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World: Protection in Danger Monthly News Brief – June 2019

Source: Insecurity Insight
Country: Bangladesh, Bosnia and Herzegovina, Burundi, Democratic Republic of the Congo, Greece, Italy, Kenya, Mexico, Myanmar, occupied Palestinian territory, Somalia, South Sudan, Sudan, Syrian Arab Republic, United Republic of Tanzania, United States of America, World


Democratic Republic of the Congo

30 June 2019: In Bukavu city, South Kivu province, a fire of unspecified origin at Zaire IDP Camp destroyed more than 200 houses, leaving 1,800 people without shelter. Source: ACAPS


Throughout June 2019: The Eritrean Government continued to deny the Human Rights Council’s Special Rapporteur on Human Rights in Eritrea access into the country. Source: Africa News


28 June 2019 (DOA): In Dadaab town, Garissa county, refugees of the Dadaab Refugee Camp have accused staff of UNHCR and partner NGOs of demanding bribes from them for their repatriation to Somalia and other services. Source: The Guardian

South Sudan

02 June 2019: In Bor, Jonglei state, a female INGO aid worker was reportedly assaulted by a male national staff member at the Bor PoC site, requiring medical treatment. Reports suggest the incidents occurred because the female staff refused demands to medically treat the male colleague's wife. The male aid worker was arrested by UNPOL. Source: AWSD


7-9 June 2019: In Bora and Habor areas, North Darfur, paramilitary groups reportedly attacked multiple farms, injuring two female IDPs who were taking shelter in the farms. Source: Radio Dabanga

17 June 2019: In Bandi village, suspected Boko Haram militants killed two IDPs. No further information specified. Source: ACLED

June (Unspecified date): In Omdurman, nine South Sudanese refugees were reported to have been killed over an indeterminant number of days. Additionally, there were reports of multiple rapes, seven injuries, and two missing persons. The identity of the perpetrators remains unclear, although reports suggest the Sudanese military may have been responsible. Source: Liveuamap

World: International Activity Report 2018

Source: Médecins Sans Frontières
Country: Afghanistan, Angola, Armenia, Bangladesh, Belarus, Belgium, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Colombia, Côte d'Ivoire, Democratic Republic of the Congo, Egypt, El Salvador, Eritrea, Eswatini, Ethiopia, France, Georgia, Germany, Greece, Guinea, Guinea-Bissau, Haiti, Honduras, India, Indonesia, Iran (Islamic Republic of), Iraq, Italy, Jordan, Kyrgyzstan, Lebanon, Liberia, Libya, Madagascar, Malawi, Malaysia, Mali, Mauritania, Mexico, Mozambique, Myanmar, Nauru, Nicaragua, Niger, Nigeria, occupied Palestinian territory, Pakistan, Papua New Guinea, Philippines, Russian Federation, Senegal, Serbia, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Sweden, Syrian Arab Republic, Tajikistan, Thailand, Turkey, Uganda, Ukraine, United Republic of Tanzania, Uzbekistan, Venezuela (Bolivarian Republic of), World, Yemen, Zambia, Zimbabwe


By Dr Marc Biot, Dr Isabelle Defourny, Marcel Langenbach, Kenneth Lavelle, Bertrand Perrochet and Teresa Sancristoval, Directors of Operations

In 2018, Médecins Sans Frontières (MSF) teams provided medical and humanitarian assistance to people facing extreme hardship in over 70 countries. From treating war-wounded ever closer to frontlines in Yemen, to responding to epidemic outbreaks such as cholera in Niger, or providing assistance to people fleeing violence in the Central African Republic, emergency response continued to be a core part of our work.

As 2018 drew to a close, the Democratic Republic of Congo (DRC) was in the midst of its second Ebola outbreak of the year, and its biggest ever. MSF was part of the response, led by the Ministry of Health. Although rapid and well-resourced, with teams having access to a promising new vaccine and several new drugs with the potential to better protect and treat people, the response, and those managing it, failed to adapt to people’s priorities, and to gain the trust of the community. This lack of trust in the health services meant people delayed or avoided seeking treatment. By the end of the year, the epidemic in North Kivu and Ituri provinces had claimed more than 360 lives and in some areas was still not under control.

Seeking care in war zones

Early in the year, Syrian civilians and medical staff were caught in the violence in Idlib, in the northwest, and in East Ghouta, near the capital Damascus. In East Ghouta, the barrage was relentless in February and March, with waves of dead and injured arriving at MSF- supported hospitals and health posts. As the siege blocked incoming aid, medical staff had few medical supplies to work with. By the end of the offensive, 19 of the 20 hospitals and clinics we supported were destroyed or abandoned, leaving civilians with few options to seek medical help.

The war in Yemen, which has left the country and its healthcare system in ruins, entered its fourth year. The Saudi- and Emirati-led coalition continued to target civilian areas with airstrikes and bombings, including our new cholera treatment centre in Abs. The war is taking a heavy toll on people, who often must negotiate constantly changing frontlines to find care for their war- wounds or their general medical needs. Yemen was the country where our teams treated the highest number of war-wounded in 2018, over 16,000 people. After a major offensive was launched in Hodeidah in June, doctors in our Aden hospital treated Hodeidah residents who had been driven for six hours, the majority of them in a critical condition. Conflict intensified on several frontlines at the end of the year, leading to an influx of people with war-related injuries. We also treated more than 150 people wounded by mines planted by Houthi-led Ansar Allah troops around Mocha. Constant attacks on our staff and patients at facilities in Ad Dhale forced us to withdraw from the town in November.

World: Aid workers killed 2018

Source: Insecurity Insight
Country: Afghanistan, Azerbaijan, Central African Republic, Chad, Democratic Republic of the Congo, Ethiopia, Mali, Mexico, Myanmar, Nigeria, occupied Palestinian territory, Pakistan, Somalia, South Africa, South Sudan, Syria...

