TEST: Ops update to Seipati

AFRICA

ANGOLA

OCBA

(7 August) In Lunda Norte/Dundo, there hasn’t been significant influx of refugees last week.

The move to Lovua camp started on 8th of August. Uncertain what is going to happen with the refugees from Kasai (DRC) staying integrated with host population in Dundo town and around, they represent more than two thirds of the refugees. Our operations will adapt to that and to the status of severity of situation.

Photo-gallery: https://www.msf.org.za/stories-news/news-our-projects/fleeing-kasai-taking-refuge-angola

CENTRAL AFRICAN REPUBLIC

OCG

(4 August)

In Berbérati, the first round of the tetanus vaccination (responsible for the high rate mortality of the new-born) was not very good in terms of results and coverage. Before the second round, sensitisation campaigns targeted a 20,038 population (women in reproductive age in the area), and it worked well as 20 921 women in reproductive age have been vaccinated.

OCB

(7 Aug) In Bangassou the team has been able to restart mobile clinics for outreach care, with an average of 70 consultations a day in the Muslim IDP camp in the city, and 100 consultations a day for the refugees in Ndu, on the Congolese side of the river. As there are many births in Ndu we are also reinforcing the team with a midwife.

In terms of context, the city of Gambo, 75 km away from Bangassou, was the theatre of heavy fighting over the weekend. Fighters from the ex-Séléka took the town back from the anti-balaka. Population movement may be expected there, including people fleeing towards Bangassou.

OCBA

(7 August) Following the clashes of previous Saturday in Batangafo, some other clashes between Ex-Séléka and Anti-balaka groups continued for few days at beginning of the week, calmer by the end of the week. The camp for displaced people was burnt and around 14,000 people took shelter in 4 different sites, most of them in the hospital compound. A total of 18 deaths were received and 12 injured people were admitted at the hospital.

In Lobaye, the team finished the second round of multi-antigen vaccination, with an estimated coverage of 86% of the target population.

OCB

(8 August) In Bangassou, mobile clinics to the Muslim IDP site have been temporarily suspended following an incident (not involving nor targeting MSF) that heightened tensions around the site. We are monitoring the situation and will restart activities once it is stabilised.

In Bangui, shots were fired near our maternity of Gbaya Dombia in the PK5 neighbourhood due to pressure from a so-called “self-defence” group towards the local population. The team treated a few people wounded.

CHAD

OCG

(4 August) Mobile clinics started again to provide care on the islands in front of Bol while the weather is still calm. Supporting the MoH, the teams provided seasonal malaria chemoprevention. For the children between 12 months and 5 years the results are good but the figures for the babies (before 12 months) seem less satisfying. The team work on an analysis to understand the reasons.

DEMOCRATIC REPUBLIC OF CONGO

(4 August) Emergency Tanganyika -  After the strong tensions in the Moba and Kansimba areas, a team of expatriates returned last week to finalise the closure of the project that was already under way before the tensions between the Bantu militia and the military in the region. The Moba project is now permanently closed and all the remaining material of the project after the donations was transferred by convoy to Kalémie; one of the MSF vehicles on return convoy rolled, but none of the occupants were injured.

In addition, new clashes more than 100 km North of Kalémie between the pygmies and the Bantu in the neighbourhood of the village Lambo katenga took place on 3th/08, causing a dozen wounded by arrows and new IDP's of which it is difficult to count for the time being. Our team in the field was looking on 4th /08 to evacuate the injured.

The MSF relationships with the pigmy and Bantu communities are quite good so there is no direct threat on MSF activities in this area

Also read:

28th July 2017 – DRC: Over one million children vaccinated against measles

http://www.msf.org/en/article/democratic-republic-congo-over-one-million-children-vaccinated-against-measles

OCB

 (7 August) A cholera outbreak is affecting a very large area (four health zones) in the former Bandundu province, east of Kinshasa. The Pool d’Urgence Congo (PUC) will be using the same strategy as during the outbreak in Kimpese from a few weeks ago, that yielded good results: a decentralized approach. In this case, we will do a deep evaluation to get strong data that will be the basis for our advocacy to push other actors to intervene. At the same time, we will provide training and intrants so that local health professionals are equipped to tackle cases from the start of the outbreak. In Kimpese the team is still busy with the cholera outbreak that is on the wane. This week the PUC is also launching a large-scale measles intervention, targeting 130,000 children in two health zones of Lomani province.

