Complete Wellness

Interview with Clarissa Brocklehurst, UNICEF Water and Environmental Sanitation Chief

UNITED NATIONS, Sep 17 2007 (IPS) – When it comes to discussing the critical health problem of inadequate sanitation, few politicians want to take the lead, despite the mountains of scientific evidence that poor hygiene and lack of proper toilet facilities are the cause of many deadly but preventable diseases.

Clarissa Brocklehurst at UNICEF House Credit: UNICEF/Susan Markisz

Still, Clarissa Brocklehurst, chief of UNICEF s Water and Environmental Sanitation division, is optimistic that the upcoming International Year of Sanitation in 2008 will put this issue much higher on the policy-making agenda.

IPS correspondent Nergui Manalsuren spoke with Brocklehurst at UNICEF headquarters in New York. Excerpts of the interview follow.

IPS: There are an estimated 2.6 billion people living without adequate sanitation, of whom 980 million are children. How is UNICEF working to resolve this problem?

CB: Whereas water supply is often a community decision, and a community responsibility, we find that sanitation is a household decision. Many families actually want to have a toilet for the privacy, convenience and the dignity that it offers. And we value that too, particularly because we work a lot with women as mothers of children. For those women, the health impact of the toilet is less important than the impact it has on their dignity and comfort, not having to go and defecate out in a public place.

We are finding that once families are convinced of the need for sanitation, they are willing to go to great lengths in order to provide their family with sanitation, which means building a toilet. And that means making sure that sanitarian equipment is available on the local market, and that we have lots of different designs of toilets so that people can chose the one that they think is the most appropriate to them.
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IPS: Why is sanitation considered one of the most neglected of all the U.N. s Millennium Development Goals (MDGs)?

CB: It is pretty easy to see why sanitation is neglected; it s something that people are embarrassed to talk about. It s what one author called the last taboo . It s embarrassing, it s seen as a very personal, private issue. It s not the one that is seen as particularly sexy or interesting. It doesn t lead to a nice photograph.

One of the things we ve been trying really hard to do is to get positive photographs of latrines, the same way that UNICEF has lots of wonderful positive photographs of water supply. And you can imagine how difficult that is, right? So in a way we compare ourselves in the sanitation sector to the people who pioneered HIV/AIDS. When the issue of AIDS first came up, advocates had to break through the fact that in order to talk about HIV and AIDS, you had to be willing to talk about people s sexual practices, and this was very difficult, but they did it. And it became very matter of fact, and people realised that it is something that needed to be discussed if the disease would be combated.

If the health MDGs are going to be met, we have to improve water supply, improve sanitation, and improve people s hygiene practices, particularly washing their hands with soap. And that means that we have to talk about people s defecation practices the same way that we had to talk about people s sexual practices. And this is a difficult thing to do, because people get embarrassed and shy, and start to giggle. So it s something that we have to address head-on.

IPS: How do you think you can generate more media and donor attention for NGOs that deal with sanitation issues?

CB: One way is through scientific evidence. There are studies available today that were not available even five or 10 years ago. They show very clearly the link between sanitation and health and particularly between hand washing with soap and health. When I say sanitation, I mean toilet, solid waste management, rubbish management, hand washing with soap, and hygiene practices, we see them all as the same thing.

It is women whose dignity and even security are threatened when there s no proper sanitation, women who have to wait all day for darkness of night to be able to go out and go to the toilet. So we want to help women to push sanitation up on the agenda, not as a health issue, but as a quality of life and a dignity issue.

IPS: Why is the subject of sanitation and human waste so rarely aired in public, and what can be done to change this mindset?

CB: It is a brave politician who will get up and talk about sanitation and publicly say that he or she supports investment in more toilets. Politicians usually like to talk about investments in modern equipment projects and things like that. But we do find brave politicians who are willing to break through the taboo and talk about it.

Sanitation is also an institutional orphan, in the sense that the agency or ministry that is responsible for water supply in a country is not necessarily the agency that is responsible for sanitation. So there will be a ministry of water, for instance, that is responsible for water resources and water supply. But then sanitation will be buried in the ministry of health. The ministry of health would be much more interested in curing a disease than in sanitation, which is sort of poorly resourced, and an embarrassing topic. So we do a lot of work to raise the profile of sanitation within health ministries.

IPS: What are the consequences of lack of sanitation among children?

CB: The thing that we re most worried about is diarrheal diseases. Most are fecal or oral, which means that you catch that disease by coming into contact with human fecal matter. And obviously in an environment where there are no toilets, if there is human fecal material available, it gets on people s hands, it gets to some people s feet, it gets into food, and it gets into water, and then we have a very high risk of diarrheal diseases like cholera, and they are deadly to small children. We also worry about worm infections. And most worm infections are caused by poor disposal of human feces and animal feces.

Then there s an issue of lost days of school. If children don t have clean toilets to go to at school, their parents are most likely to keep them at home. Especially girls, when they start menstruating. So we find that for girls, school toilets are just as important for menstrual hygiene as they are for defecation, and that means we have to design many tools to respond to those needs.

IPS: What regions of the world are most affected by lack of proper sanitation?

CB: The coverage rate for sanitation in India and China has a huge impact on the coverage rate for Asia overall. And India and China, advanced as they are in many ways, have very low, surprisingly low rates of sanitation. India is not on track to meet the sanitation target. China overall comes out as being on track, but what that hides is that there s enormous rural China that is not on track. Russia is not on track as well. Most of Africa is not on track to meet the sanitation target.

Haider Rizvi

UNITED NATIONS, Oct 13 2007 (IPS) – Despite its enormous wealth and highly advanced technology, the United States lags far behind other industrialised countries and even some developing ones in providing adequate health care to women during pregnancy and childbirth.
The U.S. ranks 41st in a new analysis of maternal mortality rates in 171 countries released by a group of U.N. public health experts on Friday. The survey shows that even a developing country like South Korea is ahead of the United States.

