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Looking for a volunteer to help fight dengue fever
Editorial
Peace-keeping efforts in Darfur
Panos Pictures
The printed journal includes an image merely for illustration
See Comment page 463 See Series page 521 For more on UN resolution 1769 see http://www.un.org/ News/Press/docs2007/sc9089. doc.htm For more on the Darfur Peace Agreement see http://allafrica. com/peaceafrica/resources/ view/00010926.pdf For more on health issues in Sudan see http://www.emro. who.int/sudan/ or http://www.unsudanig.org/
In a speech at the UN last week, UK Prime Minister, Gordon Brown, described the war in Darfur as “the greatest humanitarian disaster the world faces today”. Since the conflict began 4 years ago, 200 000 people are believed to have died and 2·5 million people have fled their homes to escape the violence. Now, there is renewed hope as the UN Security Council with the alleged support of the Sudanese Government has approved the largest peacekeeping mission in the world—the deployment of a 26 000-strong hybrid UN-African force to bring security to the region. But can this UN mission succeed when past missions in Darfur have failed? It is unclear who will supply the needed troops. The stipulation that the troops have to be mainly African will be a challenge; the existing 7000-African Union peace force is already overstretched. A firm strategy for the new deployment and the kind of peace these troops will be looking to monitor and implement are vague. Furthermore, deployment of 26 000 troops brings all sorts of logistical problems, including access to water
and allocation of land. Additionally, training troops on gender issues to protect women and children from the continued violence needs to be ensured. As attacks on aid organisations increase, many displaced civilians are simply not getting assistance. On top of the psychological trauma, the lack of access to clean water and the poor sanitation have driven up the number of cases of and deaths from water-borne diseases, and there has been a sharp increase in malnutrition. This mission must provide protection for all civilians, and access and security for humanitarian operations. It must have the authority to make both government and opposition groups accountable for acts of violence against civilian populations, and re-enforce the implementation of pledges made under the Darfur Peace Agreement. The mission can only be deemed a success when the millions of displaced people feel they are able to go back to their homes in an environment of safety, security, and dignity. The peace mission in theory is a good first step but to bring lasting peace to the region, undoubtedly, a political solution must be urgently sought. ■ The Lancet
Looking for a volunteer to help fight dengue fever
Reuters
The printed journal includes an image merely for illustration
For more on the current outbreak of dengue fever in south-east Asia see http://wap.alertnet.org/ thefacts/reliefresources/ sections/DENGUE.htm
458
“April is the cruellest month”, the poet TS Eliot famously opined. But for millions in the Asia-Pacific region, August and September will be crueller. The rainy season of the tropics and subtropics brings not only the monsoons but also dengue fever. Dengue is endemic in more than 100 countries and its vector, the Aedes aegypti mosquito, which thrives on warm-weather, heavy-rain, and crowded-cities, annually infects more than 50 million people around the world. This year has already seen even larger outbreaks in several countries, including Singapore, Cambodia, Malaysia, the Philippines, and Vietnam, with many deaths (182 in Cambodia alone) reported. The most severe form of the disease, the haemorrhagic type is a leading cause of deaths in children in endemic countries. Vector control, by insecticides, cleaning household water-storage containers, and draining pools of stagnant water, is the main component of dengue prevention. Other efforts are also required—public-health activities, better hospital care, and education, an always critical
but usually formidable task. Earlier recognition of the signs of the disease, especially in children, is important. A permanent decrease in disease incidence may only be achievable with a vaccine. Fortunately, candidate vaccines exist; unfortunately, safety and efficacy data will not be available for another few years. As with other diseases, funding is a problem, and so is health-care infrastructure. And cooperation and coordination among governmental and non-governmental efforts are in short supply. The many players in the dengue-prevention field need to be brought, at least for the present crisis, under one umbrella. Health ministers in the Asia-Pacific region, with input from organisations, such as the International Committee of the Red Cross and WHO, should quickly appoint a dengue czar. That person needs to understand public health, of course, but even more pressing at the moment is a person who can organise, coordinate, influence, and persuade. We can think of a few obvious candidates. Jimmy Carter, are you available? ■ The Lancet www.thelancet.com Vol 370 August 11, 2007
