Children and women in West and Central Africa remain vulnerable to multiple threats, including insecurity, conflict, drought, flooding and epidemics. In the Central African Republic and the Lake Chad basin, widespread violence and armed conflict characterized by grave human rights violations have led to mass displacement both internally and across borders. More than 6 million people in the region remain displaced due to conflict: 874,000 people in the Central African Republic; 1.9 million people in the Democratic Republic of the Congo; 2.6 million people in the Lake Chad basin; and more than 172,000 people due to the conflict in Mali. For countries such as Chad and Nigeria, the volatility has increased due to falling oil prices and declines in state revenues. Throughout the region, elections planned for 2017 may create further unrest. Across the Sahel, cyclical drought conditions and chronic food insecurity have caused alarming levels of malnutrition.

In addition, severe acute malnutrition (SAM) affects more than 6 million children under 55 and more than 46,000 suspected measles cases and 28,900 cholera cases were reported6 in the region in 2016. Cholera outbreaks continue to affect the Mano River, Lake Chad, Congo River and Niger River basins.

Regional humanitarian strategy

The West and Central Africa Regional Office (WCARO) will continue to support country offices in the region to respond to emergencies, in line with the Core Commitments for Children in Humanitarian Action. WCARO will support preparedness by monitoring risks and providing technical expertise to strengthen capacities to prepare for emergencies, emphasizing contingency planning for high-risk countries.

Partnerships for emergency response, capacity building and supply pre-positioning will be strengthened. WCARO will continue to provide multi-sectoral technical support to country offices in the areas of nutrition, health, HIV and AIDS, water, sanitation and hygiene (WASH), Communication for Development, child protection, education and emergency coordination and operations. Country offices will also receive support to respond to cholera, meningitis, measles and other epidemics. UNICEF will continue its integrated nutrition response, focusing on the crises in the Sahel and the Lake Chad basin. The priority will be the integrated management of acute malnutrition, focusing on lifesaving treatment of SAM, as well as the prevention of malnutrition through infant and young child feeding and the promotion of essential family practices. SAM treatment and prevention remains integrated into a package of interventions for health, WASH, education, promotion of essential family practices and psychosocial support. WCARO will support the strengthening of key child protection activities, focusing on cross-border and sub-regional emergency responses, particularly for the Lake Chad basin crisis. The priority will be to reach children associated with armed groups and armed forces, children in detention, and/or children who are unaccompanied and separated from their families, while providing mental health and psychosocial support. WCARO will support the implementation of the Safe Schools Strategy, provide technical guidance to country offices on protective learning environments and strengthen coordination and information management for country offices and clusters. UNICEF will maintain rapid response capacity for mapping and rapid assessment, surge staff deployments and regional supply hubs that pre-position supplies, enabling timely and cost-effective response. WCARO will also support country office capacities for monitoring and evaluation, increase the use of third-party monitoring in hard-to-reach areas and support more timely evidence-based decision making. Public advocacy efforts will continue to focus on countries in crisis to ensure that the rights and well-being of children in emergencies are at the centre of the global agenda and adequate resources are made available.

SITUATION OVERVIEW

In 2016, the HRP estimates that 4.3 million people are in need of humanitarian assistance of whom 1.5 million are targeted to receive assistance, which highlights the acute vulnerability in the country.
Chad continues to feel the impact of the Nigerian crisis in the Lac region as well as conflicts in neighboring countries (Libya, Sudan and CAR). The country hosts 391,745 refugees, including 311,470 Sudanese refugees who have been in the country for over 10 years, 70,310 refugees from CAR and 8,598 Nigerian refugees. The Lac region, affected by the Nigerian crisis, currently hosts 121,720 displaced people including 108,476 internally displaced, 12,920 Chadian returnees and 324 third country nationals. In addition, the country hosts 101,724 Chadian returnees from CAR settled mainly in the Southern regions and in N'Djamena, in several sites or host villages.

Food insecurity and malnutrition remain a chronic problem in the country, particularly in the Sahel belt. Food insecurity affects about 2.9 million people (21% of the total population), of whom approximatly 500,000 are severely food insecure (source: Harmonized Framework Nov 2016, current situation Nov-Dec 2016), to whom are also added refugees and returnees (not included in the Harmonized Framework). The nutrition situation is also of concern, with global acute malnutrition rates above 15% (emergency threshold) in 6 regions out of 23 and severe acute malnutrition rates above 2% (emergency threshold) in 11 regions.

The high prevalence of epidemic diseases such as cholera and measles, as well as malaria, combined with a weak health system, are causes of high morbidity and mortality among the population, especially among children under five. Chad ranks 185th according to the human development index (HDI 2015), with some of the most alarming social indicators (life expectancy of 51 years, maternal mortality rate of 860 deaths per 100,000 births, report EDS-MICS-2014-2015).

Le Tchad fait face à des crises humanitaires multiples et interconnectées, dans un contexte de vulnérabilités chroniques. L’instabilité sécuritaire dans les pays voisins (Soudan, RCA, Nigéria) a entrainé d’importants mouvements de personnes vers le Tchad, ainsi que des déplacements internes. Des millions de personnes sont touchées par l’insécurité alimentaire et la malnutrition, en particulier dans la bande sahélienne, exacerbée par les attaques acridiennes au mois de septembre, la sécheresse et les inondations souvent dans la même période agricole. Le pays connait également des épidémies persistantes de rougeole et des milliers de cas de paludisme ayant un impact direct sur la morbidité et la mortalité des populations.

Chad is facing multiple interconnected humanitarian crises in a context of chronic vulnerability. Insecurity in neighbouring countries (Sudan, CAR, Nigeria) resulted in large numbers of people moving to Chad, as well as internal displacement. Millions of people are affected by food insecurity and malnutrition. Locust attacks in September as well as drought and floods often in the same agricultural period exacerbate the situation. The country is also experiencing persistent measles epidemics and thousands of cases of malaria, all of which have a direct impact on the morbidity and mortality of the population.

From 1 September 2016 until 13 January 2017, a total of 693 cases including 11 deaths of acute jaundice syndrome (AJS) have been reported from Am Timan, Chad.

Of the 50 patients with AJS who were hospitalized, 48 were tested for Hepatitis E using the Hepatitis E virus rapid diagnostic test (HEV RDT) and 27 (56.3%) tested positive. In total, at the end of epidemiological week 2, 2017, a total of 126 HEV RDT have been performed, of them 57 (45.2%) were positive, while 69 (54.8%) tested negative for Hepatitis E. 18 (31.6%) of the 57 patients that tested positive using the HEV RDT also had a positive malaria test, and 20 (29%) out of 69 patients that tested negative using the HEV RDT also had a positive malaria test. Since September 2016, 11 deaths have been reported among the hospitalized cases but the total case fatality might be underestimated.

As of 13 January 2017, 16 pregnant women presenting with AJS have been hospitalized and tested for Hepatitis E, 12 (75%) of them tested positive using the HEV RDT. Of the pregnant women presenting with AJS, four have reportedly died (three had tested positive for Hepatitis E).

Approximately 90% of the AJS cases were reported from Am Timan which appears to be the epi-centre of the ongoing outbreak, and most of the cases are identified through active case findings. As of 13 January 2017, AJS cases have been reported from 59 different quartiers in and surrounding Am Timan.

