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	A Wake Up Call: Lessons from Ebola for the world’s health systems by MSF, Save the Children International, Oxfam   July 2015   Independent review of World Health Organisation Ebola reponse calls for major changes.   Independent experts have recommended urgent and substantial changes to the World Health Organisation (WHO) after an inadequate response to West Africa''s deadly Ebola outbreak.   The UN agency "does not currently possess the capacity or organisational culture to deliver a full emergency public health response", a panel of independent experts said in a report on the WHO''s handling of the Ebola crisis.   The panel faulted the agency for being sluggish, financially unprepared and overly reliant on "good diplomacy". It pointed to a lack of "independent and courageous decision making by the director general," Dr Margaret Chan, in the early days of the Ebola epidemic.   The report urged the agency''s regional and country representatives to be independent and ready to speak out against recalcitrant governments that do not take sufficient action on their own. And it faulted donor countries for stripping the agency''s funding, urging them to contribute immediately to a "contingency fund" designed to respond to disease outbreaks.   The panel, led by Barbara Stocking, the former head of the aid organisation Oxfam, did not call for personnel changes. But it said a rapid overhaul of the organisation was needed.   It said that WHO leaders should have declared the Ebola outbreak a public health emergency much sooner than they did, and that the delay stemmed in part from not wanting to challenge governments worried about negative economic and trade consequences. The WHO declared Ebola a global health emergency only in August 2014, after it had already killed 1,000 people.   The panel recommended that a $US100 million contingency fund, suggested by WHO for future emergencies, be fully financed by member states. It also called for the creation of a separate emergency preparedness and response unit within the WHO.   "This is a defining moment for the health of the global community," the report said. "WHO must re-establish its pre-eminence as the guardian of global public health. This will require significant changes."   Geneva-based WHO has been criticised for its response to the Ebola epidemic - which killed more than 11,000 people in Guinea, Liberia and Sierra Leone - and for its early assurances that the disease was under control despite repeated warnings to the contrary by the charity Medecins Sans Frontieres (MSF).   Director-General Dr Chan admitted in May it had been "overwhelmed" by the Ebola epidemic and "ought to have reacted far earlier".   Responding to the report, the WHO said it was already moving forward on some of the panel''s recommendations, including the development of the emergency unit and the contingency fund.   The expert panel also said the 2005 International Health Regulations, agreed by 196 WHO member countries to try to track and control the spread of disease, must be strengthened and properly implemented to allow proper handling of epidemics.   "The world simply cannot afford another period of inaction until the next health crisis," it said.   The 2005 International Health Regulations were reviewed and changes recommended in 2011 after the 2009/2010 H1N1 flu pandemic, the panel said, but many countries have not acted on that review - a failure that made the Ebola response even worse.   "Had the 2011 recommendations for revision been implemented, the global community would have been in a far better position to face the Ebola crisis," it said.   Jeremy Farrar, the director of the Wellcome Trust global health charity who has previously called for a separate emergency response unit to be established within WHO, urged governments to support the panel''s recommendations.   "It''s essential that this new body is accountable and can show leadership in the face of emerging health threats, with the authority and independence to act quickly when needed," he said. "The support of the global community is also crucial if we are to avert another catastrophe on the scale of Ebola."   http://www.bbc.com/news/health-33422635 http://www.un.org/apps/news/story.asp?NewsID=51349#.VZyzZLWpWzk http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961225-9/fulltext http://www.ipsnews.net/2015/07/ebola-recovery-focuses-on-strengthening-africas-health-systems/ http://reliefweb.int/report/sierra-leone/ebola-recovery-impossible-unless-resilient-health-systems-are-rebuilt-guinea http://www.undp.org/content/undp/en/home/blog/2015/7/8/A-look-behind-the-protective-gear-reveals-the-faces-of-Ebola.html   June 2015   The world is no better prepared today than a year ago to respond to Ebola. (MSF)   The global health system remains unprepared for mass disease epidemics warns the international humanitarian aid organisation Médecins Sans Frontières (MSF). MSF urges the leaders of the G7 countries at this weekend’s G7 summit in Elmau, Germany to commit to developing an efficient emergency response system against epidemics and international health crises, following the devastating Ebola outbreak in West Africa. The Ebola outbreak also underlines the real need to urgently fund the development of drugs and diagnostics for neglected diseases and to ensure access to existing medicines for patients in developing countries.   “If a global pandemic were to strike tomorrow, there is still no well-resourced, coordinated international response in place to kick in. The G7 leaders must recognise this gaping hole in our global health system and take concrete action to address it, or risk losing thousands of more lives in the next major epidemic,” says Dr. Joanne Liu, MSF International President. “There is a real danger of going back to business as usual: no major hospital would shut down the ER unit to only focus on general practice – both are needed for the world’s patients.”   The global failures encountered in the response against Ebola - not sounding the alarm on time, ineffective surveillance, slow international response, absence of leadership, lack of treatments and vaccines – are not unique. They are the reality in many emergencies MSF teams confront today.   “There is a palpable vacuum of global health leadership today. At the World Health Assembly last week in Geneva, the shouts of WHO reform seem to have dwindled, with UN Member States failing to pledge additional core funding, and no clear agreement on how to make a rapid and effective response a reality,” says Florian Westphal, MSF Germany, Managing Director. “We hope that the G7 leaders will show greater political leadership and prioritise health emergencies to prevent future epidemics from spiralling so far out of control.”   The global health and aid system currently rewards countries for reaching long-term development targets, but there is little incentive for countries to declare outbreaks of infectious diseases for fear of harming trade and tourism. Moving forward, countries need to be incentivised for publicly recognising an outbreak, while wealthy nations should deploy staff and resources to support Ministries of Health that are unable to cope alone.   Germany, which is chair of the G7 during 2015, has set three health issues on the G7 agenda: Ebola, neglected diseases and antimicrobial resistance. The lacking medicines and medical tools in these disease areas all reflect a broken research and development system, where needed tools are either priced far out of reach, or are simply not developed.   "The G7 summit has rightly put major burning health problems on the agenda, but they’re not talking about fixing the R&D system so we can turn this around," says Philipp Frisch of MSF’s Access Campaign.   “The lack of R&D for Ebola, antimicrobial resistance and neglected diseases is an enormous problem; millions of people suffer from diseases for which there are no effective drugs or vaccines, because they don’t represent a lucrative market for the pharmaceutical industry. The leaders of the G7 must prioritise funding for research and development into these unmet health needs.”   Drug-resistant tuberculosis is among the neglected diseases for which new drugs, vaccines and diagnostics are urgently needed. MSF treats thousands of people worldwide each year, using a two-year regimen of antibiotics that can cause horrible side effects—from constant nausea to psychosis and deafness—while managing to cure only one in two people. Some forms of the disease are now virtually no longer treatable due to resistance to existing drugs.   At the same time, existing vaccines and treatments are priced out of reach. New exorbitantly-priced hepatitis C treatments are a prime example, as are new vaccines that many so-called ‘middle-income’ countries cannot afford. While Germany showed leadership in hosting an important pledging conference to pay for new vaccines in Berlin this year, the government has done little to ensure overpriced vaccines are made more affordable for all developing countries.   "Wealthy, developed countries must take urgent action against the market failure in the pharmaceutical research and development," said Frisch. "The inaction of the international community on R&D, including the countries of the G7, has led to many preventable deaths, as drugs are not developed or are too expensive. R&D should prioritise the lives and health of people over profits."   http://www.msf.org/article/g7-world-no-better-prepared-today-year-ago-respond-ebola   Mar 2015   A Wake-Up Call: Lessons from Ebola for the world’s health systems   Almost 30 countries are highly vulnerable to an Ebola-style epidemic jeopardising the future of millions of children, warns Save the Children in its new report ‘A Wake Up Call: Lessons from Ebola for the world’s health systems’.   The report ranks the world’s poorest countries on the state of their public health systems, finding that 28 have weaker defences in place than Liberia where, alongside Sierra Leone and Guinea, the current Ebola crisis has already claimed 9,000 lives, and provoked an extraordinary international response to help contain it.   The agency warns that an increasingly mobile population intensifies the threat of infectious disease outbreaks and, added to the emergence of two new zoonotic diseases each year – those that can be passed between animals and humans - it is crucial to invest in stronger health systems to avoid a virus spreading faster and further than the current Ebola outbreak.   