KEY INDICATORS

3,550 estimated asylum seeker and migrant population in BiH outside formal accommodation capacities at the end of November 2019

3,996 Number of people assisted in formal accommodation sites (gov. and IOM run centres, NGO and formal private ac accommodation) at the end of November 2019

5,503 Medical check-ups conducted in November 2019

POPULATION OF CONCERN

36% assisted asylum seeker and migrant population in BiH belonging to family groups at the end of November 2019

475 UASC assisted by UN and partners, of which 74 boys under the age of 15

13% assisted asylum seeker and migrant female population in BiH at the end of November 2019 Most frequent declared country of origin of asylum seekers and migrants assisted by UN and partners in BiH at the end of November 2019

Global Overview

In December, retaliatory attacks in Iraq raised U.S.-Iran tensions to new heights, compounding Iraq’s political and security woes and presaging further escalation in January. In Syria, regime and Russian forces stepped up their offensive in the north west, and Turkey’s potential deployment of troops in Libya could add fuel to the fire. In Burkina Faso, suspected jihadist attacks and intercommunal violence surged, and in Niger jihadists carried out a major assault against security forces. Boko Haram intensified its attacks in Cameroon’s far north and Chad’s west. Fighting erupted in the capital of the Central African Republic and picked up momentum in the north east, where a battle for the provincial capital looms. In Mozambique, suspected Islamist militants intensified their insurgency in the far north, and an armed opposition faction may follow through on its threat to mark the president’s inauguration on 15 January with attacks on civilians. North Korea threatened to resume nuclear and long-range missile tests; India’s controversial citizenship law sparked widespread protests; and a tide of killings shook the prison system in Honduras. On the positive side, an independence referendum was held in Papua New Guinea’s Bougainville, part of the 2001 peace agreement, and the resolution of a political dispute in Somaliland could open the way for parliamentary and local elections.

In the Middle East and North Africa, the U.S.’s incendiary killing of Iranian General Qassem Soleimani in Iraq early in the New Year followed a month of escalatory strikes between the U.S. and Iran’s allies. Responding to a series of attacks on U.S. assets, including one that killed a U.S. contractor, the U.S. launched airstrikes on the Iran-backed militia Kataib Hizbollah, killing at least 25. Militia members and their supporters protested outside the U.S. embassy in Baghdad, breaking into the compound and setting the scene for further escalation in January. The confrontation compounded Iraq’s own political and security problems: wrangling over who will succeed Adel Abdul-Mahdi as Prime Minister prolonged the country’s political paralysis and security forces continued their deadly crackdown on anti-government protests. In neighbouring Syria, regime and Russian forces intensified airstrikes and a ground offensive in the north west, taking territory from rebels. In Libya, forces answering to Field Marshal Khalifa Haftar made some advances in their campaign to take the capital Tripoli from the UN-backed Government of National Accord (GNA). Turkey’s potential deployment of troops to help the GNA could escalate fighting in coming weeks.

In Africa, suspected jihadist attacks and intercommunal violence surged in Burkina Faso’s east and north, and in neighbouring Niger members of Islamic State’s Sahel affiliate continued to launch attacks against the military in the west near the Malian border, including one that killed 71 soldiers, the deadliest attack against security forces in the country’s history. In the Lake Chad basin, Boko Haram increased the rate and deadliness of its attacks in both the Far North region of Cameroon and in western Chad. In northern Mozambique, suspected Islamist militants also intensified their attacks on civilians and security forces, while a spate of deadly raids against civilian traffic hit the centre of the country; the breakaway armed faction of opposition party Renamo denied responsibility, but threatened strikes in the area on 15 January, the day President Nyusi is due to be sworn in for his second term. Violence erupted over informal taxes in Bangui, capital of the Central African Republic, leaving at least 50 dead, and fighting intensified between armed groups, especially in the north east, where a fierce fight for the provincial capital Birao is imminent. Good news from Somaliland, where the ruling and opposition parties resolved their long-running dispute over the composition of the electoral commission, opening the way for delayed parliamentary and local polls.

In Asia, North Korea threatened to resume nuclear and long-range missile tests, placing the blame on the U.S.’s continued “hostile policy” toward the DPRK. During the Workers’ Party conference on 28-31 December, Kim Jong-un warned that Pyongyang will soon possess a “new strategic weapon”. In India, a controversial citizenship law sparked protests across the country, leading to deadly clashes with security forces that left dozens dead, including at least nineteen in Uttar Pradesh. In Papua New Guinea, the autonomous region of Bougainville successfully held a non-binding referendum on whether to become independent of the national government. The vote, which had been delayed twice in 2019, was part of the 2001 Bougainville Peace Agreement, which ended ten years of conflict over revenues from mining and its environmental impact. Residents voted overwhelmingly for independence.

In Latin America, a series of killings shook the penitentiary system in Honduras, prompting President Hernández to impose a state of emergency in prisons. Unidentified assailants killed both a high-profile lawyer and the director of El Pozo jail, and mutinies broke out in several prisons, leaving dozens of detainees dead.

The twenty-third meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director General on 11 December 2019 at WHO headquarters with members, advisers and invited Member States attending via teleconference, supported by the WHO secretariat.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties provided an update on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 16 September 2019: Afghanistan, Angola, Benin, Central African Republic (CAR), Chad, Cote d’Ivoire, Democratic Republic of Congo (DR Congo), Ethiopia, Ghana, Nigeria, Pakistan, Philippines, Togo and Zambia.

Wild poliovirus

The Committee remains gravely concerned by the significant increase in WPV1 cases globally to 113 as at 11 December 2019, compared to 28 for the same period in 2018, with no significant success yet in reversing this trend.

In Pakistan transmission continues to be widespread, as indicated by both AFP (acute flaccid paralysis) surveillance and environmental sampling. Khyber Pakhtunkhwa province continues to be of particular concern. The issues noted previously by the committee, including refusal by individuals and communities to accept vaccination, and problems with politicization of the national polio program are still being addressed. Added pressure is now on the program due to confirmation of detection of cVDPV2 in several provinces (see below).

In Afghanistan, the security situation remains very challenging. Inaccessible and missed children particularly in the Southern Region represent a large cohort of susceptible children in this part of Afghanistan. The risk of a major upsurge of cases is growing, with other parts of the country that have been free of WPV1 for some time now at risk of outbreaks. This would again increase the risk of international spread. Major efforts must be made to improve access if eradication efforts are going to progress.

The committee noted that based on sequencing of viruses, there were recent instances of international spread of viruses from Pakistan to Afghanistan and also from Afghanistan to Pakistan. The recent increased frequency of WPV1 international spread between the two countries suggests that rising transmission in Pakistan and Afghanistan correlates with increasing risk of WPV1 exportation beyond the single epidemiological block formed by the two countries.

The Committee noted the continued cooperation and coordination between Afghanistan and Pakistan, particularly in reaching high risk mobile populations that frequently cross the international border and welcomed the all-age vaccination now being taken at key border points between the two countries.

In Nigeria, there has been no WPV1 detected for three years, and it is possible that the African Region may be certified WPV free in 2020. The Committee again commended the strong efforts to reach inaccessible and trapped children in Borno, Nigeria, even in the face of increased insecurity. The certification of WPV3 eradication was also welcomed by the committee and underlines that polioviruses can be eradicated.