Public health response

In response to the ongoing outbreak and event response, World Health Organization (WHO) and the Ministry of Public Health are carrying out investigations in the whole region in order to describe the extent of the outbreak. Moreover, WHO country office is also supporting passive and active surveillance strengthening outside of Am Timan, developing case definition, surveillance tools, simple case management protocols and testing algorithm, defining criteria for case hospitalization and carrying out needs assessment in and outside the town of Am Timan. WHO is also actively looking for partnerships to address the needs in terms of water and sanitation in Am Timan.

WHO risk assessment

Based on the available information, there appears to be a plateau in the number of cases reported in the past 5 weeks from the affected area with an average of 70 cases reported weekly where only a minor proportion (7.2%) requires hospitalization. The infectious risk seems confined to Am Timan and immediate surroundings. However, the event remains under close monitoring at all levels of WHO. The current level of risk for further spread remains as moderate to high and at local level , and the limited capacity to respond to date calls for additional immediate support, especially in terms of water and sanitation and social mobilisation.

WHO advice

WHO recommends the continuation of the investigations with a specific case definition as to describe the time, place and person characteristics of the outbreak and identify the source. It is important to identify the source of contamination of the surface water and, in the meantime, to ensure water safety by chlorination at the point of use by the population. Travellers to Chad should follow standard hygiene recommendations in terms of water and food safety for travellers. These should protect them against Hepatitis E, as the risk of person to person transmission is very low.

Ce rapport a été produit par OCHA en collaboration avec les partenaires humanitaires et concerne les vagues de déplacements internes depuis le 21 juillet 2015. Il est publié par OCHA Tchad et couvre la période du 1er au 31 décembre 2016. Le prochain rapport sera publié vers le 15 février 2017

Faits saillants

• Les nouveaux chiffres indiquent près de 130 000 personnes déplacées dans la région du Lac, y compris des retournés, réfugiés et déplacés internes.

• La grève des fonctionnaires a été suspendue pour un mois à compter du 12 janvier. Les cours et service sanitaires reprennent progressivement.

• Les taux d’accès à l’eau potable et l’assainissement s’améliorent, mais la qualité de l’eau dans les forages réalisés reste un défi majeur.

• Le PAM a étendu la couverture de son assistance alimentaire sous forme de transferts monétaires à un total de 48 700 personnes sur 23 sites autour de Bol et BagaSola.

106 045 déplacés enregistrés depuis mai 2015 Dont :
- 90 911 déplacés internes
- 14 810 retournés Tchadiens
- 324 ressortissants des pays tiers

Source : Cluster Abris / AME / CCCM – OIM (Matrice de suivi des déplacements du 23/01/2017).

12 759 déplacés* estimés pas encore enregistrés.
Source : Cluster Abris / AME / CCCM – OIM (23/01/2017).

8 218 réfugiés dont 5 879 dans le camp de Dar-es-Salam depuis janvier 2015. Source : HCR/CNARR (31/12/2016)

*Le statut de ces déplacés n’est pas encore déterminé, ils peuvent donc être déplacés internes, retournés, ressortissants de pays tiers ou demandeurs d’asile.

Aperçu de la situation

La situation sécuritaire est restée calme en décembre. Aucun incident n’a été rapporté.

La situation relative aux personnes en situation de reddition reste dynamique. Environ 300 hommes sont toujours retenus sur un site à Baga-Sola. Face au manque de prise en charge de leurs besoins, notamment en vivres, par les autorités compétentes, la majorité sort régulièrement du site en quête de nourriture, en plusieurs vagues depuis le 22 décembre. Ces personnes retournent ensuite sur le site. Les vagues de reddition de faible ampleur (quelques personnes) continuent ponctuellement.

La grève des fonctionnaires contre le non-paiement de leurs salaires et la suppression de certaines primes a été suspendue par les syndicats pour une durée d’un mois à partir du 12 janvier 2017. Depuis septembre, ces protestations limitaient l’accès à l’éducation et à la santé. Les cours reprennent progressivement dans la région du Lac, comme dans le reste du pays.

Un incendie d’origine inconnue a détruit 337 cases dans le village de Litri, sous-préfecture de Ngouboua, le 5 décembre. Les dégâts matériels incluent également deux moulins, 21 boutiques et 1 980 sacs de maïs. Litri est leème incendie rapporté en moins de deux mois (après Ngouboua centre, Baga Sola marché, Selia marché, Kaiga Kindjiria, et trois incendies à Tchoukoutalia). La période froide s’accompagne traditionnellement d’incendies dus aux accidents de foyers dans les habitations.

+ Pour plus d’informations, consultez la section “Historique de la crise” à la fin de ce rapport.

January 30, 2017

Eight countries recognised for efforts to reduce malaria incidence and deaths

ADDIS ABABA, ETHIOPIA (30 January 2017)– At a time of historic progress toward a malaria-free Africa, the African Leaders Malaria Alliance (ALMA) honoured eight African countries that have shown commitment and innovation in the fight against the disease.

Today at the 28th African Union Summit, the 2017 ALMA Awards for Excellence were awarded to:

• Botswana, Cabo Verde, Comoros, Democratic Republic of Congo (DRC), Ethiopia, Swaziland and Uganda, for their impact on malaria incidence and mortality; and

• Chad, for its leadership in the fight against malaria.

"Thanks to strong African leadership and innovative new partnerships, we are making unprecedented progress in the fight against malaria," said H.E Idriss Déby Itno, President of Chad and current Chairperson of the African Union. “The success of these countries shows the powerful impact that dedication and sufficient funding can have.”

The ALMA Awards for Excellence recognise countries for their significant achievements in malaria control and elimination. Botswana, Cabo Verde, Comoros, DRC, Ethiopia, Swaziland and Uganda have all achieved a reduction in malaria incidence of 40 percent or more from 2010-2015. The significant reduction in malaria in the three high-burden countries (DRC, Ethiopia and Uganda) demonstrates what can be achieved with political commitment, adequate financing and implementation of technically sound and evidence-based vector control and case management interventions, even where malaria transmission is high. Botswana, Cabo Verde, Comoros and Swaziland are commended for sustaining the gains previously made between 2000-2010. The World Health Organization (WHO) said they are all on track to eliminate malaria by 2020.

“We are turning the tide on malaria in Africa,” said Joy Phumaphi, Executive Secretary of ALMA. “The success is reflected in the countries ALMA honoured today. Our work is not done. We must remain focused to achieve our goal of a malaria-free Africa."

The 2017 ALMA Awards for Excellence come just six months after the adoption of the ‘Catalytic Framework’ at the 27th African Union Summit last July. The framework provides a roadmap for African countries to increase domestic resources, expand the use of innovation and technology, and improve health infrastructure to eliminate malaria from the continent by 2030.

“Congratulations to the winners. I welcome ALMA’s continued partnership in the fight to end malaria,” said Dr. Mustapha Sidiki Kaloko, Commissioner for Social Affairs at the African Union Commission. Further, he said, “In this regard, the Catalytic Framework is providing strategic direction to guide countries to achieve malaria control and elimination.”