Women are unnecessarily dying from pregnancy and childbirth complications because the U.S. is moving in a wrong direction, said Beneva Schulte of Women Deliver, a Washington-based group campaigning for women #39s reproductive rights and access to public health care.

Based on 2005 estimates, the U.N. analysis suggests that one in 4,800 women in the United States carry a lifetime risk of death from pregnancy. By contrast, among the 10 top-ranked industrialised countries, fewer than one in 16,400 are facing a similar situation.

The reason? According to experts, in many European countries and Japan in the industrialised world, women are guaranteed good-quality health and family planning services that minimise their lifetime risk.

Many independent experts and sympathetic legislators hold the current U.S. public health policy responsible for its dismal record because some 47 million U.S. citizens have no access to health insurance, most of them African Americans and other minorities.
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We must ensure that pregnant women are covered, Congresswoman Lois Capps, a California Democrat, told IPS. Even if we have the best technology, not everyone has the access to health care.

Capps also said the scope of the problem could be even worse than it appeared. We have to improve our data collection, she said. I don #39t think we have all the data.

U.N. experts who prepared the analysis said they developed a new approach to estimating maternal mortality that seeks both to generate estimates for countries with no data and to correct available data for underreporting and misclassification.

They hold that inconsistency in data on deaths and on classification of those deaths creates broad uncertainties in many places, even in developed countries. But all estimates almost certainly understate the problem.

Responding to inquiries by IPS, a U.S. public health official identified racial disparity as the most significant factor underlying the high U.S. maternal mortality rate. Black women are four times more vulnerable than whites, Eve Lackritz, chief of the Maternal and Infant Health branch of the Centres for Disease Control (CDC), told IPS.

In Lackritz #39s view, obesity and hypertension are two leading causes of pregnancy-related risks in the United States. We have to be more responsive, she said. This is one of our big problems.

The U.S. situation within the industrialised world aside, the other end of the spectrum shows there are 10 countries all of them in Africa except for Afghanistan where high fertility and shattered health care systems are causing extreme risks for pregnant women.

According to researchers, in countries like Somalia, Mali, Chad, and Niger, on average more than one in every 15 women is likely to die of pregnancy-related causes. In Niger, the estimate suggests that one out seven women is vulnerable to death during pregnancy.

Their analysis comes at a time when many development activists and U.N. officials are trying to evaluate how far the world has progressed in meeting the Millennium Development Goals agreed upon by the world leaders some seven years ago.

When the world leaders attended a summit in New York in September 2000, they agreed that the MDGs must be achieved by 2015. That commitment included policy initiatives to reduce maternal mortality by 75 percent.

Many experts believe that in the past seven years nothing much has changed for the millions of poor women with regard to their economic wellbeing and access to health care.

As reported by the British medical journal the Lancet this week, at the current pace, there is almost no hope that the world will be able to achieve the 75 percent target.

Annually, about 20 million women undergo unsafe abortions, which, according to the journal, is a major factor in maternal deaths and illness.

Reproductive rights activists say that governments must take drastic steps to reverse the situation if they are serious in meeting the MDGs on reducing the maternal mortality rates in the next seven years.

We still have the situation we had 20 years ago, said Ann Starrs of the independent group Family Care International in a statement. Half a million women die every year from the complications of childbirth.

A recent study by Harvard University professor Ken Hill found that between 1990 and 2005, maternal deaths did fall, but by less than one percent a year. Hill and many other researchers estimate that at least 10 to 20 million women suffer injuries from the complications of childbirth every year.

Experts say this suffering could be easily avoided if international donors contributed just 6.1 billion dollars over the next seven years.

On Oct. 18-20, more than 1,500 world leaders will convene in London for Women Deliver , a global conference that will focus on creating political will and strengthening health systems to prevent the deaths of one woman every minute of every day during pregnancy or childbirth .

David Vargas

ASUNCIÓN, Nov 8 2007 (IPS) – A sea of green stretches as far as the eye can see on both sides of the dirt road leading to the communities of Lima, Capiibary and Guayaibí, 250 km from the capital, in the northern Paraguayan department (province) of San Pedro, one of the country s poorest.

Credit:

The huge fields are planted with genetically modified soy, Paraguay s leading export product. But as it takes over more and more land, the crop is leaving sick people, displaced communities and trampled rights in its wake, according to the documentary Soberanía violada (Violation of Sovereignty).

The documentary, produced by a Paraguayan team, portrays the drama of campesino (small farmer) communities that experience the spread of soy plantations as a threat to their survival.

The economic interests of large landowners most of them foreigners and multinational corporations are destroying entire communities, felling forests, polluting streams and rivers, making children sick, causing miscarriages, killing campesinos and forcing them to abandon their land and their culture, says the synopsis of the 40-minute documentary.

Paraguay has become the world s fourth largest exporter of soy, after the United States, Brazil and Argentina. According to the Agriculture Ministry, soy is grown on 2.4 million hectares of land and accounts for 38 percent of the country s agricultural production.

The Paraguayan Chamber of Cereals and Oilseeds Exporters (CAPECO) announced that their goal for 2008 is to expand soy cultivation to four million hectares and to double export revenues from the commodity, which in the first quarter of 2007 amounted to 780 million dollars.
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But that figure fails to reflect the social and environmental consequences of the expansion of soy cultivation, which are reflected in the documentary through dozens of testimonies from campesinos.

The idea for the film came from the provincial Coordinating Committee for the Defence of Sovereignty, an umbrella group for representatives of organisations and leaders of different communities in San Pedro, Arturo Peña, one of the producers of the documentary, told IPS.

Soberanía violada has been included on the programme of the One World Berlin Film Festival to be held this month in the German capital, where it is due to be screened on Nov. 18.

