http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbFri, 20 Nov 2009 16:34:04 GMTDAKAR Friday, November 20, 2009 (IRIN) - Children’s rights advocates are taking 20 November, the 20th anniversary of the Convention on the Rights of the Child (CRC), to highlight legal advances, but say when it comes to education, healthcare and protection in conflicts and natural disasters, children are often the first to be deprived of their rights. DAKAR Friday, November 20, 2009 (IRIN) - Children’s rights advocates are taking 20 November, the 20th anniversary of the Convention on the Rights of the Child (CRC), to highlight legal advances, but say when it comes to education, healthcare and protection in conflicts and natural disasters, children are often the first to be deprived of their rights.

“The Convention has revolutionized the way children are viewed in our societies,” said Susanna Vilaran with the UN Committee on the Rights of the Child in a 20 November communiqué. “In many countries…governments, individuals and most importantly children, know [children] should be treated with respect.”

The CRC is the most widely ratified human rights treaty.

Legal instruments introduced as a result of the CRC include the 2005 UN Security Council Resolution 1612, which established a mechanism to track six violations of children’s rights in conflict, including rape, abduction, killing and maiming, and recruitment into armed forces.

The CRC also triggered regional child rights acts and policies, including the 1999 African Charter on the Rights and Welfare of the Child and the European Commission’s launch of a child rights strategy.

“The CRC has encouraged politicians to listen to children’s views and pushed their rights up the political agenda,” said Save the Children’s child rights adviser and advocate Jennifer Grant.

She pointed to a 2001 decision by the Indian Supreme Court directing the government to provide free lunches in government primary schools. This has turned into the world’s largest mid-day meal programme, reaching over 100 million children, according to Grant.

In another case the European Court of Human Rights ruled that the Czech Republic had practiced racial discrimination in 2007 by wrongly channeling Roma children into remedial schools; the court awarded damages to affected families.

Rights have no meaning if you can’t hold people to account when they are broken

National level improvements include the incorporation of children’s codes into 70 countries’ national legislation, say child rights groups.

Many national poverty reduction strategies are beginning to call for more funding for children’s access to healthcare, education and social services, say Economic Community of West African States (ECOWAS) president Mohammed Ibn Chambas and UN Children’s Fund (UNICEF) West Africa director Gianfranco Rotigliano in a joint statement.

“[When] children are better fed, and have access to health facilities...there is a multiplier effect in that the family and community economy is boosted and people may stand a chance of moving beyond the subsistence level,” Rotigliano told IRIN.

However 77 million primary-school-age children worldwide are not in school while millions of children are unable to access even basic healthcare, according to the UN.

In West Africa three million children die before age five annually and 25 million are out of school, according to UNICEF.

For Save the Children’s Grant more accountability is critical. When children’s rights are violated and the national legal system does not protect them, children cannot access an international complaints procedure, she said. “This is a case of age discrimination. Every other UN treaty with reporting obligations has such a mechanism.”

An “era of enforcement” is needed to improve the lives of children, said Grant. National governments must make their laws comply with the CRC. “Rights have no meaning if you can’t hold people to account when they are broken.”

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http://www.irinnews.org/report.aspx?ReportId=87142HODEIDAH Thursday, November 19, 2009 (IRIN) - Nearly half of children in rural areas of the western Yemeni governorate of Hodeidah, have no access to basic education, according to a new report by the Seyaj Organization for Childhood Protection (SOCP) and the Yemen News Agency.HODEIDAH Thursday, November 19, 2009 (IRIN) - Nearly half of children in rural areas of the western Yemeni governorate of Hodeidah, have no access to basic education, according to a new report by the Seyaj Organization for Childhood Protection (SOCP) and the Yemen News Agency.

A survey was conducted on a random sample of 3,249 boys and girls from 1,542 families in the districts of Lihyah, Zahrah and Beit al-Faqih, said Fahd al-Sabri, lead author of the report.

The survey results, announced on 18 November, indicate that 45 percent of boys and 52 percent of girls in the 6-15 age group have no access to basic education - for several reasons, including vulnerability of their families, lack of schools and teachers, or schools being far away from their homes, al-Sabri told IRIN.

In two villages (each having an average of 110 children), the enrolment rate was zero, he said, adding: "96 percent of mothers and 65 percent of fathers in surveyed families [there] cannot read and write.”

According to the government's Central Statistical Organization, 1.5 million of Hodeida's 2.4 million people live in rural areas.

There is no doubt that school enrolment rates for some governorates, including Hodeida, remain a huge concern for Yemen, Naseem Ur-Rehman, a spokesman for the UN Children's Fund (UNICEF) in Yemen, told IRIN.

Enrolment rates for primary, secondary and tertiary schools in Yemen, where nearly 42 percent of its 22 million population lives below the poverty line, is 55.2 percent, according to the UN Development Fund (UNDP) [http://www.undp.org.ye/y-profile.php].

Poverty

Rampant poverty is forcing thousands of rural families to send their children to the city to beg or work in the streets, cleaning cars or toiling in restaurants or `qat’ (mildly narcotic leaf frequently chewed by Yemenis) markets at the expense of their education, according to Talal al-Dubai, supervisor of a Hodeida orphanage.

“In 2008, we gathered up to 240 street children, rehabilitated them and sent them back to their families,” al-Dubai told IRIN. “We enrolled 180 of them (under age 10) in schools, gave them bags, uniforms, and reached agreements with school administrations to exempt them from tuition fees, while those aged 10-17 had access to vocational training in order to help them support their vulnerable families.”

The report recommended that children from vulnerable families be exempted from tuition fees and given transport and grants to boost enrolment in schools.

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http://www.irinnews.org/report.aspx?ReportId=87112MONROVIA Thursday, November 19, 2009 (IRIN) - In Liberia rape survivors are increasingly speaking up and seeking help as awareness of rights increases, but social taboos persist and seeking justice does not always mean that justice is served.MONROVIA Thursday, November 19, 2009 (IRIN) - In Liberia rape survivors are increasingly speaking up and seeking help as awareness of rights increases, but social taboos persist and seeking justice does not always mean that justice is served.

Sexual violence consistently comes first or second (after armed robbery) in monthly police crime listings in the capital Monrovia. The majority of rape victims are children, according to treatment centre statistics. Médecins Sans Frontières (MSF) in Monrovia reports their youngest survivor at 21 months old.

“The civil war is over,” said Monrovia resident Tupee Kiadi. “But the new war is rape, especially targeting teenagers and babies. During the war we had peacekeepers to prevent further violence…but women do not have peacekeepers to stop rape.”

During the war women and girls were subjected to rape (commonly gang rape) and sexual slavery, many becoming pregnant from rape. Since peace was sealed in 2003, sex crimes – and impunity – have persisted throughout the country.

Awareness up

MSF launched a campaign on 26 October with the message “Rape is a hospital and clinical business”, to bring rape out into the open and to educate Liberians about the free MSF-run medical and psychological services at Island Hospital in Tweh Farm, western Monrovia.

Clinic visits are up over recent years, said MSF psychologist Elias Abi-aad, who hopes further awareness has been raised by the campaign.

Elizabeth Zro, a social worker and counsellor at the clinic, told IRIN, “Rape is a huge problem here, but people are more open about it now than they used to be a few years ago.”

The MSF clinic takes in on average 70 patients per month, 80 percent of whom are girls under 18; just under half of those aged 12 and under.

In addition to a medical examination, survivors are given protection from sexually transmitted infection, means to block HIV infection and pregnancy if it is within 72 hours of the crime, a medical certificate that can be used in court and several rounds of counselling.

Deweh Gray, president of the Association of Female Lawyers in Liberia (AFELL), told IRIN: “The changing attitude we see is the increased reporting of these cases by people who want to access the system.”

Taboo persists

While awareness has improved, rape is still taboo in many families, said counselor Zro. “Lots of communities question it – ‘Did he really rape you?’ they ask.”

The silence extends to any subjects surrounding sex, family planning or reproductive health, she added.

Some NGOs, including Catholic Relief Services, are trying to encourage families to openly discuss sexual violence and sexual health, and to educate children about “good” and “bad” touching.

Only by facilitating discussion can the stigma be broken down, CRS health and nutrition officer Suena Sambola told IRIN.

Seeking justice

AFELL, along with the UN Population Fund (UNFPA) and other institutions helped the Liberian government set up a special court on rape and sexual violence in September 2008 and is now trying to encourage more survivors to bring cases forward.

So far the court has processed just four cases. There is still a big discrepancy between the number of medical cases reported and the number of police reports filed county by county, according to Sadiq Syed, Gender Based Violence (GBV) adviser at UNFPA.

This is partly because it still takes so long for national courts to pass cases onto the special court, he added.

But he said the system should speed up now that public defenders are in place, and the ministries of gender, social welfare and justice are starting to work more closely on sexual violence issues.

“We realize everyone is anxious to see cases being tried but…the dynamics of a rape trial are not easy,” AFELL’s Gray told IRIN. Delays in cases mean witnesses may disappear or evidence is destroyed, which means some cases are dropped.

UNFPA supports the government on SGBV issues, and has trained half of Liberia’s 400 magistrates in witness protection, confidentiality and other areas vital to making a rape trial work.

Just 5 percent of Liberia’s magistrates went to law school said Syed.

Felecia Coleman, chief prosecutor at the sexual violence court, told IRIN over 140 people in Montserrado County are awaiting trial on rape charges. “The fact that people are in prison and trials are going on for rape is a good signal in the fight,” she said.

But more training is needed for staff of the police’s women and child protection section, aid workers say. And more social workers are needed to counsel victims said Abi-aad.

“The government is taking rape seriously but more social workers are needed…rape is mainly a psychological issue,” he told IRIN.

UNFPA is working with the Ministry of Social Welfare to try to train more social workers to support survivors, said Syed.

Women continue to live in fear, Monrovia inhabitant Macdell Smallwood, aged 13, told IRIN. “Because of rape cases in Monrovia I am afraid to even move around with my friends…We cannot go out or play freely, as we used to when we were younger.”

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http://www.irinnews.org/report.aspx?ReportId=87122JOHANNESBURG Wednesday, November 18, 2009 (IRIN) - Good quality food aid can save billions of dollars that would otherwise be spent on saving lives, says a major report from the World Bank, one of two new studies that uncover some unsettling facts about food aid and malnutrition. JOHANNESBURG Wednesday, November 18, 2009 (IRIN) - Good quality food aid can save billions of dollars that would otherwise be spent on saving lives, says a major report from the World Bank, one of two new studies that uncover some unsettling facts about food aid and malnutrition.

