Fw: MDGs: Tracking progress on MDG six

MDGs: Tracking progress on MDG six

NAIROBI, 21 September 2010 (PLUSNEWS) - Significant strides have been made in the global fight against HIV, but major gaps remain that could prevent many countries from achieving UN Millennium Development Goal (MDG) six [ http://www.undp.org/mdg/goal6.shtml ] relating to HIV/AIDS, malaria and other diseases.

IRIN/PlusNews examines global efforts to halt and begin to reverse the spread of HIV/AIDS.

Access to treatment - More than five million people [ http://data.unaids.org/pub/Report/2010/20100917_mdg6_report_en.pdf ] currently have access to life-prolonging antiretroviral drugs, a 12-fold increase over the past six years. However, this still represents just one third of people who need HIV treatment.

In 2008, 38 percent of the 730,000 children estimated to need antiretrovirals (ARVs) in low- and middle-income countries had access to them.

The Joint UN Programme on HIV/AIDS (UNAIDS) is calling for the implementation of a new treatment approach called "Treatment 2.0", to drastically scale up testing and treatment. UNAIDS estimates that successful implementation of "Treatment 2.0" could avert 10 million deaths by 2025, and reduce new infections by a third.

New infections - Twenty-two of the worst affected countries in sub-Saharan Africa have reduced HIV incidence by more than 25 percent in the last eight years, according to UNAIDS. Some of the best performers in reducing new infections are Ethiopia, Nigeria, Zambia and Zimbabwe; HIV incidence is on the rise in Uganda, once a leader in the fight against HIV.

Eastern Europe and Central Asia remain the only regions where incidence is increasing.

Globally, there are still five new infections for every two people put on ARVs.

Prevention of mother-to-child transmission - According to the UN World Health Organization's (WHO) Towards Universal Access report [ http://www.who.int/hiv/pub/tuapr_2009_en.pdf ] for 2009, the 20 countries with the highest burden of HIV among pregnant women have scaled up HIV counselling and testing to at least 75 percent of their antenatal care facilities.

Kenya, Malawi, Mozambique, South Africa, Tanzania and Zambia are among the countries that provided HIV testing to 60-80 percent of pregnant women, while Botswana, Namibia and São Tomé and Principe exceeded the 80 percent mark.

In 2008, 45 percent of pregnant women living with HIV in low- and middle-income countries received ARVs to prevent HIV transmission to their infants - up from just 10 percent in 2004.

HIV-related maternal and child mortality - In 2008, 9 percent of all maternal deaths in sub-Saharan Africa were HIV related, according to a new report, Trends in Maternal Mortality: 1990-2008 [ http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf ] by WHO and the UN Children's Fund, UNICEF. In Latin America and the Caribbean, HIV/AIDS was responsible for 5.2 percent of maternal deaths.

The report notes that there is evidence that women with HIV infection have a higher risk of maternal death.

Access to prevention of mother-to-child-transmission (PMTCT) improves outcomes for children as well, with studies [ http://journals.lww.com/aidsonline/Fulltext/2010/02200/Decline_in_early_life_mortality_in_a_high_HIV.12.aspx ] showing that in KwaZulu Natal, South Africa, child mortality declined by 34 percent following improvement in PMTCT. According to UNICEF, HIV is one of four diseases that accounted for 43 percent of all deaths in children under five worldwide in 2008.

Condom availability and use - Globally, condom use has doubled over the past five years, according to UNAIDS. An estimated 13 billion condoms per year will be needed by 2015 to help halt the spread of HIV, but only four condoms were available for every adult male of reproductive age in sub-Saharan Africa.

Female condoms are even less accessible. According to the UN Population Fund, UNFPA, [ http://www.unfpa.org/webdav/site/global/shared/factsheets/media_fact_sheet_condoms.pdf ] in 2009, one female condom was distributed for every 36 women worldwide.

Condom use remains low in many high prevalence countries. According to UNAIDS, [ http://data.unaids.org/pub/Report/2009/JC1700_Epi_Update_2009_en.pdf ] in South Africa, the proportion of adults reporting condom use during last sex rose from 31 percent in 2002 to 65 percent in 2008, but in Burundi, only about one in five people reported using a condom during commercial sex episodes.

