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Can South Sudan Peace Deal Last?

Juba 13 April 2016

South Sudan may finally, perhaps, be on the road to peace. Rebel leader Riek Machar is expected in the capital, Juba, next week in the final step towards a government of national unity that seeks to end the fighting and glue together a country torn apart by more than two years of civil war.SPLA South Sudan

But tensions still remain high.

Since the peace agreement was signed in August, the international community has tried to re-unite President Salva Kiir and Machar in a joint administration. It has been a saga of missed deadlines and disagreements that appeared to have no end in sight, calling into question the seriousness of both sides to implement a peace deal.

The arrival today in Juba of deputy rebel chief Alfred Ladu Gore and a 60-strong delegation to take charge of an advance guard of opposition SPLA-IO troops signals progress. But in what is hopefully not a sign of things to come, one of Gore’s first statements was to condemn the arrest of 16 of his supporters who were organising a welcome.

Since South Sudan’s civil war broke out in December 2013, tens of thousands have been killed, 2.3 million displaced, with both sides accused of committing war crimes.

Machar’s planned return to Juba on 18 April from his HQ in the eastern town of Pagak could be a crucial step. But it will only be the start of the process. Both sides will have to address a range of issues that could plunge the country back into conflict.

28 states

The number of states in South Sudan, the most divisive issue between the government and SPLA-IO, will be decided by a National Boundary Commission. That mechanism itself is controversial.

Increasing the number of states from 10 to 28, decreed by Kiir in October, alters the political balance in South Sudan and upsets the accord’s delicately struck power-sharing provisions.

Kiir said the move was geared towards greater representation, but his critics see it as a land-grab on behalf of his Dinka ethnic group. The announcement stalled the implementation of the peace agreement as SPLA-IO said negotiations had been predicated on the original 10 states.

Crucial details around the adjudicating boundary commission remain unaddressed. It’s unclear how the commission is to be structured, and if it would decide or merely recommend the number of states. The distinction could be critical.

“What really matters is the issue of borders between states, counties, and communities,” said William Ezekiel, the advance team spokesman for SPLA-IO. “[The concern is the] areas that belong to a specific ethnic group, but get annexed to another group that are favored by the government. To be explicit, the creation of 28 states was meant to support and enhance and give resources and power to the Dinka.”

The border issue is most contentious in places with shared ownership like Malakal, where officials from the Shilluk community have warned they will fight if perceived gerrymandering deprives them of their traditional land.

“In Malakal, the capital city of Upper Nile, all of a sudden the whole city and the surrounding [area] were handed over to the Dinka Padang, which is contrary to tribal and colonial boundaries,” said Ezekiel.

The government counters that Machar himself had advocated the need for more states.

Military integration

The Transitional Government of National Unity, which will serve as a temporary administration for 30 months, is unlikely to stop the fighting in South Sudan, where a proliferation of militia complicates the picture.

Both sides continue to accuse each other of conducting attacks, making the integration of SPLA-IO fighters into the South Sudanese army a potential flashpoint. SPLA-IO is a largely Nuer force, and the government army predominantly Dinka. Although the origins of the conflict were political, it was a clash between the Dinka and Nuer elements within the presidential guard in Juba that triggered the start of the civil war.

“The first thing to be done [by the unity government] is to implement the security arrangement immediately,” said Antipas Nyok De Kucha, secretary for political affairs of the ruling SPLM.

General James Koang, in charge of integration of the SPLA-IO troops, said that details of the unification of the army have not yet been decided and will be negotiated in an upcoming meeting between military leaders from both sides.

It is clearly an urgent issue. On Tuesday, US State Department Deputy Spokesman Mark Toner alleged the government had “destroyed a declared opposition cantonment site at Numatina in Wau County” and followed a “surge of SPLA troops and military equipment into the area.”

The SPLA-IO has also accused the government of attacking sites in Western Equatoria and Western Bahr el Ghazal where it says its troops are supposed to assemble. The government’s response is to deny there are legitimate SPLA-IO forces in those regions.

SPLA-IO troops return to Juba
SPLA-IO troops return to Juba

“If there were any military operations conducted [in Western Bahr el Ghazal], then they must have been conducted against bandits and highway robbers,” said SPLA spokesman, Brigadier General Lul Ruaki Koang.