OCB

(8 August)

Yesterday 13 people were killed after a mystico-religious sect, Bundu dia Malaya (the political arm of the Bundu dia Kongo sect), launched an attack in Kinshasa near the general prison. Shots were fired in four locations of the capital. The PUC triggered its Eprep plan and 25 wounded were hospitalised in the facilities supported by MSF. Another four were dead on arrival. Today the opposition is calling for a “ville morte” across the country. Kinshasa seems relatively quiet, but tensions are high in Goma.

OCP

Update from the Crisis Unit on Mukanos’ arrest (8 August)

On July 20th Mukanos – the Crisis Cell’s Focal Point in Beni  – was once again summoned by the military justice to testify in court at the trial of ADF collaborators in Beni. Following a hearing, the prosecutor ordered his arrest. Mukanos was taken directly from the court to the military prosecutor's office where he has remained detained to this day. On July 27th the prosecutor sent Mukanos back before the Operational Military Court of North Kivu to be prosecuted for taking part in two insurgent movements. He is accused of taking part in the preparation of an attack against Beni’s central prison on June 11th with the Mai-Mai Saperita militia. He is also accused of being in contact and collaborating with the ADFs. Though groundless these accusations are very serious and could lead to a severe sentence against Mukanos. On July 31st our lawyers transmitted a request for release pending trial, which was denied by the court, following the same conclusions as the public prosecutor. Our lawyers also requested a one-week postponement of the hearing to prepare their defence; despite several requests, the military prosecutor had indeed still not transmitted any investigation file. The court only granted a 48-hour postponement.

The first two hearings took place on August 3rd and 4th. During the first one, Mukanos and our lawyers had to endure combined attacks by the public prosecutor and the court, with little opportunity to defend their case. But during the second hearing, after properly preparing and informing themselves, Mukanos and our lawyers were better able to fend off the public prosecutor’s and court’s attacks and restore the balance of power.

The next hearing will take place on Thursday 10th of July, maybe with pleadings on both sides – as the President mentioned he would like to conclude on that date. We’ll keep you informed of future developments.

ETHIOPIA

OCA

(4 August)

At present we run four ITFCs and 32 ATFCs in Somali region, with up to 2,300 children in the nutritional programmes. Although a decrease in admissions has been observed over the past week weeks, the centres remain pretty much full as it is difficult to discharge patients.

After hiring a number of new staff to adequately deal with the workload in the ITFCs, we made an effort to improve quality of care and we have managed to bring overall mortality rates down.

By doing community engagement we attempt to understand why many children still arrive to our centres too late, or default the programme after admission. We are looking at the barriers they encounter in seeking healthcare and how to make it easier for parents to take their children to the centres, for example by having the community take care of the other children. We are also examining how to improve family decision-making, particularly when the head of the family is absent.

While many pledges have been made to improve food prices we see little relief on the ground. Food distributions are sporadic and disorganised, with some locations not covered at all. Meanwhile there has been debate on re-introducing cash distributions. While we in principle don’t object to this approach as it benefits the economic system, we are worried about the fact that there is effectively nothing to buy. In addition, there is no new registration system for cash distributions. This means that it will fall back on former systems, thereby excluding those IDPs that have newly arrived. We are currently engaging with high-level actors on these concerns.

OCBA

(7 August) In Dolo Ado and at the border there was a very low number of arrivals this week. The context is calm on the Ethiopia side, but tenser in Mandera due to elections and in Somalia, with an attack, reported in Lafey.

In Degehbur, three rebel soldiers were reported to have been killed and two others captured around Harshin and transferred to Jigjiga on the night of 2 August. That night there were a few gunshots in Deghebur and around in celebration of the killings and the capture of the rebels mentioned above. Dintaab was closed and now we have only two outreach sites. The third one, Gaashaamo, is being considered as a third emergency nutrition base instead of an outreach site.

In the Somali region, we have now been in Gunagado for one week. Over 200 children are already in the ambulatory therapeutic feeding centre and 21 in patients in the inpatient centre. We are currently conducting activities in Degehbur, Gunagado, Degahmadow and Fik.

