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Dire health and humanitarian crisis in eastern Democratic Republic of the Congo prompts escalation of efforts by WHO, partners
The recent surge in violence in the eastern Democratic Republic of the Congo has led to significant loss of life, trauma, displacement, and the destruction of critical health infrastructure, exacerbating an already dire situation for millions of people.
The situation remains tense and volatile, and the health needs are immense. WHO remains on the ground, and has continued to respond to the health needs by providing lifesaving medical supplies, supporting health workers, and coordinating the emergency response.
Hospitals and morgues are overwhelmed. Since 26 January, 3082 injured and 843 dead have been reported from 31 health facilities in and around Goma, North Kivu.
With the alarming expansion of violence further south, 65 injuries were reported from 3 hospitals in South Kivu.
These numbers are expected to rise further as more injured people are able to reach health facilities and more dead bodies are gathered off the streets. Wound infections are a risk for those who have not been able to reach health care facilities quickly, and as health facilities are running out of supplies they need to clean and disinfect.
The sight of bodies lying uncared for is distressing. Though the bodies of people who have died from injury do not generally carry or spread disease, it is the right of the dead to be identified and receive proper burial, and important for the living to know their loved ones have received this care.
Over 70 (or 6%) of the health facilities in North Kivu have been affected, with some completely destroyed and others struggling to restart operations. Some ambulances have also been damaged. A WHO-supported health clinic in North Kivu was temporarily occupied by armed groups. Health workers have had to flee in places, while in others, they have been working round the clock for days, with limited resources and overwhelming demand, and sometimes at risk to their own lives.
Cancer, diabetes, hypertension, mental health and other routine services are also affected as medicines have run out and health workers are either absent or overburdened.
The risk of death during pregnancy and childbirth has increased from already high levels. Given the insecurity, pregnant women cannot reach health facilities for safe delivery. Experience with conflict in the region has shown the drastic effect it has, with the rate of births attended to by skilled health workers dropping to near zero during periods of intense violence.
The threat of infectious diseases has multiplied. Cholera, malaria, measles, meningitis, mpox and tuberculosis are among the infectious threats in the area. The water supply in Goma was disrupted and has only partially resumed, leading people to use water from the lake, and heightening the risk of cholera spread. Close to 600 suspected cases of cholera and 14 deaths were reported from North Kivu between 1 and 27 January.
Eastern Democratic Republic of the Congo, especially South Kivu province, is the epicentre of the mpox outbreak that prompted the WHO Director-General to declare a public health emergency of international concern last August. The mpox response is heavily impacted. Ninety percent of the mpox patients (128 of 143) in isolation units in Goma had fled for safety, making it nearly impossible to provide them with care, and increasing the risk of spread.
One in four people in the region was already facing emergency levels of hunger, with the recent violence expected to worsen the situation. Malnutrition and disease go hand-in-hand: malnourished people are less able to fight disease, while disease leads to further malnutrition. This vicious circle is especially concerning when it comes to children, and pregnant and breastfeeding women.
Goma was home to over 2 million people, including 700 000 people displaced by this crisis. These people have had to flee yet again, in search of safety. They are in temporary settlements, with their health and safety at risk.
A rapid assessment of 10 healthcare facilities in and around Goma showed a concerning rise in rape and other gender-based violence: there were 45 cases reported among the displaced, and 21 survivors of gang-rape admitted to two hospitals. These numbers are only the tip of the iceberg. These patients require medical care, psychological support, and support with maintaining their livelihood, especially when they are the sole providers for their families.
WHO has deployed emergency medical supplies, hygiene and water treatment supplies, and tents to increase hospital capacity by 1000 beds. Supplies are being depleted rapidly, and more resources are urgently needed.
WHO is preparing further deliveries as part a European Civil Protection and Humanitarian Aid Operations (ECHO)-led effort to fly in critical supplies. For this, the Goma airport, a critical lifeline, must be urgently reopened. WHO is also exploring options to deliver critical supplies through other routes.
WHO and partners were able to resume mpox vaccination in Goma on Wednesday, 5 February after a 10 day pause.
The United States’ recent decision to freeze foreign aid is significantly impacting relief efforts in the Democratic Republic of the Congo. Last year, the US contributed to as much as 70% of the country’s humanitarian response. Additionally, the US is a major funder of the mpox response, and has pledged a million vaccine doses of its own stock to global efforts. While WHO’s humanitarian response in the region relies on funding from other donors—including the European Union, United Kingdom and the WHO’s Contingency Fund for Emergencies—reductions in overall aid will have repercussions on people’s health.
To meet immediate health needs in eastern Democratic Republic of the Congo, including for safe and dignified burials, WHO has spent US$ 600 000. The overall response requires US$ 50 million.