New prevention technologies - The first positive results from a microbicide trial [ http://www.plusnews.org/Report.aspx?ReportId=89895 ] have injected fresh hope into efforts to halt the spread of the virus; the gel, containing the ARV Tenofovir, was found to be 39 percent effective in reducing a woman's risk of becoming infected with HIV.

"Treatment 2.0" also promises benefits for prevention, with evidence showing that people on ARV treatment are much less likely to transmit the virus.

A Thai vaccine trial completed in 2009 also provided the first evidence [ http://www.plusnews.org/Report.aspx?ReportId=86279 ] that a vaccine can provide some protection against HIV.

Male circumcision [ http://www.plusnews.org/IndepthMain.aspx?ReportId=73184&IndepthId=61 ], proven to reduce men's risk of infection through sexual intercourse by up to 60 percent, is being rolled out [ http://www.plusnews.org/report.aspx?ReportID=88286 ] in several African countries.

Several trials [ http://www.avac.org/ht/d/sp/i/3507/pid/3507 ] are under way to test the efficacy of pre-exposure prophylaxis (PrEP) whereby HIV-negative people take a single ARV drug or a combination of drugs with the hope that it will lower their risk of infection if exposed to HIV.

Tuberculosis - TB remains a major cause of death for people living with HIV. WHO estimates that in 2008, there were 1.4 million TB cases among people living with HIV and over 500,000 deaths. Drug-resistant TB is on the rise in several countries, but diagnosis [ http://www.plusnews.org/Report.aspx?ReportId=88489 ] remains very low.

TB research remains under-funded and the most widely used TB diagnostics are over 100 years old. For many co-infected patients in the developing world, late diagnosis leads to death.

The authors of a recent article published in medical journal The Lancet [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61428-6/fulltext ] argue that TB control is crucial to achieving the MDGs, given its link to HIV mortality as well as maternal and child mortality.

Recent developments such as a new drug [ http://www.plusnews.org/Report.aspx?ReportId=84888 ] to treat TB and rapid, more accurate TB tests [ http://www.plusnews.org/Report.aspx?ReportId=90493 ] could lead to improvements in the diagnosis and management of the highly infectious disease.

New research showing that starting TB patients on ARVs earlier leads to better outcomes could also reduce mortality in co-infected patients.

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YEMEN: IDP/refugee camps - facts and figures

SANAA, 21 September 2010 (IRIN) - IRIN takes a look at the camps for refugees and internally displaced persons (IDPs) in Yemen, their locations, capacity, needs and gaps. There are 10 IDP camps (six in Saada, three in Hajjah and one in Amran Governorate) and one refugee camp.

Kharaz refugee camp
Location: Lahj Governorate, 150km northwest of Aden city
Purpose: Hosting Somali refugees and a small group of Ethiopian Oromo refugees
Capacity: Around 14,000 refugees as of August 2010
Established: 2000, following the closure of Al Gahin camp in neighbouring Abyan Governorate Run by: the UN Refugee Agency (UNHCR) in coordination with other UN agencies and a number of local and international implementing partners such as INTERSOS, Adventist Development and Relief Agency International (ADRA), Danish Refugee Council (DRC), CARE International, Save the Children, Society for Humanitarian Solidarity (SHS) and Charitable Society for Social Welfare (CSSW).

Needs/gaps: More shelters required, according to Rocco Nuri, a UNHCR external relations officer.

"Land disputes with host communities are also impacting on shelter construction," he said.

He said security remained a concern in the area and impacts on the delivery of assistance and protection response of UNHCR.

The only refugee camp in Yemen is in a remote area of Yemen's Lahaj region with few opportunities for employment or self-reliance, according to Nuri.

IDP camps Mazraq I and III
Location: Camp I is 35km and Camp III 32km northeast of Haradh town in the northern governorate of Hajjah
Purpose: Hosting Yemenis displaced by conflict in neighbouring Saada Governorate
Capacity: Camp I hosted 8,906 and Camp III 3,440 IDPs as of 31 August 2010
Established: Camp I on 20 August 2009 and Camp III on 27 January 2010 Both are run by: UNHCR through its implementing partner Islamic Relief Yemen (camp managing partner). Other contributors are: the Yemeni government, World Food Programme (WFP), UN Children's Fund (UNICEF), Save the Children, local NGO Al Amal Society, Médecins Sans Frontières-Spain and Oxfam.

