Ops Updates – Week 7, 2017
DISCLAIMER: This Operational Update is a summary of internal operational information from the five MSF Operational Centers. The information contained herein is strictly internal and should not be shared outside MSF.
AFGHANISTAN (10 February)
Last Wednesday, the International Committee of the Red Cross was attacked in Afghanistan. This resulted in the death of six staff, and leaving two unaccounted for. MSF staff send their deepest condolences to the families, friends and colleagues of those killed. We also hope for the quick return of the missing staff.
Please read the full statement HERE
SOMALIA (10 February)
Tuesday and Wednesday this week, an MSF team combined from OCBA and OCA crossed the border from Liben, Ethiopia, into the town of Dolo in Somalia. This town is right on the border. OCA visited this location in 2013 when Liben interventions were shared between the two sections. The team hopes to collect information to get a better insight into the plight and nutritional status of the people who are currently crossing the border from Somalia into Ethiopia. This influx is related to several factors, one of which for sure being the current drought affecting Somalia.
As the return to Somalia, in line with the logic of “the return in modesty” can only be gradual and step by step, we are painfully aware that a large-scale response to the drought in Somalia in the near future is unlikely. For this reason, we are very happy with this first cross-border visit and hope it can find a place in the intersectional programme we hope to develop inside Somalia.
CHAD (10 February)
On Thursday, MSF issued a press release and held a briefing in Chad's capital, N'djamena, urging humanitarian actors in Chad to intervene in order to help curb a hepatitis E outbreak. Since September, MSF has treated 885 patients with the symptoms of hep E, with numbers increasing to an average of around 60 new cases a week. To date, 70 patients have confirmed cases of hepatitis E (HEV RDT+) while 64 have been hospitalised, and 11 have died, including four pregnant women.
CENTRAL AFRICAN REPUBLIC (7 February)
Following the unacceptable intrusion of armed men within our maternity of Gbaya Dombia the team decided to suspend all activities in the PK5 neighbourhood of Bangui (including OCP activities in Mamadou Mbaiki clinic) from tomorrow onwards until next Wednesday. A local communication will be issued today.
IRAQ (7 February)
The five OT trucks have been deployed on a south-east axis towards Mosul (Hamam al-Alil town). They will be operated jointly with OCP, who will be in charge of ER triage, while OCB will manage the operating theatre and the recovery room/ICU. This weekend, a letter of intent was signed with the DoH of Ninawa, allowing us too soon start working in Hamdaniya hospital for post-operative care in a first phase, then for hospitalisation of acute medical cases.
SOUTH SUDAN (7 February)
President Salva Kiir visited Yei yesterday and issued a very strong warning to his military, saying that soldiers committing executions will be executed.
UKRAINE (7 February)
For a week the conflict was reactivated in Ukraine. Whilst most casualties were military (for whom care is well organised), some civilians have also been indirectly affected. In the city of Avdiivka there were intense shelling since the 29th of January; electricity and heating were drastically limited, which is particularly difficult to bear for the population considering temperatures have dropped below -20°. Our team carried out an assessment over the last days in Avdiivka, Konstantinovska and their surroundings. Hospitals did not request specific additional support to the one provided by ICRC and PIN and most humanitarian needs (fuel for heating, blankets, water…) are provided by local actors. Mental health needs, however, remain uncovered and we will investigate options for a possible intervention.
SOUTH SUDAN (10 February)
The recent surge in fighting, in and around the towns of Wau Shilluk and Malakal (Greater Upper Nile region), finally forced OCBA to reduce its team in Malakal and to close the hospital in Wau Shilluk. Patients left or were transferred to a hospital where ICRC is working.
KENYA (10 February)
Major news this week, the Kenyan High Court has declared the closure of the Dadaab refugee camps illegal:
09.02.17 - MSF welcomes Kenyan High Court ruling declaring closure of Dadaab refugee camps "illegal"
NIGER (10 February)
The border between Niger and Nigeria, close to Damassakh will be closed from now on.
An explo has been launched since last week along the border between Niger and Nigeria, East and West from Diffa, to evaluate the humanitarian needs of displaced, returnees and refugees stuck in camps.
In the eastern part, around 25’000 refugees/returnees / displaced don’t have access to proper medical care neither basic needs, especially in Ngagam (Geskerou Health Zone) despite the presence of many other NGOs. This site will certainly be the focus for a future intervention.
In the west, the presence of the population in need is much lower and there is a high presence of Boko Haram, no intervention is planned.