Since 2000, malaria mortality rates across the continent have fallen by 62 percent in all age groups and by 69 percent among children under five. The increase in those sleeping under long-lasting insecticidal nets, or protected by indoor residual spraying, as well as diagnostic testing of children and treatment of pregnant women has contributed to significantly lowering incidence and mortality in Africa. These achievements come at a time when African countries are providing more domestic funding to fight malaria.

The growing role of African leaders is also reflected in the recent formation of the End Malaria Council, a group of committed business and public sector leaders that has come together to ensure malaria eradication remains a global priority. Five of the nine leaders on the council are African: H.E Idriss Déby Itno, President of Chad; H.E. Ellen Johnson Sirleaf, President of Liberia and former ALMA Chair; H.E. Jakaya Kikwete, former President of Tanzania and founding ALMA chair; Graça Machel, Founder of Foundation for Community Development; and Aliko Dangote, President and Chief Executive of the Dangote Group. The council will explore innovative approaches to mobilize political will and resources and develop new tools to help end malaria.

ALMA will also be working closely with the new Roll Back Malaria Chief Executive Officer Dr. Kesetebirhan Admasu, former Minister of Health of Ethiopia.

Malaria remains a critical threat in Africa – the region still bears the highest global malaria burden. In 2015, 195 million of the 212 million new malaria cases and 394,000 of the world’s 429,000 malaria-related deaths were in Africa.

About ALMA

Founded in 2009, ALMA is a ground-breaking coalition of African Heads of State and Government working across country and regional borders to achieve a malaria-free Africa by 2030. All African Union member countries are members of ALMA. The ALMA Scorecard for Accountability & Action is an important tool, which tracks progress and drives action.

The ALMA Awards for Excellence celebrate exemplary leadership in malaria control and elimination efforts. The Awards are chosen by an independent selection committee comprised of leaders and experts in the areas of health, academia and the private sector.

For more information, visit www.alma2030.org

About the African Union

The African Union spearheads Africa’s development and integration in close collaboration with African Union Member States, the Regional Economic Communities and African citizens. AU Vision: to accelerate progress towards an integrated, prosperous and inclusive Africa, at peace with itself, playing a dynamic role in the continental and global arena, effectively driven by an accountable, efficient and responsive Commission.

For more information, visit www.au.int/ For media enquiries, please contact:

Dr. Adiel Mushi, Malaria Focal Person, African Union Commission Email: mushia@africa-union.org Tel: +251 962 4 88800

Cooper Gatewood, Portland Communications Email: cooper.gatewood@portland-communications.com Ethiopia Tel: +251 (0) 9292 28408 Tel: +44 (0) 20 7554 1721

Saleemah Abdul-Ghafur, ALMA Email: saleemah@alma2030.org Tel: +251 929 228402

Links and directory:

About ALMA Factsheet
Malaria in Africa Factsheet
Twitter: https://twitter.com/alma_2030
Facebook: www.facebook.cm/ALMA-African-Leaders-Malaria-Alliance-356455541093491
LinkedIn: www.linkedin.com/company/african-leaders-malaria-alliance-alma-
Flickr: www.flickr.com/photos/103141785@N06

Highlights

• No major new displacement has taken place in the Lake region during December. At the end of 2016, there are 129,481 displaced persons, including IDPs, Chadian returnees from Nigeria and Niger, refugees and third-country nationals.

• More than 120 sites and displacement locations are scattered around this remote region, making humanitarian assistance a logistical challenge.

• 166,830 children with SAM were admitted and treated in nutritional units. Recovery rates are 89% for Therapeutic Nutritional Units and 86% for Outpatient Nutritional Units.

• UNICEF and its partners have provided access to safe-drinking water to 104,329 conflict-affected people through the construction of 61 boreholes and two mini-adductions in the Lake region.

• In 2016, UNICEF received US$ 30.3 million in emergency funding for the children of Chad (the HAC was 51% funded).

SITUATION IN NUMBERS

2,200,000
Children affected (UNICEF HAC 2016)

193,943
Children under 5 with Severe Acute Malnutrition in 2016
(Nutrition Cluster 2016)

129,481
People displaced (IDPs, returnees, TCN, refugees) in the Lake Region
(IOM, DTM 3 January 2017 and UNHCR 31 December 2016)

UNICEF Humanitarian funding needs in 2016 (revised)
US$ 64.6 million

Available in 2016*
US$ 33.2 million

Situation Overview & Humanitarian Needs

Impact of violence in the Lake region
The state of emergency declared in November 2015 officially ended in October 2016, but emergency measures remain in place until now. It expected that Parliament will eventually formally approve an extension.

No major new displacement has taken place in the Lake region during December. At the end of 2016, there are 129,481 displaced persons1 , including 88,726 registered internally displaced persons (IDPs), 17,009 estimated non registered IDPs, 14,790 Chadian returnees from Nigeria and Niger, 8,596 refugees and 324 third-country nationals.

More than 120 sites and displacement locations are scattered around this remote region, making humanitarian assistance a logistical challenge.

According to Chadian authorities, a wave of surrenders by Chadians living in Boko-Haram-held areas of Nigeria began in July, and peaked in October 2016. They were transferred by Chadian military to three sites in the town of Bagasola, where they were guarded by the Multinational Joint Taskforce (MNJTF). As of 31 December, at least 1,114 people who have allegedly surrendered were reported in the Lac region (Chad), of which 256 are women and 548 are children. Before the end of the year, more than 750 women and children have been transferred to their villages of origin throughout the Lac region thanks to the collaboration of local authorities, UNICEF and implementing partners.

As of 31 December, 327 men are still held under MNJTF’s surveillance. They are however to move in and out of the detention location as the legal status of this group has not yet been determined by the government.

Refugees, returnees and stateless persons from CAR in the South
In southern Chad, 70,414 Central African refugees2 and 101,724 returnees3 still live in refugee and returnee camps, and in host villages. Concern is growing over the increased evidence of protection issues linked to the limited livelihood opportunities, particularly following the reduction in food distribution. UNICEF partners have reported increased negative coping mechanisms like survival sex or prostitution, child marriage and child labor.

Epidemic Outbreaks
In 2016, there were two major epidemic outbreaks: one measles outbreak with 792 cases recorded from January to October in 8 health districts, and one hepatitis E suspected epidemic outbreak with 460 cases recorded in the health district of Amtiman (Salamat region). There were no cases of cholera recorded in 2016. During the month of December, 74 cases of non-febrile gastroenteritis due to food poisoning were reported in the Doulao village (Bessao health district, Logone Oriental).

Food insecurity and malnutrition
According to the Integrated food security Phase Classification (IPC), updated in November 2016, the forecasted cereal production for the 2016/2017 crop year has increased by 14% from last year. However, some regions recorded a decline in cereal production, including Tandjilé (-11.2%), Wadi Fira (-11%) and Bahr El Ghazal (-5%). Across Chad, 455,952 people are estimated to be living in conditions of phase 3 (crisis phase) food insecurity. Vulnerable populations are in need of food, nutrition, health, and improved access to livelihoods in order to build resilience. In the Lake region, 222,356 individuals are food insecure, including 81,438 people currently living in phase 3.

