Photo: Amr Emam/IRIN

Primary schoolchildren receiving H1N1 vaccinations (file photo)

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CAIRO, ) – The number of H1N1 influenza patients has fallen sharply in Egypt since the start of 2010, but health officials say they are bracing for a second wave of infections.

The Health Ministry said it is recording 500 infections a week, as against 2,500 a week in December.

“We’re still on high alert,” Amr Qandeel, head of the Preventive Medicine Section at the Egyptian Health Ministry, told IRIN. “Our hospitals and labs are ready to receive patients and test samples to ensure that the virus doesn’t spread on a massive scale.”

He said the Ministry had ample stocks of the H1N1 vaccine, and that around five million doses were in the nation’s hospitals.

H1N1 influenza first hit Egypt in July 2009. To date, 16,052 people have been infected and 267 have died.

Most cases have been reported in schools and universities in Greater Cairo and Alexandria, where high population density makes the spread of the virus more likely, health officials say.

Some health experts have attributed recent declines in H1N1 cases to school mid-year breaks, which began in early February and end on 19 February.

“The virus is now in the lowest part of its curve,” said Mohamed Abdelmeguid, director of Abassiya Fever Hospital, a treatment centre for H1N1 patients. “But we expect it to be active again in a matter of a few weeks.”

Overhyped?

Meanwhile, the Egyptian media have been speculating whether the H1N1 threat merits the level of government expenditure on mitigation measures.

“This virus is even less dangerous than normal influenza, which kills hundreds of thousands of people worldwide every year,” said Fathi Shabana, a leading fever specialist. “Statistics are rare in Egypt, but I’m sure that this [seasonal] influenza has caused the deaths of more people than swine flu did.”

He said the death rate per H5N1 (bird flu) case was far higher than for H1N1. Of the 96 Egyptians who have contracted avian influenza since the first case in 2006, there have been 28 deaths.

However, Amr Qandeel said the government’s preventive measures had “succeeded in minimizing infections”.

Those who had died of the H1N1 virus mostly had pre-existing health problems, the Health Ministry said.

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Photo: Dana Hazin/IRIN

Uprooted trees in the wake of floods further clog waterways

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AL-ARISH, – Floods in and around the northern Egyptian city of Al-Arish in January have highlighted the need for more and better quality disaster preparedness planning in the governorate and nationwide, officials say.

“The floods were a surprise as North Sinai had not seen floods in 30 years,” said Mohamed Fawzi, head of the Crisis and Disaster Management Sector at the Cabinet’s Information and Decision Support Center (IDSC).

He said the governorate was included in national flood planning, but few disaster preparedness activities had been undertaken.

“Other governorates, which get flooded almost every year, like South Sinai, the Red Sea and Upper Egypt [an area including many governorates], regularly do preparedness exercises, which is not the case in North Sinai,” he said, adding that only now had there been any talk of annual exercises.

The January floods in North Sinai left 780 homes totally destroyed, 1,076 submerged, and much other damage.

No building in watercourses

Muhammad al-Kiki, secretary-general of North Sinai Governorate, told IRIN one lesson learnt had been not to build in, or near, dried up watercourses (wadis). “Some people built huts and others planted trees in the floodwater gullies and hence were the ones most affected. They also harmed other people as the water diverted to other places.”

Photo: Dana Hazin/IRIN

Huts built in a floodwater gully. People living in these are the worst affected by floods

Action was quickly taken after the floods: “We started cleaning up the watercourse immediately, removing all the trees and huts. We also started reinforcing the banks of the waterway.”

He said roads traversing waterways had also hindered the flow of water. “We are studying road construction options which allow water to flow smoothly below or over them,” he said.

The Egyptian Humanitarian Relief and Rehabilitation Organization (HRRO), an NGO working on disaster preparedness by raising awareness in local communities, has experience of these issues in other governorates, but Sinai was a problem, said Ayman Ghanem, head of programmes at HRRO.

“Disaster preparedness has proven difficult in Sinai. Many people are nomads and it is very difficult to convince them of the importance of disaster preparedness. They had not seen floods for more than 30 years so they were more concerned about current needs [food aid for poor families, education] than preparing for a disaster which, they said, may or may not happen.”

Silt

One positive aspect of the flooding is that it helped replenish groundwater reserves. “The floods boosted groundwater reserves which are the main source of freshwater in the governorate. They also brought silt, which is very good for crops. We planted 30,000 feddans [126 square kilometres] of wheat,” said North Sinai Governorate’s al-Kiki.
Silt also reduces erosion of the coast when flood water reached the sea.

Meanwhile, the governorate is planning to build 200 water catchments for irrigation purposes, al-Kiki said.

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Photo: Annasofie Flamand/IRIN

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Students at the al-Hamza Girls School in Amran Governorate are taught about the risks of landmines and UXO

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AMRAN, – At al-Hamza Girls School in the northern Governorate of Amran, Afra Omar from the National Mine Action Programme (NMAP) teaches a class of 50 students about the risk of mines. She holds up photos of some of the improvised explosive devices (IEDs) that were found in neighbouring Saada Governorate, where are a war between the army and Houthi-led rebels recently ended.

“If you see things like syringes, pipes, bottles, cigarette packages – don’t touch them,” she warns the students. “They can be mines.”