Vaccine derived poliovirus

The multiple cVDPV outbreaks in four WHO regions (African, Eastern Mediterranean, South-east Asian and Western Pacific Regions) are very concerning, with seven new countries reporting outbreaks since the last meeting (Chad, Cote d’Ivoire, Malaysia, Pakistan, Philippines, Togo and Zambia). Since the last meeting, cVDPV2 has spread through West Africa and the Lake Chad area, reaching Cote d’Ivoire, Togo and Chad, and cVDPV1 has spread from the Philippines to Malaysia.

The rapid emergence of multiple cVDPV2 strains in several countries is unprecedented and very concerning, and not yet fully understood.

The committee noted that the GPEI was developing a strategy to address cVDPV2 outbreaks but was extremely concerned that the monovalent OPV2 stockpile was becoming depleted. The committee strongly supports the development and proposed Emergency Use Listing of the novel OPV2 vaccine which should become available mid-2020, and which it is hoped will result in no or very little seeding of further outbreaks.

Conclusion

The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months. The committee recognizes the concerns regarding the lengthy duration of the polio PHEIC, but concludes that the current situation is extraordinary, with clear ongoing risk of international spread and ongoing need for coordinated international response. The Committee considered the following factors in reaching this conclusion:

• Rising risk of WPV1 international spread: The progress made in recent years appears to have reversed, with the committee’s assessment that the risk of international spread is at the highest point since 2014 when the PHEIC was declared. This risk assessment is based on the following:

• the WPV1 exportation in 2019 from Pakistan to Iran and to Afghanistan, and more recently spread from Afghanistan to Pakistan;

• ongoing rise in the number of WPV1 cases and positive environmental samples in Pakistan, and to a lesser extent Afghanistan;

• the quickly increasing cohort of unvaccinated children in Afghanistan, with the risk of a major outbreak imminent if nothing is done to access these children;

• the urgent need to overhaul the leadership and strategy of the program in Pakistan, which although already commenced, is likely take some time to lead to more effective control of transmission and ultimately eradication;

• increasing community and individual resistance to the polio program.

• Rising risk of cVDPV international spread: The clearly documented spread in recent months of cVDPV2 from Nigeria to Chad, Cote d’Ivoire and Togo, and between Philippines and Malaysia demonstrate the unusual nature of the current situation, as international spread of cVDPV in the past has been very infrequent. The emergence of cVDPV2 in Zambia, which had not used mOPV2, raises further concern. The risk of new outbreaks in new countries is considered extremely high, even probable. The outbreak of cVDPV1 in Malaysia in a cross-border population shared between Malaysia, Philippines and Indonesia and which is often unreached by government immunization programs is an example of how border populations are at special risk.

• Falling PV2 immunity: Global population mucosal immunity to type 2 polioviruses (PV2) continues to fall, as the cohort of children born after OPV2 withdrawal grows, exacerbated by poor coverage with IPV particularly in some of the cVDPV infected countries.

• Multiple outbreaks: The evolving and unusual epidemiology resulting in rapid emergence and evolution of cVDPV2 strains is extraordinary and not yet fully understood and represents an additional risk that is yet to be quantified.

• Weak routine immunization: Many countries have weak immunization systems that can be further impacted by various humanitarian emergencies, and the number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies poses a growing risk, leaving populations in these fragile states vulnerable to outbreaks of polio.

• Surveillance gaps: The appearance of highly diverged VDPVs in the Philippines, Somalia and Indonesia are examples of inadequate polio surveillance, heightening concerns that transmission could be missed in various countries. Furthermore, the missed transmission in China for a year illustrates that even countries with generally good surveillance can miss VDPV transmission.

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

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

Risk categories

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

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

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

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

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

TEMPORARY RECOMMENDATIONS

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

WPV1

Afghanistan (most recent detection 10 November 2019)

Pakistan (most recent detection 12 November 2019)

Nigeria (most recent detection 27 September 2016)

cVDPV1

Indonesia (most recent detection 13 February 2019)

Malaysia (most recent detection 26 October 2019)

Myanmar (most recent detection 9 August 2019)

Philippines (most recent detection 28 October 2019)

These countries should:

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

States infected with cVDPV2s, with potential or demonstrated risk of international spread

Angola (most recent detection 21 October 2019)

Benin (most recent detection 15 October 2019)

Cameroon (most recent detection 20 April 2019)

CAR (most recent detection 6 October 2019)

Chad (most recent detection 9 September 2019)

Cote d’Ivoire (most recent detection 26 September 2019)

China (most recent detection 25 April 2019)

DR Congo (most recent detection 26 October 2019)

Ethiopia (most recent detection 9 September 2019)

Ghana (most recent detection 8 November 2019)

Mozambique (most recent detection 17 December 2018)

Niger (most recent detection 3 April 2019)

Nigeria (most recent detection 9 October 2019)

Philippines (most recent detection 25 October 2019)

Somalia (most recent detection 10 November 2019)

Togo (most recent detection 16 October 2019)

Zambia (most recent detection 25 September 2019)

These countries should:

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

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

WPV1

• none
  

cVDPV

• Kenya cVDPV2 (last environmental positive specimen 21 March 2018)
  
• PNG cVDPV1 (last environmental positive specimen 6 November 2018)

These countries should:

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

Additional considerations

Preparedness - The committee urged all countries, particularly those in Africa, be on high alert for the possibility of cVDPV2 importation and respond to such importations as a national public health emergency. This means countries should ensure polio surveillance can rapidly detect cVDPV2, and plans are in place to respond rapidly with well planned and executed mOPV2 campaigns, and with strict procedures to ensure unused vials are returned and managed so that inappropriate or accidental use is avoided.

International Coordination - Unprecedented levels of international spread of cVDPV require urgent coordinated control measures at regional and sub-regional levels. The committee strongly encourages countries to do more in support of cross border actions, such as sharing of surveillance and other data, synchronizing campaigns and where possible ensure vaccination of international travelers.

Emergency Response – The committee noted the endorsement of SAGE for the accelerated clinical development of novel OPV2 and its assessment under the WHO Emergency Use and Listing (EUL) procedure, which can be used in a public health emergency of international concern (PHEIC), and added its support to ensure the supply of monovalent OPV2.

Financing - The number of outbreaks is proving to be costly to manage, and the committee urged affected countries to prioritize polio control as a public health emergency and ensure adequate domestic funding is available for an effective response. The committee urged affected countries to mobilize domestic funding to complement the GPEI resources which are being stretched by the large number of outbreaks being fought globally.

Communication - Vaccine hesitancy is a significant factor in the spread of these outbreaks particularly certain countries including Pakistan and Angola. The committee urged countries to invest time and resources into pro-actively circumventing and countering myths and misinformation regarding vaccination is general, and rumors that arise during the course of campaigns in particular. Campaign communications need to address issues around avoiding spreading excreted Sabin-like viruses through good hygiene.

Based on the current situation regarding WPV1 and cVDPV, and the reports provided by affected countries, the Director-General accepted the Committee’s assessment and on 19 December 2019 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 19 December 2019.

La propagation de la poliomyélite à l'échelle internationale reste un problème mondial de santé publique, a conclu le Comité d'urgence convoqué par l'Organisation mondiale de la Santé (OMS).

« Le Comité a convenu à l'unanimité que le risque de propagation internationale du virus de la polio reste une urgence de santé publique de portée internationale et a recommandé la prolongation des recommandations temporaires pour une période supplémentaire de trois mois », ont déclaré les experts dans un communiqué mardi, à l’issue de leur 23ème réunion.