The final results from the national SMART nutrition survey carried out in August / September 2016 were published and confirmed preliminary findings. The resultsshow an 11.9% prevalence of Global Acute Malnutrition (GAM) (>10% is defined as serious malnutrition severity by WHO), and 2.6% of Severe Acute Malnutrition (SAM) among children between 6 and 59 months. The prevalence of GAM particularly exceeds WHO’s critical emergency threshold (15%) in the regions of Ennedi West (23.3%), Borkou (19.3%), Ouaddaï (16.9%), Batha (16.6%), Bahr El Ghazal (16.1%) and Salamat (15.6%). The Kanem region, with a prevalence of 14.9%, is also at the edge of the emergency threshold.

In this issue

US$2.66 billion required for the Sahel P.1

Lake Chad Basin: 11 million need assistance P.3

Unrest, funding shortfalls impede CAR response P.4

Regional update on epidemics P.5

Regional humanitarian news P.7

Sahel funding update P.8

HIGHLIGHTS

• Humanitarian partners require US$2.66 billion to assist 15 million in the Sahel in 2017.

• 11 million people around the Lake Chad Basin need assistance, aid groups appeal for US$1.5 billion to assist 8.2 million people.

• Insecurity persists in CAR,

1.6 million people are in need of assistance.

• Epidemics continued to threaten communities across the region in 2016.

Regional Highlights

• On 17 January, a Nigerian military jet accidentally bombs an IDP site in Rann locality, Borno state, killing at least 112 civilians, including six Nigerian Red Cross workers, and wounding 100.

• The number of internally displaced persons (IDPs) in Cameroon reaches 191,908 in the country’s Far North, more than doubling since 2015.

• Humanitarian organizations provide food assistance to more than 1 million people in January. In 2017, some 5.1 people are projected to face emergency and crisis levels of food insecurity.

• In 2016, almost 215,000 children suffering from severe acute malnutrition (SAM) were admitted for treatment across the region. Malnutrition rates remain high, with 515,000 children expected to suffer from SAM in 2017.

• A measles vaccination campaign targeting over 4 million children is underway in north-east Nigeria.

• The European Commission releases €40 million in additional humanitarian aid to support the populations in the Lake Chad region.

• The UN Central Emergency Response Fund (CERF) releases US$42 million to assist over 3 million people in Nigeria (US$22 million), Cameroon (US$10 million), and Niger (US$10 million).

• On 24 February, a humanitarian conference on Nigeria and the Lake Chad Region will take place in Oslo, hosted by the Government of Norway in partnership with the Governments of Germany and Nigeria.

Situation Overview

• The number of security incidents and civilian victims in the region increased in January. This is mainly attributed to easier movements during the dry season, as well as the dispersion of Boko Haram elements carrying out isolated actions.

• Major security incidents reported include the mistaken bombing of an IDP site, in Rann, and the accidental killing of 16 IDPs collecting firewood, in Ngala LGA, by Nigerian armed forces. Armed attacks killed five soldiers in Nigeria’s Yobe state, two soldiers in Niger, and five members of a UN monitoring mission in Cameroon along the Nigerian border.

• Humanitarian access remains a considerable challenge impeding the delivery of aid in many areas. In north-east Nigeria, four local government areas continue to be inaccessible.

Worldwide, humanitarian needs are rising, driven by conflicts that know no end, and chronic natural disasters whose effects last for years. Today more than 128 million people in 33 countries need humanitarian aid to survive — a figure not seen since the Second World War. “With this staggering level of need, now more than ever, world leaders need to step up their support to the world’s most vulnerable people,” says the UN’s Humanitarian Chief, Stephen O’Brien. “Those who are already giving need to continue their support, while new actors must also seize the opportunity to save lives.” Here, we outline 12 forgotten crises that rarely make the headlines but urgently need support this year.

Afghanistan

Last year, the number of people forced to flee their homes in Afghanistan reached over 1 million as violence mounted in the northern and southern regions, where the Taliban has taken over swaths of the country. “Families have lost their homes and livelihoods. Displaced people are living in tents, unable to feed their children who have had little or no education,” said Humanitarian Chief, O’Brien following a trip to Afghanistan last year. “This pattern of prolonged conflict must end to avoid another generation of children being lost to war and suffering.”Alarming levels of malnutrition now affect 2.7 million people, 1 million of them children under age 5.

Central African Republic

Over the past four years, Central African Republic has experienced a major political crisis. This has resulted in a violent conflict that has affected almost the entire population and left some 2.3 million people, over half the population, in dire need of assistance.

Democratic People’s Republic of Korea

About 60 per cent of the population in the Democratic People’s Republic of Korea is considered to be food insecure — in other words, 15 million out of 24.9 million people. One quarter of the population does not have access to essential health services, and 1.7 million children are at risk of deadly childhood diseases.

Democratic Republic of Congo

Armed conflict and insecurity in the Democratic Republic of the Congo have created one of the world’s most protracted and complex humanitarian crises. In 2016, 7.3 million people were affected by regional and local armed conflict, especially in the mineral-rich eastern part of the country. Insecurity is now mounting in the Kasai and Tanganyika provinces, affecting hundreds of thousands of people, and leading to fears of further displacement.

The Lake Chad Basin

Boko Haram-related violence in the four countries that border Lake Chad (Cameroon, Chad, Niger and Nigeria) has affected 30 million people and forced 11 million to need urgent assistance. Homes have been torched, possessions looted and livelihoods destroyed, forcing people to flee, blocking them from farming and fishing, and leading to border closures. The result is a dramatic rise in hunger levels, while tens of thousands of people in north-east Nigeria are living in famine conditions.

Libya

Armed conflict, political instability and a collapsing economy have disrupted the lives of 3 million people across Libya. Once a middle-income country, Libya is now home to 2.4 million people who need protection or assistance, as they have little or no access to health care, sufficient food, clean water, homes or schools. This includes the forcibly displaced, refugees, asylum-seekers and migrants, who traveled to Libya in search of work.

Madagascar

Two successive years of drought, exacerbated by El Niño, have left 850,000 people in need of help in Madagascar. In the worst-affected areas, families are resorting to selling their assets and land, eating cacti and seeds for food, and migrating in search of more-fertile conditions.

Mali

Despite a 2015 peace deal between the Government and armed groups, armed attacks, banditry and insecurity prevail in northern Mali. The insecurity continues to force people to flee their homes, stopping farming and disrupting pastoralist routes that are an economic mainstay in the north.

The Sahel

The Sahel comprises parts of Burkina Faso, Chad, Mali, Mauritania, Niger, Nigeria and Senegal — countries that between them have some of the highest poverty levels and lowest human development indicators in the world. Even in a good year, i.e., when the rains are on time and in sufficient quantity, millions of people will face hunger and malnutrition in the Sahel. In 2017, an astonishing 30 million people here (just under half the population of Britain) will not have enough to eat.

Somalia

After more than two decades of violence, Somalia is making progress on the political front, but acute humanitarian needs persist. Flooding, drought, conflict, persistent protection challenges and disease outbreaks contribute to Somalia’s fragility, exacerbated by displacement and returns of Somalis from neighbouring countries. This year 6.2 million people — or more than half of the country’s population — need assistance.