DRC (10 February)
Around Mambasa and the mines, clashes happened this week and we are preparing a Mass Casualty Plan at ER level in Mandima hospital.
In Katanga, we will start the measles vaccination in 5 health areas on 16th February.
Clashes between Bantus and Pygmees (Batwas) are still very intense in Katanga as well, and an explo/intervention will be launched next week to the health zone of Moba and Kansimba to bring assistance to the wounded.
NIGERIA (10 February)
Our team is back to Rann this week. We are also in Ngala camp, setting up an IPD and we have a team working in Banki.
09.02.17 - MSF condemns brutal killing of ICRC staff in Afghanistan
09.02.17 - Chad: MSF calls for assistance to curb hepatitis E outbreak in Am Timan
08.02.17 - Democratic Republic of Congo: Fighting measles in South Kivu
03.02.17 - In Libya, migrants are held in inhumane conditions
PHILIPPINES (10 February 2017) –Deputy Director of operations Pierre Mendiharat back from field visit
For just over a year OCP has been running in partnership with local NGO Likhaan a sexual and reproductive health programme in two clinics in Manila slums San Andrés and Tondo.
Sexual and reproductive health (contraception as well as abortion) is the subject of much controversy in the Philippines with one side ultraconservative, political and religious forces and on the other progressive forces well represented at the Ministry of Health and the municipality.
A valued partner with an extensive network of community health workers, Likhaan is an activist and highly engaged organisation well versed in advocacy with policy-makers and the central administration. In 2014, it played a key role in enacting a law ensuring provision and funding of sexual and reproductive health services in all public centres. A current objective is to obtain accreditation from PhilHealth (Philippines’ social security system) for “stand-alone family planning clinics” to enable patients to access services free of charge and thus to scale them up.
Our partnership seeks to develop sexual and reproductive health activities and improve quality of care through the provision of additional services: family planning, screening for precancerous lesions of the cervix, HPV vaccination (against human papillomavirus to prevent cervical cancer), care for victims of sexual violence and maternal health; the first three are ongoing. Screening is provided at the clinics and campaigns will be organised later. Patients with precancerous lesions are offered cryotherapy. An HPV vaccination campaign targeting all girls aged between 9 and 13 years (24,000) began in public health centers in the two slums last week. Management of sexual violence is not fully available as it is a new area for our partners and may take some time to set up. As for maternal health, we need more input on barriers to initiating care to be able to determine the most appropriate strategy. A highly sensitive subject in the Philippines, Likhaan performs abortions in its referral clinic and is asking us for support with developing skills in the treatment of complicated cases. What’s more, this project provides an excellent opportunity to propose consultations to all women.
The clinics’ capacity needs to be extended and, as buying land and building is proving too complex, we have found several places available for rent.
LIBYA (10 February 2017) - Update on our operations with Jean-Guy Vataux, HoM
There are three governments in Libya, all legitimate to some extent: the General National Congress (GNC) elected after the revolution in 2012, the House of Representatives (HoR) elected in 2014 and the Presidential Council set up by the United Nations Security Council 2015.
Hence, the political situation is tense. The capital Tripoli, is divided between forces loyal to GNC and Presidential Council. The country is separated into halves, between the GNC and Presidential Council in the West and the HoR in the East.
For the past 18 months, each of these two camps has been fighting enemies enclaved within their own controlled territories: a coalition of Islamist militias in Benghazi, Islamic State in Syria. Those battles came to an end and the future is uncertain. Many fear that both camps, if unable to reach a political agreement, might be tempted by a direct military confrontation.
However, our operations are not built to put us in a position to respond directly to such a scenario. Libya’s health system is capable of putting a lot of resources in the treatment of the wounded people, inside the country or abroad. The most severe cases are treated in Italy and Turkey for GNC’s combatants and in Russia for HoR’s fighters. As for displaced people, a very good system of assistance managed by local authorities and the Libyan Red Crescent is in place. For example, supply of NFI for newly displaced persons remains one of the main activities of ICRC. Assistance to war wounded and displaced people are an objective, but are not the cornerstone of our intervention in Libya.
The political instability and the fighting have triggered a severe economic crisis and therefore an exodus of most of the qualified immigrants who were contributing in large part to the functioning of public services. For example, many east Europeans physicians and Filipino nurses have left public hospitals.