Spending US$200 to treat a severely malnourished child can save $1,351 in treating nutrition-related illnesses, said the report, Scaling up Intervention: What will it cost? which argued that "The cost of not intervening ... is much higher. The benefits from iron fortification of staples and salt iodization alone are estimated at $7.2 billion per year."

The 2007/2008 food price crisis, followed by one of the worst economic recessions in recent times, has revived the humanitarian aid world's interest in malnutrition, especially in the quality of food aid being dispensed.

The other report, Malnutrition: how much is being spent? by international medical charity Médecins Sans Frontières (MSF), agreed with the World Bank's conclusion in that food aid abysmally fails to meet nutrition requirements.

Food aid does not necessarily focus on the "window of opportunity" from pregnancy until a child turns two, when children and women are most vulnerable, said Meera Shekar, a leading health and nutrition specialist at the World Bank and co-author of its report.

"Rarely does the food aid target the most vulnerable groups: children under five, pregnant women and lactating mothers," said Stéphane Doyon, a co-author of the MSF report.

Donors spent very little on nutrition - barely 1.7 percent of development and emergency food aid between 2004 and 2007 actually addressed malnutrition, said MSF.

Doyon said their analysis suggested that donors should maximise the value of funding by ceasing in-kind donations and provide cash instead, allowing aid agencies to source cheaper or more appropriate food in the region or beneficiary country. However, donor countries in the European Union (EU) and Canada, which had recently moved to provide cash, were not spending enough on nutrition.

The World Bank report noted that addressing malnutrition in the 36 countries where 90 percent of the world's most malnourished children live would be relatively cheap - only $11.8 billion to step up 13 proven nutrition interventions from current coverage to 100 percent of the target population.

Scaling up these programmes which include providing fortified food, deworming tablets and promoting breastfeeding could save the lives of more than 1.1 million children younger than five in these countries, where an estimated eight million children die of malnutrition-related causes every year.

The World Bank report takes a comprehensive look at the nuts and bolts of nutrition interventions like providing micronutrient-fortified foods, and not only details how much each intervention should be stepped up, but also its impact in monetary value.

Children who received fortified complementary food before they were three years old grew up to be more economically productive, said the World Bank study, citing an investigation led by John Hoddinott, a senior research fellow at the International Food Policy Research Institute (IFPRI), published in the British medical journal, The Lancet, in 2008.

The World Bank study represented "A careful attempt to assess what resources are needed to put a significant dent in malnutrition around the world ... [the] striking feature of these estimates is, in fact, how small these financial requirements are," Hoddinott told IRIN.

"For a fraction of the amount of money spent on bailing out financial institutions, governments around the world could significantly reduce micronutrient deficiencies and dramatically reduce the incidence of stunting."

The global economic slowdown, combined with high food prices, has added some 100 million people around the world to those already living in chronic hunger and poverty in 2008, according to the UN Food and Agriculture Organization (FAO).

Between 3.5 million and 5 million children under five years of age die every year from malnutrition-related illnesses, accounting for 11 percent of the global burden of disease, according to the reports.

The MSF study said about 40 percent of nutrition funding flows were allocated to sub-Saharan Africa, where the main recipient countries included Sudan, Ethiopia, Somalia, Niger, Kenya, Zimbabwe and the Democratic Republic of Congo; almost 18 percent of the funds went to South and Central Asia; the remainder was "unspecified".

The nuts and bolts

Of the $11.8 billion the World Bank said was needed to address malnutrition in the 36 countries, $1.5 billion could be contributed by wealthier households in the beneficiary countries to purchase iodized salt and fortified staple foods, such as flour, which were available locally.

The World Bank study found that undernutrition was surprisingly high, even among the wealthiest populations. "For example, in India, Bangladesh, and Ethiopia, respectively 20, 30, and 37 percent of children under the age of five in the highest-income quintiles are underweight."

The remaining $10.3 billion could buy vitamin A supplements, iron-folic acid tablets, and staple foods fortified with iron, among others, for several million children and mothers.

Besides rescuing lives, these interventions could save an estimated 30 million disability-adjusted life-years (DALYs) or years lost to premature death and disability, as well as the money needed to treat patients and provide care.

Severe acute malnutrition could be halved from the current prevalence of 19 million; an estimated 138,000 of the current 276,000 annual deaths would be averted by preventive measures; a further 50,000 deaths would be averted by treating severe acute malnutrition.

The World Bank study recommended scaling up interventions in two phases: expanding the distribution of micronutrients, and educating people about eating healthy food in Phase 1; providing complementary or therapeutic foods to prevent and treat moderate malnutrition in children younger than two, and spending on resource-intensive interventions to treat severe malnutrition in Phase 2.

However, MSF's Doyon pointed out that prevention and treatment had to run concurrently. "What's the point in educating people about micronutrient interventions when they will have to wait to access them?"

What about the money?

The World Bank study suggested that the allocation of funds in recipient countries would be made more efficient by filling the gaps in costed and agreed-upon national strategies, and noted that this perception was growing.

In a complementing move, several developed countries, including those in the EU, have "either developed new nutrition strategies or position papers on food security, or seem poised to do so".

"It's about changing the mindset from providing food aid to assistance, keeping the people's needs in mind," said Doyon.

The authors of the World Bank report were upbeat over the recent announcement by the G8 group of industrialised countries in L'Aquila, Italy, that an additional $20 billion over three years would be spent on food security.

There is also a possibility that Canada will pursue this agenda when the G8 meets next, in 2010, by moving "from food security to nutrition security", offering "yet another opportunity for financing the nutrition scale-up".

jk/he http://www.irinnews.org/report.aspx?ReportId=87106KABUL Tuesday, November 17, 2009 (IRIN) - The government has decided to reopen all schools from 23 November to 12 December to allow 7.5 million schoolchildren across Afghanistan to take exams.KABUL Tuesday, November 17, 2009 (IRIN) - The government has decided to reopen all schools from 23 November to 12 December to allow 7.5 million schoolchildren across Afghanistan to take exams.

On 1 November Afghanistan’s National Disasters Management Commission declared an H1N1 health emergency and ordered a shutdown of all schools and universities for three weeks. Up to nine million students and teachers were affected by the decision which was also criticized by some observers as "politically motivated". [http://www.irinnews.org/Report.aspx?ReportId=86858]

Universities will remain closed and students will have to take their annual exams in the spring of 2010, officials said.

Over the past month more than 500 H1N1 cases and 14 fatalities have been confirmed, according to MoPH. In total over 820 H1N1 cases (Afghans and foreigners) have been reported since July 2009.

"Certainly we are concerned about the health of students during the exams," Faizullah Kakar, deputy minister in the Ministry of Public Health (MoPH), told IRIN, adding that the UN World Health Organization (WHO) in Geneva was consulted on the reopening of schools.

Schools in the cold regions (65 percent of schools) will be closed until March 2010 but in warmer regions - such as Kandahar, Khost and Nangarhar provinces - school will resume after 12 December, according to the Ministry of Education (MoE).

Preventive measures

MoE has given assurances strong H1N1 preventive measures will be implemented during the school exams.

"Students must wear warm clothes, avoid hand-shaking and wear masks where possible," Abdul Sabour Ghufrani, an official of the MoE in Kabul, told IRIN.

"Classrooms should be kept warm during the exams and students should be advised to comply with health and hygiene standards," said an MoE statement on 17 November. The exams will take place 10am-2pm.

MoE has procured “some” masks which will be distributed to the most vulnerable and poor students while the rest will be advised to buy them, Ghufrani said.

"Students [schoolchildren] who show signs of flu but do not wear masks will not be allowed to take the exams," he said, adding that these schoolchildren would have to take their exams in February 2010.

Washing hands with warm water and soap several times a day has been strongly recommended by health specialists as an effective measure to prevent contracting the highly contagious H1N1 virus, but soap is not available in Afghan public schools: "We do not have resources to buy soap and place it in all schools," Ghufrani said.

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http://www.irinnews.org/report.aspx?ReportId=87078KAMPALA Tuesday, November 17, 2009 (IRIN) - Africa will fail to achieve most UN Millennium Development Goals unless countries adopt effective family planning programmes and control rapid population growth, experts warn.KAMPALA Tuesday, November 17, 2009 (IRIN) - Africa will fail to achieve most UN Millennium Development Goals unless countries adopt effective family planning programmes and control rapid population growth, experts warn.

"Africa has not done well in areas of family planning," Khama Rogo, World Bank senior adviser, said. "It is not that we cannot do well; we have not committed ourselves... family planning and population growth have a cross-cutting impact."

Rogo was speaking at a three-day international conference on family planning, organized by the Gates Foundation and Johns Hopkins and Makerere universities that began on 16 November in the Ugandan capital, Kampala.

More than 1,000 policy-makers, researchers, academics and health professionals from 59 countries are attending. Various speakers warned that the rate of Africa's population increase was too rapid, with women in some countries having on average seven children each.

"Family planning improves maternal health, thereby increasing women's productivity and reducing dependency at both family and national levels," Chisale Mhango, director of reproductive health at Malawi's Health Ministry, told IRIN.

"Fewer children means manageable education targets; more children means that parents will mainly educate sons, which promotes gender inequality," he added. "The fewer the children the better the care, the more the food, the lower the child mortality and there will be savings for health provision."

Malawi’s population is projected to reach 41 million by 2040 from 13 million currently. Child spacing, Mhango said, would reduce the economic burden on poor Malawian families, allowing them to invest more in each child’s care and education. This would improve family nutrition, education levels and living standards.

Education crucial

Worldwide, 200 million women seek to prevent unplanned pregnancies but cannot access contraception. This demand is estimated by the UN to grow by 40 percent by 2050 as young people enter prime reproductive ages.

Michael J. Klag, dean of the school of public health at Johns Hopkins, called for community education to ensure successful family planning policies.

"Populations need to grow and economies grow, but this must be done in such a way that ensures the health of our children," he said.

According to the World Bank, demographic health service surveys in Africa show that family planning needs have not been met by up to 30 percent, and by up to 41 percent in countries like Uganda.

"People want the services, but they cannot access them," Rogo told the meeting. "Statistics indicate that we have more people to feed, but few hands to work. We have a very big dependent population in Africa [because] 60 percent of the population is under the age of 15."

Some specialists at the conference called for more focus in global debates on the impact of population on climate change.

"If we are going to destroy our forests to create more homes and more farming areas, what will be the impact on the climate?" asked Jason Bremner, programme director in charge of population, health, environment at the Population Reference Bureau.

"There is a relationship between population growth and carbon emission which is as a result of human consumption," he added.

Humanitarian risk

The conference also seeks to lobby policy-makers to increase funding for family planning. This, participants said, would reduce global humanitarian risks.

"With higher population growth, there would be less land per holder and existing holdings would be divided among more family members," said Clive Mutunga, research associate with Population Action International.

