Public Health Emergency of International Concern (PHEIC)
Polio this week as of 24 May 2017
:: The World Health Assembly (WHA) is meeting this week in Geneva, Switzerland.  Ministers of Health and public health professionals from around the world are discussing global public health issues, including the global drive to eradicate polio.  The Global Polio Eradication Initiative (GPEI) secretariat has prepared a status report, which will inform the discussions by Member States.
:: The Global Polio Eradication Initiative (GPEI) welcomes Dr Tedros Adhanom Ghebreyesus, the new Director-General-elect of the World Health Organization, and looks forward to working with him to achieve a polio-free world. More.
:: Two separate outbreaks of circulating vaccine derived poliovirus type 2 (cVDPV2) have been reported in the Democratic Republic of the Congo, one in Haut Lomami province and one in Maniema.
:: Health Ministers of the Group of Twenty have emphasized the importance of polio eradication and transition planning efforts at their inaugural meeting in Berlin, Germany. More.
:: Polio staff in Nigeria have contributed emergency response expertise to a meningitis outbreak in Sokoto State. More.
:: Summary of newly-reported viruses this week: Afghanistan, one new wild poliovirus type 1 (WPV1) environmental sample. Pakistan, seven new WPV1 environmental samples. Democratic Republic of the Congo, four new cases of circulating vaccine derived poliovirus type 2 (cVDPV2) and one isolate from a healthy individual in the community. For more, see relevant country sections.


WHO Grade 3 Emergencies  [to 27 May 2017]
:: Hundreds of volunteers vaccinate displaced children from Mosul and other underserved areas in Ninewa governorate
Baghdad, 23 May 2017 – More than 1900 health workers and volunteers on Sunday 21 May 2017 began a mass polio vaccination campaign targeting approximately 332 000 children from conflict affected Mosul and other underserved areas in Ninewa governorate.

South Sudan  – No new announcements identified
YemenNo new announcements identified
NigeriaNo new announcements identified
The Syrian Arab Republic  – No new announcements identified

WHO Grade 2 Emergencies  [to 27 May 2017]
Democratic Republic of the Congo
:: Contingency fund aids rapid response to outbreak of suspected Ebola virus
25 May 2017 — Responding quickly to an outbreak means moving people and supplies quickly, and that means moving funds quickly too. When WHO received an alert on 9 May of a cluster of unexplained deaths in a remote part of the Democratic Republic of the Congo, it was able to deploy a team to the affected area just a day later, thanks in part to the WHO Contingency Fund for Emergencies (CFE). The CFE was able to rapidly release the money needed for transport and other vital logistics to get the investigation team to where they were needed.

Cameroon  – No new announcements identified.
Central African Republic  – No new announcements identified.
EthiopiaNo new announcements identified.
LibyaNo new announcements identified.
MyanmarNo new announcements identified.
Niger  – No new announcements identified.
Ukraine  – No new announcements identified
UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
:: Iraq: Mosul Humanitarian Response Situation Report No. 34 (15 May to 21 May 2017) [EN/KU]
:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Stephen O‘Brien, Statement on protection of civilians in Mosul’s Old City, Iraq [EN/AR/KU]
Published on 26 May 2017
I am deeply concerned for the safety of civilians behind ISIL lines in western Mosul.
Although the UN is not present in the areas where fighting is occurring, we have received very disturbing reports of families being shut inside booby-trapped homes and of children being deliberately targeted by snipers. Families in the city still lack access to clean water and medicine and many have only limited access to food.

When humanitarian agencies developed their contingency plan for Mosul last summer, we estimated that as many as one million civilians might flee the city and that 750,000 people would need assistance in a worst case scenario. Seven months into the fighting and almost 760,000 people have already fled their homes.

Yesterday, the Government asked civilians in districts surrounding and inside the Old City to leave and seek safety across government lines. We don’t know for sure how many civilians are still in ISIL-held districts, but as many as 200,000 additional people may try to leave in coming days.

I remind all parties to the conflict of their obligation under international law to protect civilians against all forms of violence and to ensure people in need have access to the assistance they require. Those who choose to flee their homes to access assistance must be free to do so without hindrance. In the context of Mosul, where ISIL fighters are known to be using human shields in densely-populated neighbourhoods, parties to the conflict must take all feasible precautions to protect civilian lives.