WHO calls for humanitarian access, the protection of health workers and facilities, and an end to attacks on health care. Health facilities, supplies, workers and patients should be protected. Ultimately, we call for peace, and an end to the unimaginable and long suffering of the people in this region.
Strengthening alliances and building movements to end female genital mutilation
Female genital mutilation is a violation of human rights that inflicts deep and lifelong physical, emotional and psychological scars on girls and women. This harmful practice affects more than 230 million girls and women today. An estimated 27 million more girls could endure this violation of their rights and dignity by 2030 if we do not take action now.
Today, on the International Day of Zero Tolerance for Female Genital Mutilation, and in response to the theme "Stepping up the pace: Strengthening alliances and building movements to end female genital mutilation", UNFPA, UNICEF and WHO reaffirm our commitment to work together with countries and communities to end this harmful practice – once and for all.
There is hope. Many countries have seen a decline in the prevalence of female genital mutilation. We are witnessing progress in countries like Kenya and Uganda, where collaborative action and community-led initiatives are proving that by strengthening alliances and building movements, we can accelerate change.
Since the launch of the UNFPA-UNICEF Joint Programme on the Elimination of Female Genital Mutilation in 2008, and in collaboration with WHO, close to 7 million girls and women access prevention and protection services. Additionally, 48 million people have made public declarations to abandon the practice, and 220 million individuals were reached by mass media messaging on the issue. In the last two years, close to 12 000 grassroots organizations and 112 000 community and frontline workers galvanized to effect change at this critical juncture.
Yet the fragility of progress made has also become starkly evident. In the Gambia, for example, attempts to repeal the ban on female genital mutilation persist, even after an initial proposal to do so was rejected by its parliament last year. Such efforts could gravely undermine the rights, health and dignity of future generations of girls and women, jeopardizing the tireless work over decades to change attitudes and mobilize communities.
Of the 31 countries in which data on prevalence are collected nationally, only seven countries are on track to meet the Sustainable Development Goal of ending female genital mutilation by or before 2030. The current rate of progress must accelerate urgently to meet this target.
This requires strengthened alliances among leaders, grassroots organizations and across sectors spanning health, education and social protection – as well as sustained advocacy and expanded social movements with girls and survivors at the centre.
It demands greater accountability at all levels to ensure commitments to human rights are upheld and policies and strategies are implemented to protect girls at risk and provide care, including justice, for survivors. It also requires increased investment in scaling up proven interventions. We are indebted to generous donors and partners who are supporting this life-changing work and call on others to join them.
We all have a role to play to ensure that every girl is protected and can live free from harm. Let’s step up the pace and act with urgency. The time to end female genital mutilation is now.
Notes to Editors
About the UNFPA–UNICEF Joint Programme
The UNFPA–UNICEF Joint Programme on the Elimination of Female Genital Mutilation: Delivering the Global Promise works to eliminate female genital mutilation through interventions in 17 countries where the practice is prevalent. The programme creates opportunities for girls and women to realize their rights in health, education, income and equality to help end the power imbalances that underpin this harmful practice.
For further information, please contact:
Eddie Wright, UNFPA New York, Tel: +1 917 831 2974 ewright@unfpa.org
Sara Alhattab | UNICEF New York | +1 917-957-6536 | salhattab@unicef.org
Laura Keenan | WHO, Geneva | keenanl@who.int and mediainquiries@who.int
About UNFPA
UNFPA is the United Nations sexual and reproductive health agency. UNFPA's mission is to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled. UNFPA calls for the realization of reproductive rights for all and supports access to a wide range of sexual and reproductive health services, including voluntary family planning, quality maternal health care and comprehensive sexuality education.
For more information about UNFPA and its work visit: www.unfpa.org
Follow UNFPA on X (Twitter), Facebook, Instagram and YouTube
About UNICEF
UNICEF, the United Nations agency for children, works to protect the rights of every child, everywhere, especially the most disadvantaged children and in the toughest places to reach. Across more than 190 countries and territories, we do whatever it takes to help children survive, thrive, and fulfil their potential.
For more information about UNICEF and its work visit:
Follow UNICEF on X (Twitter), Facebook, Instagram and YouTube
About WHO
Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable.
For more information about WHO and its work visit: www.who.int
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EU Health Task Force stakeholder meeting
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Groundbreaking Ebola vaccination trial launches today in Uganda
In a global first, Uganda’s Ministry of Health, the World Health Organization (WHO) and other partners today launched a first ever vaccine trial for Ebola from the Sudan species of the virus, and at an unprecedented speed for a randomized vaccine trial in an emergency.
