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	Why Rights Aren’t Wrong in Tough Times by Human Rights Watch - World Report   The world has not seen this much tumult for a generation. The once-heralded Arab Spring has given way almost everywhere to conflict and repression. Islamist extremists commit mass atrocities and threaten civilians throughout the Middle East and parts of Asia and Africa. Cold War-type tensions have revived over Ukraine, with even a civilian jetliner shot out of the sky. Sometimes it can seem as if the world is unraveling.   Many governments have responded to the turmoil by downplaying or abandoning human rights. Governments directly affected by the ferment are often eager for an excuse to suppress popular pressure for democratic change. Other influential governments are frequently more comfortable falling back on familiar relationships with autocrats than contending with the uncertainty of popular rule. Some of these governments continue to raise human rights concerns, but many appear to have concluded that today’s serious security threats must take precedence over human rights. In this difficult moment, they seem to argue, human rights must be put on the back burner, a luxury for less trying times.   That subordination of human rights is not only wrong, but also shortsighted and counterproductive. Human rights violations played a major role in spawning or aggravating most of today’s crises. Protecting human rights and enabling people to have a say in how their governments address the crises will be key to their resolution. Particularly in periods of challenges and difficult choices, human rights are an essential compass for political action.   The Rise of ISIS   No challenge in the past year has exploded more dramatically than the emergence of the self-proclaimed Islamic State, the extremist group also known as ISIS. One can only be appalled at ISIS’s mass execution of captured combatants and disfavored civilians. This Sunni armed group has singled out Yazidis, Turkmen, Kurds, Shia, and even other Sunnis who contest its extreme interpretation of Islamic law. Its militants have enslaved, forcibly married, and raped Yazidi women and girls, and beheaded journalists and aid workers in gruesome videotaped spectacles. Rarely has an armed force engendered such widespread revulsion and opposition.   Yet ISIS did not emerge in a vacuum. In part it is a product of the United States-led war and military occupation of Iraq that began in 2003, which produced, among other things, a security vacuum and the abuses of detainees in Abu Ghraib prison and other US-run detention centers. Funding of extremist groups by Gulf states and their citizens also played a role. More recently, the sectarian policies of the Iraqi and Syrian governments, and international indifference to those governments’ serious rights abuses, have been important factors. If the conditions that led to ISIS are left to fester, the group could deepen its hold on the two countries and expand into Lebanon, Jordan, Libya, and beyond..   World Report 2015 is Human Rights Watch’s 25th annual review of human rights practices around the globe. It summarizes key human rights issues in more than 90 countries and territories worldwide.   In his keynote, Human Rights Watch Executive Director Kenneth Roth reflects on a year so tumultuous, “it can seem as if the world is unraveling.” Surveying several of the year’s most daunting security challenges—including the rise of the extremist group Islamic State (also known as ISIS), China’s crackdown on Uighurs in Xinjiang, and Mexico’s abuse-riddled war on drugs—Roth stresses the important role that human rights violations played in fomenting and aggravating those crises.   The report reflects extensive investigative work that Human Rights Watch staff undertook in 2014, usually in close partnership with human rights activists in the country in question. It also reflects the work of our advocacy team, which monitors policy developments and strives to persuade governments and international institutions to curb abuses and promote human rights.   http://www.hrw.org/world-report/2015/country-chapters http://www.hrw.org/world-report/2015 http://mm.hrw.org/ http://reliefweb.int/report/world/world-report-2015-events-2014 http://mg.co.za/data/2015-01-30-human-rights-watch-story   Don''t forget health when you talk about human rights. (The Lancet)   Last week, Human Rights Watch (HRW) released World Report 2015, their 25th annual global review documenting human rights practices in more than 90 countries and territories in 2014. The content is based on a comprehensive investigation by HRW staff, together with in-country human rights activists.   In his opening essay, HRW''s Executive Director, Kenneth Roth, writes, “The world has not seen this much tumult in a generation…it can seem as if the world is unravelling”. Indeed, this 656-page report is a grim read in a year marked by extensive conflict and extreme violence.   But when one delves deeper, there is a hidden story that often does not make the headlines. That story is the health dimension of human rights. Viewed through the lens of health, the report contains several compelling and disturbing themes.   First, the countless attacks on health-care facilities and health workers in conflict and crisis settings. Examples are legion. The targeted killing of more than 70 polio vaccination workers in Pakistan and Nigeria by militant groups. Fear of Ebola in south-eastern Guinea when the virus emerged in early 2014, prompted attacks on treatment centres (the most notable attack was the brutal murder of six health workers and journalists).   In conflict zones, violations of human rights and international humanitarian law have been seen with arrests of health workers providing care to government protesters (in Bahrain and Turkey), and the indiscriminate bombing of hospitals, killing and injuring health workers (in Syria and the Gaza Strip). The pressure on nations to stop these attacks has been mounting.   In late December, 2014, the UN General Assembly passed a resolution calling for concerted and specific actions by States to protect health workers from violence and to assure patients access to health care in situations of conflict and insecurity.   