• Acting on an Environmental Health Disaster: The Case of the Aral Sea.

      Small, I; van der Meer, J; Upshur, R; Uzbekistan/Turkmenistan and the Aral Sea Area Program, Medecins Sans Frontieres, Tashkent, Uzbekistan. msfh-tashkent@amsterdam.msf.org (Published by National Institute of Environmental Health Sciences, 2001-06)
      The Aral Sea area in Central Asia has been encountering one of the world's greatest environmental disasters for more than 15 years. During that time, despite many assessments and millions of dollars spent by large, multinational organizations, little has changed. The 5 million people living in this neglected and virtually unknown part of the world are suffering not only from an environmental catastrophe that has no easy solutions but also from a litany of health problems. The region is often dismissed as a chronic problem where nothing positive can be achieved. Within this complicated context, Medecins Sans Frontieres, winner of the Nobel Peace Prize in 1999, is actively trying to assess the impact of the environmental disaster on human health to help the people who live in the Aral Sea area cope with their environment. Medecins Sans Frontieres has combined a direct medical program to improve the health of the population while conducting operational research to gain a better understanding of the relationship between the environmental disaster and human health outcomes. In this paper we explore the health situation of the region and the broader policy context in which it is situated, and present some ideas that could potentially be applied to many other places in the world that are caught up in environmental and human health disasters.
    • Dracunculiasis in South Sudan

      Fabiansen, Christian; Harboe, Zitta Barrella; Christensen, Vibeke; Médecins Sans Frontières, Copenhagan, Denmark (2010-05-01)
    • Epidemiological Support for a Multifactorial Aetiology of Kashin-Beck Disease in Tibet.

      Suetens, C; Moreno-Reyes, R; Chasseur, C; Mathieu, F; Begaux, F; Haubruge, E; Durand, M; Nève, J; Vanderpas, J; Médecins Sans Frontières, Brussels, Belgium. carl.suetens@ihe.be (Springer, 2001)
      We carried out a cross-sectional study in 12 rural villages in order to identify the risk factors for Kashin-Beck disease in Tibet. Children aged 5-15 years (n=575) were examined and their corresponding houses were visited. Samples were collected in order to study fungal contamination of stored grain and the organic matter content of drinking water. Multivariate analysis was performed using logistic regression and population attributable fractions were computed to estimate the impact of each factor. The following variables were independently associated with the disease: age, gender, low socio-economic status, indicators of a poorly diversified diet, iodine deficiency and small water container size (with higher organic matter levels in small containers). Selenium deficiency was severe in all study subjects. The degree of fungal contamination of barley grain was related to the highest percentage of cases (65%) in a sample of the study population. Higher urinary iodine levels were not associated with decreasing prevalence rates when Alternaria sp. was isolated. The data that we report supports the hypothesis that Kashin-Beck disease occurs as a consequence of oxidative damage to cartilage and bone cells when associated with decreased antioxidant defence. Another mechanism that may coexist is bone remodelling stimulated by thyroid hormones whose actions can be blocked by certain mycotoxins.
    • Kashin-Beck Disease and Drinking Water in Central Tibet.

      La Grange, M; Mathieu, F; Begaux, F; Suetens, C; Durand, M C; Médecins Sans Frontiéres, Brussels, Belgium. (Springer, 2001)
      A cross-sectional survey was carried out in order to study the relationship between Kashin-Beck disease and drinking water. The average volume of the water containers was larger in families unaffected by the disease. Organic material was measured by ultraviolet (UV) spectroscopy. The UV absorbency was significantly lower in drinking water of unaffected families. Thus, the organic material in drinking water may play a role in the pathogenesis of Kashin-Beck disease.
    • Localised transmission hotspots of a typhoid fever outbreak in the Democratic Republic of Congo

      Ali, E; Bergh, RVD; D'hondt, R; Kuma-Kuma, D; Weggheleire, AD; Baudot, Y; Lambert, V; Hunter, P; Zachariah, R; Maes, P (PAMJ-Center for Public Health Research and Information, 2017)
      In a semi-urban setting in the Democratic Republic of Congo, this study aims to understand the dynamic of a typhoid fever (TF) outbreak and to assess: a) the existence of hot spots for TF transmission and b) the difference between typhoid cases identified within those hot spots and the general population in relation to socio-demographic characteristics, sanitation practice, and sources of drinking water.
    • [Man-water contacts and urinary schistosomiasis in a Mauritanian village]

      Etard, J F; Borel, E; Département de Parsitologie et Médecine Tropicale, Université Lyon I et Médecins sans Frontières, Paris, France. (1992)
      For the period September to December 1985, 1226 water contacts were recorded during 8 days of direct observation. Various activities were analysed in order to determine their responsibility in transmission. An index of exposure, allowing for duration of contact, body surface exposed and infectiousness of the water was calculated for each contact. Domestic contacts, primarily female, represented 62% of the observations but only 15% of total exposure. Conversely, contacts for recreational purposes mainly involved young boys and accounted for 14% of the observations and 70% of total exposure. Between 6 and 20 years of age the mean index of exposure by contact was higher in males than in females. Changing water contact behavior seems to be an unrealistic means of preventing transmission in the community studied. The most appropriate strategy of control would appear to be selective treatment of heavily infected individuals.
    • Not a drop to drink in the Aral Sea.

      Small, I; Falzon, D; van der Meer, J; Ford, N; Upshur, R (2001-11-10)
    • Safe Water for the Aral Sea Area: Could it get Any Worse?

      Small, I; Falzon, D; van der Meer, J; Ford, N; Médecins Sans Frontières, Aral Sea Programme, Tashkent, Uzbekistan. (Published by Oxford University Press, 2003-03)
      The environmental adversities around the Aral Sea in Central Asia have been the subject of recent research. Attempts at sustainable provision of palatable drinking water in low chemical and microbial contaminants for the 4 million people in the two countries around the Aral littoral have been largely unsuccessful. In the last few years, severe drought has further depleted the amount of available water. This shortage has negatively impacted on agriculture, and accentuated the out migration of people. An appeal is made to assist the local population in this arid area to cope with the acute and chronic deterioration of water security.
    • South-Asian tsunami.

      Guthmann, J P; Sauvageot, D; De Filippi, L; Burny, M E; Brown, V (2005)
    • A tale of two cities: restoring water services in Kabul and Monrovia

      Pinera, J-F; Reed, R A; Médecins Sans Frontières, Amsterdam, Netherlands; Water Engineering and Development Centre, Loughborough University, United Kingdom (2009-01-12)
      Kabul and Monrovia, the respective capitals of Afghanistan and Liberia, have recently emerged from long-lasting armed conflicts. In both cities, a large number of organisations took part in emergency water supply provision and later in the rehabilitation of water systems. Based on field research, this paper establishes a parallel between the operations carried out in the two settings, highlighting similarities and analysing the two most common strategies. The first strategy involves international financial institutions, which fund large-scale projects focusing on infrastructural rehabilitation and on the institutional development of the water utility, sometimes envisaging private-sector participation. The second strategy involves humanitarian agencies, which run community-based projects, in most cases independently of the water utilities, and targeting low-income areas. Neither of these approaches manages to combine sustainability and universal service. The paper assesses their respective strengths and weaknesses and suggests ways of improving the quality of assistance provided.