Cuba First Country to Eliminate Mother to Child HIV Transmission

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June 30, 2015 – The Caribbean region has the second highest incidence of HIV after sub-Saharan African but has made steady progress over the past decade in reducing new infections and on Tuesday Cuba achieved a feat that has so far evaded the rest of the world.

The World Health Organization announced that the island nation has become the first country to eliminate mother-to-child transmission of HIV. The most recent figures from WHO show that 240,000 children globally were born with HIV in 2013, down from 400,000 in 2009.

“Eliminating transmission of the virus is one of the greatest public health achievements possible,” WHO Executive-Director Margaret Chan said in a statement. “This is a celebration for Cuba and a celebration for children and families everywhere.”

An estimated 1.4 million women living with HIV become pregnant annually and, unless treated with anti-retrovirals, have a 15-45 percent chance of transmitting the virus during pregnancy, labor or through breastfeeding. If both mother and child receive antiretroviral treatment during these crucial stages then the risk of transmission is lowered to about 1 percent, according to WHO.

The Caribbean nation has also eliminated mother-to-child transmission of syphilis. Some 1 million pregnant women are infected with the disease annually and it results in early miscarriage and stillbirth, newborn death, low-birth-weight and other serious infection in newborns.

The WHO guidelines for validating elimination of mother-to-child transmission of HIV and syphilis notes that as treatment is not 100 percent effective, elimination is defined as a reduction to such a low-level that it no longer constitutes a public health concern. Among the indicators are new HIV infections among infants are less than 50 cases per 100,000 live births or less than 5 percent for women living with HIV who are breastfeeding. These targets must be met for two consecutive years.

In 2013, only two babies in Cuba were born with HIV and only five with syphilis.

- Denis Fitzgerald 
On Twitter @denisfitz

Syria Overtakes Afghanistan as Top Source Country for Refugees

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June 18, 2015 - Before the conflict in Syria started, the country was among the top five refugee hosting states. It is now the number one source country for refugees, having overtaken Afghanistan which had been the number one source country since 1981.

There are now a record 59.5 million people forcibly displaced worldwide, mostly as a result of war and persecution, according to figures released Thursday by the UN Refugee Agency in its annual Global Trends report. In addition to the 3.9 million Syrian refugees in 107 countries, there are another 7.6 million internally displaced Syrians. The vast majority of Syrian refugees are hosted in neighboring countries Jordan, Turkey, Lebanon and Iraq.

The number of Afghan refugees stands at 2.6 million, making them the second largest refugee group. The majority of Afghan refugees are hosted in Pakistan and Iran.

The next highest group of refugees are Somalis with 1.1 million, mostly residing in Kenya and Ethiopia.

Sudan and South Sudan are the third and fourth largest countries of origin for refugees with the latter experiencing a massive outflow of people fleeing war and hunger in the past twelve months – some 616,200 South Sudanese are now refugees compared with 114,400 last year. Ethiopia and Kenya were the top destination countries for South Sudanese.

Armed conflicts in the Central African Republic and Ukraine saw the number of refugees from these countries grow with Cameroon hosting the majority of CAR’s 412,000 refugees while more than 270,000 Ukrainians applied for asylum or refugee status in Russia. There are also more than 800,000 displaced inside Ukraine.

Developing countries continue to bear the primary burden of hosting refugees while the Americas hosts the lowest number and Europe – excluding Russian and Turkey, which is now the world’s biggest host country – the next lowest.

UNHCR said in its report that at least 3,500 people died crossing the Mediterranean last year seeking shelter in Europe.

More than half of the world’s refugees are children, the agency said.

The full report is here.

- Denis Fitzgerald
On Twitter @denisfitz

Image: Wikimedia

Impunity Fueling Sexual Abuse and Exploitation by UN Peacekeepers

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June 11, 2015 – When UN peacekeepers commit acts of sexual abuse and exploitation, they do so knowing that their crimes have every chance of never being punished.

Under the current system, when a country contributes troops to a peacekeeping mission, it enters into an understanding with the United Nations that it will pursue cases of misconduct by its troops and report back to the UN, but in reality the UN has no way to enforce this and, at present, no way to sanction troop contributing countries (TCCs) who fail to act on cases of misconduct.

