• Heavy rain has affected western, eastern and northern regions causing floods and landslides. 36 people died, 22 in Bundibugyo District. Up to 6,000 people are displaced in Bududa District alone.

• The refugees’ transit centre in Bundibugyo District will host up to 700 internally displaced Ugandan nationals.

• Facilities are already overstretched and a new refugee influx from the DRC, linked to recent clashes in Ituri, may further exacerbate the situation.

• The local community are searching for missing people in Bundibugyo. The National Emergency Coordination Operations Centre and the Uganda Red Cross are providing immediate assistance. The Ugandan National Roads Authority is repairing damaged roads.

Zongo, le 10 décembre 2019 (caritasdev.cd) : Selon l’évaluation multisectorielle réalisée du 22 au 23 novembre 2019 dans la Ville de Zongo, « au total, à ce jour, 6.855 ménages des 7 Aires de Santé sur les 11 que compte la Zone de Santé de Zongo sont affectés » par les inondations. Les victimes, enregistrées dans les deux Communes de Nzulu et Wango, représentent 27.418 personnes, sur une population estimée 138.000 habitants. Sept de huit quartiers de Zongo ont été touchés. Les dégâts présentés par ce rapport sont énormes : « Des maisons écroulées ; des champs inondés ; des infrastructures scolaires, sanitaires et WASH endommagées ; des économies affaiblies ; les victimes des inondations, sans assistance, vivent dans des conditions très précaires. La plupart sont dans des familles d’accueil dans des conditions qui laissent à désirer ; d’autres utilisent les édifices publics comme les écoles et d’autres encore continuent à vivre dans leurs habitats habituels sur des pirogues ».

Bien que les victimes attendent encore une aide adéquate à la hauteur du sinistre subi, le Maire Adjoint de Zongo remercie le Président de la République, Félix-Antoine Tshisekedi, pour sa visite de réconfort et l’assistance en vivres qu’il leur a envoyée par l’entremise du Ministre des Affaires Humanitaires. Mr Placide Kumugo Soko l’a dit ce mardi à caritasdev.cd à Kinshasa où il effectue une mission de service.

« Il y a déjà eu décrue, mais aussi la présence des flaques d’eau dans des nids de poules. Ca nécessite que les milieux soient désinfectés. Sinon, il y a risques des maladies, surtout que les installations hygiéniques étaient sous eaux, tout comme les puits d’eau », note-t-il.

Par mesure de sécurité, la Mairie de Zongo avait demandé à la population de ne pas encore consommer l’eau ainsi pollué de ces puits.

Parlant de la réponse humanitaire à ces jours, le Mairie adjoint a indiqué que la Mairie a mis sur pied quatre Sous-Commissions devant permettre aux partenaires de canaliser leur assistance. Dans cette optique, il a cité l’association Lisanga Bana Grand Equateur (LIBANGE) qui a distribué par deux fois des vivres, des vêtements et du savon à quelques sinistrés, en passant par des chefs de blocs/quartiers. Par ailleurs, l’UNICEF a commencé une action dans la purification de l’eau, tout en promettant de construire des latrines et d’assister quelques écoles. Le gros de l’assistance actuelle est venu du Président de la République. L’enveloppe remise au Ministre central des Affaires Humanitaires, Mr Steve Mbikayi, a permis à ce dernier d’apporter une aide en vivres aux sinistrés.

Le rapport de l’évaluation multisectorielle indique que 2.797 maisons sont été affectées par ces inondations, dont 1.277 écroulées. Parmi ces bâtiments écroulés, on compte 10 maison construites en dur, 1.052 en semi-dures et 215 maisons en pisées. Par ailleurs, 17 écoles ont été affectées (dont 14 détruites).

Parlant des besoins des victimes, le Maire adjoint a cité notamment les vivres, abris, outils aratoires et semences, vêtements, moustiquaires. Du coté des victimes elles-mêmes, c’est presque le même cri du cœur. Caritasdev.cd a parlé avec les sinistrés du Quartier Yasuba.

Mardi le 26 novembre dernier, la délégation de Caritas Congo Asbl avait trouvé des habitants en train de payer 100 FC (Francs Congolais) pour traverser une centaine de mètres de l’avenue Yasuba inondée. Les victimes interrogées affirmaient n’avoir pas encore reçu d’aide humanitaire. « Mais, hier, il y avait distribution d’un peu de vivres (riz, huile végétale) et quelques biens dont des vêtements de friperie. Mais, les besoins au sein de la population sont tels que cette distribution s’est terminée dans de fortes bousculades », a dit en cœur un groupe sortant de la pirogue inter-avenue. Ce qui a poussé Mr Kongo Tukiya à plaider pour la réhabilitation de cette route dans le quartier Yasuba, impraticable avant même les inondations, disait-il. Cette rue mène vers le port et l’agence locale de la Régie de Distribution des Eaux (REGIDESO).

Les maisons bordant cette avenue étaient encore abandonnées au moment de la visite de la Caritas Congo Asbl le 26 novembre 2019. Cet élève de la 5ème année Scientifique à l’Institut Saint Laurent de Zongo le confirme : « Ma famille ne sait pas encore rentrée dans notre maison clôturée que vous voyez là sur cette avenue Yasuba. Elle compte cinq chambres. Nous continuons à être hébergés par notre oncle. Ils étaient au nombre de dix ; nous sommes venus sept ». Pour atteindre son école secondaire, Wilfred Shogeta devait passer par la grande avenue inondée de Yasuba. Ce qui l’obligeait de prendre la pirogue à l’aller comme au retour.