Needs in the two camps: UNHCR, as lead agency supporting camp management, shelter/non-food items and protection, continues to face a funding shortfall of around 44 percent of the total requirement for 2010, according to the agency's deputy representative in Yemen, Nabil Othman.

"In view of funding shortfalls, it would be difficult to respond to the needs of IDPs, which include some self-reliance activities to sustain and support their livelihoods, the replenishment of shelter and NFIs, summerization of tents, and overhauling the camp to prevent floods," he said.

Other problems include the lack of privacy for families, especially women, during the cooking of food or the performance of other outdoor domestic chores; the lack of maintenance of camp facilities; the need for more support for persons with specific needs; and the need for capacity-building of government institutions to enable them to assume their responsibilities.

IDP camp Mazraq II
Location: 28km northeast of Haradh, Hajjah Governorate
Purpose: To serve IDPs displaced by the Saada conflict
Capacity: 6,400 IDPs as of August 2010
Established: 15 November 2009
Run by: United Arab Emirates (UAE) Red Crescent with Al-Saleh Social Foundation for Development (SFD) as an implementing partner

Needs: The camp population is happy with the services provided. [
http://www.irinnews.org/report.aspx?ReportId=89129 ] Funded by the UAE government, it is the only camp not facing a funding shortfall. IDP tent s are equipped with fans and have electricity 24/7. The only concern of IDPs is that they are not allowed to keep their animals with them.

"The camp management bans entry of cattle and sheep to create a healthy environment for the population," said camp superviser Hamid al-Shamsi of UAE Red Crescent.

IDP camp Khaiwan
Location: Khaiwan District, Amran Governorate, some 100km north of Amran city
Purpose: To host IDPs displaced by the Saada conflict. Most of them came from Amran's Harf Sufyan District, one of the worst battlegrounds
Capacity: 1,731 IDPs as of August 2010
Established: 20 October 2009
Run by: UNHCR with CSSW as an implementing partner. It also receives assistance from WFP, UNICEF, the International Committee of the Red Cross (ICRC), Save the Children and the Health Ministry

Needs/gaps: Aid delivery to IDPs is hampered by insecurity and carjackings. The camp faces a shortage of medical supplies, according to camp supervisor Nabil Khamis.

"IDPs with chronic diseases have been waiting for medicine since June 2010," he said.

The camp is in an area where there has been intermittent violence between Houthis and pro-government tribesmen. Access to the camp for assessment purposes is therefore difficult, according to Khamis.

He said the camp was located at an inappropriate site, with tents too close to each other. "It needs to be reconstructed because it doesn't comply with the internationally-recognized standards of camp establishment."

Saada IDP camps: There are six IDP camps in Saada Governorate, five of which - al-Ehsaa, al-Bugallat, al-Jabbana, al-Salam and Sam - are in Saada city. The sixth, Mandaba, is in Baqim District, in the northwestern part of the governorate
Purpose: Hosting people displaced by the Saada conflict
Capacity: The six camps hosted over 18,500 IDPs as of July 2010
Established: The oldest one (al-Ehsaa) three years ago; the newest one
(al-Jabbana) 10 months ago
Run by: Yemen Red Crescent Society (YRC), with ICRC support.

Needs: Basic IDP needs are met in terms of survival and the preservation of dignity, said Rabab al-Rifai, ICRC spokesperson in Yemen, adding that ICRC and YRC policies do not allow staff to give specific details on each camp separately.

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Insecurity without borders

GARISSA/MANDERA, 17 September 2010 (IRIN) - The Islamist insurgency in Somalia has had a spillover effect on security in the northeast of neighbouring Kenya, affecting livelihoods and the delivery of services, say residents and officials.

The worst crimes reported in the region recently include killings, carjackings and abductions - including, in 2009, of aid workers and, in 2008, of two nuns. Insecurity in the borderlands has led thousands of livestock herders to abandon their traditional grazing land, say locals.

Dozens of community programmes have been disrupted, notably those dealing with reproductive health, sanitation, food security and education, according to NGOs working in the region.

