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Neglected tropical diseases are the landmines of global health | Global health

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In January the World Health Organization launched a new strategy for eradicating neglected tropical diseases, boldly setting targets to eliminate 20 of them by 2030.

But what are neglected tropical diseases (NTDs)? There is no easy answer. The concept was first proposed in the early 2000s to bring to light a group of diseases that disproportionately affect poor people yet, despite their collective impact, do not attract as much attention as diseases such as HIV/Aids, malaria or tuberculosis.

The common denominator of poverty and the dearth of prevention efforts is largely what binds these diseases together, even though they may be extremely disparate in presentation and approaches to solutions – snakebite v schistosomiasis, for example. Currently, the WHO identifies 20 NTDs and the differences between them make it difficult to talk about them all together.

How can we succinctly describe 20 different conditions that are caused by parasites, bacteria, viruses, fungi and toxins? How can we summarise complex transmission cycles involving multiple vectors – mosquitoes, sandflies or dogs? And routes – oral, , through the skin or congenital? How can we explain in a simple way the diversity of control strategies, including mass drug-administration campaigns, multiple vector-control tools, active screening of cases, dog vaccinations and facilitating the use of footwear? Most vitally, how can we illustrate the devastating impact that NTDs have on individuals and communities across Africa, Latin America and Asia?

And how can we explain to funders, governments, researchers, aid organisations and the public why we should invest money, time and effort to control and eliminate them?

Here’s an analogy that might help.

Neglected tropical diseases are the landmines of global health. Landmines have been described as “indiscriminate weapons of mass destruction in slow motion” and are well known thanks to movies and international awareness campaigns.

Landmines are designed to incapacitate, injure or kill their victims, and especially affect poor rural communities, where people are trying to make a living through activities that place them in direct contact with the ground, expose them to the elements and ultimately to pathogens, vectors and animal reservoirs; such as herding, farming or collecting water.

Landmine survivors often suffer permanent disability, with physical, mental, socialand economic consequences. Landmines have a dire impact on victims’ caregivers, families and communities. Children are often the victims of landmines and women and girls are more likely to give up their jobs or drop out of school to take care of the injured. As Michelle Bachelet, the UN high commissioner for human rights, said at the 2019 mine ban convention: “Landmines continue to kill, burn and damage limbs and other body parts in horrific ways. They cause lifelong impairments, including visual and auditory impairments. They destroy livelihoods […] and even impede national economic recovery.”

Similar language can be used to describe the impact of NTDs. Though medically diverse, NTDs can slowly kill, blind, disfigure and debilitate their victims. They cause untold suffering to victims and caregivers in the poorest communities and contribute to perpetuating a cycle of disease, stigma and poverty.

Collectively, NTDs killed more than 80,000 people and caused the loss of more than 18m disability-adjusted life years (a measure of the burden of disease burden, expressed as the years lost to ill health, disability or early death) in 2019 alone. Unfortunately, these staggering figures, which are grossly underestimated, still do not get NTDs the kind of attention they deserve.

The 1997 mine ban treaty represents an international commitment and responsibility to eliminate landmines around the world. The roadmap for NTDs sets a similar goal – to “control and eliminate the NTDs by 2030”.

Nonetheless, the resources allocated to help people suffering from NTDs remain scarce. Despite recent successes (for example, 33 countries have eliminated at least one NTD since 2012) and communication efforts (30 January has been declared World NTD Day), we have largely turned a blind eye to these conditions.

A clear and powerful message on the terrible impact that NTDs have on individuals and communities would help to raise awareness and engender the required international commitment to control and eliminate these “slow-motion, indiscriminate weapons of mass destruction” by 2030.

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Belgium might close schools and cultural activities

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Today, Friday, Belgian governments are meeting again in order to decide on new Covid measures in order to stop the spreading of the virus as numbers are spiking. This time the concertation committee is gathering on the request of the Flemish minister-president Jan Jambon who suggested to close down all indoor events, including all concerts and theatre productions. The closing of schools is also on the agenda.

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El Salvador ‘responsible for death of woman jailed after miscarriage’ | Global development

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The Inter-American court of human rights has ruled that El Salvador was responsible for the death of Manuela, a woman who was jailed in 2008 for killing her baby when she suffered a miscarriage.

The court has ordered the Central American country to reform its draconian policies on reproductive health.

The decision on Tuesday marked the first time an international court has ruled on El Salvador’s extreme abortion laws and was celebrated by women’s rights activists, who believe it could open doors for change across the region.

Since 1998, abortion in El Salvador has been banned without exception, even in cases of rape and incest. Over the past two decades, more than 180 women have been jailed for murder for having an abortion after suffering obstetric emergencies, according to rights groups.

The case of Manuela v El Salvador was brought after the 33-year-old mother of two from the countryside died from cancer after receiving inadequate medical diagnosis and treatment, leaving her two children orphaned. She had been serving a 30-year prison sentence for aggravated homicide after a miscarriage.

When Manuela – whose full name has never been made public in El Salvador – went to the hospital after miscarrying, staff failed to provide her with timely treatment and instead subjected her to verbal abuse and accused her of having an abortion, according to the Center for Reproductive Rights. Manuela was handcuffed to her bed and denied access to a lawyer while police interrogated her.

“There is no doubt that Manuela suffered an obstetric emergency,” the landmark court ruling stated. “Such situations, as they are medical conditions, cannot lead to a criminal sanction.”

The court also ruled that the state must pay reparations to Manuela’s family, and should develop comprehensive sexual education policies and guarantee doctor-patient confidentiality.

“The Inter-American court has done justice by recognising Manuela was another victim of an unjust legal context that originates in the absolute prohibition of abortion,” said Morena Herrera, at the Feminist Collective for Local Development, one of the parties in the case supporting Manuela’s family.

“Manuela’s story is a sad one, but it represents a change and becomes a path of justice and hope for all women in Latin America and the Caribbean who are criminalised for obstetric events.”

Most countries in the region respect the Inter-American court’s jurisdiction, opening the door for sweeping change, activists said.

“This is a huge advance for reproductive rights, not only in El Salvador but across Latin America,” said Catalina Martínez Coral, regional director for Latin America and the Caribbean at the Center for Reproductive Rights, another party in the case. “This is a standard we can apply to the constitutions and states across the region.”

Martínez Coral added that while the ruling was to be celebrated, the issue of poverty affecting access to reproductive rights remained a challenge.

“There are over 180 cases of women in jail, or that have been jailed, over these issues,” said Martínez Coral, who also worked as a litigator on the case against the Salvadorean state.

“What that means is we’re dealing with a state that criminalises women and, above all, criminalises poor women in the most rural and impoverished areas,” she said.

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EU commission unveils proposal to digitalise justice systems

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The European Commission unveiled on Wednesday a proposal to digitalise EU cross-border justice systems, aiming at making them more accessible and effective. Under the new draft law, the EU executive wants to tackle inefficiencies affecting cross-border judicial cooperation and barriers to access to justice in cross-border cases. Shifting paper-based communications to electronic formats would save up to €25m per year across the EU in postage and paper costs.

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