The filmmaking team s general coordinator was Catalina Servín, and the documentary was written, directed and filmed by Malu Vázquez and edited by José Elizeche, with music by W. Krauch.

Their aim, they said, was to create a tool that could be used to raise awareness on the problem, which has got worse over the last five years as transgenic soy has expanded in the area.

Thousands of families have already left the province after selling their land, usually because they were surrounded by the soy crops and endangered by the spraying of toxic agrochemicals. They had no choice, said Peña.

The soybean boom has also brought unemployment. It requires little labour, and in the east of Paraguay soy has displaced cotton, which used to employ large numbers of people, the documentary says.

Small farmers, who make up a large proportion of the country s six million people, have been displaced by large-scale soy producers.

According to a study by the non-governmental social research organisation Base-IS, 70 percent of Paraguay s farmland is presently in the hands of foreign landowners, who are mainly Brazilian.

Some small farmers, however, have refused to budge. One example is Manuel Cuevas, who has cultivated beans, maize and other subsistence products near the village of Lima for 30 years. His 10-hectare property is surrounded by Brazilian-owned soy fields.

Cuevas has received several offers for his land, but he and his family have turned them all down. So far we re doing alright, he says in a resigned tone of voice.

I will never leave. I have everything I need here: land, running water, electricity. There is no reason for me to leave my land, says Reinaldo Casco, another farmer, who adds proudly that his parents were among Lima s first settlers.

These are just two testimonies out of the dozens shown in the documentary, which reflect the abandoned state of these rural villages, left to fend for themselves for decades, with obsolete health systems, authorities who serve the interests of the big landowners, and roads in terrible condition, Peña told IPS.

And now they are also threatened by the crushing advance of the agroexport model, he said.

Sociologist Tomás Palau, one of the authors of the book Los refugiados del modelo agroexportador (Agroexport Refugees), described the main effects of the rise of soy monoculture on rural communities.

There is strong pressure on the campesinos land, because the market value has sky-rocketed, he told IPS.

The campesinos are displaced in various ways: their land is bought or leased, or they are forced to leave because of massive spraying with agrochemicals.

There are also armed groups operating in the area. It s really an eviction army, he said.

Spraying with toxic agrochemicals has negative effects on both human and animal health, causing illnesses ranging from allergies and respiratory problems to cancer, foetal malformation and miscarriage, Palau said.

The environment also suffers. The agrotoxics poison rivers and the earth, kill microorganisms in the fertile layers of soil and increase deforestation, he said.

But according to Palau, the least visible aspect of soy agribusiness is the fact that the revenues from soy exports do not remain within the country, because they belong to large foreign producers and corporations.

Without realising it, we re finding ourselves in a situation where an extremely high percentage of Paraguayan exports is controlled by three or four multinational corporations: Monsanto, which supplies seeds to 90 percent of the producers, and companies like Cargill, Louis Dreyfus and ADM (Archer Daniels Midland), he said.

Soy cultivation in Paraguay began to expand in the mid-1960s and boomed in the late 1990s with the introduction of genetically modified seeds by companies such as Monsanto.

Intensive soy production has caused a fall in traditional activities like timber extraction, cattle ranching and even production of cotton, which used to be the country s main agricultural export. The area under cotton cultivation has dropped from 509,000 hectares in 1990 to only 160,000 hectares in 2006.

Abra Pollock

WASHINGTON, Dec 5 2007 (IPS) – Globalisation, climate change, and the mass production of biofuels are pushing up food prices worldwide, which could jeopardise the livelihoods of the world #39s poorest, according to a report released Tuesday by the International Food Policy Research Institute (IFPRI).

Man working a rice field in Bangladesh. Credit: USAID

Food prices have been steadily decreasing since the Green Revolution, but the days of falling food prices may be over, said Joachim von Braun, lead author of the report and director general of IFPRI.

Titled, The World Food Situation: New Driving Forces and Required Actions , the 16-page report examined how various global trends are impacting world hunger on both the supply and demand ends of the market.

Surging demand for feed, food, and fuel have recently led to drastic price increases, which are not likely to fall in the foreseeable future, von Braun said. But climate change will also have a negative impact on food production.

Similar findings have been reported by the Organisation for Economic Cooperation and Development, the U.S. Department of Agriculture, and the U.N. Food and Agriculture Organisation, according to IFPRI.

Researchers predict that shifting weather conditions resulting from climate change will disrupt rainfall patterns that farmers rely on to nourish their crops and water the grasslands that feed their livestock. As a result, cereal production in South Asia could drop 22 percent by 2080, while wheat production in Africa may virtually disappear by that time, the report said.
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Furthermore, temperature increases of more than three degrees Celsius could in turn lift food prices by as much as 40 percent.

The production of crop-based biofuels renewable energy sources developed in response to climate change may also dramatically impact food supply, and thereby further escalate food prices.

If the countries that have already committed to biofuel production, as well as other high-potential producer countries, carry out their current investment plans, global maize prices would increase by 26 percent and oilseed prices would rise by 18 percent by 2020, according to the report. This is due to state subsidies for biofuels, as well the shift in committing scarce resources toward cultivating biofuel crops.

As biofuels become increasingly profitable, more land, water, and capital will be diverted to their production, and the world will face more trade-offs between food and fuel, the report said.

In the U.S. alone, the use of maize for ethanol production increased by two and a half times between 2000 and 2006.

On the demand side of worldwide food production, globalisation, economic growth, and urbanisation in places such as China and India have impacted people #39s dietary preferences and food choices, the report noted. While demand is on the increase for processed food and high-value agricultural crops such as vegetables, fruit, meat and dairy, demand for grains and other staple crops is declining.

This shift in tastes represents a microcosm of the food costs issue, said IPFRI research analyst Timothy Sulser, who also contributed to the report. As wealthier populations shift to a diet full of meat, fruits, and vegetables, poorer populations will struggle to afford ever pricier food staples.