"There is a direct effect of insecurity in Somalia for the humanitarian operations in northeast Kenya," Patrick Lavand'homme, deputy head for Kenya of the UN Office for the Coordination of Humanitarian Affairs, told IRIN.

"One of these effects is that Somali rebels enter Kenyan territory. Messages and threats have been received by humanitarians about their own security from some of the Somali groups," he added, noting that as a result of these incursions and indigenous banditry and armed cattle rustling, the UN classifies the region as a phase-three security zone, "which means no [UN] movement can be done without armed escorts".

A senior UN source working with security concurred, asking not to be named because he is not authorized to speak to the media.

"I think it [insecurity in Somalia] has worsened the situation in northeast Kenya. There is no government on the other side. Nobody knows how many weapons go back and forth across the border. That is always a concern," he said.

"Northeast Kenya, and Mandera specifically, is just across the border, and this is not a real border, there is no fence. There are known Al-Shabab elements in control on the other side of the border," he said, adding, however, that it was impossible to say how much of the criminality in the region could be attributed to Somalis rather than Kenyans.

"It makes it harder for the UN to do business, there is no freedom of movement without escorts, there is a 6pm to 6am curfew. It is not an area where humanitarian workers move freely," he said.

The difference between the two sides of the porous border, he added, was that Kenya had an active police unit that provides "some level of security" in the region.

Lawlessness

Kenya Police spokesman Eric Kiraithe told IRIN: "The spillover effect is mainly in terms of firearms and lawlessness. The legal way of solving disputes has also been suspended on the other side such that disputes are sometimes solved with shooting.

"The frequency [of attacks] may be small but the impact is high. humanitarian workers may not be able to do all they would like to or they may not go to the areas at all," he said.

"This feeling of vulnerability has caused a disproportional deployment of security officers there. Going by the population of the area and the economic activities, that place should not be taking the number of security officers it takes."

For such security officers, according to a recent Chatham House report, "being posted to the arid northeast, and particularly to administer the border area, is not an attractive proposition.

"It entails dealing with a 'strange terrain', 'strange people', a 'strange culture' (pastoralism) and 'strange way of life' (relentless insecurity)," Hussein Mahmoud wrote in Livestock Trade in the Kenyan, Somali and Ethiopian Borderlands [ http://bit.ly/9yPkWu ].

"As a result, soldiers' morale is usually low, and this seriously affects their performance. The problems of effectively controlling the border are compounded by its length and rough terrain," the report added.

Security reviews

To minimise risks, many agencies review security on a daily basis. Measures, often costly, such as not travelling at night, avoiding certain routes and areas, moving in convoys, ensuring field staff keep in regular radio contact with head office and using local staff to work in more sensitive areas are also employed.

"Current security management procedures and adherence have been made very strict, the security situation along the border is frequently monitored with all staff and volunteers under instructions to liaise with the security forces about any changes in the security situation," said an NGO worker.

"The [Somali] militias have made several attempts to abduct other workers and steal vehicles but failed; the threat, however, still looms," he added.

NGOs are opting to ground their own vehicles, relying on hired transportation instead. "The police stations and patrol bases in Mandera resemble a parking bay... all the vehicles owned by NGOs have been parked and instead we hire vehicles to do our work. It's expensive as transporters charge exorbitant prices and we use a lot of money to pay for security," said a member of the Mandera NGO Forum, who asked not to be named.

He said the insecurity had denied hundreds of needy families assistance because few skilled personnel were willing to work for NGOs in the insecure areas. Voluntary staff, who lack insurance, are particularly reluctant to work in risky areas.

"The NGOs which have left Mandera are not cowards. Their reasons for leaving are justified as some had been attacked and threatened as being agents of western countries and spreading Christianity," the Forum member added.

A ban, reportedly imposed by clerics with links to Al-Shabab, on public screenings of films and football matches has cut off the income of many video parlours, said one trader in Mandera.

"It's a very sad situation that a group of [foreigners] can disrupt our lives, deny young children, poor families and women the support they need most," added another resident.

Budget pressure

The situation is similar in the neighbouring districts of Garissa and Wajir, said Irshad Yussuf, the Sisters for Maternity Health Organization Community Health Programme Manager.

"Our budget has considerably increased; this has forced us to evaluate some of our projects in areas along the border.

