Photo: Prep4md/Flickr

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JUBA,  – Guinea worm, the agonizing water-borne parasite, could be eradicated within “two to three years” from Southern Sudan, health officials say.

Guinea worm, also known as dracunculus medinensis, is a crippling parasitic disease transmitted by larvae in contaminated drinking water. After mating inside the body and growing up to 1m in length, the female worms begin to burrow out after a year, launching thousands of larvae from the blisters formed on the skin.

Once common across Africa and Asia, with some 3.9 million cases in 1986, according to the World Health Organization (WHO), the thread-like worm is now limited to pockets of Mali, Ghana, Ethiopia and Southern Sudan.

“Guinea worm is one of the priority areas in Southern Sudan that the Ministry of Health is focusing on,” said Olivia Lomora from the Health Ministry.

Some 80 percent of cases worldwide are in Southern Sudan, a region left in ruins by a 22-year long civil war, which ended in the 2005 Comprehensive Peace Agreement (CPA) between north and south.

“In 2006, following the Comprehensive Peace Agreement, more than 20,000 cases of Guinea worm were reported in Southern Sudan, in eight of the 10 states,” Lomora added.

“Today we are happy to say that we have about 2,753 cases… it is our hope that we will be able to eradicate guinea worm in Southern Sudan.”

Thousands of health workers have helped slash infection rates worldwide by 99 percent, with some 3,500 cases in 2009, according to the US-based Carter Center, which is spearheading efforts to stamp out the worm.

In Sudan overall, the incidence of Guinea worm has been reduced from 118,578 cases in 1996 to a provisional total of 2,753 cases reported in 2009 – a 98 percent decrease, according to the Carter Center.

Since 2003, there have been no indigenous cases of Guinea worm disease in northern Sudan.

Last year, the previously worm-endemic nations of Nigeria and Niger achieved 12 months without new infections, according to the WHO.

Former US president Jimmy Carter, who founded the Carter Center, believes such successes can be rolled out to the remaining affected areas. “We believe that in the next two to three years we will have zero cases of Guinea worm in the Sudan,” said Carter, after meeting worm-infected patients in Southern Sudan.

If successfully destroyed, it would become the first disease after smallpox to be eradicated – and the first to be wiped out without a vaccine or medicine.

“We hope to come back soon to celebrate the death of the last Guinea worm on the face of the Earth,” he added.

“In many former endemic areas the children no longer know what Guinea worm disease is,” said Clement Wani Konga, the governor of Central Equatoria state.

“We believe that much can be achieved despite the post-war challenges in Southern Sudan. Due to a lack of access to safe water, compounded by a lack of awareness and inadequate funding…Guinea worm pains prevent people from working or [going to] school.”

Breaking the cycle

Victims are often incapacitated for days or even weeks when the worms emerge, causing fever, nausea and weakness.

The worms leave the body at a crucial period for farming, so the disease can have a severe impact on agricultural productivity and raise the risk of malnutrition among children in households whose adult members are affected.

While there is no direct treatment, the worm’s breeding cycle can be broken by ensuring people do not wash in sources of drinking water while the worm is emerging from the skin.

In addition, thousands of volunteer health workers have been trained to ensure people use a simple water filter.

Extracting the worms requires winding them around a small stick, a process that can take days, to ensure no part of the worm is left inside the human body.

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Photo: Akmal Dawi/IRIN

Over 90 percent of Kuchi children still do not go to school

KABUL,  – Only a tiny proportion of children of the Kuchi community in southern and eastern Afghanistan get a formal schooling, and community leaders say government education efforts are not enough.

A social rather than ethnic grouping, the traditionally nomadic but increasingly settled Kuchi face mutiple humanitarian issues compounded by the fact that the majority are illiterate, according to government officials and community leaders.

The government agrees that Kuchi children’s access to education has been limited by their nomadic lifestyle, and is trying to do something about it: It has built over 10 schools for Kuchis in the south and east, and established 26 learning centres for Kuchi children who settle temporarily in a given area, according to Education Ministry officials.

“In the summer when Kuchis arrive in Sorobi District [east of Kabul] we organize classes for their children while they are there,” said Asif Nang, an Education Ministry spokesman.

Nang implied some Kuchi parents appear to have little interest in educating their children: “We have a brand new school with all facilities for Kuchis in Paktia Province but it lies empty,” Nang told IRIN.

Kuchis counter that the government is not doing enough. “The government claims it has built schools for Kuchis in some provinces but those are empty buildings with no teachers, no books and no other facilities,” Mahmood Khan Silaimankhil, head of the Independent Directorate of Kuchi Affairs (IDKA), told IRIN.

School attendance among Kuchi children has been lower even than for other minority groups – 6.6 percent for boys and 1.8 percent for girls, according to a National Multi-sectoral Assessment on Kuchis in 2005. IDKA says over 90 percent of Kuchi children still do not go to school.

According to the National Education Strategic Plan 2006-2011, the Education Ministry should ensure at least 35 percent of Kuchi children have access to formal education by 2010.

Kuchi children take part in animal husbandry work, and their parents can ill-afford to be without their help, aid workers say.

“Like their right to health, Kuchis’ right to education is enjoyed considerably less than other segments of Afghanistan’s population,” said a December 2009 report by the Afghanistan Independent Human Rights Commission.

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Photo: David Swanson/IRIN

Thousands of children worldwide die of measles every year

DHAKA,  – Bangladesh has dispatched thousands of health workers and volunteers across the nation in an effort to vaccinate more than 20 million children against measles.

“The campaign started very well with 2.5 million children already immunized against measles during the first day,” Carel de Rooy, country representative for the UN Children’s Fund (UNICEF), told IRIN on 15 February.

