The World Health Organization has called for a “massive, urgent” effort to get the new malaria vaccine into the arms of African children, as it warned that about 180,000 more people were dying annually from the disease than had previously been thought.
Dr Pedro Alonso, director of the WHO’s global malaria programme, said the RTS,S vaccine, recommended for widespread rollout in October, represented a historic opportunity to save tens of thousands of lives, mostly those of under-fives in sub-Saharan Africa.
But he warned that the global community risked “massive failure” if funding commitments aimed at boosting production and helping deployment of the vaccine were not rapidly made.
“What I think is the real barrier [is] international solidarity,” he said. “Is the world going to allow that there is a first malaria vaccine that can save the lives of tens of thousands of African children every year and they’re going to let it sit on a shelf? Or are they going to step up?”
The British pharmaceutical company GlaxoSmithKlein, which developed the RTS,S vaccine, has committed to donate up to 10m doses for use in the pilot programmes already under way, and to supply up to 15m doses annually.
However, with more than 240m cases globally last year, the potential demand could reach 80 to 100m doses annually, Alonso warned. “Therefore, this is a prime example of where international mechanisms will need to come into play,” he said.
“A vaccine that could save somewhere between 40 and 70-80,000 lives every year, of African children, is something that needs to be treated with the utmost ambition and sense of urgency. And therefore, a slow, gradual scale-up, if you ask me, would not be acceptable. This needs to be a massive, urgent operation to ensure that we can reach as many children as possible and as soon as possible.”
He added: “If the global health community does not respond to this challenge, it will represent a massive failure. I cannot imagine how different leaders, leaders of philanthropy or of financing institutions, are going to go to Africa and advocate for efforts to prevent childhood deaths if they don’t, first and foremost, support the deployment of this vaccine.”
Last week, the global vaccine alliance, Gavi, said its board had approved an initial $155.7m (£117m) for the rollout of RTS,S. The funding would help the introduction, procurement and delivery of the vaccine for eligible countries in sub-Saharan Africa from 2022 until 2025, it said.
Dr Abdourahmane Diallo, CEO of the RBM Partnership to End Malaria, said the announcement would give the private sector “a crucial motive to scale up” the rollout.
“We now call on leaders to step up investment to accelerate the development and delivery of more effective, transformative tools to combat the ever-evolving malaria parasite,” he said.
New figures released by the WHO on Monday underlined the scale of the problem, with a new, “more precise” method of counting estimating that 627,000 people died of malaria last year, 180,000 more than the total would have been according to the old methodology.
The vast majority of all malaria deaths – 96% – were in sub-Saharan Africa.
In its annual malaria report, the WHO said the “doomsday scenario” some had predicted at the beginning of the Covid-19 pandemic – that deaths from malaria would double as a result of disruption to treatment and services – had not materialised.
Nonetheless, it said, deaths had risen by nearly 70,000 last year, an increase of 12%, of which nearly 50,000 were attributable to disruptions during the pandemic. One main cause of disruption was that more than a quarter of insecticide-treated bed nets – the backbone of WHO efforts to combat malaria – were not distributed in 2020.
Faced with a slowing of progress in the fight against malaria, the WHO believes the vaccine could be a crucial new weapon, even though questions have been raised over its limited efficacy. Over four years of trials, RTS,S was found to prevent 39% of malaria cases and 29% of severe malaria cases.
But Alonso rejected concerns. “A reduction of 30% [in] severe cases of malaria means a massive public health impact, larger probably than any other vaccine against any other disease being used right now,” he said.
‘We’re next’: Prisoner’s secret filming appears to show torture in Cairo police station | Global development
A video obtained by the Guardian appearing to show Egyptian police torturing detainees in a Cairo police station confirms the extent to which officers appear able to inflict violence on civilians with near total impunity, according to human rights groups.
The video, covertly recorded by a detainee through a cell door, appears to show two inmates hung in stress positions. The detainees are naked from the waist up and suspended from a metal grate by their arms, which are fastened behind their backs.
“Watch how they are torturing us and our colleagues. They came and told us we’re next,” one detainee says. Addressing the Egyptian president, Abdel Fatah al-Sisi he says: “Mister president, we want to ask why the police in el-Salam First police station are doing this to us.”
The video is one of two believed to have been recorded in November last year inside a police station in the working-class el-Salam neighbourhood of northern Cairo.
In the second, which the Guardian is not showing to protect detainees’ identities, inmates in an overcrowded cell line up to display injuries they say were inflicted by police officials and investigators, including open wounds on their heads and bruises across their chests and backs. “They are hitting us with sticks,” they say.
Humans rights groups said the videos are visual evidence of widespread abuses that they have been documenting in police stations and detention centres across Egypt for the past decade.
The Guardian has taken steps to verify the videos where possible, including requesting an assessment of the videos by a trusted expert. Detainees shown in the video also name multiple police officers who are listed in news reports as serving at el-Salam First police station.