Uganda

Uganda is now a safe haven for refugees from Burundi, the Democratic Republic of the Congo and South Sudan. It is currently hosting 865,385 refugees, the vast majority of them from South Sudan. Hunger levels are expected to increase this year due to poor rainfall.

Yemen

In Yemen a child under age 5 dies every 10 minutes of preventable causes. Armed conflict continues to intensify in Yemen, with daily air strikes and armed clashes. This, combined with structural poverty and chronic drought means 10.3 million are reliant on humanitarian assistance, making Yemen the largest food security emergency in the world.

None of the 37 countries that were part of the 2016 Global Humanitarian Appeal received 100 per cent of their humanitarian funding needs, but each of the above crises received less than 40 per cent. Twice a year, the UN’s Central Emergency Response Fund (CERF) allocates underfunded grants to the least funded emergencies with the highest levels of risk, vulnerability and humanitarian need. This is determined by analysing funding levels; vulnerability indicators, such as FEWS NET food insecurity data; INFORM conflict-risk data; human rights indicators; and other information. On 30 January, CERF released $100 million to help more than 6 million people in nine of the above-mentioned severely underfunded crises: Cameroon, DPRK, Libya, Madagascar, Mali, Niger, Nigeria, Somalia and Uganda. Eight of the nine recipients are in Africa and will receive 94 per cent of the allocation.

NEW YORK/N’AJAMENA, CHAD, FEBRUARY 9, 2017—A hepatitis E outbreak is escalating across Am Timan, in the Salamat region of South-Eastern Chad, and more humanitarian actors are urgently needed to treat patients and contain further spread of the virus, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

MSF identified the first hepatitis E cases five months ago and has treated 885 patients with Acute Jaundice Symptoms (AJS), with numbers increasing to an average of around 60 new cases a week. AJS, which commonly causes the yellowing of the skin and eyes, can indicate if a person has hepatitis E. Since September, 70 patients have confirmed cases of hepatitis E (HEV RDT+), 64 have been hospitalized, and 11 have died, including four pregnant women.

MSF has repeatedly called on other organizations to respond to this emergency, though the responses have been minimal and insufficient. A more consistent intervention is urgently needed, especially to improve water and sanitation. An immediate scale-up of support from other agencies and the government of Chad is key in containing this escalating outbreak.

“MSF is calling on all the humanitarian and development agencies present in Chad to step up the size and speed of their efforts to ensure an effective response to the hepatitis E outbreak in Am Timan,” said Rolland Kaya, MSF head of mission in Chad. “More actors are needed to implement preventative actions including water sanitation, especially as cases are increasing in frequency across the Salamat Region, and not only in the city of Am Timan.”

In addition to providing medical care, MSF has also implemented hygiene and sanitation activities since this virus is primarily transmitted from one person to another through contaminated water and in areas where access to quality water is limited. More than 600 MSF staff have been working to test for new cases, treat patients and improve water supplies and sanitation in the city of Am Timan, including chlorination of the city’s water towers.

"As a medical organization, it is not usually MSF’s job to intervene on a large scale in water chlorination activities, but with no other options to help stop the spread of the virus. We are obliged to fill this gap,” Kaya said. “Once again, we encourage the Chadian Ministry of Public Health to declare the current Hepatitis E outbreak an epidemic to enable the release of an appropriate response.”

In addition to the medical response in Am Timan hospital, MSF has rolled out a large scale bucket chlorination campaign at the 72 water points within Am Timan town. Additionally, MSF outreach staff are holding community education sessions to explain the importance of handwashing with soap and using chlorinated water at designated water points.

MSF has been working in Chad since 1981. Before the current hepatitis E outbreak, MSF was running regular medical programs in Am Timan and in Moissala.

For More Information
Brienne Prusak
Medical & Global Health Press Officer
Doctors Without Borders/Médecins Sans Frontières (MSF)
333 Seventh Avenue, 2nd Floor
New York, NY 10001-5004
Desk: +1 212.763.5769
Cell: +1 646.531.0754
brienne.prusak@newyork.msf.org

CAMEROON

FUNDING GAP THREATENS FOOD ASSISTANCE TO CAR REFUGEES

Lack of financial resources is jeopardizing WFP and partners’ ability to provide livesaving food assistance to the refugees in eastern Cameroon, leaving a US$16 million gap in funding. A complete gap is expected from June onwards, pending new food consignments. Since last October, a decline in funding had already forced WFP to cut food and cash assistance by half to some 156,000 CAR refugees, who are now surviving on a minimal food ration.

CHAD

HEPATITIS E OUTBREAK WORSENS

Hundreds of people could die in southeastern Chad as a months-long outbreak of hepatitis E worsens, MSF warned on 9 February, recording 70 cases and 11 deaths since September. Some 885 people in the Salamat region have been treated for symptoms of jaundice, which can indicate hepatitis E. Most patients are likely to be suffering from hepatitis E, the aid group said.
The death toll from the outbreak could be higher due to cases which may not have been treated in health facilities, according to the World Health Organization

GUINEA

93 CASES OF MEASLES CONFIRMED

93 measles cases have been confirmed since the beginning of the year in the affected districts of Nzérékoré, Guékedou, Coyah, Dubréka, Fria, Kindia and four communes in the capital Conakry. The Ministry of Health with support from UNICEF, ALIMA and other partners has immediately initiated vaccination campaigns in the affected regions. The outbreak is a direct consequence of the limited vaccination coverage during the Ebola outbreak which seriously affected the country’s health system in 2014-2015.

DR CONGO

PROJECTED RISE IN CONFLICTRELATED NEEDS

Humanitarian actors project that needs are likely to increase in the coming months. Last year, the number of displaced people increased from 1.6 to more than 2.1 million.
Humanitarian organizations are already responding to respond to violent clashes in the southeastern province of Tanganyika, in the three provinces of Kasai and to the needs of new refugees from South Sudan in the north-eastern part of the country.
Measles and cholera have become major recurring health issues. On 9 February, the humanitarian community and the Congolese authorities launched an appeal for US$748 million to assist 6.7 million people in 2017.

THE GAMBIA

ALMOST 150,000 PEOPLE FOUND FOOD INSECURE

Over 148,500 persons – 8 per cent of the population - are food insecure and 0.6 per cent severely food insecure in The Gambia, according to a WFP report, an increase from 5.6 per cent in 2011. Rising food prices and natural disasters are the most prominent factors that have negatively affected Gambian households’ food access and put them at risk. On 9 February, the European Union allocated €75 million as an immediate support package to address markets and socio-economic development of the country, including food insecurity, unemployment and infrastructure.

NIGERIA

OVER 10,000 DISPLACED PEOPLE RETURN TO DAMASAK

Over the past two weeks, more than 10,000 displaced people and refugees have returned to the Damasak local government area in the north of Borno state. The majority of them (70 per cent) return from neighbouring Niger and the rest from communities nearby. In recent weeks, an average of 100 families has been returning to Damasak every day

CAMEROUN

L’AIDE ALIMENTAIRE AUX RÉFUGIÉS MENACÉE PAR UN MANQUE DE FINANCEMENT

Le manque de ressources financières met en péril la capacité du PAM et des partenaires à fournir une aide alimentaire vitale aux réfugiés dans l'est du Cameroun, avec un déficit de financement de 16 millions de dollars. Une insuffisance totale de fonds est à prévoir à partir de juin, en attendant de nouveaux envois de vivres. Depuis octobre dernier, le recul du financement a déjà obligé le PAM à réduire de moitié les vivres et l'aide en espèces à environ 156 000 réfugiés de la RCA, qui vivent actuellement d'une ration alimentaire minimale.