La famille de Mme Sophie compte douze personnes. Elle a été inondée sur l’avenue Yasuba. « Nous sommes toujours dans le quartier ; mais, accueillis par des voisins. Les eaux se sont certes retirées ; mais, la maison est très endommagée. Nous ne savons que faire pour reconstruire notre maison», disait cette quinquagénaire, troisième semaine après le début des inondations.

« Nous sommes au quartier Yasuba. Nous sommes victimes d’une inondation survenue de manière brusque. Ca a commencé la nuit du 03 octobre 2019. Cette inondation a plus d’ampleur que celle qui s’était produit en 1999, surtout en matière d’habitats. Des centaines de maisons sont détruites, surtout celles construites en briques à dobe », a fait remarquer l’Ingénieur Ngilima, Sous-Proveb de l’Enseignement technique. Ce dernier a relevé la destruction des champs, des jardins maraichers, des étangs piscicoles : « des poissons sont partis, des chèvres n’ont pas pu résister au flot d’eau », a-t-il souligné. Pour lui, il leur faut des vivres, des intrants agricoles et des abris. Mr Deza Nicolas, couturier de son état, a ajouté la nécessité de désinfecter les milieux inondés. « Car, nous pourrions certes manger ; mais, sans désinfecter le milieu, des gens peuvent attraper des maladies et mourir », a-t-il insisté. Le paludisme est redouté, tout comme la fièvre typhoïde.

Dans ce contexte, Mr Théo Elumba a signalé que sa voisine a retrouvé la veille un gros serpent dans sa valise, entrouverte, pendant qu’un boa, déconnecté de la rivière, était signalé dans le quartier. Mme Masumbu Tinda a déploré les moustiques le soir et la perte de leur fruit de l’élevage qui leur permettait de vendre pour faire face à leurs besoins fondamentaux.

Maire adjoint de Zongo : « la plaie est encore béante »

« La population de Zongo, comme celle de tout le Sud-Ubangi, vit de l’agriculture. Mais, Zongo est à côté d’une capitale, celle de la République Centrafricaine (RCA). Sa population vit aussi des activités génératrices des revenus. Les inondations l’a plongée dans une misère terrible. Surtout à cause des champs inondés. Il y a nécessité d’appuyer les victimes en Cash, en outils aratoires, et même en vivres pour compenser la récolte de la saison A. Cela, afin d’éviter la famine. Il est également nécessaire d’assister la population en abris, car il y a plus de 2.000 maisons écroulées, et de désinfecter le milieu ». Ces propos sont ceux du Maire Adjoint de Zongo, Mr Placide Kumugo Soko, interviewé ce mardi à Kinshasa par caritasdev.cd. « La palie laissée par les inondations à Zongo est encore béante », a-t-il déclaré.

Il y a deux semaines, le Maire adjoint décrivait à la Caritas Congo Asbl le tableau sombre de Zongo sinistré, l’une des villes de la province du Sud-Ubangi. « Les dégâts causés par les inondations sont énormes. Ça dépasse les niveaux de la mairie de Zongo, de la Province du Sud-Ubangi, voire de la nation. Raison pour laquelle je sollicite une aide humanitaire adéquate de la part de la Communauté tant nationale qu’internationale », a plaidé Mr Placide Kumugo Soko. Il répondait aux questions de caritasdev.cd, lors de la visite de solidarité qu’avait effectuée le Secrétaire Exécutif de la Caritas Congo Asbl dans cette ville, du 25 au 26 novembre 2019.

La dernière inondation du genre observée en 1999

Bien qu’il s’observait une décrue d’environ 13 centimètres en fin novembre dernier, les conséquences de ces inondations, commencées depuis la semaine du 24 septembre 2019, resteront un peu longtemps. Elles nécessitent une surveillance permanente pour éviter le pire.

A en croire des experts, ces inondations semblent être cycliques, tous les 20 ans. Et la dernière inondation de cette ampleur serait survenue en 1999, mais avec un peu moins d’impact que la présente. Il s’agit de la crue de la rivière Ubangi, sortie de son lit, et qui a envahi les localités riveraines. Les localités victimes sont pour la plupart déjà vulnérables et avec une population en grande majorité pauvre.

Guy-Marin Kamandji

SITUATION UPDATE

As of 16 October, there were 3,233 cases (3,117 confirmed, 116 probable), 2,157 deaths, 1,038 survivors and about 3 patients confirmed with Ebola under care. During the reporting period, the risk of EVD spreading to Burundi continued to be high due to the spread of the disease to the province of South Kivu on 16 August 2019, however no cases have been confirmed in Burundi. Four alerts were reported and verified during the months of September and October, raising the total number of alerts since September 2018 to 37. In September, important progress continued to be made towards the targets defined by the EVD Preparedness Operational Plan.

Currently 21 border entry points are screening travellers regularly, with over 2,475,396 primary screenings so far conducted since August 2018. For the month of September, 285,526 persons were screened at 21 PoEs. Some 3,960 frontline health care workers and othes have been vaccinated since the start of the campaign on 13 August. Since the beginning of the year some 1.35 million people have been reached with EVD related messaging through community engagement and interpersonal communication approaches in the priority health districts. While additional funding contributions are under consideration, preparedness efforts remain underfunded with U$9.5 million still to be secured against planned requirements.

By Hamimu Masudi, Media Officer at Minority Rights Group Africa

When Faith Loyce Nangiro graduated with a Bachelor’s of Medicine and Surgery in October this year, her story made headlines in national media. Unlike her fellow graduates, Nangiro had walked a tightrope to achieve such a milestone. She had overcome forced marriage, a traditional practice rampant among her Karimojong ethnic community of North Eastern Uganda.

One of the headlines, read ‘Karimojong girl who refused early marriage graduates in Medicine.’ This is a powerful and rare story emerging from a minority community whose indigenous pastoralist identity mean they face entrenched legal and social discrimination.

