INTERNAL: Ops Update Week 13

Thursday, March 24, 2016 —

Ops Updates – Week 13, 2016

DISCLAIMER: This Operational Update is a summary of internal operational information from the 5 MSF Operational Centers. The information contained herein is strictly internal and should not be shared outside MSF.

OCA 

DRC – SOUTH KIVU (16 March)

On Sunday 13 March the MSF compound in Baraka, South Kivu, was violently robbed. The team was safe and unhurt but following the robbery the team was scaled down and activities have been reduced to a bare minimum with the provision of lifesaving supplies only.

This was the fourth armed robbery in South Kivu in one year. In the coming weeks the mission and Headquarters will revise the intervention strategy aiming to balance quality assistance for patients with minimal security requirements.

SOUTH SUDAN (16 March)

While Unity State is experiencing relative peace, the population is still suffering from continuous attacks and lacks protection. This past week, Leer was once again under attack by unidentified armed men - houses were looted, women abducted, shot and raped – including MSF national staff members – and people forced to flee. Many sought refuge at the MSF compound in Leer as they felt there was no other place to go (despite UNMISS compound only 200m away). There is some hope for stability in the nearby future, but as of now the worrying trend of attacks on the civilian population remains.

NIGERIA (16 March)

On 2 February, a critical incident took place in the Anka Lead project, which forced the mission to reduce its outreach activities – mission wide. Following this, the Field Security Advisor and, later, the Operation Managers, conducted a field visit. The objective – aside from reviewing the strategic priorities for all the projects – was to assess the current security situation. The conclusion was that the main threats come from criminal groups, which operate in rather well defined areas. In these areas MSF will not restart the work yet, whilst in outreach areas near project bases, e.g. Dareta and Haberi, we will resume activities. This approach was shared and agreed with our teams.

Meanwhile, the NOMA project in Sokota is going very well. In January, the second round of surgeries of NOMA patients was done. It is great to see these positive results and the impact it is having on patients’ lives. The next surgical intervention is planned in mid-April.
 
NIGERIA (18 March)
This week (week 10), there was an increase in measles cases reported from 146 suspected cases and zero deaths in week 9 to 265 suspected cases and zero deaths in week 10. These measles cases were reported across all four MSF operational states and this week, Kebbi and Niger states reported significantly high number of measles cases compared to previous weeks (highest number since the start of the epi year). Kebbi state reported about one-third of the total cases this week (104 cases) and also exhibited a wide spread across local government areas (LGAs) within the state (cases reported from 12 LGAs). The Ministry of Health did a measles vaccination campaign in 2015.

Following the report of five suspected cases of meningitis and 15 deaths in the community in Goronyo LGA under Sokoto State in North-Western Nigeria, the NERU team set up a Cerebrospinal Meningitis (CSM) - an acute infectious form of meningitis caused by the bacterium Neisseria meningitides - treatment centre in the nearest primary healthcare centre since 10 March 2016. The team has treated 50 cases in the treatment centre. With a population of 12,666 in the area, it has already crossed the Epidemic threshold with seven confirmed Neisseria Meningitidis serogroup C (NmC) cases in a week. NERU is continuing health promotion and active case finding in the community with the Ministry of Health. NERU is also proceeding with its negotiation with the Ministry of Health for reactive vaccination for NmC.

SYRIA (18 March)

This week marked the 5th year anniversary of the war in Syria. In the absence of a political solution, human rights violations and abuses continue to occur in the context of widespread insecurity and in disregard of international law, international humanitarian law, and human rights law. The UN estimates that over 13.5 million people are in need of humanitarian assistance, 250,000 people have been killed and over one million injured, over 4.6 million Syrians are refugees, and 6.6 million are internally displaced, making Syria the largest displacement crisis globally.