"Smaller farms are less productive overall than larger holdings, which will lead to perennial food insecurity as land productivity reduces due to over-exploitation," Mutunga added.

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http://www.irinnews.org/report.aspx?ReportId=87081LUSAKA Monday, November 16, 2009 (IRIN) - Abigail Mwanashimba has been looking after her five siblings since the age of eight, when her parents died of AIDS-related illnesses. She is now 19 years old, and without relatives to represent her at her lobola (bride price) negotiations, she was forced to hire traditional counsellors to organise the process of marriage according to the tribal customs. They did a bad job.LUSAKA Monday, November 16, 2009 (IRIN) - Abigail Mwanashimba has been looking after her five siblings since the age of eight, when her parents died of AIDS-related illnesses. She is now 19 years old, and without relatives to represent her at her lobola (bride price) negotiations, she was forced to hire traditional counsellors to organise the process of marriage according to the tribal customs. They did a bad job.

"I don't know anything about my tribe or its culture because there has never been anyone to teach or show me," she told IRIN/PlusNews. "I got very little lobola, but the last straw was the humiliation I suffered at my in-laws' home, when I embarrassed them by performing the wrong dance."

Losing out on the bride price was one thing, but when she realised that the counsellors she had hired had taught her the wrong traditional dances, she refused to pay them their 500,000 Zambian kwacha (US$100) fee, and is now facing a lawsuit.

Agnes Ngubeni, from the central town of Kabwe, also knows this kind of humiliation; she has lived with the embarrassment of not having undergone an initiation ceremony when she came of age, and not being able to speak the language of her tribe.

"People called us goats ... they said we were 'cultureless' and were not educated in the ways of our tribe. It never occurred to them that there was no-one to teach us - we lived without elders," she said.

Ngubeni and her siblings were orphaned fifteen years ago when her oldest brother was just 10. A Norwegian family living in Zambia committed itself to looking after them, which meant they were clothed and fed, but this presented them with social problems.

Their neighbours ridiculed them for eating pasta, bread and rice, instead of the staple, nshima - thick maize-meal porridge - that neither she nor her three sisters can cook.

"The neighbours laughed at us for eating the white man's food, which they said was not real food, but what are we supposed to do? We eat what we are given. That's just how it is," Ngubeni said.

Ngubeni recommends that people helping child-headed families should consider placing an adult relative or any other person of the same tribe among them to guide and mentor them in the ways of traditional society.

Out of touch with culture

In its latest report on Orphans and Vulnerable Children (OVC), the UN Children's Fund (UNICEF) found that about 20,000 households in Zambia were led by children, but the number is increasing.

The report outlines the severe deprivations of food and shelter these children often face, and concludes that with more youngsters having to take on the responsibilities of running a household at an early age, there is every likelihood that more of them will end up on the street.

Joseph Banda heads Tisunge, a local organisation that assists child-headed households to deal with the trauma of loss, and teaches them income-generating and life skills, so that the children are able to fend for themselves and can continue their schooling.

Banda said it had never occurred to him that these children would struggle with cultural issues. "I am ashamed to say that I never saw the children's situation in this way," he admitted.

"We are so engrossed in keeping the children off drugs and alcohol, and the girls from getting pregnant, and making sure that they become good citizens, that we lose sight of the fact that children need to be socialised in the ways of their tribe."

Child psychologist Trina Mayope warned that children growing up without the value of custom and tradition would have problems in future. "It's about growing up with a cultural identity ... The children feel isolation because the communities treat them as aliens, or as something not quite right because of their seeming lack of 'traditional etiquette'."

There is also the stigma attached to being orphaned by HIV/AIDS, as is mostly the case. "If these children don't conform to the cultural norms of the society they live in they will suffer a double discrimination," she noted.

Mayope acknowledged that urbanisation and the passing of time had caused people to discard many traditions, but the basics of culture were still important and largely defined how someone was perceived.

"It's difficult for most people to comprehend how a child can grow up without knowing anything about his or culture. People think they [children] are trying to act like a muzungu [European], but when you have children whose mentor is a fellow child, how are they supposed to learn traditional norms and customs?"

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http://www.irinnews.org/report.aspx?ReportId=87056HARADH Monday, November 16, 2009 (IRIN) - Aid workers at al-Mazraq camp for internally displaced persons (IDPs) in Haradh District, Hajjah Governorate, northernYemen, say more and more children are arriving at the camp in a state of moderate or severe malnourishment.HARADH Monday, November 16, 2009 (IRIN) - Aid workers at al-Mazraq camp [http://www.irinnews.org/Report.aspx?ReportId=87005] for internally displaced persons (IDPs) in Haradh District, Hajjah Governorate, northernYemen, say more and more children are arriving at the camp in a state of moderate or severe malnourishment.

"During our tent visits, we found that an average family has a severely or moderately malnourished child," said Sarah Yahya, a volunteer working with the UN Children’s Fund (UNICEF) on identifying malnourished children.

Khalid Shaibani from the UNICEF-run therapeutic feeding centre (TFC) at the camp told IRIN the number of malnourished children was increasing by the day as new IDP families arrived.

"Two babies died from malnutrition complications just a few days after their families secured shelter in the camp. Another 10 were referred to a hospital in Haradh town, 40km west of the camp," he said.

Of the 3,000 under fives targeted by a recent screening in the camp, 667 cases (22 percent) were severely malnourished and 200 (6.67 percent) moderately malnourished, according to Shaibani.

In September UNICEF screened about 1,200 under-five IDP children in the camp and found 7 percent severely malnourished. [http://www.irinnews.org/Report.aspx?ReportId=86423]

Ali Mahdi is one of the parents who brought his two young children to the TFC.

"Faris's arms and legs are getting thinner and thinner by the day. No food remains in his stomach for more than 10 minutes due to very bad diarrhoea and vomiting. He hardly stands up or sits down and spends most of the time lying on his back," said the father of the four-year-old boy.

Mahdi, his wife and their six children fled their home in the Dhafir District, Saada Governorate, to the Saudi border in mid-August because of fighting between government troops and Houthi-led insurgents. Whilst taking refuge there, they had very limited access to food, Mahdi’s wife, Khudhra, told IRIN.

After a Saudi army operation against Houthi insurgents in the border area in early November, the family was forced, along with hundreds of others, to flee again. [http://www.irinnews.org/Report.aspx?ReportId=86977]

Chronic malnourishment

Rajia Ahmed Sharhan, a nutrition officer with UNICEF in Sanaa, said moderate malnourishment is not very visible.

“Probably malnourishment was there among some children before the displacement occurred, but was not very visible. When the families had to flee and had problems with accessing proper and nutritious food for weeks, those moderate cases became severe,” she said.

"We cannot say that the war situation is the only source of the problem because mothers neglect their babies and don't know how to feed them. Several cases had shown chronic malnutrition," said UNICEF volunteer Yahya.

Tent visits to increase mothers' awareness on how to care for their babies, as well as to promote breastfeeding, revealed that many mothers often gave their babies tea with bread in the morning and at night, which can lead to anaemia and malnutrition, Yahya said, adding: "If water is given in lieu of tea, symptoms will be milder.”

"Even worse, mothers with newborns come to us and ask for milk powder, preferring it to breastfeeding. They aren't aware of the benefits of breastfeeding for their babies," Yahya said.

According to the World Health Organization, only 11.5 percent of mothers in Yemen exclusively breastfeed their babies until they are six months old. [http://www.who.int/nutrition/databases/infantfeeding/countries/yem.pdf]

Plumpy’Nut treatment

TFC provides different types of therapeutic formula to affected children, depending on how serious the case is, TFC's Shaibani said. "Acute moderate cases get two sacks of Plumpy’Nut [http://www.irinnews.org/report.aspx?ReportId=72897] a day while severe cases with serious complications are given concentrated proteins and vitamins through nasogastric tubes in the camp's clinic."

He said 75-percent fat milk is given to infants with oedema (an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body), usually caused by malnourishment complications. "If no improvement is noticed, the centre refers critical cases to the Haradh-based hospital or to Sabin Hospital in Sanaa."

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http://www.irinnews.org/report.aspx?ReportId=87062GARISSA Monday, November 16, 2009 (IRIN) - Armed with a university certificate, Hubbie Hussein Al-Haji returned to her pastoralist community in Garissa, northeastern Kenya, expecting to serve as a veterinary health assistant. But she was refused the job.GARISSA Monday, November 16, 2009 (IRIN) - Armed with a university certificate, Hubbie Hussein Al-Haji returned to her pastoralist community in Garissa, northeastern Kenya, expecting to serve as a veterinary health assistant.

But she was refused the job. "When I came back to Garissa [Northeastern Province capital], I was told you [a woman] cannot treat our animals because you menstruate - it will make our cows perish," she told IRIN.

Al-Haji and a colleague then started a local NGO, WOMANKIND Kenya (WOKIKE) to provide leadership training to women. They also set up a sanctuary for girls at risk of female genital mutilation/cutting (FGM/C).

"Girls are often seen as an object for the pleasure of men," Al-Haji said. In her community, FGM is a highly valued ritual, marking the transition from childhood to womanhood.

At present, the centre is supporting 120 girls aged around six years old because they are at risk of FGM/C from age eight. The girls, most of whom have escaped FGM/C, are enrolled on the recommendation of the government children's department and the community.

"When we started the campaign against FGM, the community turned against us; it was a taboo subject," Al-Haji explained. "The most difficult men to work with were the educated ones who see you [an educated woman] as a challenge."

With time, WOKIKE received the support of local religious leaders, most of whom are Muslim. "[Now] the religious leaders are telling the community that FGM is not a religious obligation," she said.

One success story has strengthened Al-Haji’s resolve to support disadvantaged women in northeastern Kenya. Hafsa, who has been supported by the centre for 14 years, is about to join the University of Nairobi to study pharmacy.

"I was rescued from traditional practices like FGM and early marriage," Hafsa told IRIN, adding that she came to the centre from Ijara [a district south of Garissa] at four.

"You are discriminated against either way by the community if you have not been circumcised and by friends in schools outside northeastern if you have been circumcised," Hafsa, who went to a high school in eastern Kenya, said.

At least 32 percent of Kenyan women have undergone FGM/C, according to a report by the Population Council. Among communities such as the Somali, Abagusii, Kuria, Maasai and Samburu, more than 90 percent of women undergo it.

Women’s work

The situation of girls and women in neighbouring Wajir is no better, said Haretha Bulle, a programme manager with the Wajir South Development Association (WASDA).

"In a typical Somali household, the woman's labour is needed for cooking, taking care of small babies, and it is for this [reason] that girls are often pulled out of school," Bulle told IRIN.