There are many girls and young women who find themselves in a situation similar to Nangiro’s, but because they aren’t lucky enough to navigate a web of traditional sanctions that come with standing up against a social norm, they are forced into early marriages. It’s in these marriages that they are expected to spend the rest of their lives – a life of subjugation and at risk of insidious forms of sexual, emotional and psychological violence.

While women and girls universally experience some form of gender-based violence (GBV), it’s a double tragedy for indigenous and minority women and girls. In several countries, there is a lack of legal recognition of their identity as a distinct community with distinct lifestyle, culture and a way of life, leaving them invisible in national statistics and social services.

Too often, due to inaccessible water supply – a common issue for indigenous and pastoralist peoples – women and girls will walk long distances in search of water, exposing them to sexual assault. Then, because of their marginalization, reporting and litigation is never a realistic possibility, let alone the #MeToo campaigns that have emerged in recent times as voices of survivors of sexual violence!

In other situations, because these communities are normally by-passed by universal health services and civil registrations, their children are more likely not to be registered at birth and thus miss out on certification. For instance, Kenya, with its much more robust civil registration program, the Kenya Demographic and Health Survey 2014, p. 23 shows that only 61.8 per cent of children (under age of 5) are registered with a civil authority in the largely pastoralist North Eastern region, compared to 79.5 percent in Nairobi. As reports show, this lack of proof of identity makes young girls vulnerable to trafficking, sexual exploitation and similar abuses.

In particular, women and children from Uganda’s pastoralist Karamoja region have in most times been singled out as being defenseless to commercial sexual exploitation. Early this year, the Kenyan police intercepted 11 primary school girls from Karamoja region who were being trafficked into Nairobi. Similarly, an official of Kenya’s Anti-Child Sexual Exploitation and Abuse Unit, David Gitau revealed to an undercover newspaper reporter that; trafficked girls as young as 10 years old from Karamoja region are being enrolled into brothels in the hospitality industry in Kenya while others are ending up in the hands of Somalia’s Islamist group, Al-Shabaab.

Elsewhere, in the Congo basin, the Bambuti of the Ituri forest, and the Batwa of Lake Tumba region and along the Uganda and Rwanda borders, _have experienced unthinkable violations. They have been systematically targeted by rape campaigns of various militias, such as Allied Democratic Forces (ADF) and Movement for the Liberation of Congo (MLC), who superstitiously believe that engaging in sexual intercourse with an indigenous woman belonging to one of these forest communities confers special powers to the rapist. _In its 2013 review of DR Congo, the UN Committee on the Elimination of Discrimination against Women, raised particular concerns about the situation of indigenous women, especially Batwa, around gender-based violence.

In Namibia, among the San, the International Journal of Human Rights published an article, which revealed that the San indigenous women are believed to be ‘generally sexually available and, when assaulted, do not “feel” raped.’ The article concluded that such myths not only perpetuate rape but also justify its occurrence and negate possibilities for seeking justice.

As this year’s theme for the ‘16 days of activism against GBV’ states ‘Orange the World: Generation Equality Stands against Rape,’ – it’s critical that State parties to UN agreements and the wider development sector, working in solidarity with the social movements championing the fight against GBV, approach interventions from the realities of indigenous and minority communities. Because as a distinct group living at the margins of mainstream society, they are often hit hardest!

Ethnic minority and indigenous women and girls face increased risk of rape crimes due to a ‘confluence of factors’ that interplay with gender inequality and patriarchal values to take away control over their bodies. As a result, women and girls from these backgrounds are exposed to all forms of violence including rape, child marriage, son preference, breast ironing, and Female Genital Mutilation.

As recommended in the report by the Office of the Special Representative of the Secretary-General on Violence against Children, working in concert with UNICEF, UNFPA, UN Women and ILO, the complex interplay and accumulation of risk factors at all levels of society(proximal communal relationship and history/demographic characteristics at individual level) must be addressed if minority and indigenous girls and women are to be free from all forms of violence, including rape.

Arrivals

This week, 1,471 people arrived on the Aegean islands, an increase from last week’s 957 arrivals and from last year’s 757 arrivals during the same period.
The average daily arrivals this week equalled 210, compared to 137 in the previous week.

Population on the Islands

Some 39,600 refugees and migrants reside on the Aegean islands. The majority of the population on the Aegean islands are from Afghanistan (44%), Syria (21%) and the Democratic Republic of Congo (6%).
Women account for 21% of the population and children for 35%, of whom more than 6 out of 10 are younger than 12 years old.
Approximately 15% of the children are unaccompanied or separated, mainly from Afghanistan.
Some 39% are men between 18 and 39 years old.
Demographics

Entry Points by Sea

This week 1,471 people reached the Aegean islands, the majority of whom arrived to Lesvos. The average daily arrivals on all islands was 210.

As of 30 September 2019, 881,279 Congolese refugees are being hosted in African countries. From 1 January to 30 September 2019 alone, some 77,782 Congolese fled to neighboring countries, with a particularly significant increase in refugee flows to Uganda.

UNHCR together with 57 humanitarian and development partners launched the revised 2019-2020 Regional Refugee Response Plan (RRRP) on 30 June 2019 to help respond to the needs of Congolese refugees in Africa.

Regional Highlights and Operational Context

• Since 18 August, thousands of Congolese refugees spontaneously left Lóvua refugee settlement in Angola to make their way back home in the DRC. 14,615 refugees have returned spontaneously to the DRC. Several facilities have been constructed at Lovua settlement and at Tchikolondo transit center to facilitate the voluntary repatriation of Congolese refugees.

• 1,048 shelters roofed in camps in Rwanda were with corrugated iron sheets to offer better living conditions and more protection from external elements.