More than 50,000 health staff, 600,000 volunteers and NGOs are taking part in the campaign, working at 120,000 vaccinations sites across the country.

The two-week effort is aimed at all children aged nine months to less than five years of age, while all children aged 0-5 will also be given two drops of polio vaccine.

“Children of that particular age who received measles or polio vaccine earlier will have to take the vaccine again,” Health Minister AFM Ruhal Haque said at the campaign’s launch, adding that a single child left without immunization would pose a threat to other children.

UNICEF estimates that around four million children under five in Bangladesh are not protected against measles.

Bangladesh last conducted a major national measles campaign in 2005-2006. About 35 million children between the ages of nine months and 10 years were immunized.

In 2006, there were only seven registered measles outbreaks, compared to 27 in the first two months of 2006 prior to the campaign. No measles outbreak was reported in 2007 and only one occurred respectively in 2008 and 2009, de Rooy said.

According to the World Health Organization (WHO), measles, a highly contagious viral disease, remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine.

An estimated 164,000 people died from measles in 2008 – mostly children under five.

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Photo: David Swanson/IRIN

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More undocumented Rohingya are at the site than the total number of UNHCR documented refugees at two official camps combined

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KUTUPALONG,  – A violent crackdown on undocumented Rohingya refugees in southern Bangladesh is pushing humanitarian conditions to the brink at a makeshift camp for them, aid workers and campaigners warn.

Close to 30,000 undocumented Rohingya are now at the site, which is adjacent to a government camp for 11,000 documented Rohingya refugees in Cox’s Bazar District.

“MSF is extremely concerned about the humanitarian situation in Kutupalong makeshift camp, where the number of unrecognized Rohingya refugees is growing at an alarming rate,” Paul Critchley, head of mission for Médecins Sans Frontières (MSF), told IRIN.

The Rohingya – an ethnic, linguistic and religious minority who fled en masse from neighbouring Myanmar decades ago – have long had a tenuous relationship with the Bangladeshi authorities.

Under Myanmar law, they are de jure stateless.

The Bangladeshi government views the Rohingya as illegal migrants, while local resentment over jobs and resources has intensified in recent months.

In an 18 February report, MSF calls for an immediate end to the violence, which has already forced thousands to flee the district and head to the makeshift camp.

Due to the crackdown, the number of unregistered Rohingya has swelled at the makeshift site by more than 6,000 since October, including 2,000 in January alone, according to MSF.

The Arakan Project, an advocacy organization for Rohingya, reported on 16 February that Bangladesh law enforcement agencies had been targeting unregistered Rohingya in Cox’s Bazar District since January.

A similar campaign in Bandarban District, which started in mid-July 2009, is ongoing, it said.

Photo: David Swanson/IRIN

Jamil Ahmed, 32, outside the hut he cobbled together from plastic and twigs, says he was forced from his home in Cox’s Bazar 20 days ago

The group cited increasing violence against the Rohingya, noting that hundreds of unregistered refugees had also been arrested, pushed back across the border to Myanmar, or sent to jail on immigration charges.

“A humanitarian crisis is looming,” Chris Lewa, the project’s director in Bangkok, said. “People need to wake up to what is happening and wake up now.”

According to the UN Refugee Agency (UNHCR), there are some 200,000 Rohingya living in Bangladesh, of whom only 28,000 are documented and in two government camps assisted by the agency.

Little assistance

There are only two international NGOs – MSF and Action contre la Faim – working at the makeshift camp.

In MSF’s first preliminary assessment in March 2009, 90 percent of the over 20,000 people at the time were deemed severely food insecure.

Malnutrition and mortality rates were past emergency thresholds, and people had little access to safe drinking water, sanitation or medical care, the NGO found.

But with the crackdown worsening and more Rohingya arriving, concern from aid workers is growing.

They receive no assistance other than nutritional, mental health, and water and sanitation services from ACF, and medical services from MSF – making food a major issue.

Residents previously went outside the makeshift camp to work, allowing them to buy or borrow food from other refugees, but under the current crackdown, that too is proving difficult.

Photo: David Swanson/IRIN

A young Rohingya boy at the Kutupalong makeshift site. Water, sanitation and food are key concerns for the 28,400 undocumented refugees at the site

“That coping mechanism is weakened and that’s what has changed in the humanitarian context,” said Glen Hughson, programme coordinator for ACF at Kutupalong. “As a result, they have more and more difficulties to get some food.”

Sharing food rations

As dusk falls on the site, many residents cross into the official camp – pot in hand – to beg from documented refugees, many of whom share their food rations with them.

“This is putting a strain on our resources here,” AFM Fazle Rabbi, the camp’s CIC (Camp-in-Charge), the government’s most senior official at the official Kutupalong refugee camp, told IRIN.

He said many of the camp’s water and sanitation facilities were situated along its periphery, attracting many undocumented residents.

UNHCR quandary

The situation is proving particularly difficult for UNHCR, which assists the documented refugees in the official camps, but is not permitted to work at the makeshift camp.

The government has not allowed the agency to register newly-arriving Rohingya since mid-1993.

In its report, MSF calls on UNHCR to take greater steps to protect the unregistered Rohingya seeking asylum, and not to allow its agreement with the government to undermine its role as an international protector.

But according to Kitty McKinsey, the agency’s spokeswoman in Bangkok, those concerns have been taken fully on board.

“We are obviously very concerned about the unregistered refugees in the makeshift camp and it pains us to see refugees living in such dire conditions,” she told IRIN.

“We are working together with the Bangladeshi government and very much hope we can together find a solution for their plight.”

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