Both parties have agreed to a verification process in the cantonment areas in Western Bahr el Ghazal and Western Equatoria, to be overseen by a Ceasefire and Transitional Security Arrangements Monitoring Mechanism, made up of international observers.

Economy

The unity government needs to immediately negotiate a loan from international lenders to keep the economy afloat, experts say. Inflation in South Sudan was more than 200 percent in February and the country is in the grip of a fuel shortage.

“One of the first priorities this government will need to tackle is clearly the economy of South Sudan as a state, but also for communities suffering inflation, soaring prices of commodities and lack of access to markets where goods are exchanged and traded,” UN Mission in South Sudan spokeswoman Ariane Quentier told a press briefing.

The government may resort to paying government workers through barter. Finance Minister David Deng Athorbei gave an example of paying public workers by having communities provide services for them.

South Sudan isn’t eligible for IMF or World Bank funding until a unity government is formed, according to interviews with Western diplomats. But even then, financial relief is not certain. Donors are wary to lend money to South Sudan without significant financial oversight — the envoys said the IMF and World Bank are likely to attach stringent loan conditions.

Permanent constitution

A political conflict over the country’s first permanent constitution looms.

The transitional government will have 18 months to agree to a permanent constitution, drafted by a commission made up of the SPLA, opposition, and civil society organisations.

The plan to create a constitution “wasn’t so carefully considered,” said David Deng, director of research of the South Sudan Law Society. “You can see from the various passages, it’s as though people were just throwing things in there on their wish-list without clearly thinking it through.”

Asking both sides to put down their weapons and become partners in crafting the foundational document will coincide with the period when political parties are mobilising for presidential elections.

There is “a lot of incentive to play games with the constitution, to entrench the powers of the political elite,” said Deng.

He pointed out that the process – like the peace deal itself – may not be as inclusive as was hoped.

3-D Printing of Prostheses to Be Trialled in Uganda

Malugimi Musoma

Researchers are to 3-D print cheap, custom-made prosthetics for child amputees in the developing world after winning CAD$112,000 (US$90,000) from the Canadian government.

The money is coming through the Grand Challenges Canada fund, which supports health-related innovation in developing countries.

“There are more than ten million people in the world with amputations, most of whom live in developing countries,” says Mitch Wilkie, director of international programmes at Christian Blind Mission Canada (CBM), the NGO leading the project. “Around 300,000 of them are landmine survivors and this number is growing by about 26,000 people annually.”

Conventional prosthetic sockets for the remaining part of patients’ injured limbs are made using plaster-of-Paris moulds, but these take up to a week to dry in the sun. Children also require at least two fittings a year – equivalent to around 25 prostheses over a lifetime – to adjust for body growth, making the process expensive for their families.

“We are confident that we can expedite this whole process with 3-D scanning and printing,” says Wilkie. The team hopes to produce prostheses in developing countries for around US$250. At present, they cost up to US$5,000 in developed countries.

The first step is to measure a patient’s residual limb using a handheld US$500 infrared laser scanner. This produces a digital, 3-D image in less than a minute through a freely available software called Socketmixer, which is used to design a matching prosthetic socket. The software is automatic, but once users have gained more experience in designing prostheses they can override its features to amend the resulting socket models, according to cbm Canada.

The digital model is then sent to a US$4,000 3-D printer that takes between six and 12 hours – depending on complexity and size – to print a socket using cornstarch-based plastic. The socket connects to a patient’s residual limb and a standard artificial limb provided by aid agencies.

But Martin Twiste, a prosthetics researcher at the University of Salford, United Kingdom, warns that the suggested materials need to be tested for durability before being used more widely.

He adds that the team could consider sending the digital socket image to a 3-D printer elsewhere in the world to avoid the high cost associated with buying one – in cases where the system would be used infrequently.

The CBM Canada team is currently teaching staff from the Comprehensive Rehabilitation Services for Uganda hospital to use the technology. It is also creating and testing sockets for four hospital patients, who already use traditionally made sockets, to gather their feedback.

Over the next six months, the team plans to conduct clinical field trials with 35 patients at the hospital to compare its technology with current methods.

“We want the technology to benefit as many amputees as quickly as possible,” says Wilkie. Should the trials prove successful, the team envisions offering a package comprising a scanner, software, computer, 3-D printer and training for US$10,000 to US$15,000.