Augmentation significative des cas de poliovirus sauvage 1

Le Comité d'urgence, qui s'est réuni en décembre, s'est déclaré préoccupé par « l'augmentation significative » des cas de poliovirus sauvage 1 (PVS1), la dernière des trois souches à être éliminée.

Il y a eu 28 cas en 2018, contre 113 à la mi-décembre de l'année dernière, « sans que l'on ait encore réussi à inverser cette tendance ».

Les experts ont déclaré que les progrès récents « semblent s'être inversés », car la propagation internationale du PVS1 est à son point le plus élevé depuis la déclaration d'une urgence de santé publique de portée internationale en 2014.

La transmission reste répandue au Pakistan, où les défis à relever sont notamment le refus persistant des individus et des communautés d'accepter la vaccination. On a également constaté une nouvelle propagation vers l'Afghanistan voisin, où l'instabilité persistante rend de nombreux enfants inaccessibles, en particulier dans le sud.

Entre-temps, le PSV1 n'a pas été détecté au Nigéria depuis trois ans, ce qui signifie que la région africaine pourrait être certifiée cette année comme étant exempte de virus. Le Comité d'urgence a également salué les efforts déployés pour atteindre les enfants dans l'État de Borno, dans le nord-est du pays, en proie à l’insurrection du groupe extrémiste Boko Haram depuis une décennie.

En ce qui concerne les poliovirus circulants dérivés de vaccins (cVDPV), le Comité d'urgence a rappelé que des flambées se sont produites en Afrique, en Méditerranée orientale, en Asie du Sud-Est et dans la région du Pacifique occidental. Il a également souligné que sept pays ont signalé des flambées depuis la dernière réunion.

En outre, la propagation du cVDPV2 a été enregistrée en Afrique de l'Ouest et dans la région du lac Tchad, atteignant la Côte d'Ivoire, le Togo et le Tchad, tandis que le cVDPV1 s'est déplacé des Philippines vers la Malaisie.

« L'émergence rapide de multiples souches de PVDVc2 dans plusieurs pays est sans précédent et très préoccupante, et n'est pas encore totalement comprise », s’est inquiété le comité dans la déclaration.

Recommandations par pays

Dans l'ensemble, les pays touchés par le poliovirus sauvage 1, ou par des souches de poliovirus circulantes dérivées de la vaccination, devraient déclarer officiellement que l'arrêt de sa propagation est une urgence nationale de santé publique, a précisé le Comité dans ses recommandations temporaires.

Les résidents, les visiteurs de longue durée et les voyageurs se rendant dans ces zones devraient également être protégés contre la maladie.

Les experts ont en outre recommandé d'intensifier la coordination afin d'augmenter la couverture vaccinale des personnes qui traversent régulièrement les frontières, et d'améliorer le suivi de la qualité de la vaccination aux points de transit ainsi que le suivi des voyageurs non vaccinés.

INTRODUCTION

The International Committee of the Red Cross (ICRC) was involved in physical rehabilitation services before 1979, but that year we set up the Physical Rehabilitation Department, which marked the beginning of our serious commitment. As it is an aspect of our mandate, the ICRC supports the physical rehabilitation of victims of armed conflict and other situations of violence; we do this through physical rehabilitation programmes and the ICRC MoveAbility Foundation. The range of physical rehabilitation activities we provide throughout the world has expanded since 1979. Physical rehabilitation has moved well beyond emergency response; many people who need physical rehabilitation services will need them for the rest of their lives.

PHYSICAL REHABILITATION

Physical rehabilitation involves the provision of mobility devices (prostheses, orthoses, walking aids and wheelchairs) and appropriate physiotherapy, and other services as well. It is also a means of integrating physically disabled people into families and communities, schools and workplaces.

ICRC support plays an essential role in reaching the ultimate goal of rehabilitation, which is full integration into society, whatever the cause of a person’s disability. Restoring mobility is also the first step towards enjoying basic rights such as access to food, shelter, education, employment, equal opportunities and equal citizenship.

VISION

People with physical disabilities who are affected by armed conflict and other situations of violence have access to high-quality physical-rehabilitation services, leading to improved health and well-being and the ability to achieve their full potential in society.

MISSION

To support a multidisciplinary, person- and system-centred approach to physical rehabilitation, ensuring high-quality, equitably accessible, sustainable services and societal integration for people with physical disabilities.

GUIDING PRINCIPLES FOR THE PHYSICAL REHABILITATION PROGRAMME: THE FOUR PILLARS

The Physical Rehabilitation Programme pursues a twin-track approach, combining a person-centred approach with a system approach, providing assistance to both national systems and the users of its services. Its four pillars (access, quality, long-term sustainability and social integration) are interdependent and interrelated.

The ICRC takes measures to ensure that physical rehabilitation services are equally accessible to all who need them. These measures include identifying groups that may be particularly vulnerable and working to remove barriers – related to geography, religion, wealth, ethnicity, gender, age, etc. – to services.

The ICRC ensures the quality of its services by applying internationally accepted best practices. We promote a multidisciplinary approach to physical rehabilitation and other services, and make sure that staff are competent and that mobility-device technology remains appropriate and up to date. We also strive to assess as accurately as possible the full range of people’s needs, in close collaboration with those affected, and to build and retain professional competence through training; we do this so that we can provide the highest quality of care.

In order to promote the long-term sustainability of assisted projects, the ICRC – whenever possible – runs projects with local partners from the beginning of the assistance period and strives to build up these partners’ capacities (technical skills, people and service management, and funding mechanisms). Ensuring long-term sustainability also includes advocating for policies for physical rehabilitation and social protection, leadership and governance. The long-term approach not only takes into account the principle of residual responsibility towards one of the ICRC’s target populations but also reduces the risk of loss of investment in materials and human capital.

The full social inclusion of disabled people is one of our goals. To that end, we support and promote activities and programmes that enable their educational and professional growth. Initiatives include sporting activities, academic scholarships and homeschooling, microfinance programmes, and job creation.

INTRODUCCIÓN

El Comité Internacional de la Cruz Roja (CICR) presta servicios de rehabilitación física desde antes de 1979. Sin embargo, ese año se creó el departamento de Rehabilitación Física, un hito que marcó el comienzo del serio compromiso institucional en este ámbito. En consonancia con uno de los aspectos de su cometido, el CICR presta apoyo a la rehabilitación física de las víctimas de conflictos armados y otras situaciones de violencia a través de programas específicos y de la Fundación MoveAbility del CICR. La variedad de actividades de rehabilitación física que el CICR presta en todo el mundo ha crecido desde 1979. Estos servicios ya no se limitan exclusivamente a intervenciones de emergencia: muchas personas que requieren de estos servicios los necesitarán de por vida.

REHABILITACIÓN FÍSICA

La rehabilitación física comprende la provisión de dispositivos de movilidad (prótesis, órtesis, ayudas para caminar y sillas de ruedas), además de fisioterapia y otros servicios. Es, también, un medio que permite integrar a las personas con discapacidad física en las familias y las comunidades, así como en las escuelas y los lugares de trabajo. La asistencia del CICR desempeña un papel esencial para alcanzar la finalidad última de la rehabilitación: la plena integración de la persona en la sociedad, sea cual fuera la causa que generó su discapacidad. El restablecimiento de la movilidad es, además, el primer paso para gozar de derechos fundamentales, como el acceso a la alimentación, al refugio, a la educación, al trabajo, a la igualdad de oportunidades y de ciudadanía.