• In Uganda, a total of 2,191 cases were received through the inter-agency Feedback,
Referral and Resolution Mechanism (FRRM) which allow refugees to report urgent protection and assistance-related problems.

Cases were followed-up on or referred to appropriate service providers.

Operational context and protection situation

Ituri Province

The security situation and protection environment in Ituri further deteriorated during the reporting week, due to intensified armed group activity and armed clashes in Djugu, Irumu and Mambasa territories. Five people (four aid workers and one civilian) were killed in a targeted armed attack on an Ebola treatment center in Biakato (Mambasa Territory) on 28 November, perpetrated by elements of a prominent armed group. Seven people were also kidnaped and four were severely injured in the same attack. Growing insecurity in this area risks restricting humanitarian access to displaced people. In Irumu Territory, unidentified gunmen raided the Jupayaka and Jupunvor localities. Due to fear of further attacks, about a hundred civilians reportedly hid in the woods and returned to their place of origin during night time. In Djugu Territory, an estimated 86 households (430 individuals) were displaced after two armed incursions by unidentified gunmen in Lenge locality, in which a civilian was decapitated and goods were looted. The households sought refuge in neighboring localities. The presence of unidentified armed men on the shores of Lake Albert in Djugu Territory continues to disrupt commercial, agricultural and school activities in the area. Civilians continue to endure human rights violations such as killings, lootings, abductions (including of local leaders), injuries, extortions and rape, committed by presumed elements of state armed forces, armed groups, and by unidentified armed men.

BACKGROUND: Since 6 June, generalized violence led to massive new displacements in Ituri Province. UNHCR and IOM recorded over 110,000 new arrivals in IDP sites in Djugu, Mahagi and Irumu territories between 31 May and 20 June. OCHA estimated that 360,000 people were displaced by the recent crisis; some 145,000 towards IDP sites and the rest to host communities. As displacements continued, Ituri’s Site Management and Coordination Working Group (CCCM) now estimates that almost 227,000 people are staying in 72 IDP sites, 12 of them coordinated by UNHCR and housing over 82,000 individuals (17,000 households). Outside of Bunia, the largest concentrations of IDPs are found in Drodro, Rho, Fataki, Kasenyi, Tchomia and Ramogi, in Djugu, Irumu and Mahagi territories. Overall, some 1.1 million people are displaced throughout the Province according to OCHA. UNHCR’s Protection Monitoring system documented 6,970 human rights violations between January and November 2019 in Ituri.

North Kivu Province

The security situation in Beni Territory remained alarming during the reporting period, with no improvement since the previous week. In retaliation to a major military offensive ongoing against them, presumed elements of the ADF armed group continued to target civilians, with 107 people killed in targeted attacks between 22 and 28 November. At least 35 people were also kidnapped. Attacks have since continued, with heavy casualties. Protests against MONUSCO and UN Agencies, all assimilated to the peacekeeping response, also continued in Beni. Following the torching of a MONUSCO base and of the Beni town hall on 25 November, city-wide shutdowns gained momentum, extending to North Kivu’s provincial capital Goma. The situation remains extremely tense with mob violence, lynching of armed forces and police and youth arrests. Since all but critical UN staff was evacuated, and UNHCR’s activities in Beni, Oicha and Butembo have been suspended, UNHCR and its partners are so far unable to access IDPs and assess their numbers or needs. Large displacements are believed to be taking place from rural areas (where targeted attacks are occurring), to the relative safety of cities such as Beni, Butembo and Kasindi. Meanwhile, conflict is ongoing in the rest of North Kivu. 935 households fled their villages this week in Rutshuru and Walikale territories, following armed clashes.

BACKGROUND: Over 1.5 million IDPs are located in North Kivu Province as of October 2019. The vast majority (94%) live with host communities, while some 89,000 reside in 22 IDP sites coordinated by UNHCR or IOM. Displacements are mostly cyclical, with numerous causes including armed conflict, human rights violations committed by armed groups and state armed forces, land conflicts, inter-ethnic violence, illegal exploitation of mineral resources, and others. Between March and early June 2019, attacks against civilians and military outposts by a prominent armed group led to significant displacements from Kamango to Nobili (Beni Territory). Until recently, OCHA estimated that 112,000 IDPs were in the Nobili area. However, as of late October, most of them have returned. In Masisi and Rutshuru territories, OCHA estimates that over 67,000 people were displaced towards host communities in May and June alone, while arrivals into several IDP sites have been significant. UNHCR’s Protection Monitoring system documented 12,311 human rights violations between January and end of November 2019 throughout the Province.

New York, 9 December 2019

As delivered

Secretary-General António Guterres, Excellencies and Ministers, distinguished guests,

Welcome to the 2019 High-level Pledging Event for the United Nations Central Emergency Response Fund, or CERF.

Thank you all for coming.

This is the third CERF funding event since the United Nations General Assembly endorsed a CERF funding target of US $1 billion.

I would like to thank the 127 Member States and partners for their vote of confidence in CERF. Fourteen years since its inception, CERF is our shared success.

And who better to tell us that than the people whose lives the Fund has touched.

Earlier this year, I was in Malawi and Zimbabwe, where I met women and men who told me about the help they had received from CERF-funded programmes.

I heard from women in Malawi on how CERF-funded cash assistance saved their lives between harvests.

Belifa and Dolise, who had been unable to put food on the table for their children but can now send them to school to learn with full stomachs. The cash not only respected the women’s ability to make their own choices about how to use the money, but also boosted the local economy.

A $10 million CERF allocation to UN agencies in Zimbabwe is now helping millions, including those living with HIV who had been unable to take critical drugs, to be able to eat more than once a day.