[Courtesy AllAfrica News]

Swaziland’s Dental Dilemma

8 April 2013 – Having a toothache in Swaziland can be a lot more painful than it is in many other places. Most Swazis have never visited a dentist, because in a country where 70 percent of the population lives in absolute poverty, oral hygiene is considered a luxury.

Swaziland’s 1.2 million people are served by only nine private dentists: five are in the capital, Mbabane, four are doing business in the central commercial hub, Manzini, and one is located in the up-scale Mbabane suburb of Ezulwini.

A further 15 dental practitioners are employed by the Ministry of Health, including nurses and dental hygienists, but none are specialists who can perform such procedures as root canal work or the fitting of false teeth. That’s right, your home town Newington dentist would be a rare expert here!

Even getting a filling for a tooth is almost impossible at either of the two government hospitals in Mbabane, or at the facility in Siteki, the eastern provincial capital. The public hospital in Manzini does not currently have any dental practitioners assigned to it.

“In the morning you find a queue of thirty to forty people, and it is the same in the afternoon. For that number a dentist can extract thirty for forty teeth, but he has no time for fillings or anything else more sophisticated than tooth pulling,” a private dentist told IRIN.

“People think you go to the dentist to get a nice smile, and nobody ever dies of a toothache,” said Pauline Dube, a mother of three who says she cannot afford to give her children regular dental checkups. While she works in Manzini, her children stay in a rural part of the southern Shiselweni Province, a region with no dental practitioners at all. Rural areas are not provided with any sort of dental service.

As diets change and Swazis consume more processed foods, the need for dental care has become even more pressing.

“Our teeth have not adapted yet to soft sugary foods. What we now find are Swazi teeth with cavities like in the developed world. For Swazi young people, no tooth fillings are available except from expensive dentists, who are less than ten in the whole country and they work far from most people,” the dentist told IRIN. “So, the tooth is extracted. Most Swazis go to traditional doctors, but these healers can only offer pain suppressants for tooth pain.”

Having a toothache can be a lot more serious in Swaziland. The commonly held belief that dental problems may be painful but are not fatal has changed due to HIV/AIDS, according to Yazdani Denta. Gum disease can lead to infections that can lead to the death of a person whose immune system has been decimated by HIV, the dentist noted. However, knowledge about gum infections is virtually nonexistent amongst Swazis, who have the world’s highest rate of HIV infection.

“I tell all my patients to test for HIV. The danger at government hospitals where they extract teeth is when a person with AIDS cannot produce the white blood cells to cause the blood to coagulate, and the bleeding cannot be stopped. If a patient with AIDS develops oral shingles, this can be a precursor to a more serious life-threatening disease. But the doctors don’t know enough about what goes on inside the mouth to detect this,” the dentist said.

Despite the need, no public awareness campaigns promoting dental knowledge and oral hygiene have so far been run, not seven mentioning the dental tips for braces, etc. Yet tooth decay and gum disease can be prevented with a simple daily regimen of tooth brushing and flossing.

Swaziland is not the only country on the continent with tooth troubles. “The state of dental research in Africa is lamentable when compared to the other continents,” the African Journal of Oral Health (AJOH) noted in an editorial. “While this situation is unacceptable, it is not surprising because oral health personnel on the continent are not yet strategically placed to be able to influence health policy and decisions on funding.”

[Courtesy of IRIN]

Africa: HIV/Aids Kills 7 Million Workers

Mr. Richson Nii Teye Appeynarh, Chief Executive (DCE) , has disclosed that from 1985 to date, HIV/AIDS has claimed the lives of seven million agricultural workers on the African continent alone.

He continued that it was estimated that the deadly disease could kill an additional 16 million farm workers in the next 20 years, if strong measures are not put in place to deal with the state of affairs.

He has, therefore, appealed Ghanaians to take advantage of the free volunteer services at all the health centers across the country, to know their HIV status, and also to live positively with our affected brothers and sisters.

“The Food and Agriculture Organisation’s (FAO) annual report estimates that HIV/AIDS has killed seven (7) million agricultural workers/farmers in Africa since 1985, and could kill 16 million more in the next 20 years, if strong measures are not put in place to address the situation.

“Let us all try to know our HIV status and live positively with those affected. I will like to appeal to everybody to patronise the free volunteer service,” he stated.

Courtesy All Africa News

 

Africa: Major Malaria Vaccine Less Effective Than Hoped

Researchers unveiling critical trial results of a potentially major anti-malaria vaccine are expressing disappointment that the drug’s efficacy levels have proved lower than they had anticipated.