World: Tendencias global desplazados forzosos en 2018

Source: UN High Commissioner for Refugees
Country: Afghanistan, Bangladesh, Cameroon, Central African Republic, Colombia, Côte d'Ivoire, Democratic Republic of the Congo, El Salvador, Ethiopia, Germany, Guatemala, Honduras, Iraq, Malaysia, Mexico, Myanmar, Nigeria, Pakistan, Peru, Philippines, Somalia, South Africa, South Sudan, Sudan, Syrian Arab Republic, Thailand, Turkey, Uganda, United States of America, Venezuela (Bolivarian Republic of), World

CAPÍTULO 1 Introducción

**El mundo actual tiene una población de 70,8 millones de desplazados forzosos. **

A lo largo de la última década, la población global de desplazados forzosos creció sustancialmente de 43,3 millones de 2009 a 70,8 millones en 2018 y alcanzó una cifra récord [gráfico 1]6. La mayor parte de este aumento se dio entre 2012 y 2015, provocado sobre todo por el conflicto sirio. Pero otros conflictos en distintas zonas también contribuyeron a este aumento, incluidos los de Irak y Yemen en Oriente Medio, la República Democrática del Congo (RDC) y Sudán del Sur en el África subsahariana, así como la llegada masiva de refugiados rohingya a Bangladesh a final de 2017.

En 2018 cabe destacar particularmente el aumento del número de desplazados por los desplazamientos internos de Etiopía y las nuevas solicitudes de asilo de personas que huían de la República Bolivariana de Venezuela. La proporción de población mundial desplazada también siguió subiendo, dado que el aumento de la población desplazada por la fuerza rebasó el crecimiento de la población mundial. En 2017, esta cifra era de una de cada 110 personas, pero en 2018 resultó en una de cada 1087 . En comparación, hace una década la cifra era de una de cada 160 [gráfico 2]. En total, la población refugiada bajo el mandato de ACNUR casi se ha duplicado desde 2012.

Durante 2018 se desplazó un gran número de personas. A lo largo del año, 13,6 millones de personas fueron nuevos desplazados, incluidas aquellas que buscaban protección en el extranjero (como solicitantes de asilo o bien como refugiados recién registrados)8 y 10,8 millones que fueron forzadas a huir pero permanecieron en sus países9.

Estos 13,6 millones de nuevos desplazamientos promediaron 37.000 nuevos desplazamientos diarios durante 2018 [gráfico 3]. Muchas otras personas regresaron a sus países o zonas de origen para tratar de retomar sus vidas, incluidos 2,3 millones de desplazados internos y cerca de 600.000 refugiados.

Con 1.560.800, los etíopes fueron el mayor grupo de desplazados durante el año, el 98% de ellos dentro de sus fronteras. Esto duplicó de largo en el país la población desplazada internamente.
Los sirios fueron la siguiente comunidad de nuevos desplazados, con 889.400 durante 2018. De ellos,

632.700 fueron nuevos desplazados (o nuevos registrados) fuera del país10, mientras los restantes fueron desplazados internos. Nigeria también tuvo un alto número de población desplazada, con 661.800, de los cuales se estima que 581.800 lo hizo internamente.

Entre los nuevos desplazados transfronterizos (o nuevos registrados), la gran mayoría permaneció cerca de sus hogares. En 2018, más de medio millón de nuevos registros de refugiado y solicitudes de asilo provinieron de la República Árabe de Siria, y la mayoría de ellos tuvieron lugar en Turquía [gráfico 4]. Ese número incluye tanto a los recién llegados como a quienes permanecían en el país en momentos previos al registro. Los venezolanos representaron el segundo mayor número de desplazamientos internacionales en 2018, con 341.800 nuevas solicitudes de asilo (véase la página 24 para más detalles sobre la situación de Venezuela). Los sursudaneses fueron el siguiente grupo de solicitantes de asilo, principalmente en Sudán y Uganda, seguidos de quienes dejaron la RDC, por lo general rumbo también a Uganda.

A final de 2018, los sirios siguieron siendo la mayor comunidad de desplazados forzosos, con 13 millones de personas, incluidos 6 654 000 refugiados, 6 184 000 desplazados internos y 140 000 solicitantes de asilo. Los colombianos fueron el segundo mayor grupo, con 8 millones de desplazados forzosos al cabo del año, la mayor parte de ellos (98%) dentro de su país11. Un total de 5,4 millones de congoleses de la RDC eran también desplazados forzosos, entre ellos 4.517.000 desplazados internos y 854.000 refugiados o solicitantes de asilo. Otras grandes poblaciones desplazadas a finales de 2018 – aquellas con más de 2 millones de personas desplazadas, ya sea internamente o como refugiados o solicitantes de asilo– fueron la de Afganistán (5,1 millones), Sudán del Sur (4,2), Somalia (3,7), Etiopía (2,8), Sudán (2,7), Nigeria (2,5), Irak (2,4) y Yemen (2,2).

En Camerún, la situación fue compleja debido a que fue un país de acogida y también de origen de refugiados y de solicitantes de asilo, y además, en 2018 se dieron desplazamientos internos múltiples. En total hubo 45.100 refugiados cameruneses a final del año. La mayoría de ellos fueron acogidos por Nigeria (32.800), lo que contrasta con los sólo 100 que había en el país a principios de año. Esto hay que añadirlo a los 668.500 desplazados internos, mayoritariamente en las regiones del sur, noroeste y extremo norte. Al mismo tiempo, Camerún acogió a 380.000 refugiados, principalmente de la República Centroafricana (RCA) (275 .000) y Nigeria (102.300).
Sin la protección de familiares, los menores no acompañados o separados están a menudo en riesgo de abuso y explotación. La falta de información y datos sobre ellos es un problema clave. El número reportado de esos menores que solicitó asilo durante el año fue de 27.600. A finales de año, entre la población refugiada fueron reportados 111.000 menores no acompañados o separados12. Estas cifras son a la baja dado el número limitado de países que proveen de ese dato.