The toll on the population is immense. Since the onset of the crisis, life expectancy is estimated to have shortened by almost 13 years, there is little access to primary or secondary care and there has been a resurgence of communicable diseases previously not witnessed. Hospitals are repeatedly bombed. Humanitarian access to people in need in Syria remains constrained by shifting frontlines, administrative and bureaucratic hurdles, violence along access routes and general safety and security concerns. It is increasingly difficult for Syrians to find safety, including by seeking asylum. The crisis in Syria has become a global crisis, a proxy war among international states and is tearing at the social fabric across Europe. It has now led to a highly questionable deal in the making between the EU and Turkey for the return of refugees fleeing this conflict.

We are witnessing lost generations of Syrians and children who have not seen peace, attended school, who have lost their homes and do not know what the future holds. Our MSF programming feels like a drop in the ocean compared to the needs, and it seems our role is more and more in the field of advocacy. This week, MSF sections worldwide, have launched communication initiatives to draw attention to the plight of the Syrian population to mark this anniversary.

A few examples: a package with stories of Syrian refugees, as featured on the MSF-Holland website https://www.artsenzondergrenzen.nl/5-jaar-oorlog-syri%C3%AB, Twitter (AzG_nl) and Facebook page (www.facebook.com/noodhulp), photo album: https://www.artsenzondergrenzen.nl/reportage/een-triest-jubileum, and an international website has been launched, which narrates the toll on the population from the start of the war, available in French (syria.msf.fr), English (syria.msf.fr/en) and Arabic (syria.msf.fr/ar).

BANGLADESH (18 March) 
For International Women's Day, 8 March, MSF did a communication push on our sexual gender-based violence (SGBV) project in Kamrangichar, a slum area of Dhaka, and our project with Rohingya refugees in Kutupalong. The primary objective was to continue raising visibility of MSF in Bangladesh, which will help strengthen our operational footing in several ways. The secondary objective was to test how communications on our provision of aid to Rohingyas in Kutupalong would be received inside Bangladesh. The SGBV material was picked up in several major outlets. Meanwhile the content on Kutupalong was printed in the fourth largest Bangla-language publication (and since shared 500 times on Facebook), and the largest English-language publication (and shared over 1,000 times on Facebook).

SIERRA LEONE – TONKOLILI PROJECT (21 March)
The Operational Advisor returned from a 10 day visit. The Tonkolili project is well on its way to have a lasting impact on maternal and child mortality and morbidity. At the hospital in Magburaka both the maternity and the paediatrics department are well supported; the maternity surgical theatre is almost ready. The team is supporting the blood bank and tries to involve the community as much as possible to create a solid blood donor base.

The focus for the coming period has to be with the primary health care component of the project. This PHC team will roll-out a plan that in due time will lead to coverage of the whole of Tonkolili district, but they have made a start with a selection of health facilities in Yoni Chiefdom.

Obstacles to reach health facilities have to be addressed and the project has developed a delay reduction strategy. An important goal is to ensure that referrals are done in a timely fashion. The challenge for this project is that it will work closely together with the MoH and not obstruct any existing services by setting up parallel systems, or change the current set-up of the MoH, but rather enforce them. Only then will we be able to leave behind a solid legacy at a certain moment (minimum period of 3 years presence foreseen). It means for example that we will tap into the potential of the existing Community Health Workers system that provides diagnostics and treatment for malaria, pneumonia and diarrhoea.

Engaging with Traditional Birth Attendants is just as important. IEC will get more attention in the months to come. The team was already successful in lobbying the MoH to decentralise the ambulances - that stood by idle since the Ebola outbreak ended - to more rural areas to facilitate emergency referrals.

ERU (21 March)
The ERU team is solely focused on preparing a ring vaccination for a situation in case a new Ebola case is identified. This means a lot of practical preparations but also negotiations with the MoH. The team is also asking for specific HQ involvement so they agree with the other sections on what resources can be shared and the specific cold chain requirements (minus 80C).

DRC KATANGA (18 March)
The mission is issuing a local Press Release today, in order to give attention to the fact that the population in Bukama health zone will lose access to free malaria medication. MSF intervened in eight health clinics in the most affected areas of the health zone after we found out that the facilities did not have access to diagnostic tools and treatment, although they are made available by for example the Global Fund in DRC. It is something we see on a regular basis: while in theory treatment should be available, the practice on the ground shows the opposite. Patients have to pay for consultations and this constitutes a barrier that many people cannot overtake. In the first four weeks of our emergency response we treated over 5000 cases of malaria.