The videos surfaced nearly 12 years after the death of Khaled Said, a 28-year-old civilian, in police custody in Alexandria in June 2010. Said’s death proved to be a watershed, inciting public anger at the impunity of security forces and their treatment of Egyptian citizens, and sparking the protests that began on 25 January 2011, a national day traditionally honouring the police force. The 18 days of nationwide protests that followed ended the decades-long reign of autocrat Hosni Mubarak, where abuses by security bodies were widespread.
Yet 11 years after the uprising, testimonies and evidence collected by rights groups allege that abuses by Egypt’s security services are once again out of control. Since coming to power after a military coup in 2013, Sisi has presided over a renewed era of impunity for security forces, down to the lowest ranks of the police.
Despite a clear prohibition on all forms of torture in Egypt’s 2014 constitution, trials and convictions of security officials for torture or deaths in custody remain extremely rare, while abuses are regularly documented. Domestic organisations monitoring torture and abuse in detention now struggle to continue their work, amid a prolonged crackdown on civil society activity.
“Police stations are even worse than prisons,” said Aly Hussin Mahdy, a former detainee and now exiled activist, describing his experience in detention. “The revolution happened because of this, and 11 years later we see it happening again.”
Amr Magdi, an expert on Egypt at Human Rights Watch who reviewed the videos for the Guardian, said that the detainees’ injuries and the use of stress positions are consistent with documented examples of torture in detention centres. “They all show signs of severe beatings, and they mention batons and wooden sticks which are routine torture tools,” he said. “These videos show the sad and horrifying reality of Egypt’s detention system as the police enjoy near-absolute impunity.”
Magdi said that abuse was common in police stations, where mistreatment can occur away from public view. “We know that most physical torture happens in police stations and secret NSA [National Security Agency] detention centres during the initial days or weeks after arrest, and before detainees are taken to larger prisons,” he said.
Human Rights Watch detailed the use of stress positions and the systemic use of torture in police stations in a report in 2017, describing the issue as a potential crime against humanity. The report cites 19 individual cases where detainees “were tortured in police stations and national security offices across the country, including Alexandria, Aswan, and cities in the Nile delta”. For some, torture occurred in multiple places of detention.
“The basic tools of torture were electrocution and stress positions, accompanied by beatings with fists, wooden sticks or metal bars,” they said.
Police and NSA officers “handcuffed suspects’ arms behind their back, pulled up their arms, placed their handcuffs over the top edge of a door, and hung them above the floor, an unnatural position that caused excruciating pain in the back and shoulders, sometimes dislocating them. Some officers pulled suspects’ legs downward to increase the pain,” they said. They added that detainees were often left in stress positions for long periods.
Rights groups have also documented frequent deaths among those detained. In 2015, Amnesty International provided evidence of at least nine deaths in custody in the Mattareya police station in Cairo. Three years later, it demanded an investigation after the suspicious death of 43-year-old Gamal Aweida in custody in the Mansheyet Nasir district of the city.
In rare cases of accountability, a small number of police officers have been sentenced for shooting civilians in public over the past decade. In 2016, Sisi publicly instructed the interior ministry to prevent abuses by police following an outcry after an officer shot dead a taxi driver. Last year, a police officer from the el-Salam Second police station was sentenced to three years in prison with hard labour for shooting a civilian in the chest and wounding another.
Yet convictions for deaths in custody are rare, even for low-ranking police officers. Four noncommissioned officers were imprisoned by prosecutors in 2020 for torturing a man to death at a police station in Giza. In December 2020, nine police officers were sentenced to three years in prison for beating a street vendor to death in custody in Cairo in 2016.
The Egypt State Information Service, interior ministry, and current and former officials at the interior ministry either declined to comment or did not respond to requests for comment when contacted by the Guardian to discuss video evidence of abuses and the issue of torture in police custody.
EU not evacuating staff from Kyiv
The EU will not evacuate its staff from Kyiv, the bloc’s foreign affairs chief Josep Borrell said on Monday before the meeting of EU foreign affairs ministers, who will have a video conference with US secretary of state Anthony Blinken. “Blinken will explain the reasons for this announcement, we are not going to do the same thing, […], we don’t have to dramatise, the negotiations are going on,” Borrell said.
‘I’ve already sold my daughters; now, my kidney’: winter in Afghanistan’s slums | Global development
The temperature is dropping to below zero in western Afghanistan and Delaram Rahmati is struggling to find food for her eight children.
Since leaving the family home in the country’s Badghis province four years ago, the Rahmatis have been living in a mud hut with a plastic roof in one of Herat city’s slums. Drought made their village unliveable and the land unworkable. Like an estimated 3.5 million Afghans who have been forced to leave their homes, the Rahmatis now live in a neighbourhood for internally displaced people (IDP).