GUINEA BISSAU

OCBA

 (7 August) 

Malaria makes up 34% of the admissions to the hospital, but HIV/AIDS, tuberculosis, and other infections resulted in most fatalities in the Centre de Réhabilitation Nutritionnel Intensif (CRENI).

In the Paediatric Emergency Care (PEC) project, fewer cases of malaria were admitted to the paediatric services compared to the previous week, but still remained high. However, there was no negative impact on regular activity.

KENYA

OCG

(4 August)

The security situation in the North East Provinces deteriorates for political reasons and the Al-Shabab incursions in the region. According to a source from the MoH, the ongoing strike may end before the election. However in Mirima hospital activities are still very high. The baseline survey of Mombasa projects on going and it will end this weekend. This survey will help to orientate the project for the future, as it will list the main health issues in the area. The teams work on an emergency response plan in order to be able to respond to possible violence during and after the presidential elections that will take place on the 8th.

MALI

OCBA

(7 August)

In Kidal, Coordination des mouvements de l'Azawad (CMA) has granted access to the International Committee of the Red Cross (ICRC) to 30 people held as prisoners after the retaking of Takalot and Amassine. There have been unconfirmed rumours of mass graves in Anefif village, where the health centre is supported by MSF.

In Douentza, there has been a big increase in the number of incidents in the Mopti region, including inter-ethnic clashes between Peuls and Dogon with 30 people killed. Increase in visits to the outpatient and inpatient departments with an increase as well in non-severe and severe malaria cases. We have handed the inpatient department for children over five years old to the hospital management from the 1st of August.

After resuming activities in the health centres in Kidal, we have done 161 consultations in the past week, with 50 cases of malaria among them.

NIGER

OCBA

(7 August)

In Diffa, the first round of the seasonal malaria chemoprevention (SMC) lasted 5 days, one day more than planned, because of the high number of children, reaching a theoretical coverage of 98%. The population data available is not precise due to the displacement

In Madaoua, there has been a high increase in the number of patients hospitalised, this week we have reached 250. The malaria peak has started earlier than in previous years.

OCP

(10 August) New project in Mainé-Soroa

At the end of June, MSF OCP launched a new project in Mainé-Soroa, near the border with Nigeria. This threefold project includes:

-           A general 20-bed IPD in Mainé-Soroa opened on July 25th.

-           3 mobile clinics operating in displaced/refugee camps, in health areas evacuated by the health authorities, and close to nomadic populations in Chad, Cameroon, Niger and Nigeria. On average, 1,000 consultations are conducted each week. A referral system with Mainé-Soroa IPD has been implemented, with already 43 referrals. This number will most likely increase during the malaria season peak.

-           A mobile clinic, which has just started operating on the Nigerian side of the border, covering the Kanama, Dewar and Degueltura health areas. Until a joint Niger-Nigeria medical team is set up, operations will be handled by the Nigerian E-Prep team.

Following Boko Haram attacks in the North of Nigeria, the army closed a health area where our mobile clinic was planning to go. The E-Prep team is currently negotiating with the army to be allowed to reach the population living in this health area. Meanwhile, the team is preparing to set up 24 community relays (malaria, nutrition, diarrhoea and referrals) that will soon be distributed within three health areas and four displaced sites in Mainé-Soroa.

NIGERIA

OCG

(4 August) On Friday 21th the Nigerian army released a statement about the attack of Rann. Saying that “the main reason that caused the unfortunate airstrike was a lack of appropriate marking of the area” and that “the location was not reflected on the operational map as a humanitarian base”. It clearly contradicts the statement the government and the Nigerian army made earlier. MSF is currently working on the reaction.

In the meantime, in Rann, water now surrounds the camp, and the health situation of the population which doubled compared to December 2016, is disastrous. 900 metric tonnes from UN and INGOs cannot be delivered as the trucks are stuck. MSF had already pre positioned the plumpy nut for the children, cholera and the medical kits. The difficulty remains to finish building the MSF base. Next week, donkeys will be used to transport the material.

In Banki, Damasak and Rann, the first round of the seasonal malaria chemoprevention began two weeks ago to prevent the children mortality.

In Ngala, the MSF teams are handling the Hepatitis E epidemic coming from Niger. The international staff is now ready to train the local staff, and they already began IPD and OPD for adult and children, nutritional activities in ITFC and ATFC. Other units such as laboratory, sterilization, maternity and neonatology are still under construction.