The principal investigators from Makerere University and the Uganda Virus Research Institute (UVRI), with support from WHO and other partners, have worked tirelessly to get the trial ready in 4 days since the outbreak was confirmed on 30 January. It is the first trial to assess the clinical efficacy of a vaccine against Ebola disease due to Sudan virus. The speed was achieved through advanced research preparedness, while ensuring full compliance with national and international regulatory and ethical requirements.
The candidate vaccine was donated by IAVI, with financial support from WHO, the Coalition for Epidemic Preparedness Innovations (CEPI), Canada’s International Development Research Centre (IDRC), and the European Commission's Health Emergency Preparedness and Response Authority (HERA) and support from the Africa Centres for Disease Control and Prevention (Africa CDC).
“This is a critical achievement towards better pandemic preparedness, and saving lives when outbreaks occur,” said Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General. “This is possible because of the dedication of Uganda’s health workers, the involvement of communities, the Ministry of Health of Uganda, Makerere University and UVRI, and research efforts led by WHO involving hundreds of scientists through our research and development Filoviruses network. We thank our partners for their dedication and cooperation, from IAVI for donating the vaccine, to CEPI, EU HERA and Canada’s IDRC for funding, and Africa CDC for further support. This massive achievement would simply not be possible without them.”
In 2022, during the previous outbreak of Ebola disease (also from the Sudan species of the virus) in Uganda, a randomized protocol for candidate vaccines was developed. Principal investigators were designated under the leadership of the Minister of Health, and teams were trained to allow such a trial to take place during an active outbreak.
The randomized vaccine trial to assess the recombinant vesicular stomatitis virus (rVSV) candidate vaccine was launched at a ceremony in Kampala today by the Minister of Health of Uganda. WHO is co-sponsoring the trial. WHO was represented by Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme and Deputy Director-General, and the WHO representative to Uganda Dr Kasonde Mwinga, along with other colleagues.
Three vaccination rings were defined today. The first ring involves about 40 contacts and contacts of contacts of the first reported and confirmed case, a health worker who has died.
Although several promising candidate medical countermeasures are progressing through clinical development, as of now, there is no licensed vaccine available to effectively combat a potential future outbreak of Ebola disease from the Sudan species of the virus. Licensed vaccines exist only for the disease caused by Ebola virus, formerly known as Zaïre ebolavirus. Likewise for treatments, approved treatments are only available for Ebola virus.
The vaccine for the trial was recommended by the independent WHO candidate vaccine prioritization working group. If the candidate vaccine is effective, it can contribute to controlling this outbreak and generate data for vaccine licensure.
In 2022, the research teams were trained in good clinical practice (GCP) and standard operating procedures for such trials. They completed refresher training in recent days. WHO colleagues experienced in trials and in ring vaccination arrived in Uganda over the weekend to support the trial implementation and GCP compliance.
The vaccine doses were pre-positioned in the country. WHO worked with the principal investigators and national authorities and the vaccine developer to review cold chain documentation and ensure the doses were stored correctly over the previous years. As part of the signed agreement with the Ministry of Health, WHO has a signed agreement with IAVI for additional doses of the candidate vaccine to be made available shortly.
Notes to editors
The trial is a ring vaccination cluster randomized trial designed to assess the effect of one single, promptly given, dose of the candidate vaccine whose safety and immunogenicity have already been demonstrated in Phase 1, in protecting recent contacts and contacts of contacts of a newly confirmed case of Sudan virus disease (SVD).
Ring vaccination consists of the targeted vaccination of the recent contacts of an index case. It might protect the individual vaccinated or help create a small buffer zone of immunized people that could limit propagation of the infection.
The ring vaccination trial involves a population at increased risk of infection as they have recently been in contact with a case of SVD, so it may well provide useful information about the protection of such case-contacts quickly, within just a few months.
The same study design was used in the Ebola ça suffit trial in Guinea in 2015 by WHO and the Ministry of Health of Guinea to evaluate a now-licensed vaccine against a different species of ebolavirus.
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WHO and partners enable access to candidate vaccine and treatments for outbreak of Sudan Ebola virus disease in Uganda
WHO and partners have immediately boosted their support to the Ugandan government’s response to an outbreak of Sudan virus disease outbreak (SVD, part of the Ebola family), including by facilitating access to a candidate vaccine and candidate treatments. The first 2160 doses of the vaccine candidate and the treatments are already in Kampala, Uganda, as they were prepositioned as part of outbreak preparedness.
The vaccine trial processes underway include orientation of the research teams on the trial procedures, and logistics arrangements. Research teams have been deployed to the field to work along with the surveillance teams as approvals are awaited.
The candidate vaccine and the candidate treatments (a monoclonal antibody and an antiviral) are being made available through clinical trial protocols, which will make it possible to further document their efficacy and safety.
As of 30 January, there was one confirmed case and 45 contacts who are being followed up.