Los retornos continúan siendo una pequeña parte de los desplazamientos y no superaron a los nuevos desplazamientos. Cerca de 593.800 refugiados regresaron a sus países de origen en 2018 frente a los 667.400 de 2017, menos de un 3% de la población refugiada. Además, 2,3 millones de desplazados internos regresaron en 2018, frente a 4,2 en 2017. En ciertos casos, refugiados y desplazados internos regresaron a situaciones en las que las condiciones no permitían retornos seguros ni sustentables.
La reubicación fue una solución para cerca de 92.400 refugiados.
En 2018, el Grupo de Expertos en Estadísticas sobre Refugiados y Desplazados Internos (EGRIS) presentó los resultados de su trabajo en la 49ª sesión de la Comisión de Estadística de Naciones Unidas. Establecido en 2016 por la comisión, el EGRIS tiene como labor abordar los desafíos que plantea la recolección, elaboración y diseminación de estadísticas sobre los refugiados, solicitantes de asilo y desplazados internos, incluida la falta de terminología uniforme y las dificultades para comparar internacionalmente las estadísticas.

La comisión:
• ratificó las recomendaciones internacionales sobre estadísticas de refugiados
• avaló el reporte técnico sobre estadísticas de desplazados internos y apoyó la propuesta para tomar en cuenta este trabajo y desarrollar recomendaciones formales, y
• reafirmó el mandato de elaborar un manual para recopiladores de estadísticas sobre refugiados y desplazados internos que sirva de guía práctica para las recomendaciones.

Además de los 40 países que participaron en el EGRIS y de aquellos que colaboraron a través de consultas globales en 2017, otros muchos representantes nacionales tomaron la palabra en la Comisión Estadística para dar la bienvenida a este trabajo. Algunas áreas del trabajo recibieron especial atención, como la mayor importancia dada a la coordinación y el papel clave de las oficinas nacionales de estadística, o la inclusión del potencial de otras fuentes de información y otras metodologías en las recomendaciones.

World: UNHCR Global Trends: Forced Displacement in 2018

Source: UN High Commissioner for Refugees
Country: Afghanistan, Bangladesh, Cameroon, Central African Republic, Colombia, Côte d'Ivoire, Democratic Republic of the Congo, El Salvador, Ethiopia, Germany, Guatemala, Honduras, Iraq, Malaysia, Mexico, Myanmar, Nigeria, Pakistan, Peru, Philippines, Somalia, South Africa, South Sudan, Sudan, Syrian Arab Republic, Thailand, Turkey, Uganda, United States of America, Venezuela (Bolivarian Republic of), World

CHAPTER 1 Introduction

The world now has a population of 70.8 million forcibly displaced people

Over the past decade, the global population of forcibly displaced people grew substantially from 43.3 million in 2009 to 70.8 million in 2018, reaching a record high [Figure 1].6 Most of this increase was between 2012 and 2015, driven mainly by the Syrian conflict. But conflicts in other areas also contributed to this rise, including in the Middle East such as in Iraq and Yemen, parts of sub-Saharan Africa such as the Democratic Republic of the Congo (DRC) and South Sudan, as well as the massive flow of Rohingya refugees to Bangladesh at the end of 2017.

Of particular note in 2018 was the increase in the number of displaced people due to internal displacement in Ethiopia and new asylum claims from people fleeing the Bolivarian Republic of Venezuela. The proportion of the world’s population who were displaced also continued to rise as the increase in the world’s forcibly displaced population outstripped global population growth. In 2017 this figure was 1 out of every 110 people but in 2018 it stood at 1 out of every 108 people.7 A decade ago, by comparison, this stood at about 1 in 160 people [Figure 2]. Overall, the refugee population under UNHCR’s mandate has nearly doubled since 2012.

Large numbers of people were on the move in 2018. During the year, 13.6 million people were newly displaced, including 2.8 million who sought protection abroad (as new asylum-seekers or newly registered refugees)8 and 10.8 million who were forced to flee but remained in their own countries.9 These 13.6 million new displacements equated to an average rate of 37,000 people being newly displaced every day of 2018 [Figure 3].

Still, many others returned to their countries or areas of origin to try to rebuild their lives, including 2.3 million internally displaced people and nearly 600,000 refugees.
At 1,560,800, Ethiopians made up the largest newly displaced population during the year, 98 per cent of them within their country. This increase more than doubled the existing internally displaced population in the country.

Syrians were the next largest newly displaced population, with 889,400 people during 2018. Of these, 632,700 were newly displaced (or newly registered) outside the country,10 while the remainder were internally displaced. Nigeria also had a high number of newly displaced people with 661,800, of which an estimated 581,800 were displaced within the country’s borders.
Among those newly displaced across borders (or newly registered), the vast majority remained close to home. Over half a million new refugee registrations and asylum applications originated from the Syrian Arab Republic (Syria) in 2018, the majority in Turkey [Figure 4], representing both newly arriving individuals and those already in the country for a period of time prior to the time of registration. Venezuelans accounted for the second largest flow of new international displacements in 2018, with 341,800 new asylum applications (see page 24 for more details on the Venezuela situation). South Sudanese accounted for the next largest refugee and asylum-seeker flow, mainly to Sudan and Uganda, followed by such flows from DRC, also mainly to Uganda.