There will be an even wider gap between affluent people and poorer people in terms of access to a nutritional diet if trends continue, Sulser said.

With many factors threatening the world #39s food supply and demand, immediate action is needed in the areas of international development and global trade policy in order to avert what could be a dramatic hunger crisis, according to authors of the report.

Eliminating trade barriers and programs that set aside agriculture resources is one way that developed countries could help equip developing countries for the rising food prices.

Other suggestions include strengthening policies to promote early childhood nutrition thereby diminishing the risks related to limited food access and incorporating food and agriculture considerations into the agenda for domestic and international climate change policy.

Yet these solutions may only mitigate the effects of a global trend whose causal forces, such as globalisation and climate change, have already been set in motion, say researchers.

The policy suggestions are intended to help minimise some of the impact of these changes, said Sulser. It #39s important now to look at how we can help people adapt to the changing the situation.

Ashfaq Yusufzai

PESHAWAR, Jan 24 2008 (IPS) – Although genetic sequencing tests conducted by the World Health Organisation (WHO) of samples from a man who died of H5N1 avian influenza do not confirm human-to-human transmission, authorities in this region, bordering Afghanistan, are taking no chances.
Ilyas, 28, a livestock official was admitted to the Khyber Teaching Hospital (KTH) on Nov. 22 with symptoms of bird flu and died on Nov. 22. But when it became known that his brother, Idrees, 22, had developed similar symptoms and died four days earlier it sent alarm bells ringing through the community and health officialdom.

On Dec. 28, WHO s headquarters in Geneva announced that a case of human-to-human virus transmission may have occurred in Pakistan, but a later statement on Jan. 3 said that a preliminary risk assessment found no evidence of sustained or community human-to-human transmission .

Meanwhile, KTH had received another three brothers and one cousin; all were tested positive for carrying H5N1 strain of virus.

Initially, the Ministry of Health, Islamabad dragged its feet on the result of the death of Ilyas, despite its confirmation by the National Institute of Health (NIH), Islamabad. The ministry was cautious, fearing that it would cause panic among the people, and pilgrims could face delay in flights to Saudi Arabia for Hajj.

Now it has issued an alert and started training doctors and health workers on the management of bird flu in the province. It has established two respiratory isolation units (RIUs) to cope with an emergency.
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The WHO is assisting the health department to establish two RIUs, one each at Peshawar and Abbottabad where six cases and three cases respectively of H5N1 were found, said WHO s Dr Saeed Akbar Khan.

In addition, the world health agency has agreed to establish two wards each at KTH and Ayub Teaching Hospital, Abbotabad in NWFP, at an estimated cost of 500,000 dollars, Dr Mukhtiar Zaman Afridi, a pulmonologist and focal person for bird flu told IPS.

The WHO has urged the health and agriculture departments in the NWFP to coordinate efforts because an estimated 35 percent of the population could be at risk. In case of a pandemic, thousands of people could die, and hospitals, which together have roughly 9,000 beds, would be unable to meet the challenge.

About 14 private rooms designated as the isolation ward are not up to the standard of the world health agency. There is no ventilation and investigation facility, such as x-rays, etc., due to which the affected patients had to be shifted to and from the ward, Dr. Saeed Akbar Khan told IPS.

The global health agency believes the world is closer to another influenza pandemic than at any time since 1968. Last month, its experts flew into Pakistan and visited Peshawar and Abbottabad districts of NWFP where some 200,000 poultry have been culled.

Two teams collected data on the nine bird flu cases reported from the two districts in effort to determine the epidemiological link between them. While one patient died, the rest have recovered.

Dr Khalife Mahmud Bile, WHO s country chief, said the visiting teams had validated the findings of the NIH.

Global health experts fear the virus which has killed 211 people out of 343 infections reported since 2003 could mutate into a form that spreads easily from one person to another, possibly triggering a pandemic that could kill millions.

WHO teams in Pakistan also investigated the possibility of human-to-human transmission in the reported cases. Since 2005, the government has confirmed the deaths of five people from bird flu.

Stocks of Tamiflu, an antiviral drug used for influenza virus, have been rushed to the affected districts to meet any eventuality, said Bile.

Concerned officials warn there is a need to educate ordinary people and health professionals about the risks. Most doctors are afraid of coming into contact with patients infected by the avian influenza.

According to Dr Khalid Khan of the NWFP s livestock department, the virus flourishes in zero temperature. There is a need to inform the people, especially those associated with the poultry businesses, about the preventive steps, he added.

Up to December, Pakistan reported 79 outbreaks of bird flu, the last on Nov. 29 in Murree, Punjab province. Of these, 53 outbreaks involved commercial and backyard poultry.

The NWFP, which houses 85 percent of the country s poultry farms, is introducing a law aimed at protecting people from bird flu, confirmed Shah Rukh Khan, secretary agriculture and livestock department.

Under the proposed legislation the sale of poultry would be permitted only in designated places. Poultry farms not be allowed in residential areas and poultry waste would be compulsorily buried in deep ditches.

Bird flu has crippled the provincial government. An estimated two million dollars has been paid in compensation to poultry owners who have suffered losses.

Michael Deibert

KIBUMBA, Democratic Republic of Congo, Mar 1 2008 (IPS) – In a mist-shrouded valley between the Mount Nyiragongo volcano and a pair of its dormant cousins looming in Rwanda to the east, nearly 3,000 souls wait in limbo, having fled a conflict that has succeeded in making this lush corner in eastern Democratic Republic of Congo (DRC) nothing less than hell on earth for its people.

Kibumba camp, eastern Democratic Republic of Congo. Credit: Michael Deibert/IPS

We arrived here fleeing the war, says Gilbert Naimrwango, president of the Kibumba camp #39s displaced persons association and a primary school teacher in his former life, speaking amidst a sprawling collection of grass and banana-leaf huts covered with thin sheets of tarpaulin. As he speaks, he is surrounded by dozens of other residents and shoeless children, some with distended bellies and reddish hair that suggest severe malnutrition. Life here is very complicated, and we have much difficulty finding food.