Also read: 20th July 2017 – Nord-est: porter assistance avant l’arrivée des pluies

http://www.msf.ch/news/articles/detail/nord-est-du-nigeria-porter-assistance-avant-larrivee-des-pluies

OCBA

(7 August)

In Damaturu, there are three confirmed cases of Lassa Fever in Yobe State. Samples were collected by the World Health Organisation (WHO) and tested positive in the laboratory in Lagos. MSF is responsible for the case management of one patient and is working closely with the State Ministry of Health (MoH) and WHO on the coordination and response plan for the outbreak.

In Pulka, there was a decrease in the number of new arrivals. Also 129 individuals were relocated from Pulka to Gwoza, without prior information from the IOM. Most of them are the returnees from Cameroon. We provided medical care and emergency shelter for the new arrivals. To date IOM has constructed 500 shelters, with a plan to add 500 more shelters in the same place. Delays with installation of water and sanitation infrastructure are preventing the relocation of people to the new camp.

In Banisheikh, new arrivals continued to trickle in for the last two weeks. To date, a total of 77 individuals have been received, including many children. Lack of food was reported as the main reason for displacement.

SOMALIA

OCA

(4 August) - Last week a team from the MSF Somalia mission conducted an explo in Baidoa, in southern Somalia following a first explo into this area was done as part of the preparation of the proposal for re-engagement in Somalia. The first impressions have been shared.

There are currently three hospitals in town, of which only one is functioning, for several hundreds of thousands of people. Services offered by ICRC include treatment of malnutrition and war wounded, but there is no mother and child care nor paediatrics currently. STC is present in Baidoa but also mainly focuses on malnutrition. This is not surprising in this context but it leaves many other issues unaddressed. Therefore we are trying to deepen our understanding of what created this gap, and are also aware that introducing services to fill this gap may generate potential friction with those providing community-based healthcare.

Like Galkayo, Baidoa is a reception point for people fleeing drought and malnutrition. Currently estimations range as to the number of displaced that have settled in and around town. This information was shared by our OCBA colleagues, who are reflecting on a potential intervention under their care as part of the intersectional mission. Please find also attached OCBA’s update on the explo in their bulletin “Punto Info”.

SOUTH SUDAN

OCB

(7 August) The PCV vaccination campaign which started last week had to be stopped after just three days due to security constraints. About 1,200 children were vaccinated.

SUDAN

OCBA

(7 August) Tensions remain high in camps in White Nile state after riots took place in Khor Waral, where there are over 50,000 South Sudanese refugees. Sudanese security forces were deployed and negotiations with the camp’s leaders are ongoing. The government is controlling the situation and is not allowing any movement in or out of the camps.

Our services are run mainly by South Sudanese staff and we are providing limited services for “life-saving activities”. Remote management support and strong engagement with the host community has been activated. There are serious perception issues with the refugees as two Sudanese teachers were raped (while it is not clear who is responsible, the refugees are being blamed). The teachers are in Kosti hospital where there have been protests and a wide media presence since last week. The situation is not calming down and the Sudanese government has announced that it will potentially “dismantle” Khor Waral camp and divide the refugees into three other camps. It is not clear if or when this will take place. The team is lobbying and in touch with the United Nations High Commissioner for Refugees (UNHCR).

The acute watery diarrhoea (AWD) situation in North Darfur is not controlled and there is a lot of interference from the Ministry of Health. We were granted permission to work in Kabkabiya hospital but last week we were kicked out. Negotiations continue, but no progress. Main concern in case management, infection control and a high mortality rate (which they are hiding).

In Gara Zawiya, numbers with AWD are controlled but the medical and logistics teams

ASIA

AFGHANISTAN

OCB

(8 August) In Khost the team has inaugurated new maternity units in two public health centres in Lakan and Sabari districts. This is part of a strategy to support basic health centres in districts from where lots of patients are coming to the crowded MSF maternity hospital in Khost city. MSF has carried out the construction of the new wards and provided training and supplies to the MoPH. Women should now have access to a better facility than previously, closer to home, and complicated deliveries can be referred to the MSF hospital.