The report also advises that prevention is better than cure, finding that the international Ebola relief effort in West Africa has cost $4.3bn, whereas strengthening the health systems of those countries in the first place would have cost just $1.58bn.   Ahead of an Ebola summit attended by world leaders in Brussels this week, the charity warns that alongside immediate much needed support to Sierra Leone, Liberia and Guinea, lessons need to be learnt and applied to other vulnerable countries around the world.   Justin Forsyth, Save the Children’s CEO, said: “A robust health system could have stopped Ebola in its tracks saving thousands of children’s lives and billions of dollars.   “Without trained health workers and a functioning health system in place, it’s more likely that an epidemic could spread across international borders with catastrophic effects.   “The world woke up to Ebola but now people need to wake up to the scandal of weak health systems, which not only risk new diseases spreading, but also contribute to the deaths of 17,000 children each day from preventable causes like pneumonia and malaria.”   The reports’ index looks at the numbers of health workers, government spending on health, and mortality rates. Somalia ranks lowest, and is preceded by Chad, Nigeria, Afghanistan, Haiti, Ethiopia, Central Africa Republic (CAR), Guinea, Niger, and Mali.   In a snapshot of dangerously inadequate global health systems the index shows:   In Afghanistan, public spending on health is just $10.71 per person per year, compared to $3,099 in the UK; and In Somalia, there is one health worker for every 6,711 people – by comparison in the UK there is one health worker for every 88 people.   As well as rebuilding the fractured health systems of Liberia, Sierra Leone and Guinea following the Ebola crisis, Save the Children is calling for:   The international community to make a clear commitment to Universal Health Coverage for every country – the principle that every person should have access to essential health care, not just those that can afford it – including the IMF encouraging countries to collect progressive taxes and increase investments in public health services;   Countries to increase domestic tax revenue to 20% of GDP and allocate at least 15% of their national budgets to health;   Donors to ensure that the aid they give is better aligned and contributes to building comprehensive primary healthcare systems;   The new Sustainable Development Goals – which will replace the Millennium Development Goals, due to be negotiated at the UN General Assembly in New York in September – to explicitly include a commitment to Universal Health Coverage; and World leaders to commit to end preventable maternal, new-born and child deaths by 2030.   Notes:   The Health Access Index ranks the 75 ‘Countdown Countries’, which shoulder 95% of global maternal, new-born, and child deaths. A coalition of institutions including Save the Children, The WHO, and The Lancet chart their annual progress towards MDGs 4&5.   ‘Health workers’ include doctors, nurses and/or midwives.   ‘Zoonotic diseases’ are defined by the Centre for Disease Control as diseases ‘that can be passed between animals and humans’.   ‘Universal Health Coverage’ is defined by the WHO as ‘to ensure that all people obtain the health services they need without suffering financial hardship when paying for them’.   17,000 children under five die every day, according to UNICEF Child Mortality Report 2014.   http://reliefweb.int/report/world/wake-call-lessons-ebola-world-s-health-systems http://www.thelancet.com/infographics/global-health-security   Building resilient health systems and learning from the Ebola crisis. (Oxfam)   It took the threat of a global health crisis to illustrate the failings of Africa’s health systems. Resilient health systems, free at the point of use, are evidently a global public good. They are essential for the provision of universal health coverage and for a prompt response to outbreaks of disease.   Resilient health systems require long-term investment in the six key elements that are required for a resilient system: an adequate number of trained health workers; available medicines; robust health information systems, including surveillance; appropriate infrastructure; sufficient public financing and a strong public sector to deliver equitable, quality services. Global investment in research and development for medical products is also critical.   This briefing paper identifies lessons from the current Ebola crisis, as well as previous outbreaks, to review what is required to build resilient health systems in West Africa and beyond. The paper presents recommendations for affected countries, governments, donors and international organizations.   http://policy-practice.oxfam.org.uk/publications/never-again-building-resilient-health-systems-and-learning-from-the-ebola-crisis-550092 Visit the related web page