We know that we will face significant challenges in 2020. I fear the outlook for the year ahead is bleak.

Last week, we launched the Global Humanitarian Overview. It sets out the global needs and humanitarian response plans for UN agencies and their partners.

Next year, the UN and partner organizations aim to assist nearly 109 million people - the most vulnerable people on the planet. One person in 45 around the world are expected to need our help – the highest number ever. That will require funding of nearly $29 billion.

This year, we saw an unprecedented demand for money from CERF.

CERF enabled the humanitarian community to respond to time-critical, life-threatening needs of millions of crisis-affected people across 46 countries with about $520 million. With that amount CERF has surpassed last year’s record of $500 million allocated.

These funds kickstarted life-saving assistance to people affected by conflict. The allocations helped sustain underfunded responses in countries like Cameroon. CERF supported aid workers to get ahead of weather-related emergencies like droughts, and also earthquakes, cyclones and floods in countries and regions such as Mozambique, Iran and the Horn of Africa.

The Fund helped us respond early to disease epidemics in Yemen and Sudan; and to avoid a further spread of the deadly Ebola virus in countries neighbouring the Democratic Republic of the Congo.

As we plan for next year, we aim to continue to focus our efforts in two ways that will enable CERF to transform even more lives.

First, we want to make CERF even more responsive. We can do this by getting ahead of crises and taking an anticipatory approach when data and evidence tell us that a high-impact shock is imminent.

Early funding reduces response times and costs and supports better-quality programme design. That in turn, reduces suffering. This year, we started piloting anticipatory action in Somalia in collaboration with partners, using CERF funding to mitigate the impact of severe drought on the people of that country.

Second, we want to reach more people in need. That can only happen if we make sure all our programmes are designed to reach the neediest people. Therefore, earlier this year I asked Humanitarian Coordinators and Resident Coordinators to look at gender-based violence, reproductive health and empowerment, people with disabilities, education for children in long-drawn crises and other protection concerns as they design a response. We know that the most vulnerable people in crises are typically people with disabilities, and typically women and girls. We need to do a better job to help them because not every part of humanitarian response focuses enough on these groups of people.

I also wanted to let you know that our next round of underfunded emergencies will, thanks to your generosity last year and the beginning of this, total $125 million. That is the same as the record amount for the underfunded round that we had at the beginning of this year. I hope - and we are finalizing this at the moment – that we will be able to reach even more people in need through those allocations. In particular, we hope to be able to reach those in need caught up in the Syria crisis, in the Democratic Republic of the Congo, in Central America, and in the Democratic People’s Republic of Korea.

At last year’s High-level Pledging event, Member States announced $439 million for CERF in 2019 – the highest amount ever pledged. In 2018, we also reached the highest funding level for CERF – that’s around $555 million. I am hopeful that we will exceed both these achievements this year, moving us closer to Member States’ commitment of a $1 billion CERF.

Most importantly, it will bring us closer towards our commitment to end the suffering of people affected by humanitarian crises.

Thank you very much indeed.

Last week, Western Africa continued to experience the highest rates of political violence recorded in the continent, as endemic instability across the Sahel and in Nigeria is pushing up conflict within and across states. Suspected Boko Haram militants have also contributed to increasing fatalities in neighboring Niger and Cameroon and in Chad, while the recent increase in violent activity in eastern Democratic Republic of Congo (DRC) constitutes one of the most significant escalations in years.

The epicenter of conflict activity in DRC continues to be the North Kivu province, where the Congolese army and the UN peacekeeping mission (MONUSCO) have failed to prevent the spiralling of violence in the region. Last week, attacks attributed to the Allied Democratic Forces (ADF) near Beni killed at least twenty-nine civilians, sparking a wave of strikes and demonstrations across the region and the whole country demanding MONUSCO to leave. Amid these increasing tensions between local communities and international actors, Mayi-Mayi militiamen raided an Ebola response center and an MSF clinic in Biakato destroying their facilities. ACLED has recorded more than thirty attacks targeting aid workers since the beginning of the year, 80% of which in the eastern provinces of Ituri and North Kivu only. Army operations have instead focused in South Kivu, where MONUSCO-supported troops have targeted ADF positions in an effort to curb militia activity. Separately, General Jean Pierre Gaseni – an officer in the Rwandan rebel group National Liberation Front – was killed in the Democratic Republic of Congo, reportedly as a result of an army operation. This is the third killing of a Rwandan rebel commander since September.

Further north, increasing Boko Haram activity claimed a heavy fatality toll in the Lake Chad region. In Chad, militants attacked a checkpoint manned by the Chadian army near Ngouboua in the Lac region, sparking clashes that killed thirteen Islamists and four soldiers. Clashes between state forces and Boko Haram are rare in Chad, which has not experienced the same levels of violence of its neighbors. Islamist militants also raided villages in south-eastern Niger and northern Cameroon, killing and abducting dozens of civilians during the past week. Boko Haram has long been active in Niger’s Diffa and Maradi and in Cameroon’s Extreme North regions, where they often retreated as the army troops advanced in Nigerian territory. In Nigeria, armed forces fended off two attacks conducted by Boko Haram in Borno state, killing three in Mafa and two aspirant suicide bombers in Gwoza. Militants affiliated with the Islamic State abducted six soldiers and two aid workers on a highway leading to Maiduguri, while also destroying government buildings in Kukawa and Gudumbali, south of the state capital. Elsewhere in the country, the attempted arrest of an Indigenous People of Biafra (IPOB) lawyer sparked clashes between security forces and IPOB youth, causing the death of two officers and two IPOB supporters.