TCHAD

L’ÉPIDÉMIE D’HÉPATITE E S’AGGRAVE

Le 9 février, Médecins sans frontières a averti que des centaines de personnes pourraient mourir dans le sud-est du Tchad alors qu'une épidémie d'hépatite E qui dure depuis plusieurs mois s’aggrave, enregistrant 70 cas et 11 décès depuis septembre. Quelque 885 personnes dans la région de Salamat ont été traitées pour des symptômes de jaunisse, ce qui peut indiquer l'hépatite E. La plupart des patients sont susceptibles de souffrir d'hépatite E, a indiqué le groupe d'aide. Selon l'Organisation mondiale de la santé, le nombre de décès pourrait être plus élevé en raison de cas qui n'ont peut-être pas été traités dans des établissements de santé.

GUINEE

93 CAS DE ROUGEOLE CONFIRMÉS

Depuis le début de l’année, 93 cas de rougeole ont été confirmés dans les districts affectés de Nzérékoré, Guékédou, Coyah,
Dubréka, Fria, Kindia et quatre communes de la capitale, Conakry. Le ministère de la Santé, avec l'appui de l'UNICEF, d'ALIMA et d'autres partenaires, a immédiatement lancé des campagnes de vaccination dans les régions touchées. L'épidémie est une conséquence directe de la couverture vaccinale limitée pendant l'épidémie d'Ebola qui a sérieusement affecté le système de santé du pays en 2014-2015

RD CONGO

AUGMENTATION PRÉVUE DES BESOINS LIÉS AUX CONFLITS

Les acteurs humanitaires estiment que les besoins vont probablement augmenter dans les prochains mois. L'année dernière, le nombre de personnes déplacées est passé de 1,6 à plus de 2,1 millions. Les organisations humanitaires réagissent déjà à des affrontements violents dans la province du Tanganyika, dans le sud-est, dans les trois provinces du Kasaï, ainsi qu'aux besoins des nouveaux réfugiés du Sud Soudan dans le nord-est du pays. La rougeole et le choléra sont devenus des problèmes de santé récurrents majeurs. Le 9 février, la communauté humanitaire et les autorités congolaises ont lancé un appel de 748 millions de dollars pour aider 6,7 millions de personnes en 2017.

GAMBIE

PRÈS DE 150 000 PERSONNES SOUFFRENT D’INSÉCURITÉ ALIMENTAIRE

Selon un rapport du PAM, plus de 148 500 personnes, 8% de la population, souffrent d'insécurité alimentaire et 0,6% d'insécurité alimentaire grave en Gambie, soit une hausse par rapport à 5,6% en 2011. La hausse des prix des denrées alimentaires et les catastrophes naturelles sont les facteurs principaux ayant eu un impact négatif sur l'accès alimentaire des ménages gambiens et les ayant mis en danger. Le 9 février, l'Union européenne a alloué 75 millions d'euros pour un soutien immédiat aux marchés et au développement socio-économique du pays, y compris l'insécurité alimentaire, le chômage et les infrastructures.

NIGERIE

PLUS DE 10,000 DÉPLACÉS RETOURNENT A DAMASAK

Au cours des deux dernières semaines, plus de 10 000 personnes déplacées et réfugiées sont retournées dans la région du gouvernement local de Damasak, dans le nord de l‘état de Borno. La majorité d'entre elles (70%) reviennent du Niger et de communautés voisines. Au cours des dernières semaines, une centaine de familles revenaient tous les jours à Damasak

The twelfth meeting of the Emergency Committee (EC) under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened via teleconference by the Director General on 7 February 2017.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine­derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties presented an update on the implementation of the WHO Temporary Recommendations since the Committee last met on 11 November 2016: Afghanistan, Pakistan, Nigeria, and Central African Republic. The committee also invited the Russian Federation to provide information about a VDPV event in its territory.

Wild polio

Overall the Committee was encouraged by steady progress in Pakistan and Afghanistan, and was reassured and impressed by the rapid response of the polio eradication programme in Nigeria.

The committee welcomed the dedication in Pakistan to further strengthen surveillance, and in particular the expansion of environmental surveillance to improve detection. The intensity of environmental surveillance is now at unprecedented levels, so that it is likely detections may increase even as transmission in cases is falling. These data need careful interpretation, and the committee acknowledged that this also includes interpretation of data concerning cross-border transmission. The Committee also applauded the information that there were no fully inaccessible children in 2017. However, the recent exportation of WPV1 from Pakistan into Kandahar province of Afghanistan illustrated the difficulty of halting international spread between these two countries.

While the Committee applauded the efforts of Afghanistan to reach inaccessible children and noted the overall reduction in these numbers, the continuing insecurity in parts of Afghanistan means that substantial numbers of children remain inaccessible, heightening anxiety about completion of eradication.

The Committee welcomed the continued emphasis on cooperation along the long international border between the two countries noting that this sub region constitutes an epidemiological block. The committee continues to believe that the international border represents a significant opportunity to vaccinate children who may otherwise have been missed, and welcomed the increase in the number of border vaccination teams. Opportunities to install teams at more informal border crossings should be encouraged.

The Committee commended Nigeria for its rapid response to the WPV1 cases and welcomed that there had been no further cases detected since the last meeting. However, as there remain substantial populations in Northern Nigeria that are totally or partially inaccessible, the committee concluded that it is highly likely that polioviruses are still circulating in these areas. Reaching these populations is critically important for the polio eradication effort, but it is acknowledged that there are significant security risks that may pose danger to polio eradication workers and volunteers. The Committee noted that working under this threat is likely to negatively impact on the quality of the interventions. Nigeria has already adopted innovative and multi-pronged approaches to this problem, and the committee urged that this innovative spirit be continued.

There was ongoing concern about the Lake Chad region, and for all the countries that are affected by the insurgency, with the consequent lack of services, and presence of Internally Displaced Persons (IDPs) and refugees. The risk of international spread from Nigeria to Lake Chad basin countries or further afield in sub-Saharan Africa remains high. The committee was encouraged that the Lake Chad basin countries including Nigeria, Cameroon, Chad, Niger and the Central African Republic (CAR), continued to be committed to sub-regional coordination. CAR needs to maintain the current momentum, including further improvement to AFP surveillance and if feasible introduce environmental surveillance as is currently planned.

Equatorial Guinea remains vulnerable, based on very sub-optimal polio eradication activities including poor surveillance, low routine immunisation coverage, and waning national efforts to address this vulnerability.

Vaccine derived poliovirus

The committee was very concerned that two new outbreaks of cVDPV have been identified, one in Sokoto in northern Nigeria, and the second in Quetta Pakistan. The virus found in Sokoto was unrelated to that found in Borno. Both of these outbreaks highlighted the presence of vulnerable under immunized populations in countries with endemic transmission. The committee noted the response to these outbreaks, acknowledging that in both cases it had complicated the ongoing efforts to eradicate WPV1.