Little attention was paid to the rights violations that occurred during the early stages of the Ebola response in west Africa, especially from imposed quarantines. These interventions only reinforced fear and mistrust at a time when health providers needed to strengthen a community-based response. According to HRW, access to routine health services within the quarantine zones was limited, breaching international human rights law. Furthermore, there have been reports of increased sexual risk taking because of the collapsed economy, including areas under quarantine and among young people who were excluded from school because of the epidemic. There have also been accounts of increased sexual violence against children in Sierra Leone.   Gender-based violence and the violation of women''s and girls reproductive rights were also prominent in 2014. Gender-based violence is widespread and the report is littered with examples of rights abuses worldwide. These cases include countries where abortion is illegal and access to reproductive services is limited, such as in countries in Latin America. Involuntary sterilisation (in India and Uzbekistan) are common and are often done without a woman''s informed consent and in unsafe medical facilities.   Mental health care in many countries is dire, especially for individuals living with other disabilities. In India, fewer than 20% of people who need mental health care have access to treatment. Because of stigma and lack of services, families are unable to cope, which often leads them to abandon or institutionalise relatives with disabilities.   There is also inadequate access to palliative care. The report highlights the situation in Armenia where needlessly complex prescription and procurement of opioid drugs means endless suffering for terminally ill patients due to the absence of pain medicines. Encouragingly, the 2014 World Health Assembly unanimously adopted a ground-breaking resolution that urges all countries to integrate palliative care into their health systems. India, Kenya, and Ukraine are countries in which progress has been made, but challenges remain, especially in the scarcity of trained health-care workers in palliative care.   Other rights violations against health include poor access to clean air and water. Toxic pollution is a serious threat to health worldwide, mostly affecting the poor and the powerless, and the report shows that governments have been slow to respond.   This latest HRW report is an important call to arms to protect health as a fundamental human right. HRW did not identify health as a core element in its analysis, not only as part of a comprehensive package of human rights protections but also as a necessary component of resilient human security. Their analysis should prompt all governments and international health organisations to reflect carefully on their actions to make health a core responsibility and right of all citizens. Visit the related web page
	The planetary crisis affecting almost all of us – poor nutrition by Leith Greenslade, Ramadhani Abdallah Noor The Global Nutrition Report, agencies   December 2014   The planetary crisis affecting almost all of us – poor nutrition, by Leith Greenslade from the MDG Health Alliance.   You’ve all heard about climate change but…do we have a story for you! This is the way the introduction to the world’s first report on the global nutrition crisis could have been written because it puts nutrition on a par with climate change as one of the highest stake global development challenges we ignore at the planet’s peril.   Here’s the knockdown statistic from the Global Nutrition Report: only two[1] countries in the world have levels of under-five stunting, adult overweight and anemia in women of reproductive age that fall below public health thresholds. That’s a fancy way of saying that basically every country in the world is struggling with the problem of poor nutrition. There are few development challenges that can make that claim.   These problems of poor nutrition lie at the root of the high rates of early death and disability (particularly among children, pregnant women and new mothers) in many countries. Globally, malnutrition is a major underlying cause of almost half of the 6.3 million child deaths that are occurring each year and is responsible for half of all years lived with disability by children. It is costing governments billions in healthcare costs, lost productivity and economic growth.   The Global Nutrition Report makes a compelling case for pushing nutrition to top of the global development to-do list, but that won’t happen without a dramatic increase in the political power that nutrition stakeholders wield. To build the influence needed to give the report a shot at the impact it deserves to have, here are five strategies worth considering.   The draft Sustainable Development Goals aim to “end” hunger and all forms of malnutrition by 2030 and achieve the World Health Assembly targets of a 40% reduction in child stunting, a 50% reduction in anemia among women aged 15-49, a 30% reduction in low birth weight babies, a 5% ceiling on the proportion of children who are wasted and a freeze on the number of overweight children under five. The targets also aim to increase the global rate of exclusive breastfeeding to 50%.   We’ve learned this much from the Millennium Development Goal era - indicators are everything because it’s ultimately the indicators and not the goals that shape investments and drive performance by all development partners. At the very minimum we need to see the World Health Assembly nutrition targets as specific indicators in the Sustainable Development Goals so that all stakeholders can measure progress against these goals and be held accountable for their achievement.   At the same time, we may also need more ambitious targets in a few areas. For example, when WHO acknowledges that exclusive breastfeeding has the single largest impact on child mortality of any preventive intervention, is a 50% target ambitious enough? Most of the countries that have reduced child deaths by two-thirds and achieved Millennium Development Goal 4 have exclusive breastfeeding rates above 50%.   