Following on decades of research, the third phase of testing on a vaccine known as RTS,S found that the drug reduced malaria rates among infants (age six to 12 weeks) by about a third, far lower than expected.

The study, funded largely by the Bill & Melinda Gates Foundation, is part of the largest malaria trial ever conducted, taking place in seven African countries. Results were published Friday in the New England Journal of Medicine, a U.S. publication.

While still significant, the results were disappointing in having followed surprisingly positive findings last year, when a similar study suggested that RTS,S was almost twice as effective (47-56 percent) on slightly older children, those five to 17 months old.

If this most recent phase could replicate that level of efficacy among infants, researchers had hoped that RTS,S doses could become incorporated into the standard round of initial vaccinations commonly given to newborns – an approach that has now been proven safe.

“It’s a little frustrating that we’re seeing different levels of protection in different age groups compared to last year and this year,” Andrew Witty, the CEO of GlaxoSmithKline, a major drugs manufacturer and one of the central partners in developing RTS,S, told journalists Friday from London.

“As it turns out, this phase of study was not the final step that I think many people might have hoped. But it’s an important step and takes us further forward towards the goal we’ve been working toward over the past 50 years … this remains the lead and most encouraging candidate vaccine.”

Indeed, the new research constitutes the first time that scientists have found such high efficacy for an anti-malarial vaccine for infants. Witty notes that if the two rounds of study had been reversed, the psychological impact would be far different and the findings would undoubtedly have been widely lauded.

Further, the higher efficacy among the slightly older cohort remains extremely important, given that scientists have found that this age category has greater susceptibility to severe cases of malaria than do infants. While the ease of a single early vaccination would have been the most efficient scenario, researchers say they will now be looking into additional strengthening options, such as giving toddlers a booster later on.

“Two things are very, very encouraging,” Witty says. “One, the trial is successful, despite the fact that it doesn’t achieve quite the high level we would have hoped. Two, the benefit we’ve seen is higher than bed nets, which themselves deliver about 30 percent gain over nothing.”

This last point is an important one, and hints towards the approach that researchers appear to be taking to continue moving forward. Although there are still at least 12 months of additional testing planned ahead of a 2015 projected release date for RTS,S, it now seems clear that the drug will need to play a more limited role among a package of additional interventions.

This will include treated bed nets, which the study reports 86 percent of children under observation were using. Additional research will now look into how to tweak the usage of RTS,S based on age, location and other demographic characteristics.

“In combating malaria, one size does not fit all,” David Kaslow, director of the PATH Malaria Vaccine Initiative, a U.S.-based non-profit that has led the RTS,S research, said Friday from Cape Town, South Africa.

“There is a need for new options for controlling malaria, and we expect that different combinations of tools will be appropriate in different settings in Africa. So, to understand the optimal use for RTS,S, it is critical that we get input from African researchers, because they’re on the frontlines.”

Kaslow notes that the wealth of information coming out of the RTS,S-related studies will also provide “a lasting legacy in Africa for the capacity to develop solutions for malaria and other infectious diseases for years to come.

Today’s global malaria burden falls most dramatically on Africa, where there are thought to be some 175 million cases of the disease. Ever year, around 655,000 people die of malaria, most of them children in sub-Saharan Africa.

Beyond health and wellbeing, such high numbers inevitably have a massive impact on the prospects for both individual and national economic development.

Yet even as the RTS,S studies move towards the projected 2015 release date, questions remain on how to ensure that the drug could feasibly get to the people that need it the most – whether its price can be kept low enough and whether it can be moved to areas that are often difficult to access.

On the first question, Witty says that GlaxoSmithKline has “made a very firm commitment that this vaccine will be priced at the cost of manufacture plus five percent margin, and all of that margin will be reinvested into future malaria research. So this will be a not-for-profit activity for GSK, where we seek to have the lowest possible cost to maximise access for families and children in Africa.”

On the second question, Salim Abdulla, director of the Ifakara Health Institute, an organisation based in Tanzania that is heavily involved in the current studies, says that Africa has a surprisingly positive record on getting drugs into the hands of those who need them.

“The experience so far with vaccination programmes in Africa has showed that this is one intervention that can be scaled up to reach many children,” he told journalists Friday from Cape Town. “This is one of the major reasons we’ve been able to control many types of diseases in rural Africa, even in remote areas.”