International law is unambiguous. The protection of civilian lives is a legal and moral duty that stands above all other objectives.
New York, 26 May 2017

Syrian Arab Republic
:: 25 May 2017  Syria: WoS Nutrition Reach by sub-district / Jan – Apr 2017
:: Syria Crisis: Ar-Raqqa Situation Report No. 5 (as of 15 May 2017) [EN/AR]

:: 24 May 2017  Statement by the Humanitarian Coordinator in Yemen, Mr. Jamie McGoldrick, on the Urgent need for Funding to Halt the Spread of Cholera [EN/AR]
Sana’a, 24 May 2017
Cholera continues to spread at an unprecedented rate throughout Yemen affecting men, women, and children who have for more than two years withstood the consequences of a conflict that is collapsing institutions and social safety nets. With urgency I appeal to United Nations Members States for financial and political support to help avert what is sure to be an additional and devastating blow to Yemen.

In the last three weeks, health authorities have reported over 35,500 suspected cholera cases, a third of whom are children, and 361 associated deaths in 19 of 22 governorates.

Malnutrition and cholera are interconnected; weakened and hungry people are more likely to contract cholera and cholera is more likely to flourish in places where malnutrition exists. Seventeen million people in Yemen are food insecure, including 462,000 children in the grip of acute malnutrition. Seven million people in Yemen face the possibility of famine and now over one hundred thousand people are estimated to be at risk of contracting cholera.

The speed at which cholera is spreading among the population exceeds the capacity of the health system to respond given its weakened state after more than two years of conflict, import restrictions and the lack of regular salary payments to health workers. Hundreds of thousands of people are at a greater risk of dying as they face the ‘triple threat’ of conflict, starvation and cholera.

Building on their presence in all 22 governorates across the country, national and international humanitarians are valiantly doing everything they can to prevent and treat cholera. However, they are doing so while facing a worst-case scenario – the majority of health care centers are closed, those that are open have limited staff and supplies, water and sanitation services are unable to provide clean water to the population, and humanitarian funds available to cover the existing institutional gaps and thwart the spread of the disease are meager.

Humanitarians are seeking US$55.4 million to prevent and treat cholera at the national, governorate and community level in the next six months. However, every day that funding is delayed the outbreak affects more people and more resources are needed to control it.

Cholera is preventable and treatable and no life should be lost to this disease. Humanitarians are acting and responding and we now need UN Member States to please help us by providing new funds and by ensuring that all funds pledged during the High Level Pledging Event in Geneva are made effective without delay.

:: Integrated Response Plan: Yemen Cholera Outbreak (23 May 2017)
[22 pages. OCV mention: Case Management Conduct cholera risk assessment to identify hotspot areas for possible oral cholera vaccine. May 2017, WHO]

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
:: Somalia: Drought Response – Situation Report No. 9 (as of 23 May 2017)

:: Ethiopia Weekly Humanitarian Bulletin, 22 May 2017

:: New UN fund to tackle looming famine in Nigeria reaches $24 million  23 May 2017

UNICEF  [to 27 May 2017]
24 May 2017
From cholera in Yemen to attacks on hospitals in Syria, conflict threatens lives of over 24 million children in the Middle East and North Africa
[Editor’s text bolding]
AMMAN, 24 May 2017 – Violence and conflict in the Middle East and North Africa have put in jeopardy the health of 24 million children in Yemen, Syria, the Gaza Strip, Iraq, Libya and Sudan. Damage to health infrastructure is depriving children of essential health care. Water and sanitation services have been compromised, causing waterborne diseases to spread while preventative health care and nutritious food are insufficient to meet children’s needs.

“Violence is crippling health systems in conflict-affected countries and threatens children’s very survival,” said Geert Cappelaere, UNICEF Regional Director for the Middle East and North Africa. “Beyond the bombs, bullets and explosions, countless children are dying in silence from diseases that could easily be prevented and treated.”

In Yemen (9.6 million children in need):
::The two-year conflict has pushed Yemen to the brink of famine and plunged the country into one of the world’s worst humanitarian crises, with widespread severe acute malnutrition among children,
::Salaries for health care and sanitation workers haven’t been paid for more than seven months,
::Contaminated water sources, untreated sewage and uncollected garbage, sparked a cholera outbreak with 323 associated deaths in the last month alone.
::Two thirds of the population use unsafe water,
::Health care facilities are struggling to cope with the volume of patients – many of them children – amid shortages of medical supplies and clean water.

In Syria (5.8 million children in need):
::More than 2 million children live under siege and in hard-to-reach areas with little to no humanitarian aid. Surgical and other lifesaving supplies are regularly removed from the few convoys that are allowed into these areas,
::Many children do not have access to life-saving vaccinations and those who fall ill or are injured struggle to get treatment,
::Attacks on hospitals and other health facilities have become commonplace – almost 20 per month between January and March this year. The few hospitals that are still operational function with limited staff and services.
::The threat of polio – such as the outbreak that hit Syria in 2013 – still looms.