Uganda has experienced five previous SVD outbreaks. The last one was declared in September 2022 and ended in January 2023, with 164 cases and 77 deaths. During that outbreak, a WHO committee of external experts evaluated candidate vaccines and provided recommendations on their suitability for evaluation in Uganda, as part of a clinical trial against the SVD virus.
WHO is working with the Ministry of Health of Uganda and its designated Ugandan Principal Investigators and their teams from Makerere University Lung Institute and the Ugandan Virus Research Institute, as well as worldwide filovirus and trial experts and regulators, to initiate the trials.
The trials were designed via a global collaborative effort coordinated by WHO, that included developers, academic institutions, regulatory authorities, other experts and researchers from Uganda and other countries at risk of filoviruses outbreaks.
The aim of the vaccine trial is to evaluate a potentially efficacious candidate vaccine, and if efficacious, to possibly contribute to ending the ongoing outbreak and protect populations at risk in the future. Those eligible to join the trial are those at highest risk of SVD, i.e. close contacts of a person who has been confirmed to have had SVD or who has died from the disease. The study sites will therefore be the locations where contacts of the case or cases reside. Study teams will be mobile and able to rapidly move to these areas to do their work using the ring vaccination approach.
WHO is working with the Ministry of Health and with Makerere University Lung Institute and the Ugandan Virus Research Institute, who will lead the trials’ implementation.
The development of the protocols and research priorities has been done via the MARVAC Consortium and the Collaborative Open Research Consortium (CORC) for the Filoviridae Family, and numerous developers facilitated the availability of the candidate vaccine and treatments: IAVI provided their candidate Sudan vaccine, Gilead provided remdesivir, an antiviral.
Among those supporting the trials’ implementation are the Coalition for Epidemic Preparedness Innovations (CEPI), the Africa Centres for Disease Control and Prevention, Canada’s International Development Research Centre, the European Commission's Health Emergency Preparedness and Response Authority (HERA) and WHO. This rapid action is the result of tireless efforts to build international cooperation on research, innovation and evaluation and deployment of countermeasures in the face of dangerous pathogens.
While outbreaks of SVD are controllable without vaccines, control can be achieved more quickly using safe and effective vaccines. In the meantime, a comprehensive outbreak response is underway in Uganda to rapidly halt transmission, identify contacts and carry out epidemiological investigations, while enhancing community awareness.
WHO has allocated US$ 1 million from its Contingency Fund for Emergencies to help accelerate outbreak control efforts.
Sudan virus disease is a severe, often fatal illness affecting humans and other primates that is due to Orthoebolavirus sudanense (Sudan virus), a viral species belonging to the same genus of the virus causing Ebola virus disease. Case fatality rates of Sudan virus disease have varied from 41% to 100% in past outbreaks. There are no approved treatments or vaccines for Sudan virus, but early initiation of supportive treatment has been shown to significantly reduce deaths from Sudan virus disease.
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WHO statement on potential global threat to people living with HIV
The World Health Organization (WHO) expresses deep concern about the implications of the immediate funding pause for HIV programmes in low- and middle-income countries. These programmes provide access to life-saving HIV therapy to more than 30 million people worldwide. Globally, 39.9 million people were living with HIV at the end of 2023.
A funding halt for HIV programmes can put people living with HIV at immediate increased risk of illness and death and undermine efforts to prevent transmission in communities and countries. Such measures, if prolonged, could lead to rises in new infections and deaths, reversing decades of progress and potentially taking the world back to the 1980s and 1990s when millions died of HIV every year globally, including many in the United States of America.
For the global community, this could result in significant setbacks to progress in partnerships and investments in scientific advances that have been the cornerstone of good public health programming, including innovative diagnostics, affordable medicines, and community delivery models of HIV care.
We call on the United States Government to enable additional exemptions to ensure the delivery of lifesaving HIV treatment and care.
PEPFAR’s legacy and current risksThe United States President's Emergency Plan for AIDS Relief (PEPFAR) has been a flagship initiative of the global HIV response since its establishment over 20 years ago. The current funding pause for PEPFAR will have a direct impact on millions of lives that depend on the predictable supply of safe and effective antiretroviral treatment.
PEPFAR works in over 50 countries around the world. Over the past two decades, PEPFAR funding has saved more than 26 million lives. Currently, PEPFAR is providing HIV treatment for more than 20 million people living with HIV globally, including 566 000 children under 15 years of age.
Over the past year, PEPFAR and partners, including WHO, have been working on sustainability plans with countries for greater country ownership and reduced donor support up to and beyond 2030. A sudden and prolonged stop to programmes does not allow for a managed transition and puts the lives of millions at risk.
WHO is committed to support PEPFAR and other partners, as well as national governments, in managing change processes effectively to minimize the impact on people living with HIV.