At the end of 2018, Syrians continued to be the largest forcibly displaced population, with 13.0 million people living in displacement, including 6,654,000 refugees, 6,184,000 internally displaced people (IDPs) and 140,000 asylumseekers. Colombians were the second largest group, with 8.0 million forcibly displaced, most of them (98 per cent) inside their country at the end of 2018.11 A total of 5.4 million Congolese from DRC were also forcibly displaced, of whom 4,517,000 were IDPs and 854,000 were refugees or asylumseekers.

Other large displaced populations at the end of 2018 – those with over 2.0 million people displaced, either internally or as refugees or asylum-seekers – were from Afghanistan (5.1 million), South Sudan (4.2 million), Somalia (3.7 million), Ethiopia (2.8 million), Sudan (2.7 million),
Nigeria (2.5 million), Iraq (2.4 million) and Yemen (2.2 million).

The situation in Cameroon was complex as it was both a source country and host country of refugees and asylum-seekers. In addition, it was confronted with multiple internal displacements in 2018. In total, there were 45,100 Cameroonian refugees globally at the end of 2018; they were mainly hosted by Nigeria (32,800), compared with less than 100 in that country at the beginning of the year. This is in addition to 668,500 IDPs, mainly within the South, North West and the Far North regions of Cameroon. At the same time, Cameroon hosted 380,300 refugees, mainly from the Central African Republic (CAR) (275,700) and Nigeria (102,300).

Without the protection of family, unaccompanied and separated children are often at risk of exploitation and abuse. A key issue is the lack of information and data regarding this population. The number of such children reported as having applied for asylum during 2018 was 27,600 during the year. At the end of 2018, 111,000 unaccompanied and separated children were reported among the refugee population.12 These figures are underestimates due to the limited number of countries reporting data.

Returns continued to account for a small proportion of the displaced population and did not offset new displacements. Some 593,800 refugees returned to their countries of origin in 2018 compared with 667,400 in 2017, less than 3 per cent of the refugee population. In addition, 2.3 million IDPs returned in 2018, compared with 4.2 million in 2017. In some cases, refugees and IDPs went back to situations where conditions did not permit safe and sustainable returns. Resettlement provided a solution for close to 92,400 refugees.

In 2018, the Expert Group on Refugee and IDP Statistics (EGRIS) presented the results of its work at the 49th session of the UN Statistical Commission. Established in 2016 by the Commission, EGRIS is tasked with addressing challenges associated with the collection, compilation and dissemination of statistics on refugees, asylum-seekers and IDPs, including the lack of consistent terminology and difficulties in comparing statistics internationally.

The Commission:
- endorsed the International Recommendations on Refugee Statistics;
- endorsed the Technical Report on Statistics of IDPs and supported the proposal to upgrade this work to develop formal recommendations; and
- reaffirmed the mandate to develop a compiler’s manual on refugee and IDP statistics to provide hands-on guidance for the recommendations.

In addition to the 40 countries that took part in the EGRIS and those that had also contributed through the global consultations in 2017, several country representatives took the floor at the Statistical Commission to welcome this work.

Certain elements of the work received particular support such as focusing on the importance of coordination and the central role of national statistical offices, as well as including the potential of different data sources and methodologies within the recommendations.

World: Jesuit Refugee Service Annual Report 2018

Source: Jesuit Refugee Service
Country: Afghanistan, Bangladesh, Burundi, Central African Republic, Colombia, Democratic Republic of the Congo, Ecuador, El Salvador, Eritrea, Ethiopia, Greece, Guatemala, Honduras, Iraq, Malawi, Mexico, Myanmar, Nigeria...

World: Global Price Watch: April 2019 Prices (May 31, 2019)

Source: Famine Early Warning System Network
Country: Afghanistan, Argentina, Benin, Burkina Faso, Chad, Costa Rica, Democratic Republic of the Congo, El Salvador, Ethiopia, Guatemala, Haiti, Honduras, Kenya, Madagascar, Malawi, Mali, Mexico, Mozambique...

World: The Aid in Danger Monthly News Brief, April 2019

Source: Insecurity Insight
Country: Afghanistan, Burkina Faso, Burundi, Cameroon, Central African Republic, Democratic Republic of the Congo, Dominican Republic, Egypt, Greece, Guatemala, Haiti, Italy, Kenya, Libya, Mali, Malta, Mexico, Mozambique, Mya...

World: Global Price Watch: March 2019 Prices (April 30, 2019)

Source: Famine Early Warning System Network
Country: Afghanistan, Democratic Republic of the Congo, Ethiopia, Guatemala, Haiti, Kazakhstan, Kenya, Madagascar, Malawi, Mali, Mexico, Mozambique, Nicaragua, Niger, Nigeria, Pakistan, Somalia, South Africa,...

World: Aid Workers Kidnapped 2018

Source: Insecurity Insight
Country: Afghanistan, Burkina Faso, Cambodia, Central African Republic, Chad, Democratic Republic of the Congo, Guatemala, Kenya, Libya, Mali, Mexico, Niger, Nigeria, Peru, Philippines, Somalia, South Sudan, Syrian Arab Republic, Uganda, United Republic of Tanzania, World, Yemen

Kidnapping data trends

• The number of kidnappings and individual aid workers who were kidnapped peaked in April 2018. July, August and September also recorded high numbers of kidnappings.

• Between February and May, 36 aid workers were kidnapped while travelling in Central and Western Equatoria states in South Sudan. Many incidents occurred when agencies entered previously inaccessible areas where there have been reports of conflict parties accusing aid workers of spying.

• During July and August, 20 aid workers were kidnapped in eastern DRC by armed groups that included the Forces Démocratiques de Libération du Rwanda and Mai-Mai.

• In September, 13 Yemeni aid workers were kidnapped by Al-Qaeda in the Arabian Peninsula militants in Dhale governorate, Yemen. They were freed after local tribal leaders negotiated their release.