In the Gaza Strip (1 million children in need):
::Since the main power plant shut down on 16 April, power cuts have reduced water supply to 40 litres per person per day, less than half of the minimum international standard,
::Wastewater treatment plants now deposit 100,000 cubic metres of raw sewage into the sea daily, increasing the risk of waterborne diseases,
::14 public hospitals are operating for critical services only.

In Iraq (5.1 million children in need):
::Water supplies in camps for the displaced around Mosul are stretched to the limit with new families arriving daily, many with malnourished children,
::The widespread use of unsafe well water, with the accumulation of solid waste in and around Mosul, are exposing children to the risk of waterborne diseases,
::UNICEF estimates that 85,000 children are trapped in western Mosul, cut off from humanitarian aid for the past seven months and with limited access to medical care.

In Libya (450,000 children in need):
::Last year, Libya recorded 20 attacks against health facilities, second only to Syria,
::Immunization programmes have been facing challenges since the conflict erupted in 2011, with suspected measles cases reported among young children,
::Without new funding, over 1.3 million children won’t be vaccinated against measles or rubella, putting these children – and others in the country – at risk of highly contagious and potentially fatal diseases.

In Sudan (2.3 million children in need):
::Over 8,000 cases of acute watery diarrhoea have been recorded across 10 of the 18 states in just eight months, including those hosting large numbers of refugees from South Sudan.
::Cases of acute watery diarrhoea are set to rise rapidly once the rainy season begins in June.
::Over 200,000 children under the age of five in parts of the conflict affected Jabel Marra, Nuba Mountains and Blue Nile areas have not had access to basic health services such as vaccination, for more than four years.

Across these countries, UNICEF and its partners are working around the clock to provide vulnerable children with safe water, water treatment, medical and nutrition supplies to prevent the total collapse of essential health and water systems. But as conflicts continue, and amid a shrinking humanitarian space, challenges to reach all vulnerable children with lifesaving assistance are growing.

“When children can’t access healthcare or improved nutrition, when they drink contaminated water, when they live surrounded by waste with no sanitation, they become ill and some die as a result,” said Cappelaere. “There is very little standing between them and life-threatening illness, especially when humanitarian access is denied.”

UNICEF is appealing for children’s needs to be prioritized in all conflict-affected countries through:
   :: Unconditional and sustained access to all children in need for UNICEF and other partners to deliver humanitarian assistance and supplies, including lifesaving medical items and vaccination, water purification material and waste treatment.
:: Parties to conflicts should put an immediate end to attacks on health facilities. Health facilities and civilian infrastructure should be protected at all times.
:: Urgent funding for the health, nutrition and WASH sectors. UNICEF received only one third of its 2017 funding requirements for health, nutrition and water and sanitation in these countries.

EBOLA/EVD  [to 27 May 2017]

Ebola Situation report: 25 May 2017
25 May 2017

Situation update

WHO, UN Agencies, International organizations, non-governmental organizations (NGOs) and partners con­tinue to support the Ministry of Health in the Democratic Republic of Congo to rapidly investigate and respond to the outbreak of Ebola virus disease (EVD) in Likati Health Zone, Bas Uele Province located in the north-east of the country.

On 24 May 2017, no new confirmed or probable EVD cases were reported. Two suspected EVD cases were reported, one each from Muma and Nambwa Health Areas in Likati Health Zone. The last confirmed case was reported on 11 May 2017.

Currently there are a total of two confirmed cases, three probable and 37 suspected cases. The confirmed and probable cases were reported from Nambwa (one confirmed and two probable) and Muma (one con­firmed and one probable). The suspected cases have been reported from six health areas (Nambwa, Muma, Ngayi, Azande, Mobenge and Mabongo). No healthcare workers have been affected to date. The outbreak currently remains confined to Likati Health Zone.

As of 24 May 294 contacts remain under follow up for signs and symptoms of Ebola. A total number of 520 contacts have been listed and 226 have completed 21 days of contact monitoring….

Current risk assessment
:: The risk is high at the national level due to the known impact of Ebola outbreaks, remoteness of the af­fected area, and limited access to health care including suboptimal surveillance.
:: The risk at the regional level is moderate due to the proximity of international borders and the recent influx of refugees from Central African Republic.
:: The risk is low at global level due to the remoteness and inaccessibility of the area to major international ports….

Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

Zika virus  [to 27 May 2017]
Disease outbreak news
Zika virus infection – India  26 May 2017

On 15 May 2017, the Ministry of Health and Family Welfare-Government of India (MoHFW) reported three laboratory-confirmed cases of Zika virus disease in Bapunagar area, Ahmedabad District, Gujarat, State, India….

MERS-CoV [to 27 May 2017]
[No new digest content identified]
Yellow Fever  [to 27 May 2017]
[No new digest content identified]