A lack of awareness of the value of education and no boarding-school facilities for girls has had adverse effects.

"There is no man who will trust his daughter to go to school [alone] in town without her mother," she noted. "Yet for you to go to high school you have to go to primary [school]."

Many of the girls suffer FGM/C and cannot report the practitioners. "In April, a girl who underwent FGM bled to death. The circumciser was arrested, and then released," she said.

"They are often very old women who sometimes cannot even see," Bulle added. "FGM/C cannot go away overnight. You cannot tell the Somali not to circumcise - though they don't like the Pharaonic type."

The Pharaonic form of FGM, also known as infibulation, involves the total removal of all external sex organs before the vagina is sewn up, leaving a small opening for the passing of menstrual blood.

At home, the girls too are exposed to gender-based violence, but the communities do not see it as a problem, Bulle added.

"If you try to intervene, you end up being accused by the woman herself of interfering," she explained. "[However], I cannot say that the [reported] cases of rape here are alarming."

The bigger problem was lack of support systems. "Care services for abused women in this part of the country are almost non-existent," she said. For instance, if a woman has been raped, "PEP [post-exposure prophylaxis] ... [is] only in the books in this part of the world". PEP services within 72 hours of HIV exposure help to prevent infection.

High divorce rates

In the town of Moyale, along the border with Ethiopia, women and girls were seen as "inferior" to men, assistant chief for Odda location, Rashid Osman, said.

"A woman can get married but at the end when there is a divorce, she does not get her rights," he said. "Here, people seem to marry and divorce anyhow. Consequently, there are many divorcees and neglected children."

Despite awareness-raising, traditional perceptions are hard to change. "You hear men saying that by the end of the next rains, I must marry a fourth wife then I will go for Hajj. You would expect Hajj to be more of a priority," he said.

"Sometimes people marry for very strange reasons... like to take care of the cows since the town is growing and herders have to go further out to the fields."

Across northeastern Kenya, said Rashid Karayu, chairman of the Global Integrated Development Programme, a local NGO, women were more disempowered than in other areas.

"The perception from the people and even the women themselves is that they are inferior," he told IRIN. "Even in school committees, women who are best placed to speak for their children often shy away."

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http://www.irinnews.org/report.aspx?ReportId=87063MUZZAFARABAD Sunday, November 15, 2009 (IRIN) - Rameesha Butt, 12, remembers being trapped in her classroom as the horror of the October 2005 earthquake that killed at least 73,000 people in the North West Frontier Province (NWFP) and Pakistan-administered Kashmir unfolded around her.MUZZAFARABAD Sunday, November 15, 2009 (IRIN) - Rameesha Butt, 12, remembers being trapped in her classroom as the horror of the October 2005 earthquake that killed at least 73,000 people in the North West Frontier Province (NWFP) and Pakistan-administered Kashmir unfolded around her.

“Our school was very old, and many of the walls collapsed. I was not hurt badly, but it was terrifying to see bricks and mortar fall all around us. Some pupils were trapped under the rubble,” Rameesha told IRIN.

According to government estimates, the quake damaged or destroyed 6,000 schools – making up around 52 percent of schools in the quake-affected area. Some 17,000 students and 900 teachers were killed in classrooms.

For years after the quake, children have studied in makeshift classrooms. Now, under an initiative by the UN Children’s Fund (UNICEF) and the Earthquake Relief and Rehabilitation Authority (ERRA) in conjunction with the Ministry of Education, 100 new schools have been built and handed over to provincial authorities.

The new schools are more spacious than the ones they replace, with at least one square metre of classroom space per child. Hand-washing stations have also been set up to promote good hygiene. Under the ‘build back better’ motto adopted after the quake, the new schools are also designed to be earthquake resistant and to offer a more child-friendly learning environment.

“Our aim is to ensure children receive the best possible education,” Syed Fawad Ali Shah, emergency education officer for UNICEF Pakistan, said. He said teachers at the schools had been trained in child-friendly teaching methods and corporal punishment had been banned.

“Not scared anymore”

Pupils of Government Girls Primary School Mohajir Colony in Muzaffarabad, capital of Pakistan-administered Kashmir, are among those who now have a brand new school. The girls, who for months after the quake had huddled in a freezing tent-school, were visibly excited about their new earthquake-resistant building.

“We are not scared anymore because this is a new building, not like our old school,” Shahzia Ali Lone, a fourth grade student, said.

Parents across the area hit by the quake are also relieved that their children can go to school in safety. “For over a year after 2005, I was scared of sending our three children to school. So many children had died in classroom collapses, but now there are better schools for them and we are confident they will receive a good education,” Aziz Ahmed, 40, said.

“There is no greater investment in the future of a country than an investment in the education of the children” Luc Chauvin, deputy representative for UNICEF Pakistan, said. “In partnership with ERRA, the Ministry of Education and provincial authorities, we have not just constructed schools, but have taken an important step toward ensuring that children in the areas affected by the 2005 earthquake have access to a higher quality education than ever before.”

kh/edhttp://www.irinnews.org/report.aspx?ReportId=87042DUBAI Friday, November 13, 2009 (IRIN) - An estimated 200 million children aged under five in the developing world suffer from stunted growth due to maternal and childhood undernutrition, according to a new UNICEF report. DUBAI Friday, November 13, 2009 (IRIN) - An estimated 200 million children aged under five in the developing world suffer from stunted growth due to maternal and childhood undernutrition, according to a new UNICEF report. http://www.unicef.org/publications/index_51656.html

“Stunting is associated with developmental problems and is often impossible to correct. A child who is stunted is likely to experience a lifetime of poor health and underachievement,” a UNICEF statement on 11 November said.

In the Middle East, the Occupied Palestinian Territories have a stunting prevalence of 10 percent, a surprisingly better result than other, far wealthier neighbours, which have the following scores:

Lebanon - 11
Jordan - 12
Oman - 13
UAE - 17
Saudi Arabia - 20
Kuwait - 24
Iraq - 26
Syria - 28
Egypt - 29
Yemen – 58

at/oa/cbhttp://www.irinnews.org/report.aspx?ReportId=87018BANGKOK Friday, November 13, 2009 (IRIN) - A recent spate of natural disasters in Asia has further underscored the importance of breastfeeding during emergencies, with a need for additional policies to support this.BANGKOK Friday, November 13, 2009 (IRIN) -  A recent spate of natural disasters in Asia has further underscored the importance of breastfeeding during emergencies, with a need for additional policies to support this.
 
Hundreds of thousands were displaced and forced into evacuation shelters following a series of deadly typhoons in the Philippines, Cambodia, Vietnam and Laos, and an earthquake in Indonesia in the past two months.
 
But according to experts, during such disasters, support for mothers to breastfeed is often overlooked and not given the priority it needs, despite its life-saving function.
 
Besides raising awareness of the importance of breastfeeding, aid organizations need to have policies on infant feeding, they say.

“You have to have a strong policy in place, and make sure all the actors and all the staff in that organization know about this policy,” Anna Winoto, a nutrition specialist with the UN Children’s Fund (UNICEF) in Indonesia, told IRIN.
 
In emergency situations, poor water and sanitation and security situations contribute to a heightened risk of disease among children, who are vulnerable to diarrhoea, malnutrition and pneumonia.
 
Practices such as using infant formula milk, when water may be contaminated and feeding bottles cannot be sterilized, contributes to the risk and has been shown to lead to an increase in diarrhoeal disease in infants.
 
“Breastfeeding is actually even more crucial under emergency conditions because children under five, and infants in particular, are at an increased risk of infection, disease and malnutrition,” Winoto said.
 
“Breastfeeding should be seen as a life-saving intervention,” she said.
 
In an emergency situation, establishing private spaces for mothers and infants, one-to-one counselling and mother-to-mother support is needed to encourage breastfeeding, say UNICEF and the World Health Organization (WHO).
 
“As part of emergency preparedness, hospitals and other healthcare services should have trained health workers who can help mothers establish breastfeeding and overcome difficulties,” said WHO Director-General Margaret Chan in a statement to mark World Breastfeeding Week in August.
 
Both UNICEF and WHO advocate exclusive breastfeeding for children up to six months of age, and continued breastfeeding and complementary feeding until age two.
 
Dangerous donations
 
But one obstacle to breastfeeding during emergencies is unsolicited or uncontrolled donations of breast-milk substitutes, which undermine breastfeeding, according to UNICEF and WHO.

Following a 7.9 magnitude earthquake in West Sumatra on 30 September, UNICEF Indonesia, worked with the country’s Health Ministry, and contacted local and national radio stations to broadcast requests to stop milk-substitute donations.
 
“It’s a huge problem, and the problem lies in the lack of knowledge among the donors on the potential harm,” said Winoto.
 
Meanwhile, coordination in emergencies also remains a challenge, with little capacity to locate only those children who truly need infant formula and not disrupt breastfeeding practices, she said.
 
“In our experience, it’s gotten better but it’s still a huge challenge because there are so many actors when an emergency comes, and so many donations,” she said.
 
Helping with trauma
 
Besides the health benefits, breastfeeding advocates underline the psycho-social benefit of maintaining the activity during an emergency, which is traumatic for babies and young children, experts say.
 
“In an emergency, keeping the baby on the breast is not only about nutrition, it is giving the child that security and closeness when it is scared,” Elvira Henares-Esguerra, director of the Philippine NGO Children for Breastfeeding, [http://breastfeedingphilippines.com/cfb.html] told IRIN.
 
In the aftermath of Typhoon Ketsana, which caused massive flooding in the Philippines in September, Henares-Esguerra and a handful of breastfeeding mothers with their children visited an evacuation centre.
 
They demonstrated breastfeeding practices, and encouraged displaced mothers to do the same.
 
“We discovered that infant formula was being given out by the government at evacuation centres,” said Henares-Esguerra.
 
“We wanted to encourage the mothers to breastfeed,” she said.

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http://www.irinnews.org/report.aspx?ReportId=87020WAJIR Friday, November 13, 2009 (IRIN) - Khadijah Ibrahim is a mother of six in the northeastern Kenyan district of Wajir East. The area has suffered recurrent droughts and is now facing the risk of flooding from El-Nino rains. For now, however, the effects of the drought continue to be felt, as Khadijah told IRIN: WAJIR Friday, November 13, 2009 (IRIN) - Khadijah Ibrahim is a mother of six in the northeastern Kenyan district of Wajir East. The area has suffered recurrent droughts and is now facing the risk of flooding from El-Nino rains. For now, however, the effects of the drought continue to be felt, as Khadijah told IRIN:

"My husband, who is a nomadic pastoralist, moved away with the livestock when the drought became very serious and some of the animals started dying, but we are hopeful that he will return now that the rains have started.