• 71 aid workers in Tanzania, Mali, Yemen and South Sudan were released following their abduction, while seven aid workers were killed or tortured by their abductors while in captivity in Afghanistan, CAR, the DRC and Nigeria.

• In the DRC, unidentified gunmen kidnapped three aid workers in North Kivu, two of whom were found dead the following day, while the third was released after two days. In Afghanistan, opposition forces kidnapped and killed one aid worker in Kunduz. In Nigeria, ISIS militants executed two aid workers following their abduction; three others were killed in the initial attack and one aid worker remains in captivity. In CAR, two local aid workers were abducted and tortured allegedly by anti-Balaka fighters while providing vaccinations in Haute-Kotto prefecture.

• Six aid workers were held hostage in Tanzania and Uganda. In Tanzania, casual labourers held five aid workers hostage to enforce their demands for payment for work completed. All were released after several hours of negotiations.

• Ransom demands were made for the release of six aid workers in CAR and the DRC. Five Congolese aid workers were abducted by armed men while travelling in the DRC. Two others were kidnapped and assaulted in the attack, but were released unconditionally. One aid worker was held for three days by members of the Front Populaire pour la Renaissance de Centrafrique in CAR. The aid worker was released after a ransom was paid; it is not clear who paid the ransom.

• Four aid workers were the victims of 'express kidnappings' in Kenya, Peru and Tanzania and forced to withdraw money from ATMs for their release. The aid worker in Kenya was also drugged and the one in Peru was physically assaulted.

• Nearly 50% of kidnapped aid workers are either still in captivity or their status is unknown. Seven are reported as missing in the DRC, Burkina Faso, Cambodia and Guatemala. The lack of precise information on what happened to aid workers following their abduction in Afghanistan, Somalia and Syria means that our overall understanding of the kidnapping threats facing aid workers in these countries remains incomplete.

World: Alert Spring 2019 | Vol. 20 No. 1 – No Health Without Mental Health – Providing Psychological Care in Emergencies Around the World

Source: Médecins Sans Frontières
Country: Afghanistan, Democratic Republic of the Congo, Greece, Guatemala, Honduras, Iraq, Liberia, Mexico, South Sudan, Syrian Arab Republic, Uganda, World

lert is a quarterly magazine published by Doctors Without Borders/Médecins Sans Frontières (MSF-USA) that features compelling stories and photography from our work in the field. Below is an excerpt from MSF-USA Board President John P. Lawrence's introduction to the Spring 2019 issue (Vol 20. No. 1.), No Health Without Mental Health.

Dear Friends,

I will never forget the experience of helping to respond to the devastating earthquake in Haiti in 2010. As a surgeon working with Doctors Without Borders/ Médecins Sans Frontières (MSF), I was particularly impressed by the integration of mental health care within our programs. As our surgical team made the morning rounds in the hospital wards, we would be followed by colleagues with expertise in delivering mental health services.

In Haiti, I saw that the devastating physical wounds patients were recovering from had clear psychological counterparts—whether a person was coping with the prospect of life after amputation, the loss of family members or friends, or reliving the horrors of the earthquake with each nerve-shattering aftershock.
While the surgical care we provided was a critical aspect of the healing process for survivors, their longterm well-being was entirely dependent on therapy directed to the emotional and psychological traumas they had endured.

This issue of Alert focuses on MSF’s varied responses to mental health needs. While mental health is gaining recognition as a unique medical field requiring greater attention, it remains insufficiently resourced.
As a medical humanitarian organization, MSF has had a longstanding commitment to addressing mental health needs, both as an independent service as well as part of more comprehensive care.

The importance of providing mental health support was also apparent while I was working with MSF in North Kivu province in the eastern part of Democratic Republic of Congo (DRC). This region—which is currently in the grips of an Ebola epidemic—has suffered from chronic conflict for decades, including extreme violence directed against civilians by various armed groups.
A feature of this pervasive violence is a high incidence of rape and sexual assault.

A separate unit in the hospital where I worked was devoted to caring for pregnant women who had been raped. This unit closely integrated prenatal maternal physical care with psychological supportive care.
MSF recognized the duality of health needs for both the mind and body and provided a comprehensive approach to caring for these women and preparing them to return home.

In this issue, we share the stories of survivors from a surge of conflict in DRC’s Kasai region. Over the course of a year and a half—between May 2017 and September 2018—our teams treated 2,600 victims of sexual violence at the Kananga provincial hospital. The vast majority of the victims were women. They describe horrific acts of violence, and the difficulties of healing after the attacks.
Mental health services are also often the central focus of the medical care our projects provide. For people traversing migration routes from Central America through Mexico, medical clinics supported by MSF are resourced to provide supportive mental health services and psychological first aid to help people cope with both the violence they fled in their home countries and that which they face during their journeys.

I hope you will appreciate the story about our innovative program to support community-based mental health care and outreach services in Liberia, a country whose health system is still recovering from the devastating Ebola epidemic that struck West Africa in 2014. Our last Ebola-related projects in Liberia were survivor clinics that offered care for people who continued to have physical and psychosocial issues after recovering from the disease.

When the mental health team began looking for services where they could refer patients, they learned that there was only one practicing psychiatrist in Liberia—a country with more than 4.7 million people.
This is what prompted MSF to conduct an assessment of the mental health needs in Liberia and ultimately partner with the Ministry of Health to improve and grow their services.

Finally, as explored in these pages, mental health care is not only critical for our patients, but also for our staff members. The stress of providing humanitarian care is well recognized. As an institution, MSF appreciates that we have an obligation not only to protect our employees’ physical health and security as best we can, but to ensure that their mental well-being is also prioritized.
Thank you for all that you do to support our work to provide comprehensive care for people in extreme situations.


