Sharia court sets adultery appeal ruling for 25 March--World Water Day is celebrated on Friday 22 March 2002-- Initiative to promote access to quality HIV Medicines release first batch of results -Afghanistan Health Sector Planning Conference

World Health Organization

Afghanistan Health Sector Planning Conference

March 20, 2002

Over three hundred representatives of UN agencies, NGOs, and the Ministry
of Public Health have agreed on a common strategy for rebuilding the
shattered health sector in Afghanistan. The plan of action was approved
following a four-day health sector-planning workshop held in Kabul from
March 16-19, 2002. It was the first time in twenty years that health
representatives of all of Afghanistan's 32 provinces met to forge a common
health programme.

Participants at the planning workshop have defined four priorities in the
fight to save lives in Afghanistan, starting with the control of
infectious diseases. 90% of deaths from communicable diseases are caused
by pneumonia, tuberculosis, diarrhea, malaria, and measles. These five
diseases account for half of all premature deaths, killing mostly children
and young adults.

Currently, less than 40% of Afghan children are vaccinated against the
major disease killers. International and national health officials have
set a goal of reaching 55% of children by the end of this year, thereby
saving the lives of thousands of young Afghans.

A second part of the strategy entails upgrading the knowledge and skills
of health workers at all levels through comprehensive training programmes.
The World Health Organization is also strengthening its disease
surveillance system to improve its capacity to respond to outbreaks.
Finally, the control of deadly diseases will be tackled through the
provision of life-saving drugs, especially to those in greatest need, in
rural health centers.

The second priority focuses on ensuring Afghan women are offered an
opportunity to enjoy healthy reproductive lives. Fifty-three women a day
die in Afghanistan from pregnancy-related causes. This amounts to at least
17,000 per year, making Afghanistan's maternal mortality rate amongst the
highest in the world- only surpassed by war-torn Sierra Leone. Ninety
percent of Afghan women deliver their babies at home, attended mostly by
Traditional Birth Attendants (TBAs). The Safe Motherhood Initiative
provides training to these attendants to enhance their skills to ensure
safer births. This programme will be extended in its scope in the upcoming
year to reach more TBAs, especially in remote areas. At the same time,
emphasis will be placed on increasing the access of women to emergency
obstetric care.

The recent outbreak of scurvy, a Vitamin C deficiency, in Taiwara District
in Ghor Province attests to the health dangers posed by poor nutrition.
Improving the nutritional situation for all Afghans is the third priority.
Malnutrition is particularly lethal in combination with infectious
diseases and has been ravaging vulnerable populations in Afghanistan. With
50% of Afghan children suffering from chronic malnutrition, substantially
reducing this figure is a key concern of UNICEF, the World Food Programme
and numerous NGOs involved in children's health.

The common health strategy entails targeting vulnerable groups, and
focusing on those regions most affected by drought. Proper surveillance,
training of staff on case management, and developing therapeutic and
supplementary feeding programmes make up the most important components of
controlling malnutrition in Afghanistan.

Finally, the mental health crisis in Afghanistan must be urgently
addressed. Although no figures are currently available, WHO estimates
that 40% of the Afghan population is suffering from psychosocial problems.
Unfortunately, the great majority of these people have nowhere to turn to
for support. Tackling this issue must begin with the training of health
workers to recognize and treat mental disorders. At the same time,
communities must be made aware of the causes of psychosocial distress in
order to avoid social stigmatization.

Despite the need for emergency action, rebuilding the health sector in
Afghanistan is a long-term effort, requiring careful coordination and the
input of all, including the UN, NGOs and international donors. UN
agencies and NGOs are seeking 130 million dollars to implement this health
programme in 2002. This breaks down into $60 million dollars for WHO
projects, designed primarily to support the Afghan Ministry of Public
Health and $70 million for other UN and NGO work.
It is estimated that 2.2 billion dollars will be required over the next
ten years to provide a minimal health care package for Afghans.

Currently, Afghanistan suffers from one of the world's poorest health
outlooks, with a life expectancy of 46 years, and six million people
without access to basic health service. There is a substantial gap in
health care services between rural and urban areas, and a serious lack of
qualified personnel to provide adequate health services to the population.

March 2002 Special Feature


World Water Day is celebrated on Friday 22 March 2002

Arsenic - Mass Poisoning on an Unprecedented Scale


Geneva, March 2002-The largest mass poisoning of a population in history
is now underway in Bangladesh.

It is a terrible public catastrophe, asserts Allan H. Smith, Professor of
Epidemiology at the University of California, Berkeley, and a WHO
consultant who has investigated arsenicosis in Bangladesh on several
trips.

The number of people affected by this arsenic disaster is among the
greatest of any disease facing the world today. "By virtue of its sheer
size it is pushing the limits of our knowledge and capacity to respond to
it," asserts Professor Hans van Ginkel, Rector of the United Nations
University in Tokyo.

The crisis has, however, spurred intense research in water
de-contamination techniques. How to ensure tens of millions of people
arsenic-free drinking water when their water supply comes from wells, many
of them rich in arsenic.