"When he left, my children and I were left behind as usual. We could not go with him as the children were already enrolled in school here.

"Sometimes my husband is gone for long but he always sends back some money from the grazing fields for the upkeep of the family. He sends the money with the drivers along the highway.

"But the money has been reducing as some of the livestock died along the way. Now my husband has been sending me less money yet the prices of food have gone up because of the drought.

"The children are not able to get milk since all the cows have moved away. With the drought, the price of milk from goats, cows and camels has all gone up. We are now buying a litre of goat’s milk at 120 shillings [US$1.6]. Camel milk, which used to be the cheapest, is now selling at about 70 shillings [90 US cents].

"But we are expecting the price of milk to go down, as with the rains, the animals will return.

"The price of food is still high with a kilogram of maize flour now selling at 80 shillings [$1.06] - up from 60 [80 US cents] in September. The price of meat, milk and vegetables has also gone up.

"Getting food is hard for most families here in Wajir but I would say that I am a little luckier as I live closer to the town [Wajir]."

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http://www.irinnews.org/report.aspx?ReportId=87025KABUL Thursday, November 12, 2009 (IRIN) - The sixth and last polio immunization campaign in 2009 begins on 15 November across Afghanistan: Up to eight million under-five children are expected to receive the oral vaccine, according to the Ministry of Public Health (MoPH).KABUL Thursday, November 12, 2009 (IRIN) - The sixth and last polio immunization campaign in 2009 begins on 15 November across Afghanistan: Up to eight million under-five children are expected to receive the oral vaccine, according to the Ministry of Public Health (MoPH).

About 54,000 volunteers and health workers will conduct the exercise, despite insecurity which is increasingly impeding humanitarian access.

"The MoPH has not engaged in direct talks with the armed opposition for access but through tribal elders we have tried to raise awareness about the importance of polio vaccination for all children," Farid Raaid, MoPH's spokesman, told IRIN.

In September Taliban insurgents reportedly endorsed a three-day polio immunization [http://www.irinnews.org/Report.aspx?ReportId=86136] in areas under their influence.

Five polio immunization campaigns have been carried out so far in 2009: Some threats and attacks by armed groups were reported, particularly in insecure southern provinces.

About 15 percent of Afghan children miss out on different immunizations, according to the country's latest National Risk and Vulnerability Assessment. [http://www.nrva.cso.gov.af/]

The 15 November drive will cost US$4 million - funded by UN agencies, Rotary International and other donors, Raaid said.

Most polio cases in south

Poliomyelitis has been virtually eradicated in the relatively secure north and central parts of Afghanistan but the virus has remained endemic in the insecure south and southeast, according to the UN World Health Organization (WHO).

Of the total 25 polio cases confirmed so far this year, 22 were reported in the two southern provinces of Kandahar and Helmand and one each in Nooristan, Ghor and Kapisa provinces, the MoPH said. Last year 31 polio cases were reported country-wide.

Lack of awareness, and population movements, and the return of refugees from Pakistan, are other factors militating against effective anti-polio coverage.

Afghanistan and Pakistan are two of the four countries in the world where wild poliovirus transmission has never been interrupted. In Pakistan 118 polio cases were reported in 2008 and 32 in 2007, according to WHO.

Vitamin A drops

During the immunization period about 6.8 million children aged 6-56 months will receive oral drops of Vitamin A which, MoPH officials said, enhances body resistance against flu, pneumonia and other cold-related diseases.

Afghanistan has one of the highest infant morality rates in the world and global and severe acute malnutrition are at 19.7 percent and 6.7 percent respectively among under-five children, according to WHO.

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http://www.irinnews.org/report.aspx?ReportId=86995DAKAR Thursday, November 12, 2009 (IRIN) - Six weeks after the deadly military crackdown on civilians in Guinea, families are still searching for loved ones, the wounded continue to need medical care and aid agencies are assisting state health workers cope with the aftermath, according to the UN Office for the Coordination of Humanitarian Affairs in Guinea.DAKAR Thursday, November 12, 2009 (IRIN) - Six weeks after the deadly military crackdown on civilians in Guinea, families are still searching for loved ones, the wounded continue to need medical care and aid agencies are assisting state health workers cope with the aftermath, according to the UN Office for the Coordination of Humanitarian Affairs in Guinea.

The UN on 9 November approved $416,056 from its Central Emergency Response Fund for a UN Children’s Fund (UNICEF) project to restore medical supplies, stock public hospitals, help treat people wounded in the 28 September violence and address nutritional and water and sanitation needs.

Following the December coup d'état many donors reduced or suspended development assistance, including some for the health sector. Philippe Verstraeten, head of OCHA-Guinea, told IRIN: “It is critical that the UN and aid agencies continue to help Guinea deal with the fallout of 28 September as well as stave off further humanitarian crises, as the situation remains volatile.”

The latest (2-9 November) OCHA bulletin says:

-The Red Cross continues to receive calls from families seeking relatives. “For the moment, access to Camp Alpha Yaya [Diallo / the main military camp and the junta’s headquarters] and to the detention centre at Kassa Island has not been permitted.”

-Hospitals have reported cases of secondary infections in some victims who had hesitated to seek medical care after 28 September for fear of reprisals by the army

-Protection experts say at least 225 victims of the 28 September violence remain seriously traumatized, 45 of whom victims of sexual violence

-Among the remaining protection needs are identification of rape victims, referrals and medical and psycho-social care

-The UN Population Fund (UNFPA), in collaboration with the Health Ministry, on 2-6 November held seminars to reinforce local capacity for treating sexual violence victims; the workshops included training in using rape kits

np/oahttp://www.irinnews.org/report.aspx?ReportId=87017RUDAKI Wednesday, November 11, 2009 (IRIN) - Six months after floods hit parts of southern-central Tajikistan, damaging or destroying dozens of schools and other buildings, hundreds of students are still attending school in overcrowded and sometimes unsafe buildings, according to local teachers and officials.RUDAKI Wednesday, November 11, 2009 (IRIN) - Six months after floods hit parts of southern-central Tajikistan, damaging or destroying dozens of schools and other buildings, hundreds of students are still attending school in overcrowded and sometimes unsafe buildings, according to local teachers and officials.

One of the affected schools is in Rudaki District: “We have two classrooms in a damaged building. It is not safe; it is dangerous, but we don’t have any other option,” Huseyn Toshev, headmaster of School No. 12 in Rudaki, told IRIN.

In some of the classrooms two pupils share a chair, or three are squeezed onto two chairs - unheard of in normal circumstances. “We now operate three shifts. We have 828 pupils being taught in two buildings, while the planned capacity is for only 300,” Toshev said.

The shift system meant teachers and pupils had no time for lunch breaks, he added.

“The old part of the school [where there are two classrooms for younger pupils] was built in 1927. It is not fit for purpose and unsafe. It should be demolished and a new one built,” he said. “We pray there is no quake and hope nothing happens.”

Shamigul Murodova, a teacher at School No. 38 in Sangtuda village, Rudaki District, said the school was built in the 1930s and parts of the walls collapsed during the floods. “We used to have 11 classes, with two shifts of pupils. After the floods we have three classes with 595 pupils studying in three shifts,” she said.

Mavjuda Boboeva, deputy head of the Rudaki District administration, told IRIN the floods affected 10 schools in the district, four of which were badly damaged.

“Those four schools are in a dangerous condition. If there is a four degree earthquake they will collapse,” Boboyeva said.

“In one school, the beams are rotten and if there is snow, the roof will collapse. There are other schools in very poor condition, but no funds for rebuilding. We ask donors and international organizations to help,” she said.

According to the local met office, over 50 floods and mudflows affected more than 12,000 people in April-May 2009, with the districts of Khuroson, Pyanj and Qumsangir in Khatlon Province and Nurobod, Rudaki and Rasht districts (administered directly by central government), the worst affected.

More than 2,000 buildings, including 13 hospitals and 70 schools were partially or totally damaged, according to the 12 August Early Recovery Appeal - Tajikistan Floods and Mudflows http://www.reliefweb.int/rw/RWFiles2009.nsf/FilesByRWDocUnidFilename/MYAI-7VA9UY-full_report.pdf/$File/full_report.pdf by the Rapid Emergency Assessment and Coordination Team (a local team comprising government bodies, UN agencies and NGOs).

Stalled aid

Italian NGO CESVI has drafted a US$950,000 project (as part of the Early Recovery Appeal) to rebuild three education facilities destroyed by floods in Zaynabobod, Guliston and Lohur local councils in Rudaki District, but there has been no response from donors so far.

Asked about why donors have not been generous, UN Resident Coordination Michael Jones said donors were more eager to fund humanitarian emergency projects.

“Each donor has its own policies, its own criteria that it has to apply. Some projects fit the criteria some don’t. The whole aid world over the years has become compartmentalized [such] that you have your emergency assistance, your humanitarian assistance, then you have your recovery envelope where funding facilities are very limited,” Jones said.

at/cbhttp://www.irinnews.org/report.aspx?ReportId=86976JOHANNESBURG Wednesday, November 11, 2009 (IRIN) - Plumpy'nut, a widely distributed ready-to-use therapeutic food (RUTF), has revolutionized the treatment of acute malnutrition, but its 12-year dominance is being challenged by a newcomer. JOHANNESBURG Wednesday, November 11, 2009 (IRIN) - Plumpy'nut, a widely distributed ready-to-use therapeutic food (RUTF), has revolutionized the treatment of acute malnutrition, but its 12-year dominance is being challenged by a newcomer.

The patents for Plumpy'nut - a blend of peanuts, sugar, milk powder, oil, vitamins and minerals - are owned by Nutriset, a French family-run business, and the Institute of Research for Development, a French public research institute.

Now an American family-owned company, Tabatchnick Fine Foods, is turning the heat up in the blended food kitchen by applying for a patent for their RUTF in the US - where the Plumpy'nut patent is registered - to treat malnutrition in children and boost women's immune systems.

Tabatchnick hopes to open up the market with his patent challenge and has started manufacturing an RUTF that is being evaluated by the UN Children's Fund (UNICEF), the world's largest buyer of RUTF and Plumpy'nut.

Manufacturers of similar pastes have been wary of challenging Nutriset. "The patents are so broad that if you add one micronutrient into a jar of Nutella [a widely distributed brand of nut pastes] it will fall within the patent," said Stéphane Doyon, leader of the Nutrition Team at Médecins Sans Frontières (MSF), the international medical charity.

The US patent describes Nutriset's RUTF as a "complete food or nutritional supplement" comprising "a mixture of food-grade products, said mixture being coated with at least one lipid-rich substance optionally derived partly from oleaginous seeds".