After weeks of increasing militant activity across the Sahel, the armies of Burkina Faso and Mali have claimed some successes over the past week. The Malian army has destroyed JNIM positions south of Bandiagara, a district in Mopti region that has experienced sporadic spikes in violence since June. Burkinabe troops instead repelled a raid conducted by Jama’at Nasr al-Islam wal Muslimin (JNIM) on a military detachment in Boucle du Mouhoun region and conducted air strikes in the north of country, killing dozens of militants and seizing weapons and equipment. Yet the situation remains more critical in the East region of Burkina Faso, where Islamist militants raided a church during Sunday mass targeting Protestant Christian worshippers, fourteen of which were killed. Weeks after communal violence pitting Koglweogo self-defense groups and Fulani pastoralists claimed the lives of dozens, suspected JNIM militants attacked the village of Nagare. These events further highlight how Islamist groups are able to capitalize on communal tensions across the Sahel to consolidate their presence and penetrate local communities.

In North Africa, Algeria awaits the upcoming December 12 elections with increasing tension as protests continue unabated to demand the liberation of all detained activists and the boycott of the ballots. Regime and army figures have instead supported pro-election demonstrations, claiming that such rallies attracted larger crowds than the opposition. Protests are likely to continue after December 12, as the candidates are seen as direct emanations of the regime. In Libya, fresh clashes between forces loyal to the Government of National Accord (GNA) and the Libyan National Army (LNA) killed at least fifteen of Haftar’s soldiers and two civilians caught in the crossfire in southern Tripoli. Additionally, indiscriminate shelling and air strikes continued throughout the week: on December 2, LNA warplanes bombed a residential area in Al-Jfara, south-west of the capital, killing five children and wounding ten others. Additionally, an Islamic State attack on an army checkpoint in Egypt’s North Sinai region prompting the military’s response, which launched air strikes to target Islamist positions near Rafah and Sheikh Zuweyid.

In Sudan, armed pastoralists and unknown gunmen engaged in several violent incidents throughout Darfur, marking a considerable increase compared to previous weeks. This is a worrying development, and partially confirms fears that the political re-ordering taking place in Khartoum is driving instability in Sudan’s peripheries. Meetings between Prime Minister Abdullah Hamdok and senior US officials in the USA do not, as of yet, appear to have led to a clear timetable towards the lifting of sanctions and the removal of Sudan from the state sponsors of terrorism list, despite rhetorical support given by US National Security Advisor Robert O’Brien. Finally, in South Sudan, clashes between sections of the Pakam Dinka clan in Lakes state have reached an estimated seventy-nine fatalities, prompting the deployment of UN peacekeepers from Rumbek. Reports of heavy fighting between the South Sudanese army and armed pastoralists in the disputed Tonj state also emerged during the week, with an alleged fourteen people killed. The clash was likely related to an on-going disarmament campaign in the area, which has sparked several violent events over the past year.

Dear Friends,

On my very first assignment with Doctors Without Borders/Médecins Sans Frontières (MSF), I found myself in a hospital in Aweil, in what is today the independent nation of South Sudan.

I will never forget the experience of caring for a mother with two-year-old twin girls who had been admitted with early signs of premature labor. My youngest daughter was about the same age as her twins, and I gladly eased my homesickness at this woman's bedside while doing morning rounds.

She stayed at our hospital for weeks, until one day her labor came fast and naturally. We were expecting another set of twins, but instead delivered not two but three healthy babies. They were born girl, girl, boy, and their mother gave them my names: Africa, Nicole, and Stewart. She did this partly because of our bond but also in the hopes that their “American” names might give them greater opportunities. I was honored and moved—I still am.

When I first returned from that assignment, I was reluctant to share the stories of our patients. I wasn’t sure if their stories were my stories to tell. But slowly, I started to open up. It isn’t enough to go to the other side of the world to help other mothers and their babies. I am bound to share what I saw and what these mothers experience as they try to survive and care for their families in some of the most difficult circumstances imaginable.

When I first told the story of the mother and her triplets, it was mostly to other obstetricians who reveled in the details in a way that only fellow colleagues would. Later, I told that story to a few journalists and writers who were keen to know more about “life in the field.”

But there is another side to that beautiful story. When I returned to Aweil a year later, I met that mother again in the hospital, this time in the pediatric unit. She was there with her older twin daughters and two of the three triplets. Of the two youngest girls, one had been admitted with acute malnutrition and the other was noticeably underweight. Their brother had died of malnutrition a few weeks before I arrived.

The surviving triplet girls did well, put on weight, and were discharged before I left to return home to the US. They were lucky to have access to care for malnutrition, and to get this care in the nick of time. In honor of baby Stewart, who did not survive, and in dedication to his four sisters, I have a duty to bear witness and tell the full story.

As we fight to provide access to health care for the people who need it most, an essential part of our job is this kind of témoignage—the French word for witnessing. We need to remind people that every single human being deserves to be treated with respect and dignity, and they deserve to be seen and heard.

As you read this special issue of Alert devoted to the importance of bearing witness, I hope you will take some time to look at the portraits of our patients and staff, learn about their stories, and consider the challenges people face as they are caught in crisis situations. We cover some big issues here—war, migration, natural disasters, and epidemics—but ultimately what matters is the individuals at the center of it all. The people I have met along the way during my time at MSF inspire me to keep going, to work harder, to speak out when they can’t.

On behalf of our patients and our teams around the world, thank you for supporting this extraordinary work. Thank you for caring about people whose lives might seem very different on the outside, but who are not so different on the inside.

Wishing you all a very happy and healthy new year.

Sincerely,

Africa Stewart, MD

President, MSF-USA Board of Directors

Messages clés

La situation Nutritionnelle reste préoccupante dans certains territoires du sud Kivu et Maniema selon les enquêtes territoriale Smart (ANJE) de L’UNICEF conduite en Mai 2019,d’où besoin de l’implication des tous les acteurs pour une réponse adaptée et efficace.