VISIÓN

Las personas con discapacidad física que se ven afectadas por conflictos armados y otras situaciones de violencia tienen acceso a servicios de rehabilitación física de alta calidad, lo que da lugar a la salud y al bienestar mejorados y a la capacidad de alcanzar su pleno potencial en la sociedad.

MISIÓN

Apoyar un enfoque multidisciplinario de rehabilitación física centrado en el sistema y en las personas, que garantice servicios sostenibles, de alta calidad y acceso equitativo, así como la integración en la sociedad de las personas con discapacidad física.

PRINCIPIOS RECTORES PARA EL PROGRAMA DE REHABILITACIÓN FÍSICA: LOS CUATRO PILARES

El Programa de Rehabilitación Física aspira a un enfoque basado en dos líneas de acción que combina un enfoque centrado en las personas y un enfoque centrado en el sistema, que le permite prestar asistencia tanto a los sistemas nacionales como a los usuarios de sus servicios. Sus cuatro pilares (acceso, calidad, sostenibilidad a largo plazo e integración social) son interdependientes y están interrelacionados.

El CICR adopta medidas para que los servicios de rehabilitación física sean igualmente accesibles para todos quienes los necesiten. Entre estas, se incluyen la identificación de grupos particularmente vulnerables y la labor para eliminar las barreras (relacionadas con la geografía, la religión, la riqueza, la etnia, el género y la edad, entre otras) que obstaculizan el acceso a los servicios.

El CICR aspira a mantener la calidad de sus servicios mediante la aplicación de las mejores prácticas aceptadas internacionalmente. Promovemos un enfoque multidisciplinario de la rehabilitación física y de otros servicios, y nos esforzamos por que el personal sea competente y por que la tecnología en materia de dispositivos de movilidad se mantenga actualizada y pertinente. Nos esforzamos, además, por evaluar con la mayor precisión posible todas las necesidades de las personas, en estrecha colaboración con quienes se ven afectadas, así como por generar y mantener competencias profesionales mediante la formación, para así poder brindar la máxima calidad de atención.

Con el objeto de promover la sostenibilidad a largo plazo de los proyectos que cuentan con su asistencia, el CICR –siempre que sea posible– los implementa junto con socios locales desde el comienzo del período de asistencia y se esfuerza por desarrollar las capacidades de sus socios (aptitudes técnicas, gestión de los servicios y del personal y mecanismos de financiación). La sostenibilidad a largo plazo, además, abarca promover políticas de rehabilitación física y de protección social, liderazgo y gobernanza. El enfoque a largo plazo no solo considera el principio de responsabilidad residual para con una de las poblaciones objetivo del CICR, sino que también reduce el riesgo de pérdida de inversión en materiales y de capital humano.

Uno de nuestros objetivos es la plena inclusión social de las personas con discapacidad. A tal fin, promovemos actividades y programas que permitan su desarrollo educativo y profesional. Las iniciativas comprenden actividades deportivas, becas académicas y escolarización en el hogar, así como programas de microfinanzas y creación de empleos.

• On 11 December 2019, the Emergency Committee under the International Health Regulations (IHR 2005) held its twenty-third meeting. Read the committee’s report of progress for affected IHR States Parties subject to Temporary Recommendations.

• Summary of new viruses this week (AFP cases and ES positives): Afghanistan — two WPV1 cases and two WPV1 positive environmental samples; Pakistan — 11 WPV1 cases, 13 WPV1 positive environmental samples and two cVDPV2 positive environmental samples; Malaysia — one cVDPV2 and one positive environmental samples; Zambia — one cVDPV2

R2P Monitor is a bimonthly bulletin applying the atrocity prevention lens to populations at risk of mass atrocities around the world. Issue 49 looks at developments in Afghanistan, China, Myanmar (Burma), Syria, Yemen, Cameroon, Democratic Republic of the Congo, Mali and Burkina Faso, Central African Republic, Iraq, Libya, Nigeria, South Sudan and Venezuela.

Last week in Central Asia and the Caucasus, the number of reported civilian fatalities continued to rise in Afghanistan; elections in Abkhazia, Georgia were annulled following violent demonstrations; civil society pressured Kazakhstan to grant asylum to two ethnic Kazakhs from China’s Xinjiang region; and riots broke out on the Kyrgyz-Tajik-Uzbek border. Meanwhile, though ceasefire violations between Armenia and Azerbaijan continued at a lower level last week, there were reports that forces from both sides incurred casualties for the first time since early November 2019.

Last week in Afghanistan, there was a drop in the total number of events reported compared to previous weeks. This is likely due to the severe winter weather that has struck Afghanistan with heavy snow and rainfall (Reuters, 12 January 2020). However, despite the winter lull, fighting was particularly lethal, with hundreds of civilians and combatants reported killed. In one of the deadliest events of the week, a US drone strike that killed a Taliban splinter-group commander in Herat province also led to dozens of civilian casualties; local sources claimed that at least 40 civilians were killed in the strike (TOLO News, 9 January 2020). Furthermore, two American soldiers were killed when their convoy hit a Taliban-planted IED in the southern province of Kandahar, marking the first deaths among US forces in Afghanistan in the new year. In another development, pro-government forces reported to have regained territory in the provinces of Ghor, Herat, and Farah after three weeks of ground and air operations. This includes the recapture of Kamenj valley, which, according to the Afghan Ministry of Defence, has housed a key Taliban command center since the group seized control of the area two years ago (Ministry of Defence, 11 January 2019).

On 9 January, in Georgia‘s breakaway province of Abkhazia, hundreds of opposition demonstrators stormed the presidential administration building in Sukhumi. The demonstrators reportedly broke windows and doors to enter the building, demanding the resignation of the de facto president, Raul Khajimba (Reuters, 9 January 2020). Following the incident, legislators in Abkhazia annulled the last election results and scheduled new elections for 22 March. Election-related unrest has been ongoing since mid-2019 in Abkhazia as the opposition believes Khajimba’s win was unfair and accuses his government of failing to address corruption and economic instability (TASS, 13 January 2019).

In Kazakhstan, multiple protests took place in Zaysan, Zhanaozen, and Almaty in support of two ethnic Kazakh men who were accused of illegally crossing the border from China’s Xinjiang region in October 2019. A hearing for the case was set for 6 January in Zaysan, with a number of activists rallying to support the two asylum seekers in front of the courthouse. Kazakhstan’s government has not taken a strong stance against the reported persecution of ethnic minorities in Xinjiang region, mostly due to its deep economic ties to China (Vision Times, 6 January 2020). With the court hearing expected to resume on 21 January, the case will likely remain in limbo as most asylum seekers from Xinjiang are refused refugee status yet given permission to stay in Kazakhstan (The Diplomat, 7 January 2020).

Violence on the volatile borders between Uzbekistan, Kyrgyzstan, and **Tajikistan **continues. On 6 January, a brawl took place between Uzbek guards and Kyrgyz citizens whose livestock were spotted grazing on the disputed borders. On the border between Tajikistan and Kyrgyzstan, violence targeting civilians was reported on 10 January as unknown assailants from the Tajik side of the boundary stoned cars belonging to Kyrgyz villagers near Kok-Tash village. Following the event, Kyrgyz and Tajik villagers reportedly attacked each other’s cars and houses with stones (Kaktus Media, 10 January 2020).