"The expenditure on security is enormous, our reproductive health programme is at risk because we propagate the use of condoms for family planning, raise HIV/AIDS awareness and campaign against FGM [female genital mutilation/cutting]. I am sure the guys across the border consider our mission to be anti-Islam. This is wrong. We are also Muslims," he said.

Health programmes such as child immunization suffer the most, with some community organizations unable to monitor their projects, Yussuf told IRIN.

According to the Kenya Red Cross Society, the insecurity has also complicated the planning of prompt disaster response.

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Afgoye IDPs forced out as "pirate" landlords move in

NAIROBI, 16 September 2010 (IRIN) - Property owners in Somalia's Afgoye corridor, near the capital Mogadishu, are selling the land on which thousands of internally displaced persons (IDPs) have been settled for years, displacing them anew, say locals.

"Hundreds of families have been evicted from their camps by people who bought the land," Asha Sha'ur, a civil society activist, told IRIN on 15 September. "People with money are buying property in the area known as the Afgoye corridor, displacing people who have been displaced so many times and no one is saying anything about it."

A local journalist, who requested anonymity, told IRIN: "Many of those who are acquiring the land are said to be people with piracy links." He said they were flush with cash and offering inflated prices for the land.

A well-placed security source said he had also heard of ties between piracy and those buying up plots in the corridor.

Sha'ur said many of the IDP families had been living in the area three to four years and were now moving further away from the main road, out of reach of aid groups.

"The [aid] agencies have established water points and other services in the camps around Arbiska and Ceelsha Biyaha [between Mogadishu and Afgoye], because they were close to the main highway."

Sha'ur said many of the families were not given adequate time to find new homes. "First they were displaced by war and now by greed."

"They have guns"

Fadumo Haji, a mother of three, was evicted from her shelter in the Israc IDP camp in the Arbiska area. She told IRIN that along with 450 other families in the camp, she was given a week to leave. "If you don't leave they come in and destroy your house and everything in it. They are very cruel. Where do they expect us to go?"

She is staying with friends in another camp until she finds alternative shelter. "We cannot fight them; they have guns and we don't," Haji said. "There is no difference between those who chased us out of Mogadishu and these ones."

According to Jowahir Ilmi, of the Somali Women Concern (SWC) - a local NGO working with the displaced - so far, at least 60 settlements have been affected.

"They [new landlords] are building structures for rent but I don't think anyone will be able to afford them; these are very poor people," Ilmi said.

Ilmi said the evictions coincided with increased displacement from Mogadishu following intense fighting between government troops and insurgents.

"We have had a stream of people arriving for the last three weeks and they don't have a place to shelter."

According to the UN, 26,100 people have left the city since 23 August, adding to the nearly 400,000 already displaced.

Since 2009, Mogadishu has borne the brunt of the fighting between African Union-backed troops loyal to the Transitional Federal Government and armed Islamist insurgents, who now control much of the south and centre of the country.

The evictions and continued fighting were forcing many IDPs "to move further and further, making [them] inaccessible to what little help they were getting", added Ilmi.

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IDPs return as calm returns to Sool region

WIDH-WIDH, 15 September 2010 (IRIN) - Almost all of the hundreds of households displaced after clashes  between the Somaliland army and the pro-Somali union, Sool, Sanaag and Cayn (SSC) group in Sool?s Widh-widh district have returned home as calm returns, say officials. SSC, named after the respective regions that are claimed by both Somaliland and the self-declared autonomous region of Puntland, says it is fighting for the liberation of the regions while Somaliland says it is defending its territories. Somaliland unilaterally declared statehood in 1991 but has yet to gain formal recognition. ?The displaced people have all come back to the town,? Garad Abshir Salah, a traditional leader, said. ?We have held a meeting with the people in Widh-widh discussing the issue of insecurity and we have decided to pursue our rights peacefully. ?We have been contacted by the new committee assigned to deal with the issue, and we have agreed to continue our discussion later,? added Salah. The committee was nominated by Somaliland President Ahmed Mohamed Mohamoud Silanyo in late August to address insecurity in the eastern regions. The SSC leadership, however, insists it will only negotiate if Somaliland forces quit the territories. ?If they [Somaliland authorities] use traditional contacts, we can start talks to work together for the peace and co-existence of the people and discuss our differences. But for as long as their militia is in our regions, we will not accept any talks,? Ali Hassan Sabarey, SSC?s deputy chairman, told IRIN in late August. Mohamed Isse, an elder in Widh-widh, told IRIN by telephone that fewer than 10 percent of the displaced had yet to return. ?But the problem is that the people have nothing to rebuild their lives with because they lost all their resources when they were displaced. Nothing was looted but everyone used up his resources during displacement,? said Isse. ?Now, the Somaliland army is stationed in Widh-widh and we are working together to keep the security.? According to the army commander, Gen. Nouh Ismail Tani, Widh-widh is now ?one of the safest places in Somaliland?. ?Even [before] the army had no problem with the innocent people but they ran, afraid of being hit by stray bullets.? maj/aw/am/mw full report