The mixture could be in the form of "powder, particles or granules", the seeds could be "peanuts, cocoa beans, almonds, coconuts or pistachio nuts, or they can consist of a mixture of various fats of vegetable origin".

The protein source in the RUTF could be skimmed milk, powdered yoghurt or whey, and/or at least one product which provides carbohydrates, particularly carbohydrate bulking agents, sucrose, glucose, fructose, skimmed milk, whey, or flour made of maize, wheat, millet, oats, rice, cassava or potato starch", according to the patent documents.

Plumpy'nut was the first RUTF to be developed and is regarded as the industry standard. Several similar pastes have been developed but can only be sold in countries where the Plumpy'nut patents are not registered.

"Because Plumpy'nut is a brand name, it is the most popular," said an aid agency worker. "It is like Coke - people still prefer it, even if you have other similar drinks."

Two is a crowd too

Nutriset has attempted to broaden the scope of its two patents claim industry insiders, who also say the company has been "very vigilant" in ensuring that its patents are respected; manufacturers of peanut-based RUTFs have received legal letters.

"You have to keep reminding people [by sending letters]," said Nutriset spokesman Remi Vallet. "We are not trying to protect any monopoly - there is no monopoly there are other RUTF manufacturers in the market."

In Kenya, where the Plumpy'nut patents are registered, Nutriset has threatened legal action against Compact, an Indian and Norwegian manufacturer, for storing 25 metric tons of its RUTF, eeZeePaste, which it intended to supply to Somalia and the Democratic Republic of Congo.

"Our patent lawyers are studying the letter [from Nutriset] at the moment. I think they are stretching the interpretation of their patents," said Arne Andreassen, managing director of Compact, who pointed out that conflict-torn Somalia does not have adequate storage facilities.

Vallet said Nutriset was flexible where products were for humanitarian interventions. "We are willing to talk to Compact if they can show the supply was meant for Somalia. We allowed Diva [a South African RUTF manufacturer] to supply a UNICEF programme in Kenya, and are now in talks with them to enter into an arrangement with us."

Nutriset patents are registered in the European Union, the US and Canada, as well as in 16 francophone members of the African Intellectual Property Organization and 16 members of the African Regional Intellectual Property Organization in Eastern and Southern Africa.

In countries where Nutriset patents are registered, companies granted a manufacturing license are allowed to make, store, sell or use products similar to Plumpy'nut, but may not use the brand name. A network of Nutriset franchise-holders covers Niger, Ethiopia, Democratic Republic of Congo, Ghana, Tanzania Madagascar, Malawi, Mozambique, Dominican Republic, India and USA.

Nutriset patents are not registered in India, South Africa and Haiti, which have large numbers of malnourished children, and the company said competitors were free to invest in research and development of other RUTF products that would not fall within the scope of its patents.

Ben Tabatchnick, head of the family business, said his product was still in the development phase, but the patent would be "open-source", which would allow other producers to replicate his recipe.

His company "was trying to take the fear out of other producers from producing RUTF and keeping up with demand; no one producer can supply (even with licensed franchises) the world demand for RUTF and RUSF [ready-to-use supplementary foods]", he commented. "By allowing others free access (with proper oversight by UNICEF and MSF), this can and will be accomplished."

MSF's Doyon said patents for humanitarian products should be "filed only on an exceptional basis and ... licensing agreements should be offered to third parties on flexible terms and conditions, so as to ensure the widest possible availability of nutritional products of a humanitarian nature. We have been saying [this] to Nutriset ... [but] their reaction to Compact seems to say that they do not agree."

All the nuts in one jar

According to a study commissioned by UNICEF, Nutriset supplies the bulk of its product from France and the UN agency is the world's largest buyer of Plumpy'nut, which accounts for 89 percent of its RUTF procurement every year.

The cost and difficulty of exporting Plumpy'nut from France could be significant. In 2008 most of UNICEF's emergency supplies to Ethiopia had been air-freighted - 39 percent of the cost - whereas a local supplier in Kenya could have decreased transportation costs by around $80,000 per year and reduced overall supply-chain delay from eight weeks to one week.

[However] "It does not always work out cheaper to buy in the south," than to ship RUTF from Europe said Steve Jarrett, principal advisor in UNICEF's supply division. The study noted that there were "considerable risks in having a vital product like RUTF produced only by one dominant world supplier".

Nutriset has taken a number of precautions to protect the production process, including security staff, and the ability to rapidly shift staff and equipment to scale up production outside of France, including in the US.

But if Nutriset's manufacturing facility were to "go off-line for any reason — be it mechanical failure, worker strike, natural disaster, or a host of other reasons — the ramifications could effectively halt the entire RUTF supply chain for all of Nutriset's customers", the study commented.

A single global producer "limits the extent to which the supply chain includes surge capacity"; in the face of a complex emergency Nutriset would be forced to prioritize orders and reduce its ability to meet needs elsewhere. The study also suggested that multi-sourcing could bring down costs.

Jarrett said UNICEF was in favour of encouraging the production of RUTFs in beneficiary countries because this would help to "advocate its use - it is easier to get a buy-in from countries."

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http://www.irinnews.org/report.aspx?ReportId=86979NAIROBI Wednesday, November 11, 2009 (IRIN) - When the working members of a household die from HIV-related illnesses in northern Tanzania, older dependants have to work longer hours to cope financially, according to recently published World Bank study.NAIROBI Wednesday, November 11, 2009 (IRIN) - When the working members of a household die from HIV-related illnesses in northern Tanzania, older dependants have to work longer hours to cope financially, according to recently published World Bank study.

"Adult death is associated with increased farm hours ... Older women who suffer the loss of a co-resident member among their baseline household are working five hours more each week," the study found.

More than 1,000 men and women older than 50 were surveyed over a 13-year period between 1991 and 2004 in the Kagera region. http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2009/09/02/000158349_20090902155306/Rendered/PDF/WPS5037.pdf.

Older adults who had relied on remittances and other in-kind support from their adult children were left with the burden of caring not only for themselves but also their orphaned grandchildren.

"Grandparents who should be in retirement are forced to start working and parenting again, often when they are not in the best physical condition," said Wamuyu Manyara, portfolio manager at the Africa Regional Development Centre of HelpAge International http://www.helpage.org. "An older woman with thinning bones should really not be forced to return to the field and farm."

The study noted that the shocks caused by the death of adult children were primarily felt by older people living with the children when they died. Women had less secure access to land and assets than men, but shouldered most of the labour after their children died, and also felt the shocks more than men. Owning more assets, such as land and animals, could act as a buffer.

"Policies which help ensure complete markets for livestock and other forms of assets, provide asset accumulation, and preserve women's rights to property may help mitigate the long-run negative impact of prime-age [15-50 years] deaths," the report said.

Little support

The elderly were often marginalised by state welfare programmes. "Older people are not organised enough to advocate for their needs, and they wind up being grouped in government departments with either children or people with disabilities - both these groups have powerful lobbies that drown out the needs of older people," said HelpAge's Manyara.

"In Kenya we are currently in the process of identifying community spokespeople to give them a public voice, but because many of them can't speak English or are illiterate, they are not always willing to take on the challenge."

Several African governments were doing more to include older people in social welfare programmes, particularly older carers. "There is now an appreciation of the magnitude of the problem, and there are some programmes catering for older people's economic needs," Manyara noted.

"Old-age pensions and child-care grants provided to older South Africans, and cash transfer programmes for older Kenyans, are practical examples of the types of programmes that need to be rolled out across the region ... [but the need] is still much higher than the numbers being catered for."

Research by the UN Children's Fund, UNICEF, in five African countries found that between 40 percent and 60 percent of all orphans in Kenya, Namibia, Tanzania, Uganda and Zimbabwe were being cared for by grandparents, particularly grandmothers.

Need for targeted programming

"Some of these older people can still work - they have energy and should be supported in their work with income-generating projects," Manyara suggested. "The conditions for accessing microfinance are usually so rigid that older people do not qualify; something should be done to encourage older people still able to work to access these funds."

Kavutha Mutuvi, HelpAge International's regional advocacy coordinator, said older people needed secure incomes. "There should be social pensions ... especially for those who are caring for households in their old age," she said.

Yet the bureaucratic hurdles in accessing support were considerable. "When a grandmother wants to claim a foster care grant, she may be asked for death certificates for her children or birth certificates of the grandchildren," Mutuvi pointed out.

"She may not have or have access to this documentation, but the fact that she is their grandmother can easily be verified by consulting community leaders - there should be a way to do away with much of the red tape they go through to claim support."

Older people also needed psychosocial assistance when their children died and they were left to raise the grandchildren. "We have tried to form support groups, which are more successful among women than men, but when it comes to helping grandparents with parenting skills, there is a definite need ... because they do come to us with questions when kids, for instance, want to know about sexuality," Mutuvi said.

The role of older people should be acknowledged when drawing up national home-based care policies and programmes, she said, by providing meaningful support such as physical help from community workers.

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http://www.irinnews.org/report.aspx?ReportId=86984HARARE Wednesday, November 11, 2009 (IRIN) - Tendai Javangwe (not his real name) is 16 years old but looks half his age; he was born HIV-positive and has been staying at a home run by Mashambanzou Care Trust, a community care and support organisation. HARARE Wednesday, November 11, 2009 (IRIN) - Tendai Javangwe (not his real name) is 16 years old but looks half his age; he was born HIV-positive and has been staying at a home run by Mashambanzou Care Trust, a community care and support organisation.

He had been living with his aunt since his parents died, but illness forced him to drop out of school and seek medical treatment at Mashambanzou - meaning "the dawn of a new day/life" in Shona - in Waterfalls, a residential area southwest of the capital, Harare.

When Javangwe was admitted the staff were shocked that his relatives had allowed his condition to deteriorate to such an extent. "He was thin and seriously ill. His relatives ... just kept him at home without realizing he needed help," Chipo Munyorovi, the sister in charge of Mashambanzou, told IRIN/PlusNews.

Javangwe is now well enough to go home but officials have classified him as a child in need of state protection after the neglect he was subjected to at home, and have said he should be placed in an orphanage or home, which has magnified his problems.

Zimbabwe has almost a million orphans, but the country's political and economic meltdown means the extended family is often too poor to cope with additional children.

High levels of stigma and discrimination prevent many HIV-positive children from being adopted or being adequately cared for by relatives, so caregivers find it hard to place those who have been abandoned in homes or orphanages.

A recent report by a local child rights organization, Streets Ahead, said at least 52 percent of children living and working on the streets of Harare and its satellite towns had lost one or both parents to AIDS-related illnesses. Most did not live on the streets permanently, but came occasionally to supplement meagre family incomes, begging to raise money for school fees and food.