Clashes between Armenia and Azerbaijan resulted in casualties last week. On 7 January, a serviceman of the Azerbaijani Border Service was killed by sniper fire in the Gazakh district of Azerbaijan. On 11 January, an Armenian soldier was wounded by Azerbaijani sniper fire in Armenia’s Tavush region. Overall, however, ceasefire violations continued at slightly lower levels compared to weeks prior, as Azerbaijan’s Ministry of Defence reported 52 armed engagements along the Artsakh-Azerbaijan Line of Contact and 21 armed engagements along the Armenia-Azerbaijan Line of Contact.

• Pakistan intensifies cVDPV2 response efforts, focusing on comprehensive outbreak response, strengthened routine immunization, communication and enhanced surveillance. See ‘Pakistan’ section below for more details.

• Summary of new viruses this week (AFP cases and environmental samples):

  • Pakistan: seven WPV1 cases; and, five WPV1-positive environmental samples
    
  • Angola: two cVDPV2 cases
    
  • Benin: one cVDPV2 case
    
  • Central African Republic (CAR): two cVDPV2 cases
    
  • Ghana: one cVDPV2 case; and, six cVDPV2-positive environmental samples
    
  • Malaysia: one cVDPV1-positive environmental sample; and, one cVDPV2-positive environmental sample
    
  • Philippines: two cVDPV2 cases
    
  • Togo: two cVDPV2 cases

Direct economic losses and damage from natural disasters in 2019 were estimated at USD232 billion. This was reduced from recent elevated levels in 2016, 2017 and 2018. The USD232 billion was 3 percent lower than the average (USD239 billion) and 5 percent lower than the median (USD243 billion) during the 21st Century. The economic losses were a further 20 percent lower than the average and 12 percent lower than the median of the past decade (2009-2018).

As climate change continues to affect the frequency and intensity of weather events, and as demographic patterns shift around the world, the impact of natural disasters – including financial costs − will only increase. Building resilience and properly planned disaster mitigation efforts are therefore critical.

• The GPEI Polio Partners Group convened the eighth annual technical workshop on 6 December 2019 where a global overview of the status of poliovirus detection was presented among other polio updates. The meeting presentations are now available here.

• Summary of new viruses this week (AFP cases and environmental samples):

  • Afghanistan: one WPV1 case and three WPV1-positive environmental samples

  • Pakistan: two WPV1 cases, four WPV1-positive environmental samples and six cVDPV2 cases

  • Democratic Republic of the Congo (DR Congo): ten cVDPV2 cases

  • Côte d’Ivoire: two cVDPV2 positive environmental samples

  • Ghana: two cVDPV2 positive environmental samples

  • Malaysia: two cVDPV1 cases

  • Philippines: two cVDPV2 cases and two cVDPV2 positive environmental samples

  • Togo: one cVDPV2 case

New generation of young activists lead fight against worsening repression in Asia

• New report reviews human rights in 25 Asian and Pacific states and territories during 2019

• Young protesters take to streets in response to increasing repression

• Detentions, arrests and deaths as authorities clamp down on dissent with excessive force

• But protests vital in helping secure landmark human rights wins

A wave of youth-led protests across Asia is defying escalating repression and a continent-wide crackdown on freedom of expression and peaceful assembly, Amnesty International said today as it published its annual report on human rights in the region.

‘Human Rights in Asia-Pacific: A review of 2019’, which includes a detailed analysis of human rights developments in 25 countries and territories, describes how a new generation of activists are fighting back against brutal crackdowns on dissent, poisonous social media operations and widespread political censorship.

“2019 was a year of repression in Asia, but also of resistance. As governments across the continent attempt to uproot fundamental freedoms, people are fighting back – and young people are at the forefront of the struggle,” said Nicholas Bequelin, Amnesty International’s Regional Director for East and South-East Asia and the Pacific.

“From students in Hong Kong leading a mass movement against growing Chinese encroachment, to students in India protesting against anti-Muslim policies; from Thailand’s young voters flocking to a new opposition party to Taiwan’s pro LGBTI-equality demonstrators. Online and offline, youth-led popular protests are challenging the established order.”

Hong Kong’s defiance echoes across the world

China and India, Asia’s two largest powers, set the tone for repression across the region with their overt rejection of human rights. Beijing’s backing of an Extradition Bill for Hong Kong, giving the local government the power to extradite suspects to the mainland, ignited mass protests in the territory on an unprecedented scale.

Since June, Hong Kongers have regularly taken to the streets to demand accountability in the face of abusive policing tactics that have included the wanton use of tear gas, arbitrary arrests, physical assaults and abuses in detention. This struggle against the established order has been repeated all over the continent.

In India, millions decried a new law that discriminates against Muslims in a swell of peaceful demonstrations. In Indonesia, people rallied against parliament’s enactment of several laws that threatened public freedoms. In Afghanistan, marchers risked their safety to demand an end to the country’s long-running conflict. In Pakistan, the non-violent Pashtun Tahaffuz Movement defied state repression to mobilize against enforced disappearances and extrajudicial executions.

Dissent met with crackdown

Peaceful protests and dissent were frequently met with retribution by the authorities.

Protesters faced arrest and jail in Vietnam, Laos, Cambodia and Thailand as repressive governments across South-East Asia took severe steps to silence their opponents and muzzle the media.

In Indonesia, several people were killed as police clamped down on protests with excessive force. Yet few steps were taken to hold anyone to account for the deaths; no police were arrested nor were any suspects identified.

In Pakistan and Bangladesh, activists and journalists alike were targeted by draconian laws that restrict freedom of expression and punish dissent online.

And in Hong Kong, police deployed reckless and indiscriminate tactics to quell peaceful protests, including torture in detention. Demands for a proper investigation into the conduct of the security forces have yet to be met.

“The authorities’ attempts to crush any form of criticism and suppress freedom of expression were as ruthless as they were predictable, with those daring to speak out against repressive governments often paying a high price,” said Biraj Patnaik, South Asia Director.

“Asians are told their aspirations for fairer societies are fantasies; that economic disparities can’t be addressed; that global warming is inexorable and natural catastrophes unavoidable. Most emphatically of all, they are told that challenging this narrative will not be tolerated,” said Biraj Patnaik.

Minorities feel the weight of intolerant nationalism

In India and China, the mere risk of insubordination in nominally autonomous areas has been enough to trigger the full force of the state, with minorities conveniently deemed a threat to “national security.”

In the Chinese province of Xinjiang, up to a million Uyghurs and other predominantly Muslim ethnic minorities have been forcibly detained in “de-radicalization” camps.

Kashmir, India’s only Muslim-majority state, saw its special autonomous status revoked as authorities imposed a curfew, cut access to all communications and detained political leaders.

In Sri Lanka, where anti-Muslim violence erupted in the wake of the Easter Sunday bombings, the election of President Gotabaya Rajapaksa dimmed hopes of human rights progress. Another self-styled strongman, Philippine President Rodrigo Duterte, continued his murderous “war on drugs.”

Governments have tried to justify repression by demonizing their critics as pawns of “foreign forces” and to bolster that repression through sophisticated social media operations. Neither ASEAN nor SAARC, the two main regional bodies, tried to hold their members to account, even in the case of gross human rights violations.

It has been left to the International Criminal Court to investigate crimes against humanity committed by the Myanmar military in Rakhine State against the Rohingya in 2017. The court is also looking into the thousands of killings carried out by police in the Philippines, and hearing an appeal on its decision not to authorize an investigation into war crimes and crimes against humanity in Afghanistan.