	They want to erase journalists in Mexico by Lydia Cacho The Observer, agencies Mexico   April 2015   Mexican journalist, author and campaigner Lydia Cacho is in London this week to rally support for those who risk their lives to expose corruption.   “I suddenly had a clearer understanding than ever of the power that journalism has to give a voice to those who have been silenced by the crushing weight of violence.”   So wrote Mexico’s best-known journalist and human rights campaigner, Lydia Cacho, upon seeing her colleagues from the press gather to cover her arrival for interrogation before judges at Puebla, central Mexico, after what she calls a “legal kidnap” by the police.   The first stage of that prolonged ordeal 10 years ago had been a terrifying 36-hour drive from her home in the coastal state of Quintana Roo to the courthouse and jail, during which she had been sexually violated, threatened with death and “disappearance”, and horribly intimidated.   Cacho was to be charged with libel after the publication of a book, The Demons of Eden, which revealed a sex-trafficking and pederast-paedophile ring with connections to power on high. The appalling story of power’s revenge, its searing impact on Cacho and the implications of the affair for all reporters is told in a further book, Memorias de una Infamia (Memories of Infamy), in which, vindicated by subsequent events and trials, Cacho demonstrates that the pederasts and sex criminals were protected by the governor of Puebla state, by the judiciary and by people even higher up – with connections also to drug trafficking.   The foreword is written by the one reporter who worked alongside Cacho during her ordeal, revealing crucial material – including phone taps – that swung the narrative from the jaws of incarceration and torture into her favour. This was Carmen Aristegui, Mexico’s most famous broadcaster, who was sacked last month by her employer, MVS Radio, after revealing that the wife of President Enrique Peña Nieto had acquired a vast luxury property from a group that had won several lucrative government contracts.   The fate of the two journalists has stirred to fever pitch the discourse about repression of free speech and the acute physical dangers faced by journalists in Mexico. Scores of reporters have been killed – often tortured and decapitated – in what is now seen as a pincer-movement against their work by drug cartels and the state.   The Los Angeles Times reported: “The loss of one of Mexico’s most critical journalistic voices comes as revelations of corruption and killings by police and the army have roiled the country and plunged Peña Nieto into the worst crisis of his 27-month presidency.”   While all this was happening last month, Peña Nieto was a guest of the Queen and the British government.   Cacho – who has won innumerable awards for her work and was made a Chevalier d’Honneur of the French Republic – will rally support this week for Aristegui and her endangered colleagues at the London Book Fair, part of a PEN festival focusing on Mexico.   Ahead of her visit, Cacho told the Observer: “After all these years, every time my mobile phone rings and I see the name of a colleague I fear the worst: assassination, kidnapping or forced disappearance. When I was arrested 10 years ago, I was not so well-known, at least not to the broader news readers; now I’ve published 10 books and still live under tremendous pressure from corrupted politicians and traffickers who want me either dead or exiled and silenced.”   Of her friend, Cacho added: “Carmen Aristegui is probably the most famous newscast journalist in our country. She was fired most probably for investigating the president, which happened months after I was fired from El Universal, one of the main national newspapers. If this is happening to us, the visible ones, can you imagine what local reporters are going through in the provinces, where rule of law is almost nonexistent?”   Cacho thinks the timing of Aristegui’s firing is accounted for by “the return of the PRI party, who ruled Mexico for more than 70 years. Peña Nieto’s advisers are obsessed with protecting his image at all costs. It seems they want us back into the 1980s, when nobody dared to investigate the president and his ministers.   “Aristegui’s team not only uncovered the fact that the president’s wife and his finance minister, [Luis] Videgaray, had received a couple of luxurious residences from a big construction conglomerate that was doing business with the federal government; they also exposed a network of corruption, a radiography of how the president is managing the country’s finances as if he was a feudal lord, as if laws, international treaties and transparency did not exist.   This case exposes, once again, how a small group of politicians and tycoons handle all media permits in order to control freedom of expression, and they do so through monopolies and the destruction, persecution of free media and journalists.”   A report published by the London-based Article 19 organisation at the end of March and launched in Mexico City by Aristegui and Cacho – found that “under the current administration headed by Enrique Peña Nieto, the number of assaults on the press was nearly double that reported during [his predecessor] Felipe Calderón’s term of office … Failures in the justice system continue to prevail.”   