Here we are with women and children, with little food, little water, where bandits can get us, adds Rusigariye Nubaha, a 54-year-old farmer who says he fled conflict in the district of Rutshuru, to the north, in late November.

The camp took shape in November 2007 amidst brutal fighting between army forces loyal to President Joseph Kabila, backed by the government #39s local paramilitary allies such as the Patriotes Résistants Congolais (Congolese Resistance Patriots, PARECO), and the army of renegade general Laurent Nkunda. An ethnic Tutsi, Nkunda leads the Congrès National pour la Défense du Peuple (National Congress for the Defence of the People, CNDP), a politico-military organisation.

Further poisoning an already lethal mix, the Forces Démocratiques de Libération du Rwanda (Democratic Forces for the Liberation of Rwanda, FDLR) a group with its roots in Rwanda #39s 1994 genocide, and comprised mainly of ethnic Hutus also took part in the fighting.

Nkunda claims to be defending the rights of Tutsis in North Kivu, where much of the fighting has been centered, as well as in neighbouring South Kivu. Both provinces straddle a mineral and timber-rich area, collectively abutting the borders of Burundi, Rwanda and Uganda.
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The Kabila government for its part has claimed that Nkunda is little more than a proxy for Rwanda itself, where a Tutsi-led government has ruled since toppling the Hutu regime that attempted the extermination of Tutsis and Hutu moderates over a decade ago, killing an estimated 800,000 people. All sides in the conflict have been accused of gross human rights abuses.

Intense combat and attendant atrocities, including widespread rape and the forced recruitment of child soldiers, have succeeded in emptying whole villages, with residents fleeing to what they regard as safer ground. The United Nations Office for the Coordination of Humanitarian Affairs estimates that since 2003, some 800,000 people have been displaced by fighting in North Kivu out of a population of 4.2 million, or roughly one in five.

A report released in January by the International Rescue Committee relief organisation asserted that 45,000 people were dying monthly in Congo, largely as a result of health-related concerns caused by the social and economic disruption of the ongoing conflict. The report estimated that 5.4 million deaths occurred between August 1998 and April 2007, and about 2.1 million since the formal end of the DRC #39s 1998-2002 civil war.

Everybody #39s victimised, even the people who have not been displaced: they are very poor and they have tremendous problems, says Johann Siffointe, emergency co-ordinator with the United Nations High Commissioner for Refugees, in Goma the provincial capital of North Kivu. It #39s a protected emergency.

In Rutshuru itself, a three-hour drive north from Goma over deeply-pitted roads, the situation is no better. A sprawling displaced persons camp has taken over the grounds of a local school and aid workers say they have witnessed first-hand the conflict #39s grievous toll.

The conflict has made things worse as far as the situation with malnutrition, because most of the people farm for themselves, says James Cogbill Jr, an American physician working at a hospital run by the humanitarian organisation Médecins Sans Frontières (Doctors Without Borders, MSF), in Rutshuru. When they get displaced from their land, they automatically have no food source.

According to the sexual violence programme at the MSF hospital, the facility recorded 129 cases of sexual assault between the start of the year and mid-February, with the victims ranging in age from 11 to 80 years old.

Despite a tentative peace deal reached between the CNDP and the Kabila government at a conference in Goma in January there is still deep distrust between the actors in the conflict, and many refugees are reluctant to return home to the scene of previous fighting.

The situation of exclusion and racial discrimination in this province, saying that some are more Congolese than others, continues, says Muiti Muhindo, an attorney in charge of external relations for Nkunda #39s CNDP in Goma, proceeding to rattle off areas which he says have seen massive movement of military material in recent days.

We need a commission of genuine national reconciliation, but on the contrary the government is moving arms from Kisangani towards Walikale, from Bunia towards Beni. They are preparing for war.

The government says that there have been clashes between CNDP and PARECO elements although it claims these were minor but it denies any plan for a return to full-scale conflict.

We are observing the ceasefire, says General Vainqueur Malaya, overall commander of the Congolese army in the North Kivu region. Things are improving slowly.

As darkness falls on Kibumba amidst the talk of renewed fighting, the residents of the camp, gathering outside their fragile shelters far from home, have a simple question.

Our biggest preoccupation is this, says Faustin Seruhungo, a former student who lives in the camp with his family. When will we be able to return home?

Daniela Estrada

SANTIAGO, Apr 2 2008 (IPS) – Chilean President Michelle Bachelet has announced a new policy for indigenous people, which includes novel approaches to political participation and the protection of natural resources in the hands of the country s native groups.
Some say the problem facing indigenous people is just poverty, and that good targeting of subsidies would be the most appropriate policy. But we, on the other hand, maintain that it is a matter of rights, of a collective identity seeking expression in a multicultural society, said Bachelet at a ceremony Tuesday in the palace of La Moneda, the seat of government.

We are making progress on indigenous affairs, but now is the time to go further, and above all at a faster pace. We have the will, the grassroots support, the resources, the commitment and the legitimacy to do so, she said.

The president announced the new policy for the nine ethnic groups recognised by the state, in the presence of ministers, members of Congress and representatives of indigenous communities, as well as former President Patricio Aylwin (1990-1994), who promulgated the 1993 Law on Indigenous Peoples and chaired the 2001-2003 Commission for Historic Truth and a New Deal.

A 2006 census known by the acronym CASEN found that 1,060,786 people identified themselves as belonging to native groups, equivalent to 6.6 percent of the Chilean population. The largest indigenous community is the Mapuche, who make up 87.2 percent of the country s indigenous people.