John P. Lawrence,
MD President, MSF-USA Board of Directors

World: Global Price Watch: February 2019 Prices (March 31, 2019)

Source: Famine Early Warning System Network
Country: Afghanistan, Chad, Democratic Republic of the Congo, Ethiopia, Guatemala, Haiti, Kazakhstan, Kenya, Madagascar, Malawi, Mali, Mexico, Mozambique, Nicaragua, Niger, Nigeria, Pakistan, Somalia, South A...

World: The Aid in Danger Monthly News Brief, February 2019

Source: Insecurity Insight
Country: Afghanistan, Burkina Faso, Central African Republic, Chad, Democratic Republic of the Congo, Haiti, Iraq, Kenya, Lebanon, Mali, Mexico, Myanmar, Nigeria, occupied Palestinian territory, Pakistan, Somalia, South Sudan, Sudan, Syrian Arab Republic, Venezuela (Bolivarian Republic of), World, Yemen


Central African Republic

07 - 10 February 2019: In Kaga Bandoro region, Nana Gribizi prefecture, the outbreak of fires in close proximity to an IDP site left 31 people injured and resulted in shelters and personal items being damaged, as well as a resulting in the partial destruction of a mobile clinic. An estimated 4,500 people were affected by the fires, resulting in humanitarian agencies in Kaga Bandoro planning a renewed push to provide non-food items, health care, food, water, sanitation, hygiene, and education. Further, humanitarian agencies began drive to inform IDP protectors about fire prevention in the area. Source: UN-OCHA

Burkina Faso

02 February 2019: In Kongoussi region, militants presumed to be from Ansaroul Islam (JNIM) attacked and stole a Burkina Faso Red Cross vehicle, abducting its four passengers and driver in the process. Source: ACLED1


19 February 2019: In Ngouboua locality, Lac region, armed assailants entered the Bouraboura IDP camp - home to over 1,000 displaced people - and opened fire, killing five and wounding four others. A further attack targeted a village home to around 365 displaced people, and where four people were abducted. There is limited security in the region and an upsurge in violence in neighbouring Nigeria has led to large numbers of civilians fleeing across the border into Chad. Source: UN-OCHA

Democratic Republic of Congo

24 February 2019: In Katwa town, North Kivu province, an area where mistrust in international aid efforts and false rumours about treatment are rampant, unidentified perpetrators threw stones at an MSF-run Ebola treatment centre before setting parts of the structure on fire, killing one person, and injuring another. In response, MSF suspended its operations in the area. Sources: ABC News, Africa News, Axios, Devex, IRIN, MSF, Reuters, Time, The Guardian, The Telegraph, The Washington Times and VOA News

27 February 2019: In Butembo city, North Kivu province, an area where mistrust in aid workers and false rumours about treatment are rampant, unidentified perpetrators set vehicles and parts of an MSF-run Ebola treatment centre on fire, destroying medical wards and equipment, and leaving four patients missing. This attack has also put the lives of patients and MSF and Health Ministry staff in danger. In response, MSF suspended its operations in the area. Sources: Axios, CIDRAP, Devex,
IRIN, MSF, Reuters, Time, The Guardian and The Washington Times


22 February 2019: Update: In Chakama village, Kilifi county, villagers and security forces have suggested that an Italian aid worker who was abducted by suspected al Shabaab-linked perpetrators on 21 November 2018 may have been involved in a multimillion shilling ivory trade and kidnapped after her partners soured on the deal. Source: Esoft


15 February 2019: In Bourem district, Gao region, two armed individuals abducted a team of aid workers before releasing them the following day, taking their vehicle and personal belongings in the process. No harm was reported to have come to the aid workers. Source: UN-OCHA


28 January 2019: In Rann town, Borno state, Boko Haram militants on motorcycles attacked and set fire to hundreds of structures serving as shelters for IDPs, killing at least 60 people. Source:
News 24 February 2019: In Bama locality, Borno state, large population displacements have resulted in an unspecified IDP camp becoming overwhelmed with newly displaced people, local schools being unable to cope with the numbers of children, and poor living conditions for camp occupants. Source: UN-OCHA 07 February 2019: In Monguno town, Borno state, an outbreak of fire at the Stadium IDP camp left two children and one elderly person dead, five others with burn injuries, and a total of 7,839 having been directly affected through the destruction of their homes and property, including valuables and food. The fire had allegedly started from a cooking area in the camp. Local agencies responded by attempting to increase awareness on fire outbreak risks and mitigation. Source: UN-OCHA


28 February 2019: In Gedo region, suspected al Shabaab militants kidnapped six national aid workers. Around ten people were initially reported kidnapped but some of the group successfully escaped the kidnappers to alert authorities. Source: AWSD2 and BBC News

South Sudan

02 February 2019: In Bor town, Jonglei state, four unidentified perpetrators assaulted a male South Sudanese national UN staff member after blaming him for the perceived increase in the number of non-national staff members in the country 'stealing jobs' from nationals, leaving him with minor injuries. Source: AWSD2 21 February 2019: In Bor town, Jonglei state, a staff member from an INGO who was distributing food inside the UN-run Protection of Civilians site was assaulted by an IDP under unspecified circumstances. The staff member received minor injuries. Source: AWSD2


08 February 2019: In North Darfur state, a group of government-backed militiamen attempted to rape nine women in the Kassab IDP camp. The women fought back and four were seriously wounded due to stabbing injuries and were treated in hospital. Source: ACLED1 09 February 2019: In Abyei region, an Ethiopian military helicopter crashed inside the compound of the UN Peacekeeping Mission, killing all three passengers on board, and injuring 10 more.
Source: ANN 14 February 2019: In North Darfur state, a protest was held at the Zamzam IDP camp to demonstrate against the rape of five women the previous week as well as in opposition to the rule of President Bashir. The security forces responded by violently suppressing the protest with tear gas and batons. Sources: ACLED1 and Star Tribune