IRAQ (21 March)
The health promotion and community engagement advisor visited two projects in Kurdistan-Iraq.  Kalar project, the team is very busy, energetic and motivated to implement new medical interventions including HPCE intervention. New for me was that HPCE activities were part of the medical programme from the start of the project. This way the HPCE activities could contribute to the harmonisation of the integrated approach within the different medical components in the health facility and act as a bridge between the community and the PHC. The HPCE staff was welcoming patients, explain the health services-patient flow, mapping the patients by asking them where they were coming from, health needs, access to care, and other health providers.  MSF is providing healthcare on a crossing point of different controlled areas within an hour distance of each other, for especially national staff quite a challenging area to work in.
Sulaymania project - OCA is supporting the main hospital (there is healthcare breakdown as a result of the financial crisis) lack of medical staff, equipment, dirty etc. Besides we are running a small HPCE component in Arbat camp (now Ashti camp). Very interesting to see that this small HPCE component has a health impact on the beneficiaries. There is better access to care, improvement in hygiene and empowerment. For example some feedback from camp community: “When they told us to move from Arbat camp to Ashti camp, we were able to say NO because there was no electricity available in new sections in Ashti. Thanks to the MSF who empowered us by creating a safe space to discuss these social and health matters. Before we would wait and nothing would happen, now we feel empowered to undertake action.”
"MSF invited us to discuss hygiene, through these workshops we are taking responsibility to clean our shared latrines. We meet to organize a cleaning rooster for the latrines. MSF has helped us to work together" "Through the meetings with MSF we are aware which services are available in the camp, who is responsible for what components. If the water provision system is broken we do not just wait till something will happen. Now we know where to go and who is responsible."

OCB
DEMOCRATIC REPUBLIC OF CONGO (16 March)
On the night from Sunday to Monday earlier this week, the OCA base in Baraka, in Fizi Territory of South Kivu Province, was attacked by armed men. There were no injuries. But this is the fourth time over the past year that OCA has been attacked in Baraka. Generally, the levels of violence and insecurity are increasing in both Kivu provinces, and the OCB teams in North Kivu are monitoring context-developments in their area.

GREECE (16 March)
On Monday, more than 1,000 migrants that are blocked from crossing the border between Greece and Macedonia tried unsuccessfully to enter into Macedonia by crossing a river close to Idomeni and were pushed back by Macedonian border guards. MSF sent two teams to assess the situation.

SEARCH AND RESCUE (16 March)
In the night between Monday and Tuesday, eight boats with 953 migrants were rescued by ships in the Mediterranean sea off the coast of Libya. This was the biggest rescue operation in 2016 so far.
 
NIGER (17 March)
The process of handover of the Guidam Roumji project is continuing smoothly, and the team is on-track for exiting the project at the end of this month.

Meningitis continues to appear in several areas of the country. An OCB team is vaccinating some 7,000 people against meningitis in Dosso area this week. The different sections of MSF are following closely whether areas are reaching the outbreak level and then to make sure that vaccination is planned and ensure MSF support and supervision. There is some concern about whether there are enough available vaccines to cover the expected probable needs in Niger.

The team has also been requested by the MoH to supervise a measles vaccination campaign in Niamey 2 district next week, once WHO and other actors have committed to their part of the process (particularly human resources and vaccines).

Coming Sunday is the run-off of the elections whereby President Issoufou is standing against opposition leader Amadou. Amadou was in jail but released for medical reasons last week and it has been reported that he will be evacuated to France. Unclear at this stage on how this will impact on the elections.

SIERRA LEONE (17 March)
Ebola is officially over (for the second time), but ongoing vigilance is necessary and MSF will retain a capacity to provide a rapid response if a new case should be identified.