PHILIPPINES

OCP

(4 August) Fighting opposing Islamic State groups and the army broke out in Marawi in southern Mindanao province 10 weeks ago. Almost all the town’s inhabitants (approximately 200,000) and 150,000 people from the surrounding area have been displaced and are assembled here and there in small groups. Fewer than 5% are currently in official displaced persons centres.

Given the presence of other humanitarian organisations, our team—all Philippine nationals based in Iligan¬—are setting up mental health and WASH programmes and monitoring the risk of epidemics. 639 hygiene kits have already been distributed. Regarding mental health activities, 500 people have attended group sessions and several are receiving one-to-one psychological care.

Discussions on how to proceed with the operation are being held with the team.

EUROPE

GREECE

OCG

(4 August) OCB report illustrates the vulnerability of the asylum seekers with 80% suffering from MH trauma and 20% have a history of ill treatment. In regards to those figures it gives more justification for MSF OCG to keep some activities in Greece while other sections are considering to scale down their activities. OCG is planning to develop their one stop clinic and travel medicine service.

Also read: 24th July 2017 – Greece: A dramatic deterioration for asylum seekers on Lesbos http://www.msf.org/en/article/greece-dramatic-deterioration-asylum-seekers-lesbos

MEDITERRANEAN SAR

OCA

 (7 August) At the beginning of July, the Italian government announced it was to draw up a “Code of Conduct” with the aim of regulating search and rescue operations in the Mediterranean, and to restrict the activities of NGOs that might facilitate smuggling activities.

The Code of Conduct was presented to nine organisations involved in search and rescue operations in the Mediterranean. MSF has refused to sign the Code, as have other organizations. Several others have agreed to sign while other actors have requested more information. Primary reason for not signing as MSF is that, although the Code states as its main objection the protection of human lives, it is felt that the implementation will only further compromise safety at sea, placing thousands of lives at risk. Furthermore, it is considered as the first step onto a slippery slope of blurring humanitarian rescue activities within a larger policy of migration and border control.

Since beginning search and rescue operations in 2015, MSF has adhered to all international, national and maritime laws applicable in the Mediterranean Sea as well as our own code of conduct, the MSF charter, which is based on medical ethics and humanitarian principles.

We will continue to operate our search and rescue activities under the coordination of the MRCC and in accordance with all relevant international and maritime laws. Both the MSF boats remain at sea; the Aquarius has already been requested by the MRCC to undertake two rescues or assistance operations. Meanwhile, we continue to advocate for European Member States to set a dedicated and proactive search and rescue mechanism to support Italy.

Please read the official press statement here: http://www.msf.org/en/article/msf-committed-saving-lives-mediterranean-will-not-sign-italian-code-conduct, and read the Q&A, including explanatory video, here: http://www.msf.org/en/article/qa-why-msf-didn%E2%80%99t-sign-code-conduct-search-and-rescue

OCB

(7 August) Prudence disembarked 127 people in Lampedusa at the weekend and is now in Catania for restocking. There are still big discussions and arguments in the media in Italy, and not only, on the Code of Conduct, the MSF’s decision of not signing it and the repercussions it may have on our operations. Meanwhile, in the last days, we have observed an increased capacity of Libyan coast guards in the interception of boats coming from Libya and it's still unclear if this is linked to the additional support provided by Italian authorities in Libyan waters. The situation remains very volatile and delicate and we will continue to conduct internal meetings at different levels to define the next operational and positioning steps.

MENA

IRAQ

OCG

(4 August)

In West Mosul, MSF is addressing important needs for a key vulnerable population: pregnant women. The first delivery was done on June 24th, two days after the first surgical intervention. More than 120 deliveries including less than 10% C-sections were done in the first month. C-sections represent an important part of the surgical activity (10 % in week 26 and 25% in week 27). There are still many things to fine-tune and protocols to implement. The management of neonates should be discussed in the future as there are no trustable facilities in Mosul where referring neonates in need of medical care. If we compare to the situation at the beginning, it can be observed that Nablus activities are increasing very fast. So knowing that the targeted population might have been bigger than the current population in West Mosul, the maternity activity might grow quite fast. This needs to be anticipated from now to avoid either to refuse patient, either to reduce the quality of care. In this challenging context, this project is really pertinent and started well.