The new Social Pact for Multiculturalism addresses three main areas: political systems, rights and institutions; integrated development of indigenous communities; and multiculturalism and diversity. These are to be added to the guidelines for action presented by Bachelet in April 2007.
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In the first area, the president announced that she would promote direct participation by indigenous people in Congress, regional legislatures and local councils. I want indigenous representatives in parliament, said Bachelet, to a round of applause.

The proposal that has been analysed in greatest detail is to go back to a draft law presented in 1991 by two lawmakers, proposing the creation of an indigenous electoral district which would be entitled to elect a given number of members of both houses of Congress, Rodrigo Egaña, commissioner for Indigenous Affairs, said after the ceremony.

Egaña, appointed by Bachelet in February to coordinate and propose new policies for original peoples, said they hope to send several draft laws to Congress in three to five month s time.

It is likely that the draft law on the indigenous electoral district will be combined with reform of the two-candidate or binominal electoral system, which is part of Bachelet s government programme, as it has been for her three predecessors, all of them belonging to the centre-left Coalition for Democracy, since the return to democracy in 1990.

The binominal system, which benefits the two largest party coalitions, has not been eliminated because of opposition from the right, and because if affects the interests of sitting lawmakers.

The creation was also announced of a Subsecretariat of Indigenous Affairs within the sphere of the Planning Ministry (MIDEPLAN), a Council of Indigenous Peoples, conceived of as a representative body for consultation on policies affecting native communities, and a Ministerial Committee for Indigenous Affairs.

The present National Corporation for Indigenous Development (CONADI) is to be restructured, in order for it to implement policies. In addition, an Indigenous Affairs Unit will be established in each cabinet ministry.

In the second area, the president said that land would be restored in the immediate term to 115 indigenous communities, and decisions would be made with respect to the applications of another 308 communities. The Land and Water Fund, administered by CONADI, will be overhauled.

Programmes will be set in motion to boost the economic development of native groups, as well as the areas of communications, housing, drinking water, electricity and rural innovation, Bachelet said.

The special indigenous health programme will be strengthened, and actions will be studied to guarantee the right of indigenous peoples to have a say in the education of their children.

The third and final area of the new policy is aimed at generating cultural change among the Chilean population. The main novelty is that a Code of Responsible Conduct will be drawn up to regulate private and public investment projects in Indigenous Development Areas and on indigenous lands.

The Code will include the right of indigenous people to be consulted about the projects, to share in the benefits, to be compensated for damages, and not to be relocated from their homes except under the conditions stipulated in the (International Labour Organisation) Convention 169 (on Indigenous and Tribal Peoples), the president said.

We are thinking of an indigenous communities impact assessment for investment projects, similar to the environmental impact assessment studies that are already required, Egaña said.

Lastly, policies fomenting multiculturalism and inclusion will be created, and specific programmes will be developed for indigenous people living in urban areas.

Although Bachelet launched an indigenous affairs policy in April 2007, intended to last until 2010 when her term of office ends, the resurgence of the Mapuche land conflict in the southern region of Araucanía forced her to announce further reforms.

The first five guidelines for action she proposed were strengthening indigenous communities participation in the political and social arenas, recognition and strengthening of their rights, improvement of the quality of life of indigenous people living in urban areas, empowerment of women, and promoting education and culture.

In January, however, Mapuche student Matías Catrileo was shot and killed by the police when, with a group of fellow activists, he trespassed on a private estate that the Mapuche claim as part of their ancestral lands.

Another activist for the Mapuche cause, Patricia Troncoso, who is serving a 10-year prison sentence for terrorist arson , went on hunger strike for over 100 days.

Troncoso called off her fast when the government granted her prison privileges, including transfer to a prison farm and weekend leave, measures which were implemented in March.

Mapuche communities involved in conflicts over land have accused the police of repression and the justice system of persecution. These complaints, Egaña said, will be dealt with by the Presidential Advisory Commission on Human Rights, and by the courts.

Meanwhile, the country s indigenous groups are opposed to the way Congress ratified ILO Convention 169, which it did with a controversial interpretative declaration on article 35.

The Convention and the appended declaration are now being studied by the Constitutional Court, after which the treaty could be approved by President Bachelet.

Another government promise that has not yet been fulfilled is a constitutional amendment recognising indigenous peoples, which is currently making its way through Congress.

Javier Mamani Castro, an Aymara town councillor in Colchane in the north of the country, told IPS he was pleased with the president s speech, especially her announcement about introducing indigenous political participation in Congress.

But according to Paulina Acevedo, of the non-governmental Observatory for Indigenous Peoples Rights, who was invited to Tuesday s ceremony, there were no important announcements in what the president said, except for the social policies to do with health and education.

Acevedo said the announcements about political participation were vague. Nothing was said, for example, about a quota system for parliamentary representation. We ll have to wait and see what mechanism is finally chosen to implement these measures, she told IPS.

Mohammed Omer

GAZA CITY, May 14 2008 (IPS) – The Israeli siege of Gaza that has restricted access to food, water and medicine is now beginning to hit unborn children and newborn babies.

It can be a hard life for babies from day one, or even earlier. Credit: Mohammed Omer

Many babies are born suffering from anaemia that they have inherited from their mothers, Dr Salah al-Rantisi, head of the women s health department at the Palestinian ministry of health in Gaza told IPS. And the mothers are becoming anaemic because they do not now get enough nutrition through pregnancy.

That in turn happens because the Israeli blockade has choked the supply of food and medicines.

Dr al-Rantisi also heads the women s health unit at Nasser hospital, where about 30 to 40 children are born every day. Many suffer from anaemia, he says.

Anwaar Abu Daqqa, 30, has lost three babies prematurely. The foetuses were malformed as a result of lack of nutrition and medicine for the mother, Dr al-Rantisi said. And in the last case she reached hospital late because she could not find transport.