SYRIA (17 March)
We are hopeful that the reduction in Russian military personnel from Syria is a sign that there will be a continuation of the reduction in violence in the north of Syria - particularly bombing - since the (partial) implementation of the cease-fire agreement on 27 February. However reports of Jabat Al Nusra militia starting to fight against other armed opposition groups is a clear demonstration that there is still volatility and potential for ongoing suffering and significant emergency medical-humanitarian response requirements. The OCB support programme team for northern Syria has recently started supporting two new Syrian mobile clinic teams in Idlib governorate.

OCBA

COLOMBIA (18 March)
There is an alert for increased number of malaria cases (14,862 from week 1 to week 9), 68% in Chocó and, more worrisome, 64% due to Plasmodium falciparum. (Ministry of Health
reported lack of treatment for falciparum and a delay of 13 weeks to bring it into the
country).
Last week, the team treated 66 people in mental health consultations, in some communities
of Alto Baudó; Chocó, affected by fighting between the ELN and the criminal organization
Autodefensas Gaitanistas de Colombia.

In Tumaco: A psychosocial team went to Bajo Jagua to assess the psychosocial situation
of the people after the displacement of 85 families due to violence. The team conducted
psycho-education activities with children and adolescents and a therapeutic intervention.

MEXICO (18 March)
As part of the support of Gynaecology/Obstetrics in the Hospital of Arcelia, we will donate
the equipment and medical items needed to set-up a blood storage (needed for the major
surgeries, including C-sections).

VENEZUELA (18 March)

The bodies of the missing miners have been found in Bolivar. There has been very little news about this topic in the last few days. The main suspect is a mafia leader, but there has not been a real official position by the Government.
President Maduro declared the full coming week holiday in the country.
There was a meeting at Hospital Universitario de Caracas (main public hospital) to propose support from MSF due to the difficult situation the hospital is facing in terms of lack of drugs. The proposal will be discussed at board of directors’ level and an answer will be given to us.
If support is accepted it may help to open a door for importation of drugs.
We continue with the effort to find ways to import medicines and find some at local market as the situation is getting worse by the day especially in public hospitals.
We have come to the end of trainings for Fe y Alegria personnel and we got excellent feedback from participants and officials.
After Easter holidays we will start trainings for MDs and psychologists from Alcaldia Sucre
so as to cover the area of Petare.

NIGER (18 March)
The second round of elections are this coming Sunday, March 20th. The opposition candidate, Hama Amadou, has been evacuated from prison in Niger due to health reasons and travelled to France. The coalition of opposition supporters have stated that they will boycott the election this weekend. The situation remains calm but there is a possibility of security problems; the international airport in Niamey will be closed before and after the election period.
The Niger mission has multiple outbreaks to manage in all project sites:

In Diffa project, there is an outbreak of measles just outside of Yebi IDP camp within a new
installation of returning refugees from Tchad.  A rapid assessment is ongoing to confirm the cases and plan for a vaccination campaign next week. The Diffa team will also implement the second round of the preventive cholera vaccination campaign next week (March 23-25).

In Madaoua project, there are small outbreaks of measles in two communities (Ourno and Eroufa) where we will implement ring vaccination campaigns around the communities.

In Bouza project, the team is managing two ongoing outbreaks of meningitis in Galmi
health area and Keita District. The team has just finalised a first round of vaccinations
in Galmi but was waiting for more vaccines to arrive in the country to begin a second round. 
Galmi will target 30,200 between ages of 2-29 and Keita will target 17,500.
 
The current number of meningitis cases in all of Niger (736) is almost 500% greater
than the number of cases (149) at this time last year.    

MALI (18 March)
In other parts of the country, there is an ongoing outbreak of meningitis outside of Bamako
(managed by Alima and the Ministry of Health) and new reports of meningitis cases are arising in and around Bamako. 
There are a number of measles cases reported in and around Kidal and MSF will implement
a vaccination campaign starting on Monday, March 21st. It will target 20,200 children. 
 

NIGERIA (18 March)
After reports of 250 suspected measles cases and 10 deaths in Jakusk LGA (Yobé State),
MSF was requested to respond. A combined Ministry of Health and MSF team visited the
area over the past weekend and assessed the situation on the ground. No immediate
intervention is required right now as the numbers (cases and deaths) reported and on ground do not tally, and most of the cases observed by the team in the communities were in remission.