World: CrisisWatch February 2019

Source: International Crisis Group
Country: Afghanistan, Aland Islands (Finland), Angola, Armenia, Azerbaijan, Bangladesh, Bosnia and Herzegovina, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Colombia, Côte d'Ivoire, Democratic People's Republic of Korea, Democratic Republic of the Congo, Egypt, El Salvador, Eritrea, Ethiopia, Gabon, Georgia, Guatemala, Guinea, Guinea-Bissau, Haiti, Honduras, India, Indonesia, Iran (Islamic Republic of), Iraq, Jordan, Kenya, Lebanon, Liberia, Libya, Madagascar, Mali, Mauritania, Mexico, Morocco, Mozambique, Myanmar, Nepal, Nicaragua, Niger, Nigeria, occupied Palestinian territory, Pakistan, Philippines, Rwanda, Senegal, Somalia, South Sudan, Sri Lanka, Syrian Arab Republic, Thailand, the Republic of North Macedonia, Tunisia, Turkey, Uganda, Ukraine, United Republic of Tanzania, Venezuela (Bolivarian Republic of), Western Sahara, World, Yemen, Zambia, Zimbabwe

Global Overview

February saw a dangerous escalation between India and Pakistan. In Yemen, the warring parties took a small step to cement a ceasefire in Hodeida, but a breakdown of talks could trigger new clashes. Fighting in Libya’s south intensified and could worsen, and Chad called in French airstrikes to halt a rebel advance. Al-Shabaab stepped up deadly attacks in Somalia, and in South Sudan a government offensive against rebels in the south is picking up steam. Sudan’s President al-Bashir took a harder line against persistent protests. Suspected jihadists stepped up attacks in Burkina Faso; violence escalated in Cameroon’s Anglophone region; and Angola’s separatists announced a return to arms. In Nigeria, election-related violence rose and could flare again around polls to elect governors in March, while there are growing concerns around Ukraine’s upcoming presidential vote. The confrontation hardened between Venezuelan President Maduro and opposition leader Juan Guaidó. In Haiti, anti-government protests turned violent. U.S.-Russia relations deteriorated further in a worrying development for the future of arms control. On a positive note, Taliban and U.S. officials resumed talks on a deal for Afghanistan, negotiations aimed at ending the Western Sahara conflict are planned for March, and Nicaragua’s government resumed dialogue with opposition leaders, raising hopes for an end to the political crisis.

World: Global Price Watch: January 2019 Prices (February 28, 2019)

Source: Famine Early Warning System Network
Country: Afghanistan, Chad, Ethiopia, Guatemala, Haiti, Kazakhstan, Kenya, Mali, Mexico, Nicaragua, Niger, Nigeria, Pakistan, Senegal, Somalia, South Africa, South Sudan, Sudan, Tajikistan, Uganda, World, Yem...

World: Commission Implementing Decision of 11.1.2019 on the financing of humanitarian aid actions from the 2019 general budget of the European Union – ECHO/WWD/BUD/2019/01000

Source: European Commission's Directorate-General for European Civil Protection and Humanitarian Aid Operations
Country: Afghanistan, Algeria, Angola, Bangladesh, Belize, Benin, Bhutan, Bolivia (Plurinational State of), Botswana, Burkina Faso, Burundi, Cabo Verde, Cameroon, Central African Republic, Chad, China, Colombia, Comoros, Congo, Costa Rica, Côte d'Ivoire, Democratic People's Republic of Korea, Democratic Republic of the Congo, Djibouti, Ecuador, Egypt, El Salvador, Equatorial Guinea, Eritrea, Eswatini, Ethiopia, Gabon, Gambia, Ghana, Guatemala, Guinea, Guinea-Bissau, Haiti, Honduras, India, Iran (Islamic Republic of), Iraq, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Lebanon, Lesotho, Liberia, Libya, Madagascar, Maldives, Mali, Mauritania, Mauritius, Mexico, Mongolia, Morocco, Mozambique, Myanmar, Namibia, Nepal, Nicaragua, Niger, Nigeria, occupied Palestinian territory, Pakistan, Panama, Paraguay, Peru, Philippines, Rwanda, Sao Tome and Principe, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sri Lanka, Sudan, Syrian Arab Republic, Tajikistan, Thailand, Timor-Leste, Togo, Tunisia, Turkey, Turkmenistan, Uganda, Ukraine, United Republic of Tanzania, Uzbekistan, Venezuela (Bolivarian Republic of), World, Yemen, Zambia, Zimbabwe


Having regard to the Treaty on the Functioning of the European Union,

Having regard to Regulation (EU, Euratom) 2018/1046 of the European Parliament and of the Council of 18 July 2018 on the financial rules applicable to the general budget of the Union, amending Regulations (EU) No 1296/2013, (EU) No 1301/2013, (EU) No 1303/2013, (EU)
No 1304/2013, (EU) No 1309/2013, (EU) No 1316/2013, (EU) No 223/2014, (EU) No 283/2014, and Decision No 541/2014/EU and repealing Regulation (EU, Euratom) No 966/20121 , and in particular Article 110 thereof,

Having regard to Council Regulation (EC) No 1257/96 of 20 June 1996 concerning humanitarian aid2 ('the Humanitarian Aid Regulation' or 'HAR'), and in particular Article 1,

Article 2, Article 4 and Article 15(2) and (3) thereof,

Having regard to Council Decision 2013/755/EU of 25 November 2013 on the association of the overseas countries and territories with the European Union ('the Overseas Association Decision')3 , and in particular Article 79 thereof,


(1) In order to ensure the implementation of the humanitarian aid actions of the Union for 2019, it is necessary to adopt an annual financing decision for 2019. Article 110 of Regulation (EU, Euratom) 2018/1046 (‘the Financial Regulation’) establishes detailed rules on financing decisions.