KENYA: Malnutrition levels in northeast stubbornly high

NAIROBI, 13 September 2010 (IRIN) - Malnutrition levels in pastoralist districts of northeastern Kenya have remained high, despite recent rains that boosted livestock productivity, the mainstay of the local economy, officials said.

"There could have been improvements in the nutrition situation for individuals, but it will be difficult to see an impact at population level, given the various factors that affect nutrition," said Joyce Owigar, a nutritionist with the World Food Programme.

The Ministry of Health and its partners recently found Global Acute Malnutrition (GAM) levels above the UN World Health Organization's 15 percent emergency threshold in Mandera Central Districts, Wajir South and Wajir East. Mandera West recorded GAM rates above 25 percent.

"Due to the high illiteracy levels that characterize this region, most people, especially women, [do not] ensure that children receive a balanced diet. This makes malnutrition a [common] occurrence," the ActionAid Kenya northeast region coordinator, Enrico Eminae, told IRIN.

This view was echoed by the Kenya Food Security Outlook for August report: "Improvements in household food security have not translated into a decisive reduction in rates of child malnutrition in the northeastern districts." [ http://www.fews.net/docs/Publications/Kenya_FSOU_August_2010_final.pdf ]

Eminae called for alternative income sources and a change in eating habits. "To generate income, milk, beans, green-grams and eggs are sold to buy maize, wheat flour and rice. In the process all nutritious food is sold to buy and consume only starch," he said. "Most people in this region prefer foods that can be prepared with the least effort, time and water. These are mainly starches, [such as] corn flour, rice, spaghetti and wheat flour."

Because livestock numbers have gone down, the pastoralists no longer have the milk, meat and blood that used to constitute their diet. Health facilities are also few and far between. Water remains scarce and migrating herds mean children are left without access to milk.

"The biggest problem in this region is continued poor development, which is best seen in the lack of and deterioration of infrastructure and services," noted Benoit Collin, head of the European Commission Humanitarian Aid Disaster Risk Reduction programme. "One approach to the complex problem in this region is to increase availability and access to natural resources, especially water."

According to Owigar, disease "and malnutrition have a synergy, such that an increase in one will also lead to an increase in the other".

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Somali civilian deaths at "alarming" levels

NAIROBI, 9 September 2010 (IRIN) - Clashes between Somali government forces and Al-Shabab fighters in Mogadishu have reached "alarming levels", with at least 250 people killed and 400 wounded in the past two weeks, the UN Refugee Agency (UNHCR) warned.

At least 68,000 civilians have fled the Somali capital this year and sought refuge within East Africa. Of these, 37,000 have been registered as refugees in Kenya, including 6,500 who arrived in August.

"Thousands of others are stuck inside Somalia and in areas where humanitarian agencies have no access," said Roberta Russo, UNHCR spokeswoman for Somalia. "We keep on appealing to all fighting parties to respect neutrality of humanitarian assistance and allow us to bring relief to desperate Somali civilians, who are the only real victims of this conflict."

The International Committee of the Red Cross says Medina and Keysaney hospitals have treated over 200 patients with weapon-related injuries since 23 August - more than twice the average admitted in previous weeks. The fighting has been condemned by Somali Foreign Minister Ahmed Aboul Gheit and the Organization of the Islamic Conference Secretary-General Ekmeleddin Ihsanoglu, who urged warring parties to cease fire during the last days of Ramadan.