Testing will now take place on the longer-term efficacy of RTS,S, including 30 months after a third dose, as well as the impact of an additional booster. Results should be released by the end of 2014.

Courtesy All Africa News

A Real Sophie’s choice: Famine forces mothers to decide which child lives and which dies

Wardo Mohamud Yusuf walked for two weeks with her one-year-old daughter on her back and her four-year-old son at her side to flee Somalia’s drought and famine.

When the boy collapsed near the end of the journey, she poured some of the little water she had on his head to cool him, but he was unconscious and could not drink.

She asked other families travelling with them for help, but none stopped, fearful for their own survival.

Then the 29-year-old mother had to make a choice that no parent should have to make.

‘Finally, I decided to leave him behind to his God on the road,’ Yusuf said days later in an interview at a teeming refugee camp in Dadaab, Kenya.

‘I am sure that he was alive, and that is my heartbreak.’

Parents fleeing the devastating famine on foot — sometimes with as many as seven children in tow — are having to make unimaginably cruel choices: Which children have the best chance to survive when food and water run low? Who should be left behind?

‘I have never faced such a dilemma in my life,’ Yusuf said.

‘Now I’m reliving the pain of abandoning my child. I wake up at night to think about him.

I feel terrified whenever I see a son of his age.’

Dr. John Kivelenge, a mental health officer for the International Rescue Committee at Dadaab emphasizes the extreme duress Somali mothers and fathers are facing.

‘It is a normal reaction to an abnormal situation. They can’t sit down and wait to die together,’ he said. 

‘But after a month, they will suffer post-traumatic stress disorder, which means they will have flashbacks and nightmares.

The picture of the children they abandoned behind will come back to them and haunt them,’ he said.
‘They will also have poor sleep and social problems.’

The United Nations estimates that more than 29,000 Somali children under age five have died in the famine in the last three months.

An unknown number too weak to walk farther have been abandoned on the sandy trek to help after food and water supplies ran out.

Faduma Sakow Abdullahi, a 29-year-old widow, attempted the journey to Dadaab with her baby and other children ages 5, 4, 3 and 2. A day before she reached the refugee camp, her 4-year-old daughter and 5-year-old son wouldn’t wake up after a brief rest.

Abdullahi said she did not want to ‘waste’ the little water she had in a 5-liter container on dying children when the little ones needed it.

Ahmed Jafar Nur, a 50-year-old father of seven, was traveling with his 14-year-old son and 13-year-old daughter to Kenya. But after only two days of walking, they ran out of water. By the third day, they could only sit beneath a big tree — thirsty, hungry and exhausted.

The two children could not walk on anymore. Then instead of us all dying there, I was forced to leave them to their fate, especially after I thought of the other five children and their mother I left behind at home. I said to myself, ‘Save your life for the interest of the five others. These two have their God,” he said.

‘That was the worst thing I experienced in my life. It was a heartbreaking experience to abandon my children who are part of myself,’ he said. ‘For almost three months, my mind was not stable. Their images were in front of me.’

Miraculously, the two teenagers were saved by nomads, and they have since made their way back to their mother in Somalia. But Nur said he can’t afford to bring the rest of his family to Kenya because it cost too much.

‘I was a farmer and had no education that can help me now get jobs. We depend on handouts,’ he said. ‘My mind is preoccupied with them: Will they all die, including their mother, or will some survive? That is what I always ask myself.’

When Faqid Nur Elmi’s 3-year-old son died of hunger and thirst on the road from Somalia, his mother could only surround his body with small dried branches to serve as a grave. She couldn’t stop to mourn — there were five other children to think about.

‘Where will I get the energy to dig up a grave for him?’ she asked. ‘I was just thinking of how I can save the rest of the children. The God who gave me him in the first place took him away. So I didn’t worry much about the late son. Others’ lives were at risk.’

[Courtesy of AFRICANseer]

MYANMAR: Mass Vaccination to Target Polio

A rare strain of the polio virus is re-emerging in Myanmar after three years, say health workers. One case was confirmed in Myanmar last December – followed by two more of unknown origin reported but not yet confirmed in January – prompting health officials to organize a mass vaccination campaign to target millions of under-five children.

A seven-month old infant was infected with vaccine-derived poliovirus (VDPV) in December in central Myanmar’s Mandalay division in Yamethin Township, according to the UN Children’s Fund (UNICEF) office in Myanmar.

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