"Individuals don't want to adopt them into their families, they want healthy children. Even the established orphanages tell us they have no space for the children ... This is why these children end up stuck with us," said Munyorovi.

But Mashambanzou's finances were stretched and the staff struggled to cope with the large numbers of children, who often stayed for a long period of time because they had nowhere else to go.

Paurina Mpariwa-Gwanyanya, Zimbabwe's Minister of Labour and Social welfare, attributed these problems to the collapse of social services after years of neglect and underfunding by the previous administration, and told a recent media workshop that the unity government was working hard to restore social services to protect orphans and vulnerable children.

New government estimates put the number of HIV-positive children in Zimbabwe at more than 105,000, of which only about 13,000 were on treatment. Javangwe may be one of the few lucky ones on antiretroviral drugs, but without a stable home he may not get the support he needs to make his treatment work.

st/kn/he http://www.irinnews.org/report.aspx?ReportId=86986LESIDAI Tuesday, November 10, 2009 (IRIN) - Many Kenyan children are in school, but enrolment in the north has been adversely affected by insecurity, food scarcity and traditional attitudes, residents and teachers said.LESIDAI Tuesday, November 10, 2009 (IRIN) - Many Kenyan children are in school, but enrolment in the north has been adversely affected by insecurity, food scarcity and traditional attitudes, residents and teachers said.

"I just joined a new school a few weeks ago [20 October]," 14-year-old Kelly Lanyasunya said at Lesidai primary school in Samburu Central District (central-northwestern Kenya). "I got a new uniform and I am making friends but if this area gets insecure, I will have to move to another school."

Like her classmate, Nabik Kekichorumongi, is forced to change schools whenever bandits attack the surrounding villages.

Stephen Leparachwo, head teacher at Lolkunono primary school in Samburu Central, said Lesidai primary school often receives parents bringing their children from Pura, a neighbouring area affected by banditry.

"When they come, some are even without food… The bandits follow the fleeing residents [and their cattle], not giving the children a chance to read," he said.

Cattle-rustling

Much of the insecurity is due to cattle-rustling between the Samburu, Pokot, Turkana and Borana communities, according to local residents. In September, for example, Pokot cattle raiders killed 32 people in Samburu Central.

Rustling has also affected food production, especially in fertile areas like Ngano on the Kirisia ranges, where bandits lurk in the beautiful landscape.

In 2008, insecurity worsened in Ngano, according to the headmaster of a local school, Simon Lenolkulal. "We could hear gunshots, so we were seeking cover on the ground with the children," he said, recalling a recent incident.

"There is a high rate of transition even of school teachers here… Teachers are reluctant to work here because of the insecurity. One week there is peace, the next week we are moving... Every week we enrol new children, then when there is tension they leave."

The school relies on food aid from agencies like the UN World Food Programme (WFP). According to Lenolkulal, however, people could farm the land and eliminate food aid, if there were more security.

At neighbouring Lgoss primary school, deputy head teacher Bernadeta Lesuruan told IRIN: "When there is conflict and the parents flee, we have more children coming to the classes."

Hunger

Food scarcity tends to drive up school attendance, local residents said.

When there is a general food distribution, enrolment in school goes down, while in more difficult times the number of children increases, Lesuruan said.

"During such times you see young children carrying toddlers to school for the food… During the drought, the children were entirely relying on food in school. Some were fainting after coming from home hungry. When there is no food [at all], school attendance is very low."

In August, WFP was feeding at least 900,000 children in schools to help drought-affected families in Kenya's arid and semi-arid regions.

"Food is an issue," said Peter Emanman, the school feeding programme officer in Samburu Central.

Recent rain has brought hope of an improved food situation. "People are starting to plant but the food crops will not be ready by December [the next school holiday month]. What will happen then?" Emanman asked.

Few girls at school

There are few school teachers and hardly any female teachers. At Lgoss, Lesuruan was the only female member of staff.

"Since I came here [in 2008] more girls are staying in school especially those who would run away for the period of their menstruation," said Lesuruan. "I bring pads to the school for the girls."

Apart from the location of the school, 12km from the nearest shopping centre, the high cost of sanitary pads also feeds absenteeism.

Early marriages also affect girls’ attendance at school: Most drop out in the middle primary school classes. In 2008, some Samburu schools had no girl candidate sitting the national primary school leaving exam.

"There is a mentality that if girls are educated and get jobs, the earnings will not return home but go to the husband," said another teacher.

Most of the boys in school are late entrants; some of the girls stay at home to work. "In this community people are not fond of keeping children in schools," the teacher added.

Night school

However, some communities are trying to educate residents about the value of education: Currently under way in Baragoi District, the pastoralist night school initiative targets cattle herder children who are unable to attend day school.

"The children leave the fields at 4pm and then attend class," said Emanman. "The students get `uji’ (maize meal porridge) in the evening and are taught until 10pm."

Some children from these schools have progressed to the formal education system, but the night school initiative is largely designed to teach basic literacy to herders and others, he added.

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http://www.irinnews.org/report.aspx?ReportId=86968MALAKAL Monday, November 09, 2009 (IRIN) - Hundreds of cases of kala azar (also known as visceral leishmaniasis), a parasitic disease transmitted by the sand fly, have been reported in Southern Sudan in the past month, aid workers and doctors have said. MALAKAL Monday, November 09, 2009 (IRIN) - Hundreds of cases of kala azar (also known as visceral leishmaniasis), a parasitic disease transmitted by the sand fly, have been reported in Southern Sudan in the past month, aid workers and doctors have said.

"The numbers have surprised us, but we are coping and are treating those we receive," said Tut Gony, director of Malakal hospital in Upper Nile State.

Kala azar is endemic in some parts of Southern Sudan and outbreaks occur every 5-10 years. The sudden rise in cases has caused concern, said Gony, because it has hit some of the most remote and difficult-to-access regions of Upper Nile and Jonglei states, areas also suffering from recent inter-ethnic clashes.

For treatment to be effective it needs to be prompt. Malakal hospital had recorded over 70 cases since 23 October, with numbers expected to rise further, hospital officials said.

"Those who reach the hospital here, have had a difficult journey usually by boat because there are few roads, and where there are roads many are closed due to the rains," Gony added.

Over the weekend, IRIN found many patients resting under the shade of trees in the Malakal hospital compound.

In a 6 November statement, the medical charity Médecins Sans Frontières (MSF) said it had treated 107 patients since October - compared to 110 in the whole of 2008.

An additional 275 were being treated by a Sudanese NGO, which it did not name, in Old Fangak, Jonglei State.

The disease is almost always fatal within one to four months unless treatment is given, but some 95 percent recover if treated in time, MSF said.

Challenge

Health workers in the underdeveloped south face huge challenges. Both Jonglei and Upper Nile have suffered a string of inter-ethnic clashes in recent months.

"In Southern Sudan, where almost three-quarters of the population have no access to even the most basic healthcare, it is a race against time to reach patients," said David Kidinda, MSF medical coordinator for Southern Sudan.

"We suspect that the number of kala azar patients reaching clinics in some areas is just the tip of the iceberg… Without treatment, those infected can die within weeks if their immune system is already weakened," he said.

Treatment involves an injection every day for a month - requiring patients to stay near health facilities, which can put enormous pressure on those caring for them.

"With all the barriers facing people here - the severe lack of infrastructure, few proper roads, the crippling absence of healthcare staff and structures, and the current increase in violence and insecurity - survival becomes a cruel obstacle course for those in need of life-saving treatment," Kidinda said.

The disease suppresses the immune system, leaving victims open to other infections such as malaria or pneumonia. Symptoms include fever, diarrhoea, vomiting, nosebleeds, a swollen spleen and jaundice.

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http://www.irinnews.org/report.aspx?ReportId=86940NAIROBI Monday, November 09, 2009 (IRIN) - Some of the most widespread forms of malnutrition can best be reduced by delivering micronutrients and fortifying food in new, cost-effective ways, in combination with community outreach work, experts have said.NAIROBI Monday, November 09, 2009 (IRIN) - Some of the most widespread forms of malnutrition can best be reduced by delivering micronutrients and fortifying food in new, cost-effective ways, in combination with community outreach work, experts have said.

Approaches could range from the obvious - adding iron to flour – to the novel, such as vitamin-enriched chewing gum, a Nairobi conference heard.

Vitamin A, iron and iodine are the most important micronutrients in global public health terms, according to the World Health Organization (WHO), particularly for children and pregnant women in poor countries.

Vitamin A deficiency affects more than half of all countries, especially in Africa and Southeast Asia, and it is "especially important where under-five mortality is high," Sue Horton, a malnutrition economist, told the conference.

The conference on nutrition, held in Nairobi on 3 November, was organized by Danish think-tank The Copenhagen Consensus Center (CCC).

CCC has ranked micronutrient supplements as a top development priority following findings of a study it commissioned in 2008 to identify the best ways to spend aid and development money.

Provision of Vitamin A, it added, to children aged six months to five years every four to six months could reduce mortality by 23 percent.

Currently, Vitamin A deficiency is the leading cause of preventable blindness in children and increases disease risk and death from severe infections. In pregnant women it causes night blindness and may increase the risk of maternal mortality, according to WHO.

CCC says that up to 219 million children worldwide are susceptible to Vitamin A deficiency, and over one billion people to zinc deficiency.

Supplements not the only answer

Experts at the conference said current systems of providing the vitamin through supplements often missed out on some target groups.

"[Community] outreach is important in remote areas and among migratory groups, as relying on immunization days alone does not work," Horton said.

Kenya, for example, used to achieve coverage rates of over 80 percent for Vitamin A twice a year using mobile immunization campaigns. From 2007, supplements were only provided at health facilities. Coverage then declined to 20 percent for six to 59-month-old children, Horton said. A similar decline was observed in India.

The CCC also noted that global zinc supplementation to reduce the impact of diarrhoea was low, yet it could reduce diarrhoeal mortality for children under five by 50 percent.

"Outreach can be particularly cost-effective when Vitamin A supplementation is combined with the delivery of other services such as deworming, distribution of bednets, etc," it noted.

Shawn Baker, vice-president of Helen Keller International, said additional childhood interventions needed to be institutionalized yearly to avoid locking out some children on routine child health days.

"We need to be thinking not only of what we can do well but what we can do well at a large scale," Baker said.

Food fortification

Such interventions could include fortification and the addition of nutrients to widely-used foods. According to the CCC, salt iodization and flour fortification with iron are cheap.

In West Africa, a regional initiative is promoting folic acid fortification in wheat flour and Vitamin A in cooking oil.

"This has the potential to reach a large number of people with essential nutrients," said Kodjo Gbemou, director of the Grand Moulins du Togo, a flour milling company.

