplient des attaques et des exactions dans les territoires de Masisi et Rutshuru au Nord-Kivu, tandis que dans les territoires voisins (Beni et Lubero), on observe une perturbation globale des activités agricoles et un accès limité aux moyens d’existence par les populations. Cette situation pourrait compromettre la production agricole dans cette partie de l’Est considérée comme grenier agricole de la région.

Les affrontements inter-ethniques qui continuent entre les Banyamulenge et Banyindu dans la commune de Minembwe, province du Sud-Kivu, ont occasionné le déplacement d’environ 20,000 ménages depuis mars 2019, abandonnant leurs moyens d’existence. Cette situation arrive en période charnière de transhumance pour les éleveurs et de préparation de récolte pour les agriculteurs en cette saison B en cours, ce qui rendrait la période de soudure plus précoce que d’habitude.

En dépit des efforts du gouvernement et des acteurs humanitaires, la maladie à virus Ebola dans la partie Nord-est du pays persiste, le mécanisme de riposte est saboté par certains groupes armés y opérant. On note, à ce jour, l’augmentation des nouveaux cas confirmés qui va d’une moyenne de deux cas par semaine au premier trimestre à huit cas par semaine actuellement. Cette situation réduit la participation des ménages aux activités agricoles et présage court terme, des faibles disponibilités alimentaires dans cette région.

La poursuite des activités des grandes récoltes de la campagne agricole 2018-19 dans la partie Sud-est du pays coïncide à l’interdiction d’importation du mais de la Zambie, ce qui limitera les disponibilités pour ce produit dont la dépendance à la Zambie est estimée à 70 pourcents. Cela pourrait faire augmenter les prix du maïs sur les marchés du Sud-est et limiter son accès aux ménages.

Contents

261 Meeting of the Strategic Advisory Group of Experts on immunization, April 2019 – conclusions and recommendations

Sommaire

261 Réunion du Groupe stratégique consultatif d’experts sur la vaccination, avril 2019 – conclusions et recommandations

Health & Nutrition key highlights

In Adjumani district, 185 measles cases, inclusive of nine (4.9%) refugees have so far been reported and managed in Adjumani district from 01 February to 31 March 2019. A Total of seven deaths, including a one year old refugee child, has so far been reported (case fatality rate of 3.8%). The cumulative attack rate for the district is 50 measles cases per 100,000 population.

Following achievement of 27,907 (95% ) and 31,527 (92%) coverage for measles and polio vaccination during the first round of the multi-antigen vaccination campaign in February 2019 respectively, the second round of multi-antigen vaccination campaign was conducted in Imvepi and Rhino camp refugee settlements from Friday 29th March to Sunday 31st March.

Infants and children 6- 59 months received BCG, Polio, DPT, Hepatitis B, Heamophillus Influenza B and those that missed the first round received measles vaccination.

Measures put in place to control the outbreak included: cases management in health facilities for detecting the cases; health education in health facilities and community sensitization; active and passive search for measles cases; vitamin A supplementation of all children aged 6 –59 months; targeted immunization of all children aged 6 – 59 months in affected sub counties; and, multi- antigen vaccination campaign in refugee settlement for children aged 6 – 59 months with coverage of 96%; and routine immunization continued in all immunizing facilities for children aged 6 -12 months