Meanwhile, Australia’s egregious offshore detention policies left refugees and asylum-seekers languishing in deteriorating physical and mental condition on the Pacific islands of Nauru and Manus, Papua New Guinea.

Progress against the odds

People speaking out against these atrocities were routinely punished, but their standing up made a difference. There were many examples where efforts to achieve human rights progress in Asia paid off.

In Taiwan, same-sex marriage became legal following tireless campaigning by activists. In Sri Lanka, lawyers and activists successfully campaigned against the resumption of executions.

Brunei was forced to backtrack on enforcing laws to make adultery and sex between men punishable by stoning, while former Malaysian prime minister Najib Razak took the stand on corruption charges for the first time.

The Pakistani government pledged to tackle climate change and air pollution, and two women were appointed as judges on the Maldivian Supreme Court for the first time.

And in Hong Kong, the power of protest forced the government to withdraw the Extradition Bill. Yet, with no accountability for months of abuses against demonstrators, the fight goes on.

“Protesters across Asia in 2019 were bloodied, but not broken. They were stifled, but not silenced. And together, they sent a message of defiance to the governments who continue to violate human rights in pursuit of tightening their grip on power,” said Nicholas Bequelin.

• It is with profound sorrow that the WHO announces the sudden demise of Dr Peter Salama, who passed away on 24 January 2020. Dr Salama contributed to polio eradication at WHO through his work as Executive Director of the Health Emergencies Programme and most recently as Executive Director of the Division of Universal Health Coverage – Life Course. Read more

• Want to know more about the new cVDPV2 strategy and nOPV2? have a look at the newly released fact-sheet which provides a summary of the current situation and the new tool under development.

• With the evolving public health emergency associated with the increase in new emergences of circulating vaccine-derived poliovirus type 2, a draft decision has been made available for consideration by the Executive board. Read more

• Summary of new viruses this week (AFP cases and environmental samples):

  • Afghanistan: three WPV1 positive environmental samples
  • Pakistan: six WPV1 cases, ten WPV1 positive environmental samples, four cVDPV2 cases and one cVDPV2 positive environmental sample
  • Nigeria: two cVDPV2 positive environmental samples
  • Democratic Republic of the Congo (DR Congo): two cVDPV2 cases
  • Somalia: three cVDPV2 positive environmental samples
  • Angola: 15 cVDPV2 cases
  • Ethiopia: one cVDPV2 positive environmental sample
  • Philippines: one cVDPV1 case

Global Overview

In January, the security situation in the Sahel deteriorated, especially in central Mali, western Niger and northern Burkina Faso, where suspected jihadists inflicted a heavy toll on civilians. In Nigeria, Boko Haram stepped up attacks and jihadist group Ansaru claimed its first attack since 2013. Al-Shabaab intensified deadly raids in Kenya, and violence rose in Cameroon’s Anglophone areas and eastern DR Congo. Political tensions increased in Somalia’s Galmudug state and Guinea-Bissau, and security forces hardened a crackdown in neighbouring Guinea. February could see fighting erupt in Somalia’s Gedo region, escalate in the Central African Republic, and resurge in South Sudan where leaders face a new deadline to form a unity government. The U.S.’s killing of Soleimani caused U.S.-Iran tensions to soar, and Iraq felt the brunt of the fallout. Fighting intensified in northern Yemen and across the Yemen-Saudi Arabia border raising the risk that violence spread. Fighting looks set to escalate in north west Syria as Turkish forces strike back against government troops. The U.S.’s release of its peace plan for Israel-Palestine triggered an angry backlash and in Lebanon clashes between protesters and security forces intensified. Venezuela’s political crisis deepened, but on the up side, the security situation in El Salvador improved, a key insurgent group in Thailand joined formal peace talks, Kosovo’s three-month political deadlock ended, and February could see a deal between Ethiopia, Egypt and Sudan to resolve their dispute over the Nile waters.

In Africa, security in the Sahel continued to deteriorate as suspected jihadists upped attacks on civilians in northern Burkina Faso, intercommunal and jihadist violence intensified in central Mali, and in Niger jihadists carried out the deadliest assault yet on security forces, killing at least 89. In Kenya’s north east and east, Somali militant group Al-Shabaab stepped up the frequency and ambition of its attacks, while in neighbouring Somalia, tensions mounted in Galmudug state as rival camps appointed parallel parliaments and state presidents, and in coming weeks clan militias could clash in Gedo region. In South Sudan, new violence could break out this month as President Kiir and main rebel leader Riek Machar may not have reached an agreement on core issues before the 22 February deadline to form a unity government. Ethiopia, Egypt and Sudan made progress in talks to resolve their dispute over the Grand Ethiopian Renaissance Dam on the Nile, creating an opportunity to strike a comprehensive deal in February.

Ahead of Cameroon’s parliamentary and local elections in February, Anglophone separatist militants determined to block the poll stepped up their attacks including against electoral staff and the military intensified deadly raids. In eastern DR Congo, militia violence rose in Ituri and North Kivu provinces and, as we feared, fighting escalated between armed groups and among ethnic groups in the Central African Republic’s east and north east, which could lead to larger scale violence in coming weeks.

In Nigeria, Boko Haram factions stepped up their attacks in the north east, and the jihadist group Ansaru claimed an attack in the north west for the first time since 2013. In Guinea, security forces hardened their crackdown on protests against President Condé’s alleged plan to run for a third term leaving at least six dead, while in neighbouring Guinea-Bissau, a standoff emerged amid allegations of electoral fraud.

In the Middle East and North Africa, the U.S.’s killing of Iranian general Qassem Soleimani in Baghdad caused U.S.-Iran tensions to soar, triggered Iranian strikes on the U.S. military in Iraq and reinvigorated Iraqi efforts to evict U.S. and coalition forces from the country. The White House’s long-awaited plan to resolve the Israeli-Palestinian conflict, published on 28 January, provoked an angry rejection by the Palestinian leadership, further dimming prospects for peace. As Lebanon’s dire economic situation worsened, the anti-government protest movement swelled and clashes between protesters and security forces intensified.

Battle picked up tempo on several fronts in northern Yemen and across the Yemen-Saudi Arabia border between Huthi forces and the Saudi-led coalition, raising the risk that fighting intensify and spread further in February. Troop movements also suggested a looming escalation further south between the Sunni Islah party and forces backed by the United Arab Emirates. In north west Syria, fighting could intensify yet further as the Turkish military engages Russian-backed government forces in Idlib.

In Asia, in a major step forward in efforts to resolve the conflict in Thailand’s deep south, Barisan Revolusi Nasional, the main insurgent group, and government officials met for the first time in a formal peace dialogue. Though overall levels of violence have declined in recent years, ongoing attacks show that the conflict remains a threat.

In Latin America, Venezuela’s political crisis deepened as the government of President Maduro seized control of parliament. Both opposition leader Juan Guaidó and a member of parliament backed by Maduro, Luis Parra, now claim leadership of the National Assembly. In El Salvador, the security situation continued to improve with President Bukele reporting that January was the least deadly month since the end of the civil war in 1992.

In Europe and Central Asia, in a positive development, Kosovo’s President Thaçi on 20 January nominated Vetëvendosje party leader Albin Kurti as the next prime minister, ending three months of political deadlock.