The team has donated drugs – antibiotics and symptomatic treatment, and fluids,
to the two health centres for support for treatment. 
There is general concern that in many areas where MSF is visiting, there is a very weak
health system including very poor surveillance. The team recommends a more thorough
assessment of the malnutrition situation as this is one demonstrated vulnerability
throughout the entire area of MSF intervention.
 

ETHIOPIA (18 March)
Cholera cases continue to be on the increase. Mission continues negotiations in order to support the case management and prevention on Liben and SNNPR areas. But unfortunately there have been positive results so far (last week situation seemed to be more optimistic but not the case this week).

Nutritional response continues for the mission. Emergency Committee took place this
week with specific points on Ethiopia NUT. A global picture and possible scenarios were
provided in order to have a comprehensive understanding from everybody. Not major 
decisions or changes in the strategy proposed by the mission at this point. Main line 
is to continue supporting Afar and Siti intervention and close monitoring of other highly
populated areas in the county (Amhara, Oromia and SNNPR). 

SOUTH SUDAN (18 March)
Malakal, strong condemnation and reports from different UN and external actors are ongoing. 
Main point is the lack of protection of civilians by GoSS, rebel actors and UNMISS. 
OCBA continues defining best ways to gather information and prepare advocacy, (with OCA who are present in the Bentiu PoC). 

SUDAN (18March)

Tawila is reporting whooping cough cases and negotiations for a massive vaccination campaign are ongoing.

SYRIA (18 March)
Putin announced the withdrawal of Russian Air Forces from Syria, after nearly six months of air support to GoS. “Terrorist” target will remain a priority. Antiassad demonstrations took place in Azaz as well as in other Syrian cities.

OPD consultations: There were 1,586 OPD consultations and 478 Emergency Room consultations. Numbers are decreasing and soon we will be going back to normal activities.
EPI was implemented during outreach activities (nutritional and EPI screening and vaccination) covering Al Sham, Al Shuhada and Sijo camps, for a total of 584 children.
There were NFI distribution to 1,025 families. We are waiting for further distribution of tents, watsan activities and latrines.

SIERRA LEONE (18 March)

Sierra Leon was declared free of Ebola this week.
There is a measles outbreak in Koinadugu. While we are ready for a vaccination campaign, we are still waiting for the vaccines to be delivered in the country. We are working on case management for now (isolation+drugs+trainings).
 
DRC (18 March)
Three villages were burnt down in Tushunguti area, leaving more than 210 families displaced, with some sexual violence cases reported that have been treated. The team started NFI distribution, especially aimed at those who lost their houses. Health centre in Tushunguti wass reopened and running normally after the peak of violence.

RCA (18 March)
One of MSF vehicles was stolen in Ndele by three armed men. During the carjacking, the driver sustained a minor injury to the head. After the events, MSF immediately informed the local authorities who organized a team to pursue the carjackers in the road between Ndele and Birao. While the assailants were running into the bush, there was an exchange of fire. A member of the team deployed by the authorities was shot and died.
Ministry of Health declared meningitis outbreak in Kabo and Batangafo.

Case management activities are ongoing. We are waiting for MoH decision about potential vaccination (very unlikey due to vaccines scarcity at international level).
Eureca team is carrying out activities in remote management for Bambouti refugees, waiting for clearance of the airstrip.

SEARCH AND RESCUE OPERATIONS (18 March)
 
 Operations with the boat will restart next month.
 
YEMEN (18 March)

PR published on the two airstrikes that hit the Moustaba market. About 125 have been killed and more than 40 people injured and received at Abs hospital:

http://www.msf.org/article/yemen-msf-treats-more-40-wounded-following-deadly-airstrike-marketplace 
 
ANGOLA (18 March)
Six positive PCR in autochthonous cases from Huambo province were confirmed this week, probing local transmission.   

This justifies mass vaccination in Huambo and will allow us to go ahead with the ICG
request which required proof of autochthonous cases. We will target the 2 million people based in areas of higher transmission, local transmission confirmation and vector presence in Huambo.