Premature babies born dangerously underweight is a daily and increasing phenomenon in Gaza s hospitals, he says.
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The Gaza Strip is poorer and harder hit than the West Bank, but there too there are well documented instances of women having to give birth at checkpoints because of restrictions on movement.

The ministry of health says 9,000 to 10,000 babies are born in the Gaza Strip every month. Of every 1,000 born, 28 die from malnutrition, anaemia and other poverty-related causes. The ministry has no figures for surviving babies suffering from malnutrition.

There are many cases of pregnant women who need medicines that are not available in Gaza, al-Rantisi said. Most families could not afford them if they were available, he said.

The World Bank said last month that the poverty rate in Gaza is now close to 67 percent and that economic growth last year was zero.

One consequence of poverty is anaemia. The condition, a direct consequence of poor nutrition, is not new to Gaza. The United Nations Relief and Works Agency (UNRWA) reported in 2002 that 19 percent of Gazans suffer from anaemia. That figure is estimated by UNRWA now to be 77.5 percent. Children receive on average only 61 percent of their daily need of calories from UN supplies.

Many of the newly born have been hit by the political situation before they could open their eyes to the world. Of the many deliveries that take place at al-Shifa hospital, the largest in Gaza, no one can tell how many of these children could grow up to live happy and healthy lives. Through the many dangers has arisen awareness of this new one that sanctions can hit Gazans quite literally prematurely.

The fear of bombing comes later; the first dangers are the lack of food, water and medicines.

Tahani Safi, 29, lies worrying about the caesarean section scheduled for the next day. She suffers from malnutrition, high blood pressure, diabetes, and a shortage of protective water around the child in the womb.

There are many mothers with such difficulties. Such cases can be found at any hospital, but doctors say the number of cases of conditions a result of poor food and medical care in Gaza is now rising. Health authorities have warned that the life and health of countless unborn babies is in serious danger all across Gaza.

So far 146 Gazans have died directly as a result of the Israeli siege, and the border closures and shortage of medication and health care this has brought, according to the ministry of health.

The U.S. celebrated Mothers Day Sunday May 11. No one in Gaza did.

Julio Godoy

BERLIN, Jun 13 2008 (IPS) – Climate change induced by global warming is provoking health hardships in Europe, especially through new, prolonged allergies, authorities say.
The most important new allergy affecting Europeans is being caused by ambrosia artemisiifolia, popularly known by several names, including common ragweed, annual ragweed, bitterweed, blackweed, or, more telling, hay fever weed.

The plant was native to North America, but was brought to Europe several decades ago, according to German biologists and health authorities. But with the recent, steady rise in temperatures in Europe, the plant, which grows to about a metre in height, has spread in Germany, France, Hungary, Italy and other European countries.

The plant s pollen is known to provoke hay fever, characterised by sneezing, runny nose, itching eyes, and even heavy attacks of asthma and conjunctivitis. Cases of skin infection provoked by ambrosia have also been reported.

Because the plant blooms during the summer and until October, it is prolonging the normal European allergy season by at least two months, Thomas Duemmel, meteorologist at the Free University of Berlin told IPS.

Duemmel said other allergenic plants, such as birch, alder, hazel, and horse chestnut flourish in the early spring and until mid-May. Now, with ambrosia added, the allergy season starts early in March and can go on until October.
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The higher temperatures of recent years have prolonged the blossom season of all these plants, thus worsening the allergenic affections of millions of people, Duemmel said.

The proliferation of ambrosia is particularly worrisome in health terms, because one single tree can produce up to one billion pollen, which, helped by wind, can spread hundreds of kilometres, Duemmel added.

We have to stop the proliferation of ambrosia, because the plant produces one of the most allergenic pollen known, said Stefan Nawrath, biologist and ambrosia expert at the Institute for Ecology, Evolution and Diversity at the University of Frankfurt, some 450 kilometres south of Berlin.

Ten grains of the ambrosia pollen per one cubic metre of air are enough to cause headaches, rhinitis, and even asthma, Nawrath told IPS.

The state-owned Julius Kuehn Institute for botanical research points out that ambrosia has been the most allergenic plant in North America.

In an official research paper, the institute says that ambrosia, because of its late blossoming, is unfertile in cooler regions of the world, and therefore cannot proliferate. The paper adds that given rising temperatures associated with climate change, it is important to research which climatic conditions make possible the fertilisation of ambrosia s seeds.

The health worries caused by ambrosia are so serious that several German health agencies have approved a plan to exterminate the plant. The health of millions is at stake.

Nawrath told IPS that in some regions in countries like France and Italy, at least 12 percent of the population is allergic to ambrosia s pollen. Ambrosia can also be a plague for agriculture, because it reduces productivity of fields.

In Germany, the incidence of allergies caused by environmental change has markedly increased since the post-war era.

According to official health reports, the percentage of the West German population suffering from hay fever or other forms of pollinosis went up from 20 percent for those born between 1942 and 1951 to 27 percent for those born between 1962 and 1971.

The German Society of Allergology and Immunology goes further, and says that today a third of the country s population suffers from one form of allergy or other. In its White Book on Allergies in Germany , the society says allergies have dramatically increased in recent years.

By now, deaths caused by allergenic asthma are more numerous than those caused by traffic accidents, the society says.

This increase in allergic diseases is necessarily linked to changes in the environment, says Heidrun Behrendt, director of research on allergology and immunology at the Technical University in Munich, 500 kilometres southeast of Berlin.

The genetic disposition for allergies cannot increase substantially within a given population, Behrendt said in an interview. Therefore, we have to look for explanations for the increase of allergic diseases in environmental changes.

In her most research, Behrendt and her team found that so-called pollen dependent lipid signallers (PALMS, after its German name) trigger allergic diseases by provoking interaction between allergen pollen and airborne chemical pollutant particles, such as auto emissions.

We could prove that pollen corns and air pollutants set free the PALMS, and are therefore an explanation for the recent increase of allergies, Behrendt said.