Wheat flour is industry-processed while the rest of locally grown cereals are processed at home, Gbemou said. West African countries, he added, were accelerating regulations to make fortification mandatory, as is the case in Cote d'Ivoire and Senegal.

Chewing gum

Globally, private companies are also developing innovative products to deliver micronutrients. Such products include Danish Gumlink's Vitamin A chewing gum.

The gum, prepared in a dry-cold process to protect the heat-sensitive Vitamin A, is sugar free and easily digested. It comes in two forms - for children aged 3-5, and for pregnant and lactating women.

"The gum promotes mouth hygiene, is easy to administer compared to other programmes that rely on co-immunization campaigns, and children find gum fun," Henrik Jespersen, Gumlink Group vice-president said.

"Our idea is to use our technology to provide one more way of delivering Vitamin A to those who need it."

Deworming

Other effective interventions include regular deworming. Deworming works well as the parasites stop nutrients from being fully digested.

"Mass treatment is safe and inexpensive... The cost of delivering one round of treatment is about 15 US cents per child when administered in school and 25 US cents for pre-school children when combined with another intervention in programmes such as Child Health Days or in primary health care facilities," the CCC said in a paper.

The Nairobi conference called for improved community nutrition, including the use of locally available nutritious foods and breast-feeding education.

Such practices, CCC director Bjorn Lomborg said, were crucial in a world with competing challenges and funding constraints. "Where do we get the most bang for the buck?" he asked.

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http://www.irinnews.org/report.aspx?ReportId=86945KABUL Thursday, November 05, 2009 (IRIN) - The average per capita monthly expenditure of nine million Afghans is less than 66 US cents a day, and millions of other Afghans spend about $42 a month, according to a summary of Afghanistan’s new National Risk and Vulnerability Assessment (NRVA).KABUL Thursday, November 05, 2009 (IRIN) - The average per capita monthly expenditure of nine million Afghans is less than 66 US cents a day, and millions of other Afghans spend about $42 a month, according to a summary of Afghanistan’s new National Risk and Vulnerability Assessment (NRVA).

NRVA 2007/08 was produced by the government with European Union funding and in collaboration with aid agencies.

A bleak picture is painted:

26 percent literacy rate (12 percent female and 39 male)
24 percent of all child deliveries are attended by a skilled birth attendant
Less than 30 percent of people have access to safe drinking water
Over 90 percent do not have access to proper sanitation
About 20 percent have electricity in their homes.
Half of the estimated population of 25 million is under 15

“NRVA is an effective tool for… poverty alleviation and development programmes,” Naseer Ahmad Popal, an official from the Ministry of Rural Rehabilitation and Development, told IRIN.

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http://www.irinnews.org/report.aspx?ReportId=86889CAIRO Thursday, November 05, 2009 (IRIN) - Despite a number of positive economic indicators, Egypt has a hunger problem: Nearly a third of all children are malnourished, according to a new report compiled by the Ministry of Health and the UN Development Programme (UNDP).CAIRO Thursday, November 05, 2009 (IRIN) - Despite a number of positive economic indicators, Egypt has a hunger problem: Nearly a third of all children are malnourished, according to a new report compiled by the Ministry of Health and the UN Development Programme (UNDP).

The Egyptian Demographic Health Survey (EDHS) 2008, [http://www.measuredhs.com/pubs/pdf/FR220/FR220.pdf] published in March 2009, recorded a 6 percent increase in undernourishment severe enough to stunt growth in children under five, pushing the percentage of stunted Egyptian toddlers to 29 percent from 23 percent in 2000.

The survey collected data in 2007/2008, when gross domestic product (GDP) grew by 7.2 percent, indicating that strong economic growth had not benefited ordinary Egyptians. A slower GDP growth of 4.7 percent is forecast for 2008/2009.

“Within the recent context of economic crises and economic slowdown, in addition to the growing epidemics of avian and H1N1 influenza, nutrition is not treated as a priority,” said Hala Abu Khatwa, head of communications in Egypt for the UN Children’s Fund (UNICEF).

Government-run food programmes are in place: In partnership with the World Food Programme (WFP), fortified date bars have been distributed in high-risk schools since 1963; and government-subsidized flour and cooking oil - used to make ‘baladi’ bread - are fortified with iron/folic acid and Vitamins A and D.

Chicken cull

Yet some government policies have adversely affected the nutrition of the poorest.

UNICEF and WFP said the EDHS report of a spike in malnourished children was partly attributable to the government’s decision to cull millions of chickens in 2007.

“The culling had a significant and substantial impact on household consumption of poultry and eggs, especially [on] young children, and also put considerable strain on household resources since poultry sales accounted for nearly half of the incomes of many Egyptian households,” said UNICEF’s Abu-Khatwa citing a 2007 study by the Food and Agriculture Organization (FAO) entitled Livelihood Impact Assessment in Egypt. [http://www.fao.org/docs/eims/upload//239037/ai294e.pdf]

Gianpietro Bordignon, the director of WFP in Egypt, attributed growing malnutrition among children to “the successive series of shocks that affected people, especially the poorest. This started with the outbreak of avian flu and the subsequent killing of poultry that lowered the intake of protein, and then the financial and food crises that followed.”

No data has yet been collected on the nutritional status of the estimated 70,000 unofficial garbage collectors and pig farmers in the Cairo area [http://www.irinnews.org/Report.aspx?ReportId=86742] who relied on pigs for meat, income and organic waste.

Economic reforms

Since 1991 Egypt has embarked on economic reform programmes which have not necessarily helped the poorest in society.

A July report by Egypt’s General Authority for Investment and Free Zones, seen by IRIN and entitled Towards Fair Distribution of the Fruits of Growth, found that 66 percent of the wealth generated in Egypt is sector specific, benefiting only those directly employed by the sector rather than the economy as a whole.

“Between 2005 and 2008, the risk of extreme poverty increased by almost 20 percent. Poverty levels are highest in Upper [southern] Egypt where 70 percent of the country's poor live,” Abu Khatwa said. Upper Egypt is home to about 17 percent of the country’s 82 million people.

WFP’s Bordignon also pointed out that since Egypt is not a “least developed country”, it misses out on international food aid.

According to the 2009 UNDP Human Development Report, [http://hdrstats.undp.org/en/countries/country_fact_sheets/cty_fs_EGY.html] 23 percent of the population are below the poverty line. Food riots [http://www.irinnews.org/Report.aspx?ReportId=77691] in 2008 were symptomatic of widespread poverty.

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http://www.irinnews.org/report.aspx?ReportId=86893WAJIR EAST Thursday, November 05, 2009 (IRIN) - The sound of the evening bell at a local boarding high-school in Wajir, in the northeast of Kenya, did not always signal the end of the day's classes. Instead it marked the end of the evening bathroom break as “bucket toilets” were emptied for the day. WAJIR EAST Thursday, November 05, 2009 (IRIN) - The sound of the evening bell at a local boarding high-school in Wajir, in the northeast of Kenya, did not always signal the end of the day's classes. Instead it marked the end of the evening bathroom break as “bucket toilets” were emptied for the day.

Such stories are commonly told with a mixture of humour and concern in the semi-arid region of Wajir, where most residents have little access to improved sanitation - with serious health implications.

"Wajir is prone to diarrhoea outbreaks," Francis Njoroge, Wajir East medical health officer, told IRIN. "Diarrhoeal diseases are [the] third [most] common illness in children below five years.

"Several factors could be contributory: the town lacks a sewerage system [and] uses a bucket system... people depend on boreholes... and many of the community water wells are not protected, exposing them to contamination," Njoroge said.

Outside the town, people use water from open dams, which they share with animals. "During the rainy season, run-off water washes animal waste into the dam, contaminating it," he said.

Wajir residents rely on shallow wells, due to increasing water salinity at depth, which are exposed to contamination during flash floods and from seepage.

The larger Wajir, which borders Somalia, Ethiopia, as well as the Kenyan towns of Mandera, Moyale, Isiolo and Garissa, lies in an area with large aquifers supplied by perennial rivers and dry seasonal river basins - also sources of contamination.

Like most of northern Kenya, Wajir has experienced a prolonged drought and livestock deaths. Animal carcasses litter watering points, posing a further health risk.

Contamination

Wajir South Development Association (WASDA) programme manager, Haretha Bulle, told IRIN of the challenges.

"There are [largely] no flush toilets and no pit latrines," Bulle told IRIN. A few flush toilets can be found in some hotels and in newer settlements but are rare in households.

According to a UN World Health Organization report, latrine coverage in rural Wajir is about 5 percent and just a little higher in the town.

Because of the high water table, pit latrines are not viable, and residents mainly rely on unhygienic bucket toilets - improvised from plastic jerry cans.

"Waste is collected from the bucket latrines by a tractor, which serves the whole town," Bulle noted. The town has a population of about 220,000.

"Households are not able to dispose of waste [and] are forced to dispose it anywhere," she said. "When it rains, the whole town smells. The water gets contaminated more easily and changes colour."

Refuse pit and open pit dumping is prevalent.

El Niño threat

According to Wajir town resident, Khadijah Ibrahim, ongoing El Niño-related rains will only exacerbate the situation. Her family of eight shares one bucket toilet with three other households - about 24 people in total.

"Sometimes the municipal council comes to empty the bucket after a week or 15 days. By the time the waste collectors come, the bucket toilet is already overflowing," Ibrahim said.

Her children, the youngest of whom is three, have been trained to wear shoes before going to the toilet to protect themselves, "but they only use soap to wash their hands before they eat", Ibrahim said.

Eco-toilets

The Arid Lands Development Focus (ALDEF) NGO is piloting eco-toilets, which use heat trapped by solar panels to burn human waste, reducing it to ash.

The toilets do not use water, instead relying on a dehydration/evaporation system. Diyad Hujale, ALDEF programme manager, told IRIN the target was mainly the town centre, which requires about 5,000 toilets.

Hujale recommended that Wajir town’s by-laws should make it compulsory for any upcoming construction to have an eco-toilet facility. The challenge, he said, is "how to get rid of the bucket toilet".

However, the cost of setting up an eco-san unit, about KSh60,000 (US$800), is prohibitive for private households.

Health education

Past recommendations to improve drainage and sanitation in Wajir have not yielded much, according to Bulle of WASDA. "It is one disaster after the other. When the rains come, we think of the drainage but forget about it when the drought comes."

At present, village elders in Wajir are being taught how to chlorinate the community wells, according to health officer Njoroge. Health education on the importance of protecting the wells is also being provided.

He said the construction of more toilets is being encouraged in new settlements, where communities are provided with water treatment chemicals.

"Health education is ongoing. Of importance is that there is continued disease surveillance in the district," he said. The solution lay in "providing clean water to the community and safe disposal of human waste via a sewerage system".

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