The Committee welcomed the provision of information by the Russian Federation at the meeting about the recent detection of VDPV in two children from the Chechen Republic, and also welcomed the surveillance and immunization activities taken to date in response. The Committee noted that the investigation by the Russian Federation had shown that one of the children was immunosuppressed. The Committee requested that the WHO European Regional office and WHO HQ should continue to work with the Russian Federation to confirm the classification of the viruses. Therefore as the risk of international spread is still being assessed, no recommendations regarding this situation have been made by the committee.

In Guinea, the most recent case of cVDPV had onset in December 2015, and based on the most recent assessments and the criteria of the committee, the country is no longer considered as infected, but remains vulnerable.

The committee also noted the detection of non-circulating VDPV in several other countries.

Conclusion

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

• The outbreak of WPV1 and cVDPV in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears high.
• The continued international spread of WPV1 between Pakistan and Afghanistan.
• The persistent, wide geographical distribution of positive WPV1 in environmental samples and AFP cases in Pakistan, while acknowledging the intensification of environmental surveillance inevitably increasing detection rates.
• The current special and extraordinary context of being closer to polio eradication than ever before in history, with the lowest number of WPV1 cases ever recorded occurring in 2016.
• The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases. Even though global transmission has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur would be grave.
• The possibility of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a possibility.
• The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
• The continued necessity for a coordinated international response to improve immunization and surveillance for WPV1, to stop international spread and reduce the risk of new spread.
• The importance of a regional approach and strong cross­border cooperation, as much international spread of polio occurs over land borders, while also recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.
• Additionally with respect to cVDPV:
  • cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
  • The ongoing circulation of cVDPV2 in Nigeria and Pakistan, demonstrates significant gaps in population immunity at a critical time in the polio endgame;
  • The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016;
  • The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies, including the post Ebola context;
  • The global shortage of IPV which poses an additional threat from cVDPVs.

FAITS SAILLANTS

• Plus d’1,5 million de personnes ont été assistées par la communauté humanitaire au Tchad en 2016.

• Près de 600 000 personnes, étaient en situation de déplacement à l’ouest, au sud et à l’est du Tchad à la fin 2016.

• En 2016, plus de 3,7 millions de personnes ont été touchées par l’insécurité alimentaire dont plus d’un million en insécurité alimentaire sévère.

Malgré de multiples défis, plus d’1,5 million de personnes assistées en 2016

Les défis structurels persistants entravent la réponse humanitaire

En 2016, le Tchad a fait face à trois grandes problématiques humanitaires, à savoir les mouvements de population, l’insécurité alimentaire et la malnutrition ainsi que les urgences sanitaires. Ces urgences interviennent dans un contexte déjà marqué par des défis structurels importants dont des taux de mortalité maternelle et infantile parmi les plus élevés au monde (860 décès pour 100 000 naissances), un taux d’alphabétisation de moins de 40 pour cent et un accès à l’eau potable en dessous de 70 pour cent. Les conditions d’accès difficiles dans certaines zones, dues principalement au contexte sécuritaire dans la région du Lac et à l’impraticabilité des routes en saison pluvieuse, s’ajoutent aux défis auxquels font face les acteurs humanitaires.

Sur un total de 2,3 millions de personnes dans le besoin au Tchad, 1,5 million ont été ciblées pour recevoir de l’assistance humanitaire en 2016. Il s’agit de près de 400 000 réfugiés (dont les Soudanais à l’est, les Centrafricains au sud et les Nigérians à l’ouest du pays), plus de 100 000 retournés de la République Centrafricaine et du Nigéria, plus de 105 100 déplacés internes dans la région du Lac à l’ouest et plus d’1,7 million de personnes dans les localités hôtes. Au final, avec peu de moyens, la communauté humanitaire a pu répondre aux besoins urgents d’1,5 million de personnes ciblées sur les 4,3 millions qui étaient dans le besoin. Cette assistance a été rendue possible grâce à la contribution des bailleurs de fonds et à l’engagement des acteurs.

La communauté humanitaire avait, dans le Plan de réponse humanitaire de 2016, estimé à 541,3 millions de dollars américains l’enveloppe nécessaire pour assister les 1,5 million de personnes ciblées ayant le plus besoin de l’aide humanitaire. Cependant, seulement 288 des 541,3 millions de dollars ont été reçus, soit 53 pour cent. Toutefois, l’on note une légère augmentation des financements sur les trois dernières années, passant de 39 pour cent en 2014 à 53 pour cent en 2016. Les défis continuent de s’accroître au fil des années en même temps que les moyens requis pour apporter l’aide humanitaire à ceux qui en ont le plus besoin.

En dépit de l’insuffisance des ressources, la communauté humanitaire a apporté une réponse en sécurité alimentaire, santé, protection, eau, hygiène et assainissement, éducation, articles ménagers et abris d’urgence et logistique.

L’épidémie a été déclarée dans le district sanitaire d'Am-Timan qui connait une flambée du virus de l'hépatite E (VHE), depuis septembre 2016

Aperçu

Depuis septembre 2016, 956 cas d’hépatite E ont été rapportés dans le district sanitaire d’Am-Timan dont 12 décès. Des cas suspects ont aussi été signalés dans les localités de Adoudéïa et Haraze. Le 14 février, le Ministère de la Santé Publique a déclaré officiellement l’épidémie dans la région du Salamat. Le VHE est endémique dans de nombreux pays où les services d’eau et assainissement sont faibles.

La réponse actuelle n'est pas suffisante. Les efforts visant à identifier la ou les sources de cette flambée n'ont pas donné de résultats - sans lesquels l'épidémie ne peut être stoppée.

Le positionnement d’acteurs santé et eau, hygiène et assainissement dans la région est prioritaire, notamment pour l’élargissement des activités au-delà d’Am-Timan.

Le Salamat compte une population total de 400 000 personne dont 52% a moins de 15 ans. Les femmes enceintes et les personnes en situation de dépacement (nomades, réfugiés, retournés) sont particulièrement vulnérables.

Qu'est-ce que l'hépatite E?

L'hépatite E est une maladie du foie causée par une infection par un virus appelé virus hépatite E (VHE). Le VHE se transmet par voie féco-orale, principalement par l'eau contaminée.

Les symptômes principaux sont :

• Jaunisse des yeux et de la peau

• Fièvre (haute température)

• Nausées et vomissements

• Douleurs articulaires et musculaires

Risques

18-25% Taux de mortalité parmi les femmes enceintes (troisième trimestre)

4% Taux de mortalité

8-11% Effets néfastes à long terme sur le foie

Réponse

• Le ministère de la Santé travaille en partenariat avec MSF pour répondre aux cas signalés dans l'hôpital régional d'Am-Timan et avec l’OMS dans les zones situées en dehors de la ville (Mina,
Mirére et Ablalaye) ainsi que dans le cadre de la surveillance épidémiologique.

• La surveillance épidémilogique se fait dans le district sanitaire de Am Timan par l’OMS.