How many Bangladeshi are exposed to a high level of arsenic? Estimates
vary from a low of 28-35 million to a high of 77 million, more than half
the population of the country.

The Bangladeshi are being poisoned by drinking well water, usually without
knowing it. Only three decades ago health and development experts, and
small local contractors, dug between 7-11 million deep tube wells
throughout Bangladesh. The experts encouraged the whole nation to drink
well water because it was safe. It was free of the bacteria that caused
water-borne diseases such as diarrhoea and other intestinal maladies that
have long plagued tropical Bangladesh.

Ironically, the people of Bangladesh exchanged water-borne diseases for
arsenicosis. In the 1970s public health specialists and government
policy-makers did not think of arsenic. It was only in 1993 that the
"clean" well water was discovered to contain dangerous quantities of the
poison.

Arsenicosis can cause skin cancer as well as cancers of the bladder,
kidney and lung, and diseases of the blood vessels of the legs and feet,
and possibly diabetes, high blood pressure and reproductive disorders.

WHO's most recent guideline for a maximum amount of arsenic in drinking
water recommends 10 parts per billion (ppb). That was in 1993 when it was
lowered to that level from 50 ppb. A new guideline is anticipated in 2003.
But most water that is drunk in arsenic affected areas in Bangladesh has
substantially higher levels, frequently far above 50 ppb.

Arsenic-contaminated water is not restricted to developing countries. In
the western states of the United States of America about 13 million people
drink arsenic-tainted water, albeit less contaminated than the well water
in Bangladesh. Australia, too, has arsenic-contaminated water. So do
Argentina, Brazil, Chile, Hungary, Mexico, Taiwan (Province of China),
Thailand, Viet Nam, and the eastern areas of India in Bengal.

"Unfortunately," says WHO sanitary engineer, Hiroki Hashizume, a Japanese
expert on arsenic, "it is virtually impossible, with present measurement
techniques, especially in the developing world, to measure quantities
below 10 ppb. When drinking water guidelines or national standards are
established, careful attention has to be paid to analytical capability,
arsenic removal technology, etc., to ensure that the levels are really
achieved. Since the principal health gain comes from targeting those most
exposed to arsenic poisoning, using an intermediate target of 50 ppb,
until a lower target can be achieved, would already improve people's
health given Bangladesh's limitations.

"Another unfortunate and complicating fact about arsenic poisoning,"
Hiroki Hashizume adds, "is that it generally takes from seven to 10 years,
sometimes longer, for the disease to be recognized. When it finally is, it
may be too late to treat."

Professor Robert Goyer, who headed a nine-member commission of the US
National Academies of Science, says its findings bolster a 1999 study by
the Academy that found that men and women who drink every day water with
10 ppb of arsenic have an increased risk of more than 3 in 1000 of
developing bladder or lung cancer during their lifetime. That risk rises
to 7 in 1000 at 20 ppb.

Arsenicosis is recognizable from skin color changes, blotches all over the
face and body, hyper pigmentation on the chest and upper arms, hard
patches on palms and soles of the feet, inability to walk, debilitating
pain, watery eyes.

Recently, a woman staggered into a village in Chandpur District where
Nasrine R. Karim, the head of a Bangladeshi non-governmental organization,
Earth Identity Project, was visiting arsenic-sick villagers.

"She was in a pitiful state," recalls Nasrine. " She could barely walk or
stand up. Her face and body were covered with dreadful splotches. Her
hands and the bottoms of her feet were a solid mass of hard patches, her
eyes watery. Her lips and tongue were blue. I had never seen a victim of
arsenicosis in such a ghastly condition."

Nasrine, whose NGO deals with 5,000 villagers who have been drinking the
arsenic-tainted water found in 98% of the area's wells, decided to
transport Chandrabanu to Dhaka. There she was given vitamins and was well
nourished for her severe malnutrition. Nasrine took the woman into her
house for two months.

"During this period she followed the STAR water treatment," Nasrine says.
"STAR stands for Stevens Technology for Arsenic Removal. Stevens is an
institute in Hoboken, New Jersey, and one of their engineers, an
environmental chemist named Xiaoguang Meng, has invented an effective and
inexpensive method for filtering out the arsenic from drinking water for
individual households.

"You pour well water into a 20-liter bucket and then empty into it a small
packet of powder containing 3.8 grams of an iron sulphate mixture with a
small quantity of calcium hypochlorite. You stir with a stick for less
than a minute. Then pour the water into three or four inches of sand which
serve as a filter. To make sure that no arsenic has slipped through the
sand, we throw away this first water. The next batch of water flows into a
hole in the bucket through a tube into a second bucket. It is perfectly
clean and ready to be drunk.

"In about two months Chandrabanu felt and looked well enough to return to
her village. Since then, the splotches on her face and body and the hard
patches on her feet have disappeared. Today she is no longer in any pain,
and she is walking and working. She has improved tremendously, and yet we thought we couldn't possibly save her life.