20 July 2017 - Iraq: Babies most affected by malnutrition around Mosul

http://www.msf.org/en/article/iraq-babies-most-affected-malnutrition-around-mosul

OCB

(7 August) All the patients in Hamam Al Alil have been discharged or referred to other facilities and the hospital of HAA is closed. The team is still working on the logistics and supply part of the closing of the project. In Hamdaniya we continue to negotiate an extension of our presence in that hospital until November, when we’re scheduled to be able to start work in the new facility in east Mosul.

OCBA

(7 August)

The Iraqi prime minister, Haidar al-Abadi, has rejected a call by Muqtada al-Sadr, the powerful Iraqi Shia leader, to dissolve the Popular Mobilization Forces (PMF) and its integration into the Iraqi Security Forces.

After one week of the nutrition programme in Qayyarah, our team has admitted 87 children with moderate acute malnutrition at Jeddah 6 camp for internally displaced people. We expect to extend our nutrition screening to the other camps progressively this week.

First data from community health workers screening shows a percentage of vaccination of 39.2%.

In Mosul, from 24 July to 6 August, the ITFC admitted 11 patients aged 6 to 59 and 6 patients less than 6 months. Five other patients are followed by the ambulatory therapeutic feeding centre (ATFC). Two paediatric rooms are already rehabilitated and furnished.

OCP

Still active frontline in South Qayyarah (8 August)

Since Iraqi Prime Minister announced Mosul’s fall on July 9th, we’ve seen a spike in ISIS (Islamic State of Iraq and Syria) attacks on the southern front, near the Hawija pocket controlled by the group. The front has moved closer to Qayyarah where the hospital’s team has managed four mass casualty events, mostly from the military. The team has been reduced from 17 to 9 expats. Furthermore, Golden Division members broke into the hospital on July 9th looking for suspected ISIS members. This increased military presence has made access to the hospital more difficult for civilians and IDPs living in Qayyarah camps. But since July 31st the situation has calmed down: the front has stabilised, the curfew was lifted and access to the hospital has been restored. Explo mission near Tal Afar (8 August) After taking back Mosul, Iraqi armed forces led an offensive on Tal Afar with the coalition’s support, a city that is still under ISIS control, 80km west of Mosul and 60km away from the Syrian border. On August 3rd, the team visited a primary care centre on the Mosul-Tal Afar line. Its members are considering leading a one-off intervention to provide care for the wounded outside of Tal Afar.

SYRIA

OCG

(2 August) – Syria: Raqqa’s besieged residents deprived of urgent medical care  http://www.msf.org/en/article/syria-raqqa%E2%80%99s-besieged-residents-deprived-urgent-medical-care

OCBA

 (7 August) The wider presence in Idlib governorate of Hayat Tahrir al-Sham (HTS), an Al Qaeda affiliated group opposing the de-escalation zones, has created concern among humanitarian actors and among the population. This may lead not only to a potential military intervention in the area, but also to a possible withdrawal of funds from the aid community by the main donors, worsening the situation. There has been a movement of refugees and fighters from Arsal camp (Lebanon) to Idlib following a ceasefire agreement between Hezbollah and Al Nusra. The aid community organised the movement and reception of around 9,000 people.

In South Syria, overall the ceasefire is still holding in Dara’a, with no airstrikes reported. However, in the north/west of Dara’a there are still road side bombs reported.

The local council of Neimeh estimates 740 families are returning from several locations in Dara’a.

In Al Salama hospital of Aleppo governorate, one additional suspected case of measles was reported. The programme of immunisation that MSF was carrying out will be expanded to East Azaz and Al Bab.

(10 August) Situation update in the North

Idlib

Slightly more than a week ago Tahrir al-Sham (HTS), coalition whose main branch is Al-Qaeda in Syria, took control of the Idlib province after driving out the Syrian rebel group Ahrar al-Sham, an Islamist and Salafist coalition mainly supported by Turkey. This event has had multiple consequences:

1.         To reassure the NGOs involved in the Idlib province, HTS invited all of them – except MSF – to a meeting to guarantee them that their work wouldn’t be under any threat.

2.         NGOs founded by Western countries could see their financial resources severely cut as they now operate in a zone controlled by Al-Qaeda.

3.         The Ministry of Health could also freezing the salaries of the health staff working in this province controlled by Al-Qaeda.

4.         Following the expulsion of Ahrar al-Sham, Turkey announced that construction material would no longer be sent to Idlib. However this embargo doesn’t apply to medical supplies.