• Réponse WASH par MSF : sensibilisation, chloration, et distribution de 10 500 kits d’hygiène, dans la ville d’Am-Timan.

• Réponse WASH par UNICEF : distribution de 280 kits d’hygiène aux établissements de santé de la région.

Actions prioritaires

Eau, hygiène, et assainissement (WASH) : Intervention urgente des acteurs pour élargir les activités WASH à toute la région du Salamat et reprendre les activités de réponse de MSF**, qui à partir de fin février va se concentrer sur les activités médicales à Am-Timan.

Santé : Assurer la surveillance épidémiologique et la réponse médicale dans toute la région.

Sensibilisation et épidémiologie : Rechercher et décontaminer la ou les sources du virus de l’hépatite E dans la région. Un programme de sensibilisation doit être mis en place dans toutes les zones touchées.

2016 saw a significant scale-up in the response across the worst-hit areas of the Lake Chad region. Owing to the support of donors and collective efforts by Governments, UN agencies and non-governmental organisations, children were rescued from malnutrition, vaccinated against life-threatening diseases and able to access education. Families on the move were sheltered and provided with help. Communities were assisted with food or livelihoods to avoid hunger.

ACROSS THE LAKE CHAD REGION

• Up to 1.6 million people received life-saving food and nutrition support
  
• Over 1 million children were vaccinated against measles
  
• 4.4 million people. accessed emergency primary health care
  
• 1.4 million farmers and pastoralists received the means to resume their livelihoods
  
• Almost 300,000 boys and girls out of school resumed their education despite the odds
  
• 2.3 million displaced families and their host: were provided with access to safe water, improved sanitation and hygiene
  
• 300,000 children under 5 and nursing mothers were treated for malnutrition, including 194,000 severely acutely malnourished children at risk of dying
  
• 300,000 infants received adequate food to prevent malnutrition in worst-hit areas
  
• 492,000 children who faced trauma benefitted from essential psychosocial support
  
• 8,200 children separated from their families or unaccompanied received care
  
• 6,000 women and children associated with armed groups or who survived gender-based violence were assisted
  
• Almost 420,000 pupils received learning materials to continue their education
  
• 75,000 refugees were registered and received identification documents
  
• 97% of refugee families living in camps across the region have access to adequate dwellings
  
• 4 Governments of the region adopted the Abuja Action Statement which spells out concrete actions to address immediate protection needs and design durable solutions

CAMEROON

Despite persisting insecurity and large numbers of displaced persons living in hard to reach areas, some 200,000 people received life-saving food or cash assistance. At least 33,500 famers and herders received seeds, tools and support to improve their food security. Almost 335,000 people were provided with access to safe water, sanitation and hygiene services. 28,000 children under five were treated for severe acute malnutrition, and 43,000 children received learning support.

CHAD

Seizing the opportunity of significant improvements in humanitarian access and scaled-up operational capacities, some 30 humanitarian partners assisted 127,000 people with food assistance and 94,000 people with cash transfers. '0,000 children under five affected by severe acute malnutrition were treated. NIGER Despite persisting insecurity and access challenges, 58 humanitarian organizations are currently working in Diffa. Since 2015, 70,000 tons of foods were distributed. Humanitarian actors provided shelters to 120,000 people in 2016, while half a million people received potable water and hygiene support.Over 240 schools were re-localised to safer areas and emergency education provided to 45,000 school-aged children. Almost 90,000 children received psychological support.

NIGERIA

As areas previously cut off from aid have become accessible, relief actors also discovered new depths of needs and significantly scaled up aid delivery. Food assistance increased over four-fold in the past six months, reaching an average of 1 million persons each month. Over 4 million people accessed primary healthcare, 1.7 million benefitted from safe access to water, hygiene and sanitation, and 736,000 people received basic household items or vouchers to purchase them. One million children were vaccinated against measles and 160,000 treated for severe acute malnutrition. 1.7 million people, of which many children, received protection services including legal aid or psycho-social counselling. 1.5 million men, women, boys and girls accessed contraceptives and other sexual and reproductive services.

by Dr Rick Brennan, WHO Director of Emergency Operations

Oslo, Norway 24 February 2017

As several speakers have noted today, while there are enormous food security, nutrition and protection dimensions to the crisis in the Lake Chad Region, this is also a public health crisis, with rates of death, malnutrition and disease rarely seen over the past 20 years.

In Nigeria and the Lake Chad Region, lack of qualified health workers, essential medicines and the destruction of medical facilities hamper the delivery of lifesaving health care. Widespread food insecurity and malnutrition are associated with severe health consequences. As you know, malnutrition lowers the body’s capacity to fight infection – a malnourished child is far more prone to contract an infectious disease such as pneumonia, diarrhoea and measles – and then to die from that disease. As one of our local staff in Niger said to me once – between malnutrition and death, there is always disease.

All four countries in the Lake Chad Region have similar health priorities: rapidly expanding access to a package of essential health care – including child and reproductive health; boosting immunization rates; preventing, detecting and responding to disease outbreaks; effectively treating malnutrition and its consequences. We also must address psychosocial problems, sexual and gender-based violence, and violent trauma leading to physical injuries. Together, health sector partners seek to help 8.2 million people this year.

The most urgent needs are in north-eastern Nigeria, particularly Borno State. This is the heart of the Lake Chad Region crisis, where at least 6.9 million people, including 1.8 million internally displaced persons, urgently need the expansion of life-saving health services.

In Borno State, people in many communities have not received any form of health care in years due to conflict. A major health assessment by WHO found that 60% of health facilities are not functional. Of those facilities that are still functioning, only a modest proportion is supported by one or more of our 18 health sector partners. We invite more partners and ask for more resources to expand the response, and we know other sectors face similar capacity constraints.

Over 2016 there were serious outbreaks of measles and polio – in fact, the eradication of polio in Africa, and globally, is threatened by the crisis in Northern Nigeria. The risk of further disease outbreaks is compounded by weak surveillance networks and the limited capacities of outbreak alert and response. This also highlights the importance of a sub-regional approach for disease control across the four affected countries.

The situation is grave, but progress is being made. We are inspired by the spirit and resilience of the communities that we serve and we are doing what we can, where we can with the limited resources we have.

When local responders, WHO and health sector partners gain access, we see results. Government authorities are key to securing that access. Together we are operating over 100 mobile medical teams across Borno State that are providing life-saving services to the most vulnerable countries. We have increased disease surveillance to 160 sites covering 85% of internally displaced persons. Working with the governments, UNICEF and partners, together we vaccinated 10 million children across the region against polio and 4.7 million people against measles.

We need rapid disbursement of humanitarian funds and sustained commitments from partners to expand our impact. But during 2016, the health sector received only 32% of all requested funds across the region, including 22% for northern Nigeria. In 2017, the health sector has collectively appealed for US$ 125 million for the region. We can only hope that an appropriate proportion of the pledges committed today will be directed to health partners

Finally, we have repeatedly heard from speakers over the past two days that we must address the underlying causes of the crisis. No one appreciates this better than the health sector – where the principle that prevention is better than cure is one of our greatest truisms. Perhaps this can be the guiding principle that we apply collectively, as we commit to moving from providing humanitarian assistance to promoting integral human development in the Lake Chad Region and beyond.

Thank you