Good morning everybody

It’s fantastic to be here. Thank you Ramesh, thank all the panelists for joining us. But most of all thank you to all of you. It’s my first time here, and I’m pleased to have the opportunity to join you at the event. I want to thank the Government of Switzerland who support this generously. As Ramesh said, this is the sixth year we have been engaged in bringing everyone together.

Thousands of you – more than we’ve ever had before, from hundreds of organizations, are representative of the enormous diversity of the humanitarian response sector. All the colleagues of the UN agencies, from the Red Cross family, from academia, the private sector, the military, lobby groups and think tanks, community-based organizations and international NGOs. It’s a tremendous advert for the professionalism, commitment courage determination bravery and passion of the humanitarian sector. Thank you to the thousands of you and the tens of thousands of your colleagues around the world who have made the humanitarian response system much more effective than it’s ever been.

The sector is growing, and the truth is, the reasons it’s growing are not fantastic. But it’s also important that if there are large numbers of people in humanitarian need around the world that they get the help and protection they need.

And what we have today is an effective humanitarian response system. I’ve been working on these issues myself for a lot longer than my children would believe – the whole of my adult life basically - and I compare the way the sector deals with challenges now with the way we used to deal with things when I first used to work in the mid-1980s I see a complete transformation.

My first job was working on a response to the famine in Ethiopia in 1985-86. And then what we thought humanitarian response was mostly about, was trucking and dumping or air-dropping food and maybe a bit of shelter and water. Now we know that we need a much more comprehensive response and a much stronger focus on collaboration and coordination.

All those years ago, 35 years ago, there used to be 2 million people a year who would lose their lives in these crises. Now because we have a better system, the loss of life is much smaller. The world is not getting better at solving the underlying reasons we have crises but it is getting better at protecting and saving the lives of people caught up in crises, notwithstanding all the difficulties that we see in front of us at the moment.

One of the consequences of having a sector which is entirely voluntary and is as diverse and big and complicated as ours is that there is need for coordination. And what my office is trying to do is to provide a coordination service for all of you.

We’re trying to do four things. We’re trying to identify need – who is being caught up in humanitarian crises, who needs what help and we do that through the Global Humanitarian Overview which we published the latest version of here in Geneva in early December.

Second, we’re trying to support the coordination sector to get better response plans and the UN system has an important role to play there because about 70 per cent of global humanitarian activity takes place through the response plans that my office coordinates. They hold a whole plethora of organizations - the NGOs, Red Cross and others - and they represent the bulk of responses in crises.

The third thing we’re trying to do is to support all of you with the fundraising. Last year through the appeals that I coordinate, we raised a record US$16 billion in funding – that’s more than three times as much as 15 years ago. Of course that in of itself is a consequence of there being greater need. But all of the contributions we get for our responses are voluntary. And I do take it as an important responsibility for my office and myself to try to do everything we can to support the fundraising so you get the resources that you need to implement your programmes.

And the fourth thing we do is to try to support implementation of the plans with the money that’s raised especially through negotiating access and trying to break down the barriers that prevent some help from reaching some people.

I want to say a little bit about how I see the prospects for humanitarian challenges in 2020. And I do this in all humility. In December 2018 I projected that there would be 145 million people in need of humanitarian assistance during the course of 2019. And that was wrong by 20 million in the wrong direction. It turned out we needed to try to reach 165 million people.

Now, my projection for 2020 as we set it out in the GHO at the beginning of December is we’re going to have a more difficult year this year than we had last year. The reasons for that are essentially because of the nature and drivers of humanitarian crises around the world at the moment.

The single biggest driver of the problem is essentially geopolitics. Most people caught up in crises are caught up in conflict and displaced by conflict. And those things are made worse by the way States and non-State groups interact with each other. And the declining compliance with the rules of law that were established primarily after the Second world war through international humanitarian law. We are seeing declining compliance with those values, and that’s reflected for example in the fact that that last year there were more than 800 attacks on health workers and health facilities that were part of the humanitarian response.

Unfortunately it’s not my forecast that we will see an improvement in that set of problems during the course of 2020. I think you’ve already seen how the year has started in the Middle East. We see a lot of problems right now in parts of Syria. We see what’s happening in Libya. It was a very bad year last year in the Sahel and I’m afraid our projection is that it will not improve this year. And we see continuing challenges in places like Afghanistan.

The Second big driver of need is climate-related events. In recent years we’ve seen 300 climate-related emergencies a year, on average. That’s twice the level of what we were seeing 20 years ago. There are both the wet events – storms, such as Hurricane Dorian in the Bahamas, the storms that hit Mozambique last year. But also floods. We’ve had a spate of floods related to climatic events, especially across the Horn of Africa over the last six months.

There are also all the dry events. The droughts particularly affecting southern Africa, central America and large parts of the horn of Africa. Associated with those, a new problem that I’m particularly alarmed about right now is this huge locust threat in Ethiopia, Somalia and Kenya which has the potential to be the most devastating plague of locusts in any of our living memories if we don’t reduce the problem faster than we’re doing at the moment. Again it’s not my projection that we will see a slowdown or a decrease in the number of these climate related events.

The third of set of challenges is related to pandemics. You all know we’ve been dealing with this long-running Ebola outbreak in the Democratic Republic of the Congo. You’ve all seen the spate of measles outbreaks in various parts of the world. There was a 700 per cent increase in measles cases in Africa in the first three months of last year compared with the previous year. You all saw the human cost of the measles outbreak in Samoa and other parts of the Pacific at the end of last year. Now everyone is trying to understand the implications of the Corona Virus.

Some of the problems we’re dealing with relate to the continued fragility and weakness of immunization systems. There’s no reason why there should be measles outbreaks - there’s a vaccine that deals with it. But until immunization systems have sustained and perpetuating coverage there’s a risk of problems of the sort we’ve seen in Africa last year and in the Pacific in the last few months being sustained.

Now, the only solutions to this set of problems are in the space of achieving the Sustainable Development Goals. If countries get richer and more resilient they’ll have fewer crises and be able to cope with them better.

And in the space of the world getting more effective in the way it used to be during the 1990s and first part of the current century, in preventing resolving and dealing with conflict. Until we do better on those things and deal with the climate emergency, I’m afraid no one should expect we’ll see a reduction in humanitarian need.

That is why in the GHO we published in December, we forecast that in 2021 and 2022 there will be further increases in the number of people in need - currently one in 45 around the planet will need humanitarian assistance and protection.

At the same time there are some opportunities to help countries move these forward.
And it’s really important where there are opportunities that they are seized.

In Sudan where I was late last year, and where the people of the country are very proud of what they call their revolution, there is an opportunity in a country which has been devastated by conflict and other humanitarian crises for 30 years, to help them move forward. And the international community would be smart to take those opportunities when they arise. Unfortunately Sudan has had a lot more help in the form of words than in terms of actual practical concrete action. The world would be smart to change the balance there.

Likewise in Somalia after a long time there is now a prospect of Somalia getting debt relief which will happen before the end of next month. That will open up a whole new availability of resources to help the country resolve its problems.

So when we see opportunities, it’s really important to take them to help countries move forward.

It’s also very important that we sustain and continue to improve the humanitarian response system. And I hope one of the big things that you will get from networking and partnerships week this time is talking to each other, learning from each other, working out how in every organization we can improve to deal with the challenges ahead.

We have to improve because the needs are outpacing our ability to respond to them. And we have also to be aware that the whole system is voluntarily financed. And unless the people who finance it believe that we are committed to make our system even better, we’re going to run into problems with sustaining high-level finance.