As it stands, the UN merely has administrative jurisdiction over its military contingents. Under the Status of Forces Agreement, which the UN negotiates with the the host state, each TCC retains exclusive jurisdiction to prosecute and otherwise discipline its military personnel. This immunity cannot be waived by the Secretary-General since jurisdiction is exclusive to the TCC (the immunity can be waived in the case of UN employees).

Most militaries have a poor record of holding their personnel accountable for violations. In the majority of cases, perpetrators are sent home – sometimes to a state where there is no legislation for sexual crimes or where such crimes are not taken seriously – and no further action is taken.

Similarly, when women give birth to babies fathered by UN peacekeepers, the United Nations policy is to assist the mother in making a claim for financial support but that claim is then forwarded to the troop contributing country for consideration. NGOs have called for the UN to establish a Trust Fund for victims and children who are born to peacekeepers, but no action has been taken on this.

While it’s unlikely that troop contributing countries will cede jurisdiction for their troops, the UN could enforce sanctions on troop contributing countries who fail to act on cases of misconduct such as barring them from future UN missions and garnishing pay of peacekeepers who father children while on duty. What is lacking right now is the will to push through such measures but if the UN is to live up to its promise, the Secretariat, member states and troop contributing countries must all do a lot more to eliminate sexual abuse and exploitation from UN peacekeeping.

- Denis Fitzgerald
On Twitter @denisfitz

South Sudan’s Expulsion of UN Official Brings Controversial Integrated Approach Into Focus

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June 2, 2015 – Since the early 2000s, the United Nations has favored an integrated approach for some of its most difficult missions with the ostensibly neutral Humanitarian Coordinator also double hatted as the explicitly political Resident Coordinator, and triple hatted as the deputy special representative of the secretary-general.

The reasons behind an integrated approach were well-intentioned: to streamline UN efforts and ensure that the objectives of all UN forces and agencies are channeled towards an over-arching common goal (Weir:2006). But aid agencies have raised concerns on the basis of neutrality and impartiality, saying that the line between the UN’s military objectives and its humanitarian objectives is increasingly blurred by an integrated approach, and that it leads to the shrinking of humanitarian space (see Stimson Center report here). In Somalia and Afghanistan, NGO’s have withdrawn from, or refused to enter into, UN coordination mechanisms because of the support of these missions for the Afghan and Somali governments respectively.

UNMISS in South Sudan is one of the more recent integrated UN missions. On Monday, the government in Juba expelled Toby Lanzer, reportedly for comments he made criticizing the government’s failure. Lanzer is an experienced United Nations official who was chief-of-staff of one of the first UN integrated missions, in Timor-Leste in 2006. In South Sudan, he wears four hats: deputy special-representative of the secretary-general; UN resident coordinator; humanitarian coordinator; and resident representative of UNDP.

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Diagram from UN OCHA showing civil-military coordination in South Sudan: source UN OCHA

His is, or rather was, an impossible task – Lanzer was due to be replaced at the end of the month. The original UNMISS mandate in 2011 called for UNMISS to protect civilians and support the South Sudan government in consolidating peace and building state institutions, but the language on supporting the government has been stripped from subsequent resolutions – the most recent mandate renewal was passed by the Security Council last week.

UNMISS has essentially shifted into neutral mode following reports of mass graves, extra-judicial killings, sexual violence, attacks on peacekeepers and massive displacement of civilian populations – tens of thousands of whom are sheltering in UN bases – and the world’s newest country is currently at risk of famine.

But peacekeeping missions are hardly neutral and require the support of the host government to achieve peacebuilding and institution building mandates and need freedom of movement to fulfill a protection of civilians mandate.

UNMISS is a $1 billion mission, financed by mandatory assessments on UN member states, while the UN’s humanitarian appeal for South Sudan is for $658 million, though only $70 million has been received as it relies on voluntary contributions.

There are no easy answers to the South Sudan crisis but it puts the utility of integrated missions once again under the microscope and the wisdom of having one person responsible for coordinating humanitarian activities while also responsible for political activities and institution building and will likely lead to further calls for the UN to re-examine the integrated approach.

- Denis Fitzgerald
On Twitter @denisfitz