According to Behrendt s study, PALMS activate infected cells and suppress immune cells in human organisms, thus opening the way for allergies. This finding could explain why people suffer more from allergies in regions with high concentrations of air pollutants, either in urban zones with dense automobile traffic or near intensive chemical industries.

Diego Cevallos* – Tierramérica

MEXICO CITY, Jul 20 2008 (IPS) – Mexico is drafting measures to regulate the sales of pharmaceuticals over the Internet: reforms have been announced for laws dating back to the 1980s, when the world wide web did not yet exist, and new monitoring systems are in the works to track the who, how and what of online sales.

For medications sold online, caveat emptor. Credit: Public domain

Enlarge your penis. Want to lose weight? Say good-bye to impotence. Who hasn t received messages like this by e-mail?

The sale of medications over the Internet involves thousands of vendors and continues to grow, fuelled by low prices, lack of need for a medical prescription and a supposed guarantee of anonymity. But the medicine that is purchased this way may be adulterated, it may have been stolen, it may be contraband, or may simply have passed its expiration date, and in the worst case may contain dangerous or even deadly compounds.

The World Health Organisation (WHO) estimates that 10 percent of the medications sold worldwide are fake, although in some developing countries that proportion can reach 25 percent. And half of the medicines sold over the Internet on web sites that hide their real address are believed to be fakes.

A study published last month by the European Alliance for Access to Safe Medicines says that 62 percent of the pharmaceuticals sold online are false and do not meet the minimum standards for health, including those intended to treat serious cardiovascular, respiratory, neurological and psychiatric conditions.

Ninety-five percent of the online pharmacies studied operate illegally, and 94 percent of their web sites do not have an identifiable pharmaceutical chemical in their product. More than 90 percent provide people with prescription-only medications without requiring a prescription.
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In Mexico, which has the largest pharmaceutical market in Latin America and ninth in the world, annual sales of medications represent about 9 billion dollars. But because of sales of fake medications the drug companies lose 700 to 900 billion dollars annually.

Furthermore, every so often pharmaceutical shipments are reported stolen, and 40 percent of the medications that expire end up in the garbage, in illegal markets or sold on the Internet.

The government and non-governmental organisations warn of the dangers surrounding online sales of drugs, but general measures to fight the trade have yet to be defined, although there are some isolated efforts.

Mexico will confront the phenomenon, although authorities, pharmaceutical executives and activists consulted by Tierramérica admit that it will be very difficult to shut down Internet sales.

Before the end of the year, Mexican health authorities will present new Internet monitoring and tracking systems. There will be a new focus on this reality, Luis Hernández, an advisor of Cofepris, the federal health protection commission, told Tierramérica.

This agency, entrusted with monitoring the safety of medications, is in an intense process of readaptation that aims to determine which medical products are being sold online, said Hernández.

In addition, Cofepris will propose a new general law on health to replace the law currently on the books, drafted in 1984 and since then undergoing regular reforms. Globalisation brought with it a new focus on commercial practices, which is why there has to be legislation with a current viewpoint, he said.

Cofepris warns the public that medicines are not merchandise, that it s not the same as buying a pair of shoes. They are inputs for health, which implies a risk, so that this new form of sales over the Internet needs to be dealt with and regulated, Hernández said.

Thousands of web sites, some operating inside Mexico, offer mostly pharmaceuticals to enhance sexual performance, fight depression, lose weight or lower cholesterol.

Mexico right now has no regulation for sales of medicines over the Internet, but the best way is to raise consumer awareness with broad campaigns and set up pages on the Internet itself to inform people about the risks of buying their medications online, said Héctor Bolaños, president of the Association of Free Access Medications Manufacturers (medicines that do not require prescriptions).

We have seen adulterated medicines or which do not contain the ingredients of the original formula, and others with lower quantities (of the active ingredient) or toxic substances, he told Tierramérica.

For Alejandro Calvillo, president of the consumer protection group El Poder del Consumidor, many pharmaceutical companies that operate in Mexico sponsor the Internet sales sites, although they complain that some send fake or adulterated products, in the end for them it is part of the business, it is a way of positioning their brands.

The WHO discourages pharmaceutical advertising, but in Mexico medications are openly advertised and, further, through ad campaigns they even create diseases in order to sell more and more, Calvillo said in a Tierramérica interview.

In this country of 104 million people, with 70 percent of the population self-prescribing its meds, there are 224 pharmaceutical laboratories belonging to 200 companies, 46 of them corporations that are majority foreign-owned. Their drugs are sold in supermarkets and in about 23,000 pharmacies.

Mexico is a good market for the sector, because of its demographic characteristics. In 1970, the population over age 65 represented four percent of the total. By 2025 it will be 15 percent, and life expectancy will reach 81.6 years for women and 76.8 years for men.

The drug companies know that the higher the age the greater demand for health services and for medications.

I know that because of embarrassment many adults buy Viagra (a drug for erectile dysfunction) over the Internet. It s difficult to fight that, but they have to be warned that they could be in danger from the pills they buy online, said Bolaños.

In 2004, The U.S. Drug Enforcement Administration found in a worldwide investigation that in Mexico there were about 200 pharmacies that sold their products online, and most were located along the U.S.-Mexican border. From those sites they sold adulterated versions of Viagra and some illegal narcotics.

According to the U.S.-based Centre for Medicine in the Public Interest, in 2010 the global value of sales of falsified medications will reach 75 billion dollars, representing a jump of more than 90 percent from 2005 levels.

The Internet, where sites appear one day and disappear the next, is an excellent place to sell adulterated medicines. The consumers must be informed about this because their health is at stake, and the authorities should monitor it to the maximum extent, said Bolaños.

(*Diego Cevallos is an IPS correspondent. Originally published by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme, United Nations Environment Programme and the World Bank.)