Dans les territoires de Kasongo et Kabambare, la situation nutritionnelle est précaire, au regards des résultats des données anthropométriques et de mortalité. La malnutrition chronique révèle une situation d’urgence(MC>40%)dans le territoire de kasongo.les prévalence de la malnutrition aigüe globale et sévère dans les deux territoires sont respectivement < aux seuils de 10% MAG et MAS =2%.

Dans les territoires de Walungu et Kabare au Sud Kivu, la situation nutritionnelle est urgente MAG>10%et MAS>2%. La malnutrition chronique révèle également une situation d’urgence MC>=30%.

Dr. Richard Kojan is a Congolese anesthesiologist and intensivist who has dedicated his career to caring for the most vulnerable populations. After 10 years with Médecins Sans Frontières, he joined The Alliance for International Medical Action (ALIMA) in 2010, where today he is president.

While working for ALIMA’s Ebola response in remote Guinea, Dr. Kojan recognized that their patient mortality rate was 55%, versus 18% for those treated in resourced hospitals. Intrigued by this difference, he set out to identify and address the cause. The result was the creation of a portable biosecure emergency care unit known as the CUBE.

Dr. Kojan’s team visited European hospitals that had cured Ebola patients. There, they observed isolation rooms that allowed physicians to continuously monitor patients and adjust treatment in a manner not possible in Guinea. The main constraint in Guinea was that staff were required to wear multiple layers of protective equipment—which takes 30-minutes to apply and remove, and can only be worn for 30-minutes due to risk of overheating—limiting their interaction with patients to 3x daily.

Dr. Kojan developed technical specifications for a portable, Biosafety Level 4 unit (the highest certification possible), allowing physicians to continuously observe and treat patients for any disease regardless of transmission method, and ensure affordable and rapid deployment of the unit in lowresource settings. Together with the French firm Securotec, they developed the CUBE, which ALIMA debuted at the onset of the Ebola outbreak in DRC. Today, they are treating 300+ patients in 26 CUBES with a current mortality rate of <35% versus 55% prior to the CUBE; a meaningful step towards reducing the spread of the disease and ultimately its elimination.

The CUBE is a significant improvement in rapid response to disease outbreaks. Each requires only three hours set-up, costs USD18,000, weighs 250kg packed into three bags, and is re-usable. And with a reduced need to wear non-reusable protective equipment—at USD50 per wear—the CUBE pays for itself. Comparatively, the dorm-style treatment center in Guinea cost USD1million and took six weeks to build on 2.47 acres of forest.

The CUBE changes the way medical staff interact with patients and creates an atmosphere of transparency within the community. Each CUBE has glove-like sleeves built into its clear plastic walls, allowing staff to reach in and interact with patients and equipment, enabling the use of tools previously unavailable such as oxygen concentrators.

The CUBE’s transparent walls allow family members to see loved ones while in treatment. The Guinea center separated patients from their family members, often creating an atmosphere of distrust and fear, making others reluctant to seek treatment, furthering the spread of the disease.

Dr. Kojan is overseeing the training of other humanitarian agencies interested in using the CUBE in their emergency responses to Ebola and other diseases, and is also testing for additional uses such as remote surgical theaters. The World Health Organization is reviewing the CUBE for inclusion in their formal guidelines as the preferred method for treating Ebola.

ALIMA is on the front lines of humanitarian relief and is often one of the first on the ground to respond to a crisis. Since 2009, ALIMA has been partnering with local agencies, hospitals, and other international aid organizations, sharing resources and local knowledge to gain a deeper understanding and context of where they are working so that they may provide the best quality care.

For further information:

Janet Kleinbaum, Director Marketing & Communications, The ELMA Philanthropies jkleinbaum@Elmaphilanthropies.org

Charlie Kunzer, Executive Director, ALIMA US charlie.kunzer@alima.ngo

Guillaume Le Duc, Development Director, ALIMA Intl. gld@alima.ngo

Key figures

278,275: Total number of refugees and asylum-seekers living in Tanzania

205,024: Burundian population of concern

72,771: Congolese population of concern

78,394: Burundian refugees returned voluntarily since September 2017

Operational Highlights

• International Day of the Girl Child celebrations kicked off in colourful fashion across the three camps on 11 October. This year’s theme was ‘GirlForce: Unscripted and Unstoppable’. UNHCR and partners held a series of events, including; traditional singing and dancing, football tournaments, and sack races, to commemorate the day.

• Some 2,294 refugees returned to Burundi this month, bringing the total number of Burundian returnees to 78,394 since September 2017. The number of refugees signing up for returns in October stood at 1,405 people. UNHCR remains firmly committed to supporting durable solutions for refugees in Tanzania, including the voluntary return to Burundi for those who want to go back. In addition to this, it continues to ensure that all returns take place in safety and dignity, and are based on a free and informed choice.

326,442: Total Burundian refugees residing in the main hosting countries (United Republic of Tanzania, Rwanda, the DRC, Uganda).

20,527: Burundian refugees assisted to voluntarily return so far in 2019, with some 2,293 assisted in October.

9,323: Total Burundian arrivals recorded in 2019. In October, 1,695 new arrivals were reported.

79,311: Total Burundian refugees assisted to return between September 2017 and 31 October 2019, mainly from Tanzania. For more information, please check the Voluntary Repatriation dashboard.

103,412: Number of IDPs in Burundi as of October 2019 according to IOM’s Data Tracking Matrix, for 77 per cent the factors of displacement are linked to natural disasters, for 23 per cent they are linked to the socio-political situation.