(2) The human and economic losses caused by natural disasters are devastating. These natural disasters, be they sudden or slow onset, that entail major loss of life, physical and psychological or social suffering or material damage, are constantly increasing, and with them so is the number of victims. Man-made humanitarian crises, resulting from wars or outbreaks of fighting (also called complex or protracted crises) account for a large proportion of, and are, the main source of humanitarian needs in the world.
There is also a need for international support for preparedness activities. Disaster preparedness aims at reducing the impact of disasters and crises on populations, allowing early warning and early action to better assist those affected.

(3) The humanitarian aid funded under this Decision should also cover essential activities and support services to humanitarian organisations as referred to in Articles 2(c) and 4 HAR, including notably the protection of humanitarian goods and personnel.

(4) The Union became party to the Food Assistance Convention on 28 November 2012; the Convention entered into force on 1 January 2013. In accordance with Article 5 of the Convention, an amount of EUR 350 000 000, to be spent as food and nutrition assistance funded under this Decision, is to be counted towards the minimum annual commitment for the year 2019 of the Union under the Food Assistance Convention.

(5) Although as a general rule grants funded by this Decision should be co-financed, by way of derogation, the Authorising Officer in accordance with Article 190(3) of the Financial Regulation, may agree to their full financing.

(6) The envisaged assistance is to comply with the conditions and procedures set out by the restrictive measures adopted pursuant to Article 215 TFEU. The needs-based and impartial nature of humanitarian aid implies that the Union may be called to finance humanitarian assistance in crises and countries covered by Union restrictive measures.
In such situations, and in keeping with the relevant principles of international law and with the principles of impartiality, neutrality and non-discrimination referred to in Article 214(2) of the Treaty on the Functioning of the European Union, the Union should allow and facilitate rapid and unimpeded access to humanitarian relief by civilians in need. The relevant Union restrictive measures should therefore be interpreted and implemented in such a manner as not to preclude the delivery of humanitarian assistance to the intended beneficiaries.

(7) The Commission may acknowledge and accept contributions from other donors in accordance with Article 21(2)(b) of the Financial Regulation, subject to the signing of the relevant agreement. Where such contributions are not denominated in euro, a reasonable estimate of conversion should be made.

(8) It is advisable to maintain a part of the Union budget for humanitarian aid unallocated in order to cover unforeseen operations, as part of an operational reserve.

(9) In cases where Union funding is granted to non-governmental organisations in accordance with Article 7 HAR, in order to guarantee that the beneficiaries of that funding are able to meet their commitments in the long term, the Authorising Officer responsible should verify if the non-governmental organisations concerned satisfy the requisite eligibility and selection criteria, notably as regards their legal, operational and financial capacity. The verification to be made should also seek to confirm whether the non-governmental organisations concerned are able to provide humanitarian aid in accordance with the humanitarian principles set out in the European Consensus on Humanitarian Aid4 .

(10) In cases where the Union finances humanitarian aid operations of Member States' specialised agencies in accordance with Article 9 HAR, in order to guarantee that the beneficiaries of Union grants are capable of fulfilling their commitments in the long run, the Authorising Officer responsible should verify the legal, operational and, where the entities or bodies concerned are governed by private law, financial capacity of any Member States' specialised agencies desiring to receive financial support under this Decision. The verification to be made should notably seek to confirm whether the Member States' specialised agencies concerned are able to provide humanitarian assistance or equivalent international relief outside the Union in accordance with the humanitarian principles set out in the European Consensus on Humanitarian Aid.

(11) Pursuant to Article 195(a) Financial Regulation, it is appropriate to authorise the award of grants without a call for proposals to the non-governmental organisations satisfying the eligibility and suitability criteria referred to in Article 7 HAR for the purpose of humanitarian aid.

(12) In order to ensure an effective delivery in the field of Union-funded humanitarian aid in all relevant crisis contexts while taking into account the specific mandates of international organisations, such as the United Nations and the international component of the Red Cross and Red Crescent movement (International Committee of the Red Cross and International Federation of Red Cross and Red Crescent Societies), it is necessary to use indirect management for the implementation of Union-funded humanitarian aid operations.

(13) The Commission is to ensure a level of protection of the financial interests of the Union with regards to entities and persons entrusted with the implementation of Union funds by indirect management as provided for in Article 154(3) of the Financial Regulation. To this end, such entities and persons are to be subject to an assessment of their systems and procedures in accordance with Article 154(4) of the Financial Regulationand, if necessary, to appropriate supervisory measures in accordance with Article 154(5) of the Financial Regulation before a contribution agreement can be signed.

(14) It is necessary to allow for the payment of interest due for late payment on the basis of Article 116(5) Financial Regulation.

(15) It is appropriate to reserve appropriations for a trust fund in accordance with Article 234 Financial Regulation in order to strengthen the international role of the Union in external actions and development and to increase its visibility and efficiency.

(16) In order to allow for flexibility in the implementation of the financing decision, it is appropriate to define the term 'substantial change' within the meaning of Article 110(5) of the Financial Regulation.

(17) The measures provided for in this Decision are in accordance with the opinion of the Humanitarian Aid Committee established by Article 17(1) HAR.

World: CrisisWatch January 2019

Source: International Crisis Group
Country: Afghanistan, Bangladesh, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Colombia, Democratic Republic of the Congo, Egypt, Eritrea, Ethiopia, Guatemala, Guinea, Haiti, Honduras, India, Indon...

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