A few groups are excluded from the public health care especially the migrants, to start with. There are two types of migrants: those who have not been caught and wait for passage to Europe, and those in detention centres. The first population is in a desperate situation but is very difficult to reach and assist. An exploratory mission is ongoing in Misrata and Bani Walid to identify a possible intervention with these migrants. The presence of smugglers groups and of the Islamic State in the vicinity are a concern.
The migrants who are arrested by the police are put in detention centres before to be sent back to their country of origin. OCA in Tripoli is assisting them in 8 detention centres. OCP would like to provide primary health care and hospital references for acute cases in 3 detention centres in Khoms – were the conditions of detention are appalling-, Misrata and Zliten (a former prison newly rehabilitated).
Displaced populations are also in need of medical assistance. Last year, MSF opened a clinic delivering paediatric and Gynobs ambulatory care for displaced people in Benghazi, a mental health activity for children with trauma linked to war has just been started.
We are also looking to address some specific medical problems: infections with multi-resistant bacteria, cancer and treatment of Hepatitis for example. Regarding multi-resistant bacteria, we start to develop a scientific partnership between the main hospital of Misrata and our very own Amman Hospital. The Libyan Minister of Health asked MSF to look at the cancer issue in the east part of the country where no diagnosis or treatment options are available anymore. Finally, we'll try to provide Hepatitis B and C treatment (potentially HIV) for migrants and immigrants: the treatments are available but nowadays restricted to Libyan citizens.
Finally, we are evaluating the project of Al Marj, a support to a very active public hospital's maternity.
Rotavirus vaccine developed by MSF and Epicentre available soon
Over 300,000 of the world’s children die annually from rotavirus infections that in Europe usually pose no risk. Two vaccines exist, but they are expensive and bulky and need to be kept at a low temperature.
MSF and Epicentre have worked to develop a new, cheaper vaccine created by the Serum Institute of India, conducting a clinical trial to test its efficacy and tolerance in a research centre in Niger. The results of the trial have shown the vaccine’s efficacy (around 70%) to be comparable to that of the two existing vaccines. Besides being cheaper, it is thermostable and can be stored at for up to 6 months at a temperature of 40° and for up to 12 months at 37°. In December 2016, the Indian regulatory body approved the vaccine — a major step towards the WHO prequalification required for UN agencies to be able to purchase it.
This is the first time MSF and Epicentre have been instrumental (in partnership with an Indian manufacturer) in developing a new product that not only addresses the needs of children we assist and others but also those of national programs that have to deal with the constraints imposed by the current vaccines.
YEMEN (6 February)
Tensions are mounting, with all parties to the conflict intensifying attacks. Particularly concerning is the West Coast: up to 5,300 families may have fled embattled Mokha and need immediate assistance, while escalating tensions around Hodeida port could leave millions of people cut off from vital supplies. The Saudi-led Coalition called for wide-scale retaliation against Houthis following an attack against one of their warships in the Red Sea, and if that naval entry point gets totally blocked consequences will be devastating, as it is key to bring in food and emergency aid. In our main area of intervention, Hajjah governorate, ground-fighting around Midi is on the rise, and in the last days, several airstrikes were reported near Abs, where bridges are being increasingly targeted – including the one MSF uses for referrals and supply transport.
The influx of war-wounded to Hajjah is growing in parallel to warfare around Midi, from 5 to 7 cases per day to an average of 10 – and with 21 on one single day. Over 65 cases were registered during the week. Bed occupancy rate exceeded 100% in the IPD.
In Abs, more than 520 ER consultations were conducted. Nearby airstrikes and roaming planes didn’t deter people from going to the hospital as much as feared, but some patients urged medical staff to discharge them on the shortest delay. In the maternity, almost 60 deliveries were attended (3 C-sections). ITFC is currently half full. According to the team, MSF may be receiving fewer children due to the fact that MoH’s outreach program is not operational.
NORTH SYRIA AND TURKEY (6 February)
Fighting is still on going in the Al Bab City and Qabasin area, North-East of Aleppo governorate, with advances towards Qabasin, though the area is still controlled by IS. In the east, clashes between FSA/TAF and IS continue. And the GoS continues its advance in the South West of Al Bab, where they are already 5 km from the city.
In some areas they are already bordering the area controlled by TAF. The TAF airstrikes on SDF positions in Tal Rifat continued this week, allegedly targeting SDF military warehouses.
The situation stabilised in the countryside of Idlib and Western Aleppo governorates after the merging of opposition groups to create two large coalitions. We were able to resume our movements since 31/01. Airstrikes against leaders of opposition groups were registered in Idlib during last week.