Further, when we know that breastfeeding within an hour of birth can significantly reduce newborn deaths, why can’t we have a specific target for early breastfeeding initiation of 60 or even 70%? This alone could set the stage for a mass mobilization of maternity facilities all around the world to work harder to help women initiate breastfeeding right after delivery.   When the Global Nutrition Report estimates that 70% of the recent reduction in childhood stunting in a country like Bangladesh is due to advances in education, incomes, sanitation and contraception, it means that nutrition needs to put down deep policy development, program design and service delivery roots in sectors other than health.   The recent work by GAIN and Alive & Thrive to encourage large employers of young women in Viet Nam and Bangladesh to educate women about nutrition, provide nutritious foods and breastfeeding support at work is one example of how to pursue opportunities outside the health sector, but we need many more.   Within the health sector there are also many opportunities for integration. Why are so many vaccines being delivered, often door to door in the case of polio, without a nutrition component? When we talk about integrated Community Case Management (iCCM) of the three major childhood illnesses - pneumonia, malaria and diarrhea - why is nutrition left out?   And why are so many malaria campaigns (e.g. bed nets and seasonal malaria chemoprevention) happening without nutritional supplements? Kudos to the Clinton Health Access Initiative, the Children"s Investment Fund Foundation, Nutriset, the Government of Nigeria and UNICEF for the recent campaign in Kano State where children received nutritional supplements alongside their malaria medicines, protecting them against the double scourge of malaria and malnutrition at a particularly vulnerable time of the year. But when will the inclusion of nutrition in existing health outreach efforts among vulnerable populations be routine?   The makers, distributors, advertisers and sellers of the vast majority of foods that people consume are not governments or non-profit organizations, but profit-seeking individuals and companies. Food is not medicine, and there is no health system standing between consumers and the food they regularly purchase for daily consumption in all but the most desperate of humanitarian settings.   Not only do companies provide food, but they are also in steady dialogue with consumers through their marketing channels which are becoming ever more sophisticated with rapid income growth and urbanization occurring everywhere alongside rising consumption of processed foods.   Other areas of global health (e.g. vaccines, malaria and HIV/AIDS) have made great strides by working closely with companies, whether it’s the pharmaceutical companies who make medicines or the large employers who are trying to protect the health of their workforces. It is even more important that the nutrition sector fully engage the companies who produce, market and sell food and who employ large populations in the countries struggling with malnutrition. The burgeoning SUN Business Network has emerged as a promising platform for private sector engagement in nutrition and all stakeholders need to rally behind it.   Initiatives like the Access to Nutrition Index also have the potential to shape the behavior of companies by publicly releasing corporate performance against 170 indicators - investors and consumers take note. Let’s hope the 2015 Global Nutrition Report is able to include a much greater focus on how corporations can be brought to the nutrition negotiating table as full and equal partners.   There is a quiet revolution underway in international development finance with the new Global Financing Facility under construction and due for launch in mid-2015. This Facility has to date mobilized $4 billion of funding that country governments can access to achieve their reproductive, maternal, newborn, child and adolescent health goals. As a major contributing factor in maternal, newborn and child deaths, nutrition has a strong claim for investment but this will be dependent on how much country governments prioritize nutrition in their national health plans.   Nutrition stakeholders need to roll up their sleeves and get to work in the countries with the largest nutrition challenges to make sure that nutrition is front and center of national health plans. Nutrition leaders should also mobilize any additional resources needed to create a dedicated “window” for nutrition money to flow from the Global Financing Facility to countries. If the Global Financing Facility is launched without a major focus on nutrition in 2015, it will be a major missed opportunity.   The Global Nutrition Report calls for “National Nutrition Champions,” but the real champions of nutrition are the hundreds of millions of disempowered women who are responsible for feeding future generations under the most challenging of conditions.   It is often these women, mostly mothers, who shoulder the burden of farming, shopping, cooking and feeding families when they themselves are often struggling with poor nutrition, low levels of education and severe restrictions in their ability to earn an income and make household decisions.   So profound is the nutrition-gender nexus that recent work by Rohini Pande and Seema Jayachandran suggests that India’s preference for sons may actually explain the mysteriously higher levels of stunting among Indian children. This study revealed that first born children in India are actually taller than firstborn African children and that stunting emerges within Indian families only after the arrival of the first son. This suggests that India will never end child malnutrition without broader shifts in attitudes towards daughters.   There is now a powerful political movement to advance the health of women and children led by the UN Secretary-General - the Every Woman, Every Child movement - and nutrition stakeholders need to plant their agenda for action firmly within the broader framework of women’s empowerment. If there is one major lesson from the Millennium Development Goals, it is that gains for women have been major drivers of progress in the countries that have met the goals. Improving the nutritional status of women will be a key ingredient for success in the Sustainable Development Goal era.   * Leith Greenslade is Vice-Chair at the MDG Health Alliance, a special initiative of the UN Special Envoy for Financing the Health Millennium Development Goals in support of Every Woman, Every Child, an movement spearheaded by the United Nations Secretary-General to advance the health of women and children.   http://globalnutritionreport.org/2014/12/17/the-planetary-crisis-affecting-almost-all-of-us-poor-nutrition/ http://www.fao.org/about/meetings/icn2/toolkit/key-messages/en/   Africa’s “Hidden Hunger”, by Ramadhani Abdallah Noor.   Just over 20 years ago, South African photographer Kevin Carter shocked the world with a controversial photograph of a famished young Sudanese child being watched by a vulture during a famine. Critics slammed the shot as “disaster porn,” calling it yet another example of how the international media sensationalize African problems.   But what disturbs me is not the photograph. Rather, it is that two decades later, the conditions that the photograph depicts remain basically the same. Every year, 3.1 million children around the world still die of hunger.   As an African doctor, I know that the ravages of serious malnutrition and hunger are not always visible. They are not always as manifest as they are in the protruding ribs of ghostly children hooked up to feeding tubes, like those I used to see in hospital wards in Tanzania. Chronic malnutrition, or “hidden hunger,” shows itself in other ways – but it can be just as devastating and deadly. And while deaths from many other diseases, including acute malnutrition, have declined, hidden hunger remains pervasive.   In the last two decades, significant success has been achieved in the fight against HIV, tuberculosis, and malaria. New HIV infections have dropped by as much as 50% in some countries in Africa, with AIDS-related deaths down by 30-48%; TB cases have declined by 40%, and malaria cases by 30%.   But the stunting of early childhood growth as a result of malnutrition remains high, dropping by only about 1% over the same period. In Africa, hunger remains the leading cause of death in children, accounting for half of all deaths of children under the age of five and killing more than AIDS, TB, and malaria combined.   In fact, many scientific studies have shown that a malnourished child is much more likely to contract an infection, to suffer from other illnesses, and to suffer from them longer. Diarrhea, for example, is a deadly disease for severely underweight children, who are 12 times more likely to die from an ailment that should be easily treated. And severely underweight children are 9.5 times more likely to die from malaria as well.   Indeed, childhood malnutrition is now confirmed to be the leading cause of the global disease burden, with the World Health Organization attributing to it 45% of all deaths under the age of five in 2011. Recent reports from the war-ravaged Central African Republic indicate that more children there are dying from hunger than from bullets.   These numbers make the problem of malnutrition look insurmountable. But what works is no secret: vitamin A, iodized salt, and fortified foods. The lack of vitamin A alone results in blindness in a half-million children every year, with half of them dying within 12 months of losing their sight. Similarly, half of all women of childbearing age in developing countries suffer from weakened immune systems, owing to anemia caused by iron deficiency.   The long-term damage caused by malnutrition has a domino effect, impeding educational achievement, and ultimately, hobbling national economies. Addressing this ongoing crisis requires money – an estimated $10 billion per year – and new and better strategies to bring life-saving solutions to the mothers and children who most need them.   But the cost looks far less daunting when one considers the cost of hunger. UNICEF estimates that the cost of Africa’s child malnutrition is $25 billion a year. And this is not the whole story. Malnutrition costs an estimated $3.5 trillion every year to the global economy, owing to loss of productivity and higher health-care costs.   To meet this challenge, save lives, and improve economies, Africa needs a comprehensive strategy and increased investment in agriculture.   The Africa Union declared 2014 the year of agriculture and food security in Africa, and the continent’s agriculture sector. In theory, that should improve overall nutrition; but increased investment in agriculture is not a panacea. We need to concentrate on building nutrition-sensitive agriculture programs that include small-scale farmers, households, women, and children.   A big step would be to increase women’s control over land ownership and farming decisions, along with access to agricultural credits and subsidies designed to encourage domestic food production through home gardening and cattle and poultry husbandry. Studies show that women are much more likely than men to spend additional income on food and health. Increasing their farming income and decision-making power ultimately has a greater impact on children’s health and nutrition.   Moreover, agricultural policies, subsidies, and investments have traditionally benefited cereal farmers. But policymakers need to concentrate on increasing access to more nutritious foods, such as meat, fruit, and vegetables, which are too expensive for the poor.   Malnutrition causes the greatest damage during the first thousand days of life, leading to grievous and irreversible changes in infant health. To make real inroads against hidden hunger, African governments, supported by global development partners, must act quickly. Childhood hunger in Africa does not have to be as dramatic as that depicted in Carter’s 1993 photograph to be just as deadly.   * Ramadhani Abdallah Noor, is a Tanzanian doctor and research associate at the Harvard School of Public Health Visit the related web page
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