For Chandrabanu it is a miraculous cure. For us at the Earth Identity
Project it is a remarkable result, full of hope. I don't dare yet to call
it a 'cure,' although it has all the signs of one." Nasrine says that her 5,000 villagers are all using the same water treatment and "responding favorably. The results are, again, very encouraging."

Jamie Bartram, Coordinator of WHO's Water, Sanitation and Health
Programme, says "we know that arsenic is rapidly excreted in urine. So,
for early or mild cases of arsenicosis no specific treatment other than
clean, safe water is required. Nasrine Karim's experience seems to suggest
that ceasing to drink arsenic-tained water, combined with the natural
excretion of the arsenic in urine, can eliminate arsenicosis. Any
technique that guarantees uncontaminated water, will do the trick. It
remains to be seen, however, whether all the possible long-term
after-effects of arsenicosis will really have been eliminated. Basically,
clean water is the cure."

Considering what approach one should take for curing or preventing arsenic
poisoning, Professor Smith of U. Cal. Berkeley, agrees that "the basic
treatment is to supply the patient with drinking water that is free from
arsenic. This is the first priority. Indeed, in the absence of good
evidence for the effectiveness of other treatments, the second priority is
to continue providing arsenic-free water, and the third priority is to
monitor patients to ensure that they remain unexposed to arsenic."

And is Nasrine Karim's success on a small scale meaningful for the tens of
millions of other Bangladeshi who are exposed to arsenic poisoning?

"I think so," she says. "Instead of paying $10 for the buckets and
importing the chemical packets from the United States, we could easily
manufacture them here in Bangladesh in huge quantities and sell them at a
far lower price. To do this we need substantial funding. I'm often told
that health funding is available if it's for a good cause. Coping with the
arsenic poisoning of millions of women, children and men -'the largest
mass poisoning of a population in history' -- is a good cause, is it not?"

20 March 2002

INITIATIVE TO PROMOTE ACCESS TO QUALITY HIV MEDICINES RELEASES FIRST BATCH OF RESULTS TODAY

A new effort to assess the quality of HIV medicines could make treatment
services more accessible to poor countries. The World Health Organization
(WHO) has evaluated several HIV-related medicines and today publishes the
first list of products which were found to meet WHO recommended standards.
This initial phase of the project includes forty products from eight
branded and generic manufacturers. Managed by WHO, the initiative counts
on the expertise of UNICEF and the UNAIDS Secretariat, and is supported by
the UN Population Fund (UNFPA) and the World Bank.

"The project demonstrates the vital contributions research-based and
generic companies can make to innovation, quality, and access to
life-saving medicines," says Gro Harlem Brundtland, Director-General of
WHO. "We want to see an expansion in people's access to quality health
care, particularly in relation to those diseases, like HIV/AIDS, that keep
them poor and prevent the economic development of their communities."

The Access to Quality HIV/AIDS Drugs and Diagnostics project is part of a
UN-wide strategy to improve access to HIV treatment. The strategy is
meant to promote rational use of drugs; affordable prices for medicines
and diagnostics; sustainable financing; and reliable health and supply
systems.

"This process will assist countries, as well as UNICEF and other agencies,
in the procurement of quality products for HIV treatment," says Carol
Bellamy, Executive Director of UNICEF.

"This UN initiative marks an important step in increasing the number of
qualified suppliers of HIV medicines and improving the procurement of
these drugs for people living with HIV/AIDS in developing countries," says
Dr Peter Piot, UNAIDS Executive Director. "We hope this project will help
HIV-positive people gain greater access to affordable HIV medicines of
good quality."

The list released today includes eleven anti-retrovirals (ARVs) and five
products for opportunistic infections. The ARVs on the list allow for
several triple therapy combinations.

The pilot project evaluates pharmaceutical products according to WHO
recommended standards of quality and for compliance with Good
Manufacturing Practices. It is just the beginning of an ongoing process
that will keep adding products and suppliers to its list, as and when they
are found to meet the set standards. The list is now available on the web
sites of WHO and the other collaborating agencies. So far, eight
companies have been evaluated but another 13 suppliers and 100 products
are currently under review.

"We are involved in a dynamic process," explains Jonathan Quick, Director
of Essential Drugs and Medicines Policy at WHO. "We expect that the list
will grow steadily as more companies take an interest in participating and
countries expand their HIV/AIDS programmes."

Appropriate diagnostic support is essential to monitoring the progression
of AIDS, the success of medical treatment and the extent of viral
resistance to medication. Through its department of Blood Safety and
Clinical Technology, WHO is also evaluating HIV test kits and technologies
to monitor HIV drug treatment.

In addition, guidelines on minimum requirements for laboratory monitoring
of HIV drug treatment are being developed. WHO is also developing
training and quality assessment programmes for health care workers to
ensure correct use of diagnostic tests.

HIV/AIDS has become the leading cause of mortality in Africa; out of the
40 million people living with AIDS in the world, 28 million are in Africa.
In Asia and the Pacific, AIDS is rapidly spreading. An estimated 7.1
million people are now living with HIV/AIDS in the region.