This unexpected change in circumstances points to a new wave of violence in the area, most likely in the form of bombings by the Syrian army and their Russian ally. In this context, NGOs could have to cease any medical assistance. For now, MSF is going through with its operations and has implemented mobile clinics to ensure primary healthcare and vaccination to IDPs in transit centres in Marat Saeed and Alatareb, close to Maarat Misrin city. As a reminder, Idlib isn’t part of the 4 de-escalation zones suggested by Russia.

ERSAL BEGAA GOVERNORATE (10 August)

This weekend Hezbollah and Syrian groups came to an agreement for the groups’ fighters and their families to leave North Lebanon. Members of the Free Syrian Army will go to Qalamun and those of HTS will go to Idlib.

YEMEN

OCG

(4 August)  At country level, 443,000 cases and 1,921 deaths (CFR 0.4%) have been registered. The teams continue seeing a decreasing trend in the number of cholera cases and admissions to the CTCs in Ibb and Kilo. Since the beginning of May, both centres have treated 13,300 cases, with a CFR of 0.1%. Additionally, since 10th July, the teams have treated another 243 cases in the CTU in Al Udeyn.

Outreach activities have started in Ibb with visits to targeted areas after alerts received in the CTC. The strategy is still under development and will be as well implemented in Kilo CTC. Questionnaires for community household level are also under development.

Also read: 3rd August 2017 – Yemen: crisis update – July 2017 http://www.msf.org/en/article/yemen-crisis-update--july-2017

OCBA

(7 August) Cholera admissions are decreasing, but the outbreak has not yet abated. Over 463,000 suspected and confirmed cases have been registered to date in Yemen, with 1,940 deaths. Since 30 March MSF has treated 82,000 patients, which represents nearly one-fifth of the total reported across the country.

Hostilities are ongoing, and more examples of the disregard for the protection of civilians were reported last week, with attacks on a house in Al Safra district and on a private vehicle in Razeh District in Sa’ada Governorate resulting in the death of at least 12 civilians including women and children, allegedly, and 10 others injured.

Since the beginning of the epidemic, MSF Spain has treated about 20,000 patients in Hajjah governorate: 14,804 cases in Abs (with an average of 31 per day last week, compared to 43 the previous week) and 5,352 in Hajjah until the Cholera Treatment Centre (CTC) was handed over to the International Organisation for Migrations (IOM). In Abs the downward trend is consolidating.

In Abs hospital, admissions at the inpatient therapeutic feeding centre (ITFC) increased again, with up to 39 severely malnourished children with complications being admitted. The most worrying trend is the extremely wasted patients among under 12 months. In Hajjah, 36 war-wounded were treated, mostly from blasts, due to the ongoing fighting around the front lines of Haradh and especially Midi.

Web update: http://www.doctorswithoutborders.org/article/yemen-urgent-need-aid-remote-areas-stop-cholera-deaths

SOUTH AMERICA

MEXICO

(4 August)

24 July 2017 - Mexico: “One in four patients we assist has experienced violence”

http://www.msf.org/en/article/mexico-%E2%80%9Cone-four-patients-we-assist-has-experienced-violence%E2%80%9D

VENEZUELA

OCB

 (7 August) The team is keeping a close eye on what is happening in Valencia (a town in the west of Venezuela). There are rumours that a military contingent may have changed sides to join the protesters. The teams need to be ready in case this is a signal of a context shift, potentially heralding an increase in violence.

OCBA

(7 August) The new “Constituyente” General Assembly took over on 4 August amid accusations of fraud by the company that provides the automatic system for the voting. There have been fewer protests on the street as the army and police exercised strict control over the last few days. The majority of countries in the world have rejected the new assembly as anti-democratic. Economic sanctions have been put in place by the USA and undefined suspension of Venezuela in Mercosur due to “rupture of democratic order”. This pushes Venezuela further towards political and economic isolation. Inflation is at its highest (176%) being the second highest in the world (after South Sudan) with an increase in prices of 22% in the last month. Two main opposition leaders (Lopez and Ledezma) were taken from their homes to jail and were then returned to house arrest in less than a week.

Over the weekend, a group of ex-military men rebelled in Valencia and attacked a garrison. The attack was repelled after a few hours.

The team is on stand-by in Salud Chacao health facility. No injured people have arrived.