We also need to see if we can identify problems earlier and deal with them earlier. Because we know if we respond earlier to predictable events - when there is a drought in the Horn of Africa, the consequences are predictable; when locusts start swarming the consequences are predictable - there’s a lot more, using technology pre-agreed financing and pre-agreed deliver systems that we could organize earlier. And that involves cheaper action, less suffering and less likelihood of contagion. So one of the big challenges for our sector is to get all of that early action connected.

I am in favour of networks and of partnerships. And my office wants to everything it can including through our support through the Inter Agency Standing Committee system and all the guidelines and the information material that we provide to support all of you. I hope that one of the things you will do over the course of this week is to let us know if there are things you want more of, or indeed that you’d like less of, from the coordinating system. We’re here to serve you, and through you, people who are caught up in these crises. So please do tell us the things you would like us to do better.

Enjoy the week thank you very much.

• The WHO Executive Board is currently holding its 146th session at the WHO headquarters in Geneva. Among many others, polio is one of the topics of discussion, take a look at the report by the Director-General on polio eradication.

• cVDPV2 confirmed in Kinshasa: a number of new cVDPV2s cases have been confirmed in DR Congo which may have significant implications on the current outbreak response activities. While none of the newly-confirmed cases are new emergences, the virus has now been detected in the mega-city of Kinshasa which is the first case in the city. See ‘DR Congo’ section below for more.

• Summary of new viruses this week (AFP cases and environmental samples):

  • Pakistan: eight WPV1 cases
    
  • Democratic Republic of the Congo (DR Congo): five cVDPV2 cases
    
  • Somalia: one cVDPV2 positive environmental samples
    
  • Angola: eight cVDPV2 cases
    
  • Burkina Faso: one cVDPV2 case

Coronavirus puts millions out of school, the areas where 85% of girls don't get an education and a mortar attack on a primary school - it's all in our news roundup.

Coronavirus shuts down schools in China

The coronavirus has put millions of children out of school in China. The shutdown of education to reduce the risk of the virus spreading has been extended until at least the end of this month in several provinces.

Shandong - which has a population of 100million - said all types of schools will stay closed until the end of February to guarantee students' safety.

Hebei - which surrounds the capital Beijing and has 75 million residents - will keep classrooms closed until at least March 1 to control the coronavirus outbreak. Schools also remain shut in a number of other provinces and municipalities, including Jiangsu and Shanghai.

China's education ministry said a cloud platform will be launched on February 17 to provide students in elementary and secondary schools with resources. For students in remote or rural areas with poor internet access, a Chinese education television channel will start airing classes on February 17 for them to study at home.

In Hong Kong, Education Secretary Kevin Yeung said secondary and primary schools would not return from an already prolonged break until at least March 16.

19 children injured by mortar attack on school in Myanmar

At least 19 children were wounded when a village primary school was hit by mortar shelling in Myanmar's Rakhine state yesterday.

Clashes between government troops and ethnic insurgents have intensified in Rakhine, where more than 730,000 Rohingya Muslims fled a military crackdown in 2017. The Arakan Army, which recruits from the mostly Buddhist majority, has been fighting for greater autonomy for the western region from the central government.

Schools are meant to be safe spaces where children can learn free from danger. The Safe Schools Declaration - a commitment to protect schools from attacks and military occupation - has been signed by 101 countries.

Meanwhile, UNICEF has released details of how a pilot programme to introduce the Myanmar school curriculum to Rohingya refugee children will work. Bangladesh finally agreed last month to offer formal education to children under 14 living in refugee camps.

A pilot starting in April will help 10,000 students from grades six to nine because they currently have less access to education. It will then be expanded to other grades. An extra 250 teachers will be recruited in addition to the existing 8,900 teachers to teach the children in a double-shift system.

85% of girls out of school in some Afghan areas

The number of children at primary school in Afghanistan increased from just one million to 8.5 million between 2002 and 2019 - but a third of school-age children (3.7 million) are still not getting an education.

The statistics are revealed in a humanitarian update by the UN Office for the Coordination of Humanitarian Affairs. About 60% of out-of-school children are girls and in some provinces as many as 85% of girls are not in school.

The update says: "While girls’ access to education may be limited by cultural expectations, in many cases it is also tied to perceived and real security risks, as well as the appropriateness of the school curriculum and physical set-up under local cultural norms."

Only about 5% of children with disabilities are in school. Attacks on schools also continue to result in children being deprived of education. During 2019, 488 schools were reported to have been forcibly closed due to insecurity, affecting around 150,000 children - 72,000 girls and 78,000 boys.

Call for action on girls' education

Celebrities, youth activists and world leaders gathered at the UN this week to call for action on the issue of adolescent girls’ education. More than 130 million girls worldwide are not in school.

U2 singer Bono and former Irish President Mary Robinson were at the event, along with UN Secretary-General António Guterres and UN Women Executive Director Phumzile Mlambo-Ngcuka.

“One of these girls who is getting an education today, could be the one coming up with the solution to climate change tomorrow. We need to ask for help and demand education for all girls,” said Bono, who called on men to play their part in advancing gender equality.

Other speakers included Sonita Alizadeh, an Afghan rapper and youth activist who shared her own experience of being forced to marry while still a child. She said: “I want everyone to know that a girl’s education is worth a lot more than her dowry."

Missionaries help child soldiers through education

To mark International Day Against the Use of Child Soldiers - also known as Red Hand Day - on February 12, Salesian Missions has highlighted its programmes to help former child recruits through education.

Salesian missionaries began working in 2001 to rehabilitate ex-child soldiers in Sierra Leone. Since then, Don Bosco Fambul in the capital Freetown has become one of the country’s leading child welfare organisations.

In Liberia, the Don Bosco Youth Center in Monrovia provides a foundation of education and support for former child soldiers and other young people with limited opportunities.

“Children utilised in hostilities and war have faced unimaginable violence and abuses and need our support to have a second chance in life,” says Father Gus Baek, director of Salesian Missions. “In countries around the globe, Salesian missionaries work with former child soldiers so that they may overcome the traumas of war and reintegrate into society.”

A time-limited working group has been put together to manage and coordinate GPEI’s activities to enable a rapid and effective roll out of nOPV2. Take a look at the terms of reference for the working group.

With the evolving public health emergency associated with the increase in new emergences of circulating vaccine-derived poliovirus type 2, a draft decision was adapted by the WHO Executive Board during last week’s meeting. Read more Would you like to improve your knowledge on polio in an interactive way? A one-hour online course – Introduction to Poliomyelitis and the Global Polio Eradication Initiative is now available on theOpenWHO learning platform. Using your OpenWHO credentials to log in, the course can be accessed here.

Summary of new viruses this week (AFP cases and environmental samples):

• Pakistan: five WPV1 cases, twelve WPV1 positive environmental samples and three cVDPV2 positive environmental samples
  
• Nigeria: one cVDPV2 case and one cVDPV2 positive environmental sample
  
• Democratic Republic of the Congo (DR Congo): two cVDPV2
  cases
  
• Somalia: two cVDPV2 positive environmental samples
  
• Angola: three cVDPV2 cases
  
• Cote d’Ivoire: three cVDPV2 positive environmental samples
  Ethiopia: seven cVDPV2 cases
  
• Philippines: one cVDPV2 case and three cVDPV2 positive environmental sample