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UNICEF to boost aid efficiency by targeting poorest

By Louis Charbonneau

UNITED NATIONS, Sept. 7 (Reuters) - The U.N. children's foundation UNICEF plans to make the poorest and most remote regions of needy nations top priority for aid, an approach it said on Tuesday is not only morally but economically sound.

"It's not often that the right thing to do is also the most cost-effective thing," UNICEF chief Anthony Lake told Reuters in an interview.

Lake, who was former U.S. President Bill Clinton's National Security Adviser, said a new study on aid distribution undertaken by UNICEF showed aid agencies could save millions of lives by going first to the most disadvantaged mothers and children and their communities.

Traditionally aid programs have focused first on a country's capital and major cities, where underprivileged populations are relatively accessible, only later moving to difficult-to-reach pockets of poverty and disease.

But the new study, Lake said, found that the economic and developmental impact of going straight to the neediest and hardest to reach communities, and then working back to the central cities, was significantly greater than the traditional approach.

One reason for that approach is that remote poverty-stricken areas lack infrastructure and personnel. But Lake said it was possible to work with a minimum of infrastructure and provide locals with sufficient expertise to supply routine medical services.

UNICEF, he said, would be focusing its future humanitarian and developmental aid in line with the results of the study.

NOT WITHOUT RISKS

A report on the UNICEF study released on Tuesday said it showed that by comparing the effectiveness of different strategies for aid delivery, targeting the poorest and neediest children could save more lives per $1 million spent than the current path.

Among the advantages of what UNICEF describes as an "equity-based approach" to aid delivery would be the ability to avert many more child and maternal deaths and episodes of stunted growth than the current approach.

A $1 million investment in reducing the deaths of children younger than five years in a low-income high-mortality country would avert an estimated 60 percent more deaths than the current approach, UNICEF said.

Because disease, ill health and illiteracy are concentrated in the most impoverished child populations, focusing on such areas could also improve poor nations' progress towards meeting the Millennium Development Goals aimed at slashing poverty by 2015 and reduce disparities within countries.

The approach is not without risks, Lake said. Sometimes the remotest and poorest communities are in areas where the central government has little authority and insurgents are in control, making the distribution a very risky business.

This is the case in countries like the Democratic Republic of the Congo, Afghanistan or Somalia. But Lake said UNICEF has proven capable of getting into and operating in unstable regions because it is apolitical and focuses on children.

"If you're a local militant, you wouldn't want the mothers saying that you weren't letting in UNICEF," he said. (Editing by Jerry Norton)

For more humanitarian news and analysis, please visit www.alertnet.org

No high school, no hope in Gedo

NAIROBI, 8 September 2010 (IRIN) - Primary school is a dead end for many children in Somalia, particularly in the southwestern Gedo region where many end up jobless, joining a militia, or emigrating.

Years of civil conflict, following decades of colonial neglect, have produced grim educational statistics: nationally, about one in five children of primary school age actually goes to school, according to the UN Children's Fund (UNICEF). Less than half go on to secondary school, an essential step for those wanting to attend university in the Somali capital, Mogadishu, or in the city of Kismayo.

Until an escalation in clashes between Islamist insurgents and Transitional Federal Government forces in 2009, a high school diploma opened doors in Somalia's burgeoning telecommunications and other business sectors.

The headmaster of the 500-pupil primary school in the Gedo town of Buur Dhuubo, 480km southwest of Mogadishu, is pessimistic.

"Some of them will finish primary school but they don't have a chance for secondary school here," said Abdi Haji.

In Gedo, a region with more than half a million inhabitants, there is only a single secondary school.

"Most of the boys will stay in the town, return to the countryside, migrate [to countries such as Yemen http://www.irinnews.org/Report.aspx?ReportId=87590 ] or join a militia," Haji said.

More and more children were dropping out because "they see the ones who have finished school idling on the street. It is unfortunate but after eight years they hit a dead end."

Job opportunities barely exist in Gedo, Haji noted, adding that many youngsters joined armed groups such as the TFG forces, Islamist insurgents or criminal gangs.

One civil society worker who deals with children told IRIN that children in Mogadishu were able to avoid recruiters because schools were more numerous and the city large enough to make encounters with recruiters less common.

"But in a place such as a small town in Gedo, if the child is not in school he would be a prime target for recruitment into armed groups," he said, asking not to be identified.