Highlights and Operational Context

• On 30 October, Michel Kafando, the United Nations Special Envoy to Burundi, informed the UN Security Council that he planned to step down from the post he has held for two years, amid concerns over the impartiality of elections set for 2020. Kafando pointed out that even though Burundi's security situation has improved, and that the government has put in place a "framework for political dialogue", there remains a lack of progress of the inter-Burundian dialogue guided by the East African Community, and warned about the ongoing deterioration of the socio-economic situation.

• On 28 October, UNHCR, repeated its call to ensure that refugee returns from Tanzania to Burundi remain voluntary, following a bilateral agreement between the two governments in late August to increase return rates. This also followed public statements made on 11 October during a rally in Katavi region in northwestern Tanzania, by President Magufuli urging Burundian refugees to return home. UNHCR continues to work with local officials to ensure refugee returns are voluntary and only taking place under the existing Tripartite Agreement between the Tanzanian and Burundian governments and the UN Refugee Agency. Some 79,000 refugees have made the choice to return to Burundi under this arrangement since 2017.

• In October, the International Refugee Rights Initiative released the report“Returning to Stability? Refugee returns in the Great Lakes region”. Among others, this report looked at the voluntary repatriation process for Burundians who fled to Tanzania after the 2015 crisis. It also highlights the social, economic and political dynamics of refugees’ experience both with local authorities and their communities once back in Burundi. While returnees generally encounter solidarity and mutual assistance, they are also facing mistrust and socio-political exclusion.

HIGHLIGHTS

• “Abandoning my home country and especially my family has left its mark on me”

• Cholera outbreak in Burundi: "Fortunately, my family is cured"

• WHO transfers six tonnes of medical material to Burundi

• UNICEF leads efforts on Water, Sanitation and Hygiene to combat cholera

• Burundi: Humanitarian Snapshot (October 2019)

BACKGROUND

"Abandoning my home country and especially my family has left its mark on me"

Since 2002, Burundi has generously hosted refugees from the Democratic Republic of Congo (DRC) and currently some 84,469 Congolese refugees reside in Burundi. Most of them have fled insecurity caused by clashes between non-state armed groups (known among the Congolese as the 'Mai Mai') in the North and South Kivu provinces. Of these, 36,528 are urban refugees, with the majority of them living in Bujumbura Mairie, particularly in the popular communes of Kamenge, Kinama and Buterere. The rest (57 per cent) are spread between five refugee camps in the north and eastern parts of the country.

In his thirties, married and a father of two children, Bernard* is one of them. In 2013, he fled from the DRC to Burundi to seek asylum.

Persecution and intimidation

In 2006, the Mai Mai began to force the Congolese youth to join their ranks to "fight rebels". However, Bernard and many other young people opposed this idea. In 2010, Bernard and a group of activists began raising community awareness to encourage young people to continue their studies instead of joining armed groups. As a result, they were pursued by members of the Mai Mai.

Escape

Six years later, Bernard recalls his ordeal: "abandoning my home country and especially my family has left its mark on me". He fled his home and evaded the soldiers by taking refuge with his older sister for three months. However, eventually, he was caught and imprisoned twice. Bernard finally made the decision to escape the country to Burundi where a family friend hosted him. "He saved me", he explains.

Life in Burundi

After two months, his rescuer advised him to register with the United Nations Refugee Agency (UNHCR) and apply for asylum. "Today, I work as a teacher without much difficulty. Of course, a refugee's life is never easy, but you gradually adapt."

Today, Congolese refugees and asylum seekers continue to reside in Burundi, with the support of the Government of Burundi, through its National Office for the Protection of Refugees and Stateless Persons and the UNHCR. Together with the help of various humanitarian actors, the necessary protection and assistance services are provided to refugees that are essential to safeguard their rights and well-being.

However, under-funding and rising living costs continue to have a significant impact on refugees' and asylum seekers' access to quality basic services and their level of vulnerability. In 2020, an estimated $23,4 million will be needed to assist the refugee population in Burundi.

** Names and identifying details have been changed to protect the privacy of individuals.*

1. Situation update

In the week of 2 to 8 December 2019, eleven new confirmed Ebola virus disease (EVD) cases were reported from four health zones in North Kivu and Ituri provinces in Democratic Republic of the Congo. The confirmed cases were reported from Beni (55%; n=6), Mabalako (27%; n=3), Mandima (9%; n=1), and Oicha (9%; n=1). Compared to the previous week (25 November to 1 December 2019), the proportion of confirmed cases coming from known contacts (70%(7/10) vs. 73%(8/11)) and the proportion of community deaths among confirmed cases (20% (2/10) vs. 9% (1/11)) remain relatively similar. The volume of alerts reported and contacts traced are slowly improving after a reduction due to insecurity in recent weeks, but they are not back to the levels observed before the security incidents.

In the past 21 days (18 November to 8 December 2019), 28 confirmed cases were reported from 14 of the 71 health areas within four neighbouring active health zones in North Kivu and Ituri provinces: Mabalako (43%, n=12), Mandima (25%, n=7), Beni (25%, n=7), and Oicha (7%, n=2). The majority of the cases (93%, n=26) are linked to known chains of transmission. More than half (54%; n=15) of the cases over the last 21 days have epidemiological links to a funeral in Lwemba Health Area.

As of 8 December 2019, a total of 3324 EVD cases were reported, including 3206 confirmed and 118 probable cases, of which 2209 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 56% (1873) were female, 28% (939) were children aged less than 18 years, and 5% (164) were healthcare workers.

As of 1 December 2019, a total of 3313 EVD cases, including 3195 confirmed and 118 probable cases have been reported, of which 2204 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1866) were female, 28% (936) were children aged less than 18 years, and 5% (163) were healthcare workers.