There are no jobs. But the 50-year-old has hospital fees to pay for two of her sons, one of whom is paralysed and the other who has mental illness, as well as medicine for her husband.
“I was forced to sell two of my daughters, an eight- and six-year-old,” she says. Rahmati says she sold her daughters a few months ago for 100,000 afghani each (roughly £700), to families she doesn’t know. Her daughters will stay with her until they reach puberty and then be handed over to strangers.
It is not uncommon in Afghanistan to arrange the sale of a daughter into a future marriage but raise her at home until it is time for her to leave. However, as the country’s economic crisis deepens, families are reporting that they are handing children over at an increasingly young age because they cannot afford to feed them.
Yet, selling her daughters’ future was not the only agonising decision Rahmati was forced to make. “Because of debt and hunger I was forced to sell my kidney,” she tells Rukhshana Media from outside her home in the Herat slum.
Afghanistan is on the brink of “a humanitarian crisis and economic collapse”, according to the UN. The agency’s ambassador to Afghanistan has said it is “experiencing the worst humanitarian crisis of its contemporary history”. Drought, Covid-19 and the economic sanctions imposed after the Taliban seized power in August 2021 have had catastrophic consequences on the economy. Dramatic rises in inflation have resulted in soaring food prices.
The kidney trade has been growing in Afghanistan for some time. But since the Taliban took power, the price and conditions under which the illegal organ trade takes place has changed. The price of a kidney, which once ranged from $3,500 to $4,000 (£2,600 to £3,000), has dropped to less than $1,500 (£1,100). But the number of volunteers keeps rising.
Rahmati sold her right kidney for 150,000 afghani (£1,000). But her recovery from the operation has not been good and now, like her husband, she is also sick, with no money left to visit a doctor.
More than half of the country’s estimated 40 million population face “extreme levels of hunger, and nearly 9 million of them are at risk of famine”, according to the UN refugee agency, UNHCR. For a growing number of Afghans, selling a kidney is their only way to get money to eat.
“It has been months since we last ate rice. We hardly find bread and tea. Three nights a week, we can’t afford to eat dinner,” says Salahuddin Taheri, who lives in the same slum as the Rahmati family.
Taheri, a 27-year-old father of four, who scrapes together enough money for five loaves of bread each day by collecting and selling recycled rubbish, is looking for a buyer for his kidney. “I have been asking private hospitals in Herat for many days if they need any kidney. I even told them if they need it urgently, I can sell it below the market price, but I haven’t heard back,” Taheri says. “I need to feed my children, I have no other choice.”
In the past five years about 250 official kidney transplants have taken place in the hospitals in Herat province, with a very limited number being a family member donating their organ, says Asif Kabir, a public health official in the province. The cost of a kidney transplant is 400,000 afghani, plus the price of the kidney, according to Kabir.
But the true number of kidney operations may be far higher. A doctor working in one of the hospitals where most of the transplants take place, who spoke on the condition of anonymity, says: “Recently the number of people who want to sell their kidney has increased in Herat and most of them live in the displaced camps, in Herat’s slums. The customers also go to the displaced camps to find a cheap kidney.”
Sayed Ashraf Sadat, a civil society activist in Herat, was a member of a delegation assigned by president Ashraf Ghani to investigate the illegal kidney trade in May 2021.
“We found that the hospitals were not working according to the law. People are working inside and outside the country to encourage people to sell their kidneys. These people get them visas and send them to the other side of the border. There is more demand for kidney transplants outside Afghanistan. Countries like Iran need kidneys, and poor Afghans are forced to sell them.”
Sadat says the investigation he was part of identified two hospitals in Herat where kidney transplant operations take place; one of them said it had completed 194 operations and the other said 32, but more than 500 people were claiming to have sold their kidney, 100 from a single village in Herat. “This shows the kidneys were taken outside Afghanistan,” says Sadat.
“For example, a kidney is purchased for 300,000 afghani (£2,100) inside Afghanistan, and it is sold for more than £7,500 to £11,000 outside the country,” says Sadat.
“We found evidence that some are encouraged to sell their kidneys, taken outside the borders, and their kidneys are sold for 200,000 to 400,000 afghanis ,” says Sadat. “It seems that the doctors are involved in the illegal trade. But unfortunately, our investigation was stopped due to a worsening security situation.”
Two months have passed since Rahmati’s kidney operation, and the money has already gone to pay off medical debt. Her recovery from the operation continues to go badly.
“I am so sick. I couldn’t even walk because the wound has been infected. It is very painful,” she says, adding that the recipient of her kidney only paid for the operation fee, two nights in hospital and her first medicine bill.
On the day of the transplant, Rahmati was sick and the doctors refused to operate. “I couldn’t breathe properly, so the doctors took me down from the hospital bed, but I returned. I told them ‘I am happy with my own death, but I can’t tolerate seeing my children hungry and ill’,” she says.
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