According to a report by Mexico’s National Human Rights Commission in January, 97 reporters have been killed over the past four years for doing their job. There have been 22 disappearances of reporters and 433 registered attacks since 2005, when the current drug cartel war began in earnest.   Just as the report appeared, a long line of murderous attacks on reporters in the state of Veracruz culminated in the discovery of the decapitated body of a freelance website reporter, Moisés Sánchez, who had disappeared in the small town of Medellín de Bravo. The mayor of the town has been charged with having ordered the murder, but activists believe the attacks on reporters – 13 in Veracruz alone – have been orchestrated on higher authority, in the state administration.   Among the victims in Veracruz was Regina Martínez, a reporter for Proceso magazine, who had been seeking to establish those connections. Her violated and tortured body was found in 2012.   In her book, Cacho differentiates between “fame”, which she sees as something “for artists”, and notoriety, which she says she has achieved simply by refusing to be silenced. Either way, her struggle has become what the great anti-mafia writer Roberto Saviano calls “the Lydia Cacho cause”.   In her London appearances, Cacho will also focus on violence against women, and lifting the impunity of those who violate them. Ahead of the visit she said: “When Peña Nieto was governor of the state of Mexico [in the south of the country] the femicide rate went through the roof: up by 185%, according to specialist Humberto Padgett. Young women were being assassinated relentlessly. Some were taken by the cartels for sex trafficking; others, younger than 15, exploited as slaves in the drug fields..   “Peña Nieto denied everything; on his way to the presidency he could have been the hero, approving gender equality laws, forcing the justice system to act as law requires. Instead he ordered journalists to be quiet, his team bought some off, and the honest ones had to flee the region, or where threatened, or killed by unknown criminals”.   A woman of passion as well as courage, Cacho surveys the scene: “These are dark times for our country,” she says by telephone from Quintana Roo. “Civil society is confronting the powers that be, but the free media is becoming smaller day by day; narco lords rule some states and provinces. There are not enough hours in a day to help those voices that need listening to, those hundreds of thousands of victimised families that need seeing. Journalism is essential in a country that lives in a silenced war, a masked war. They can erase us journalists from the mainstream media, and they can eliminate us physically. What they will never be able to do is deny the true stories, snatch away my voice, our voices and our words. As long as we are alive we will continue to write and what we have written will keep us alive”.   Cacho recalls the last time she talked to her colleague and friend Anna Politkovskaya. “We laughed in a hotel room, we talked about family and children, about love and work, we discussed the risk of our jobs. One morning watching the news I froze as I heard she had been assassinated after coming back from buying food for her family. This fact made me aware of my own mortality.”   But by way of a message to herald her arrival in Britain, Cacho insists: “I am a woman who will not give up her rights, nor will I sacrifice the rights of others to have a comfortable living. Being a journalist in Mexico is not a job; it’s a calling, a responsibility, never a sacrifice. It is to be part of the counter-power that makes life worth living.”   http://www.hrw.org/news/2015/05/04/wake-call-mexico http://www.hrw.org/news/2015/04/28/letter-mexicos-attorney-general-human-rights-crisis http://www.amnesty.org/en/latest/news/2015/08/mexico-shooting-the-messengers-will-leave-us-all-in-the-dark/ http://www.ipsnews.net/2016/07/teachers-and-students-tip-of-iceberg-of-mexicos-human-rights-crisis/ http://www.pen.org/blog/president-pe%C3%B1a-nieto-investigate-murders-journalists-mexico-and-establish-mechanisms-protect http://www.theguardian.com/world/2015/apr/11/mexico-fearless-journalist-lydia-cacho   August 2015   Mexican photojournalist Rubén Espinosa was found tortured and murdered, along with human rights activist Nadia Vera and three other women.   Freedom of expression is under attack in one of Latin America''s oldest democracies, and Rubén is the 14th journalist killed in the southern state of Veracruz where governor Javier Duarte has made open threats against reporters. Almost none of these crimes have been solved.   But this case has sent thousands into the streets and set off an explosion in the national and global media. Now hundreds of journalists, writers and artists have signed an open letter demanding justice for journalists in Mexico murdered for doing their jobs.   The letter is already making waves with the government, but if we add over a million more names, and get it published on the front page of Mexican media, we can show that people from every country in the world stand with the freedom of expression fight in Mexico. Join half million people around the world, by adding your voice to protect journalists and freedom of expression in Mexico, sign the petition via the link below. Visit the related web page
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