In Turkey, countrywide, police operations continued taking place against IS, around 600 people were taken into custody, 47 of them were from Gaziantep. The Gaziantep governorate banned all demonstrations and gatherings until February 28.
In Azaz, after some suspected measles cases were notified in Sandy HP, the team is working on a proposal for a Mass Vaccination campaign for the North of Al-Bab. In Aleppo governorate countryside, the EPI activities decreased on the due to bad weather conditions.
The last donations to health facilities in Idlib and Western Aleppo countryside were finalised (4 hospitals, 4 PHC and 2 mobile clinics). Since the beginning of this intervention, we supported the HF with 180 m3 of medicines and medical equipment. Two fully equipped ambulances were also loaned to OCP for their mobile clinics in the area.
DRC (6 February)
On February 1, Etienne Tshisekedi, 84, a historic opposition figure, died in Brussels, leaving behind a gaping hole in the façade of the Congolese opposition. Negotiations between government and opposition on the organisational structure / composition of the government are still ongoing in Kinshasa, without significant results.
In South Kivu, tensions remaining in Lulingu. We registered an increase of Sexual violence cases, most of them coming after 72h. 12/30 health zones are reporting measles cases. Last year the government did a massive vaccination campaign and reported a high level of coverage.
COLOMBIA (6 February)
6,300 FARC guerrillas and other FARC militiamen arrived at the 26 areas where they will be concentrated during the weapon delivery and reintegration process. The MERT team has been providing MH and PH assistance to the communities of Valledupar and Palestina in the San Juan River (Valle and Chocó) affected by self-confinement due to the presence of new armed actors in the area.
MEXICO (6 February)
This has been a violent week in Guerrero State, with a balance of 37 deaths only in Tierra Caliente and the north municipalities of the state. A new group called “Los Jefes” left several narco-messages as a threat to the different groups currently fighting for the area. A mobile clinic in the rural areas is ongoing, after the clearance regarding security and acceptance was obtained.
BOLIVIA (6 February)
The National Programme of Chagas is still blocking the dissemination of the MSF Manual in the different Bolivian regional departments. Meetings are ongoing in order to first understand the reasons behind this blockage and to identify possible solutions. The fact that the project to integrate Chagas care in the Primary Health facilities has been successfully implemented by MSF and the Health authorities in Monteagudo could not hide the fact that in Bolivia there are still a lot of gaps regarding Chagas access to treatment at national level, hence the need to continue to speak out in order to raise awareness amongst the population and decision makers.
EL SALVADOR (6 February)
The explo team has been in touch with actors delivering assistance to IDPs coming to San Salvador. These IDPs usually stay confined in the secret “albergues” due to fear of going out, even to the health structures. Cases of displacement in rural areas are reported almost in a daily basis as well.
SOUTH SUDAN (6 February)
In Wau Shilluk, the town was taken by SPLA last Friday. According to national staff, they are in the MSF hospital compound. There was sustained shelling and small arms fired between the SPLA and the opposition Agwelek forces. Agwelek fled in large numbers in midst of civil population. MSF National team and all patients were evacuated to Kodok and arrived safely. As a result, 20,500 WS inhabitants and 10,000 more from villages north of WS are displaced. A cluster of IDPs settled in Lul half way between Kodok and Wau Shilluk and more and more IDPs have arrived to Kodok. If all population south of Kodok are moving, there could be a total of 50,000 IDPs.
The team is planning together with ICRC to cover the health needs of the population living and arriving at Kodok.
That will include all OPD and support to ICRC for hospitalisation. We are also considering the option to have a temporary health facility with IPD capacity as the ICRC hospital in Kodok might be overwhelmed and they were only specialised in surgical cases. A message has been passed to the SPLA to ask them to respect health facilities
ETHIOPIA (6 February)
In Dolo and on the Somalia border, the refugee influx recorded a slight decline from 980 in week 3 to 648 in week 4. Reports indicate that more households are still coming and are waiting to cross the border. A total of 3,062 new arrivals were recorded in Dolo Ado from 1-31 January 2017 (averaging 108 per day), which is the highest in several years. In the Reception Centre, MSF screened 191 children <5 years, of which 20 (10.5%) children with SAM, 140 (73.3%) MAM. In Gambella, the final opening of activities in the hospital is planned for February 8.
SUDAN (6 February)
In the White Nile area, due to the ongoing fighting, 23 casualties have arrived in Al Kashafa MSF facility. About 14 people with severe gunshot wounds were referred to Kosti hospital.