Children are one of the main groups being addressed in a mine risk education campaign launched in March that is also focussing on the country’s 250,000 internally displaced persons (IDPs).

An estimated 150,000 people were displaced since the last round of the northern war began in August 2009. The rest were displaced by previous rounds of fighting since 2004. Many of the displaced are hopeful of returning home after the two sides agreed a ceasefire on 11 February. However, landmines and unexploded ordinance (UXO) litter the former war zone and threaten to claim more lives if people return too early.

“The handmade mines that the Houthis planted do not give the impression that they are mines, encouraging children to touch them and pick them up,” Mansour al-Azi, general director of the National Mine Action Committee (NMAC), said. He added that children made up the largest percentage of casualties of the 5,500 landmine and UXO-related accidents in Yemen since 1962.

“It’s a huge problem,” said NMAP manager Nabil Razzam. Some 700,000 people in Saada, including IDPs in 1,239 villages, were exposed to landmine or UXO risks, he said. In the Harf Sufyan District of Amran Governorate alone, he estimated that 45,000 people in 84 villages were at risk.

Photo: Edward Parsons/IRIN

A deminer at work in a previous demining operation (file photo)

Shuruh al-Hubeish, 14, fled her home in Harf Sufyan last year and, like many of the 48,000 IDPs in Amran, yearns to go home but is afraid.

“Before I was scared of the fighting, now I am scared of the landmines,” she said.

Local authorities estimate that 10 percent of IDPs from Amran have already returned to their homes and with them the first casualty reports are trickling through. According to the Ministry of Interior, five people have been killed and 20 injured as a result of contact with explosive devices in the Malaheed and Marran areas of Saada, and in Harf Sufyan in Amran.

Mine action plan

Three demining teams from the army have been dispatched to the north to clear main roads and assess the gravity of the threat. It is estimated that their initial impact survey will take three months to complete while their technical survey, to mark contaminated areas, will take six to eight months.

A mine action plan will be devised based on these surveys.

“Clearance is slow, but as long as people know where the mine fields are, they can avoid them,” Al-Azi said.

One of the problems deminers face is the lack of maps of mined areas as the Houthis kept no record of where mines were laid. Although the Yemeni army is being assisted by their former adversaries, mines were laid randomly by the rebels without central coordination. “The problem is if the person who laid some mines died, the information as to where the mines are died with him,” Al-Azi said.

Implementing the Mine Action Plan would cost about US$5 million and take two to three years, according to al-Azi, with four platoons of deminers, four survey teams and four mine dog groups. “We are ready to start in the north. We only need the money from donors and then we can move immediately,” he said.

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Photo: Tariq Saeed/IRIN

In rural Pakistan streams and waterways are often used for cleaning and as toilets, posing risks to health

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ISLAMABAD ,  – Awareness raising and the consequent widespread adaptation of toilets and latrines has significantly reduced the number of people relieving themselves outdoors in Pakistan, according to a 15 March World Health Organization (WHO) report.

The Progress on Sanitation and Drinking Water – 2010 report says that as a result of awareness campaigns the prevalence of open defecation in Pakistan fell from 51 per cent in 1990, to 38 per cent in 2000 and 27 per cent in 2008.

People have begun building basic pit latrines in outhouses or other toilet facilities attached to their homes, rather than going outdoors. “I built a pit latrine at my home and it cost very little,” villager Irshad Masih told IRIN. “It’s much easier now for all of us, especially the women.”

Sanam Gul, 30, a teacher at a government primary school for girls just outside Islamabad, said that since reading a leaflet by a local NGO on the dangers of open defecation, she has been passing the message on to her students. “After I spoke to them, some of my pupils motivated their parents to build pit latrines rather than use streams as toilets,” she said.

Although modern toilets are plentiful across urban parts of Pakistan, basic latrines are less common in rural areas where about 65 percent of the country’s 169 million inhabitants live.

It is only recently that I learned that using a stream as a toilet could be dangerous. Villagers who live upstream also do the same and we get sick as a result.

“It is only recently that I learned that using a stream as a toilet could be dangerous. Villagers who live upstream also do the same and we get sick as a result,” said Uzma Bibi, 40, who uses the stream running through her village to collect drinking water, bathe and relieve herself. “For women, the water and the bushes around it also provide privacy.”

The World Bank Strategic Environmental Assessment for Pakistan estimates the total health care cost of diarrhoea and typhoid, both water and sanitation related diseases, to be Rs112 billion (US$1.33 billion), or 1.8 percent of the country’s gross domestic product (GDP).

“The main issue for the rural population is waterborne diseases. Cholera and gastroenteritis is common. And open defecation is a key factor in this because the waterways are polluted,” said Dr Uzair Muhammad, who works at a community clinic in Islamabad. He said “Even in urban areas there is a problem with this practice.

According to the WHO report, open defecation decreased globally from 25 percent in 1990 to 17 percent in 2008, representing a decrease of 168 million people practicing open defecation since 1990.

“It’s simple measures, like not going to the bathroom outdoors, which can be very effective in preventing sickness. We need to do more to promote these ideas and overcome the awkwardness people feel in talking freely about them,” said Sanam Gul. “The girls I teach were shocked when I first brought up the topic, but now they are happy it was discussed.”

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