"Sometimes the children join these armed groups out of wanting to belong to something and they provide three meals a day," he added.

According to a UNICEF statement released in May 2010, "recent reports indicate that children as young as nine years of age are being used by multiple armed groups across Somalia, and that some schools are being used as recruitment centres".

Determined to learn

Despite the lack of opportunity, students in Gedo are keen to continue their education.

"I finished primary school [in Buur Dhuubo] in 2007 and up to now I can't go to secondary school," said Mohamed Farah Dahir, 17. Some of his friends have travelled to Yemen, others have joined militias.

"I have been approached by a militia but I told them I am going off to school in another town," he said.

Kheyro Muhumud Abdullahi's three children have completed primary school but are now idle.

"I don't want my boy to go to Yemen or join a militia or my two girls getting married at an early age," she said, adding that she could not afford to send them to school elsewhere.

Abdullahi said she was hoping "someone will build a school here, so I don't have to worry about my children".

Aden Abdullahi, in Luuq town, told IRIN the problem of uneducated youth is "killing our country".

"Without an educated youth Somalia will never recover," said the deputy head of Luuq primary school. "The choice is the pen or the gun. I want our youngsters to choose the pen and have a decent opportunity for a normal life," he added.

Barlin Mohamed Hashi, 18, completed primary school in 2006 and has been at home since then. "I am at home doing nothing; I am fighting off men who want to marry me."

But she was not ready to get married yet. "I want to continue with my education and become a gynaecologist," she told IRIN. There was a great need for doctors in her community, she said.

ah/am/mw

[END]

Helping Galkayo IDPs to help themselves

NAIROBI, 7 September 2010 (IRIN) - Authorities in Galkayo, in Somalia's self-declared autonomous region of Puntland, are offering internally displaced persons (IDPs) skills training in a bid to integrate them into the community, officials said.

The move comes nearly a year after many IDPs and their businesses were targeted by mobs [http://www.irinnews.org/report.aspx?ReportID=87541] for suspected involvement in explosions in the town.

"We host a very large number of displaced people and we want them to integrate with the host community," Bashir Mohamed Mire, the deputy governor, who launched the initiative, said. "This training will equip them with skills to make a living and become part of the community."

Mire said that once the IDPs acquired skills, they would not only support themselves but also contribute to the local economy.

"Once they are established, they will interact with the people and become part of the community," he said.

The training is also expected to reduce criminal activities among the young. "Instead of engaging in illegal or idle activities, like chewing khat, they can learn skills that will be beneficial to them and the community," Mire added.

Mire said he was grateful to the Gothenburg Initiative (GI), a Swedish NGO, which was implementing the training through the Galkayo Vocational Training Centre (GVTC). The participants take their courses, run by GI, at the centre.

Abdulqadir Aden, GI's Puntland field manager, told IRIN it had trained about 240 IDPs this year, 60 percent of whom were women.

Aden said participants received three to six months' training in various fields, including mechanics, welding, carpentry and electrical engineering for men, and tailoring, beauty therapy and interior design for women.

Fleeing the violence

In the past 20 years of civil strife in south-central Somalia, thousands of IDPs fleeing the violence have settled in many parts of Puntland. There are more than 40,000 displaced persons in Galkayo, according to the UN.

Aden said various agencies were funding the programme. "We have the DRC [Danish Refugee Council], UNESCO [the UN Educational, Scientific and Cultural Organization], Save the Children, Diakonia, and EDC [Education Development Centre].

Aden said the training was open to both IDPs and the host community. "Sometimes the difference between the two is marginal. There are locals who are as poor as or even worse off than the IDPs," he said.

Muhyadiin Khalif, an IDP from the town of Jowhar, is one of the lucky ones selected for the programme. "I work with a truck that brings stones for buildings. Some days there is no need for stones so I don't get work," he told IRIN.

Khalif is now training to be a mechanic. "This will give me a better chance to take care of my family," said the father of five.

"We have been promised tools, so as soon as I complete the course, I want to start my own business."

Deputy governor Mire called on other aid agencies to help deal with the growing problem of displacement in the area.

"Programmes like this help not only the IDPs but also the locals. It is like teaching someone how to fish instead of giving him fish every day," he said.

ah/mw
[END]