Peace-keeping efforts in Darfur
Panos Pictures
The printed journal includes an image merely for illustration
See Comment page 463 See Series page 521 For more on UN resolution 1769 see http://www.un.org/ News/Press/docs2007/sc9089. doc.htm For more on the Darfur Peace Agreement see http://allafrica. com/peaceafrica/resources/ view/00010926.pdf For more on health issues in Sudan see http://www.emro. who.int/sudan/ or http://www.unsudanig.org/
In a speech at the UN last week, UK Prime Minister, Gordon Brown, described the war in Darfur as “the greatest humanitarian disaster the world faces today”. Since the conflict began 4 years ago, 200 000 people are believed to have died and 2·5 million people have fled their homes to escape the violence. Now, there is renewed hope as the UN Security Council with the alleged support of the Sudanese Government has approved the largest peacekeeping mission in the world—the deployment of a 26 000-strong hybrid UN-African force to bring security to the region. But can this UN mission succeed when past missions in Darfur have failed? It is unclear who will supply the needed troops. The stipulation that the troops have to be mainly African will be a challenge; the existing 7000-African Union peace force is already overstretched. A firm strategy for the new deployment and the kind of peace these troops will be looking to monitor and implement are vague. Furthermore, deployment of 26 000 troops brings all sorts of logistical problems, including access to water
and allocation of land. Additionally, training troops on gender issues to protect women and children from the continued violence needs to be ensured. As attacks on aid organisations increase, many displaced civilians are simply not getting assistance. On top of the psychological trauma, the lack of access to clean water and the poor sanitation have driven up the number of cases of and deaths from water-borne diseases, and there has been a sharp increase in malnutrition. This mission must provide protection for all civilians, and access and security for humanitarian operations. It must have the authority to make both government and opposition groups accountable for acts of violence against civilian populations, and re-enforce the implementation of pledges made under the Darfur Peace Agreement. The mission can only be deemed a success when the millions of displaced people feel they are able to go back to their homes in an environment of safety, security, and dignity. The peace mission in theory is a good first step but to bring lasting peace to the region, undoubtedly, a political solution must be urgently sought. ■ The Lancet
Looking for a volunteer to help fight dengue fever
Reuters
The printed journal includes an image merely for illustration
For more on the current outbreak of dengue fever in south-east Asia see http://wap.alertnet.org/ thefacts/reliefresources/ sections/DENGUE.htm
458
“April is the cruellest month”, the poet TS Eliot famously opined. But for millions in the Asia-Pacific region, August and September will be crueller. The rainy season of the tropics and subtropics brings not only the monsoons but also dengue fever. Dengue is endemic in more than 100 countries and its vector, the Aedes aegypti mosquito, which thrives on warm-weather, heavy-rain, and crowded-cities, annually infects more than 50 million people around the world. This year has already seen even larger outbreaks in several countries, including Singapore, Cambodia, Malaysia, the Philippines, and Vietnam, with many deaths (182 in Cambodia alone) reported. The most severe form of the disease, the haemorrhagic type is a leading cause of deaths in children in endemic countries. Vector control, by insecticides, cleaning household water-storage containers, and draining pools of stagnant water, is the main component of dengue prevention. Other efforts are also required—public-health activities, better hospital care, and education, an always critical
but usually formidable task. Earlier recognition of the signs of the disease, especially in children, is important. A permanent decrease in disease incidence may only be achievable with a vaccine. Fortunately, candidate vaccines exist; unfortunately, safety and efficacy data will not be available for another few years. As with other diseases, funding is a problem, and so is health-care infrastructure. And cooperation and coordination among governmental and non-governmental efforts are in short supply. The many players in the dengue-prevention field need to be brought, at least for the present crisis, under one umbrella. Health ministers in the Asia-Pacific region, with input from organisations, such as the International Committee of the Red Cross and WHO, should quickly appoint a dengue czar. That person needs to understand public health, of course, but even more pressing at the moment is a person who can organise, coordinate, influence, and persuade. We can think of a few obvious candidates. Jimmy Carter, are you available? ■ The Lancet www.thelancet.com Vol 370 August 11, 2007