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Andorra

General
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This small country is situated between France and Spain. Because of its elevation and proximity to the Pyrenees the climate is generally pleasant throughout the year.
Climate
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During the summer months the temperatures can rise to 30c but there is usually a cooling breeze. Lightening storms can occur during the summer months associated with torrential rain.
Sun Exposure and Dehydration
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Those from Northern Europe can develop significant sun exposure and so remember to use a wide brimmed hat when necessary. The altitude can also lead to significant tiredness and dehydration so take sufficient initial rest and drink plenty of fluids.
Safety & Security
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The level of crime throughout the country directed at tourists is very low. Nevertheless take care of your personal belongings at all times and use hotel safety boxes where possible.
Local Customs
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There are strict laws regarding the use of illegal drugs. Make sure you have sufficient supplies of any medication you required for your trip and that it is clearly marked. The European E111 form is not accepted in Andorra and so it is essential that you have sufficient travel insurance for your trip.
Winter Sports
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Andorra is one of the regions where many travel to partake of their winter sport facilities. Generally this is well controlled and one of the safer regions. Nevertheless, make certain your travel insurance is adequate for the activities you are planning to undertake.
Vaccination
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The only standard vaccine to consider for Andorra would be tetanus in line with many other developed countries of the world.

Travel News Headlines WORLD NEWS

Date: Thu, 12 Jul 2018 15:24:06 +0200

Andorra la Vella, Andorra, July 12, 2018 (AFP) - The tax haven of Andorra has long been a favourite destination for smokers looking to stock up on cheap cigarettes, but the enclave said Thursday that it would soon stop advertising the fact.   The government said it had signed up to the World Health Organization's (WHO) anti-tobacco convention, which aims to encourage people to quit smoking and combat contraband sales.   "The goal is to contribute to public health and pursue the fight against trafficking," government spokesman Jordi Cinca said at a press conference.

The tiny principality of Andorra, perched in the Pyrenees on the border between France and Spain, attracts millions of shoppers each year to duty-free stores, where prices of alcohol, cigarettes, electronics and clothes can be up to 20 percent cheaper than elsewhere in the EU.   High taxes on tobacco imposed by many countries to help people kick smoking make Andorra's cigarettes a particularly good deal.   The average pack costs just three euros ($3.50) compared with eight euros in France, which has said it will gradually raise the price to 10 euros a pack by November 2020.

Tobacco sales bring in some 110 million euros a year for Andorra, whose economy is otherwise based almost entirely on tourism.   It is also an enticing destination for smugglers, with French and Spanish border agents regularly seizing cartons from people trying to sneak them out, either by car or by hiking down the mountain trails which criss-cross the Pyrenees.   No date has been set for the advertising ban, which will come into effect three months after the ratification of the WHO accord is voted by parliament.
Date: Fri, 16 Mar 2018 02:41:51 +0100

Andorra la Vella, Andorra, March 16, 2018 (AFP) - The tiny principality of Andorra is witnessing a once in a generation phenomenon -- a widespread strike.   Around a third of civil servants across the mountainous micro-state have walked out to protest proposed reforms to their sector in what has been described as Andorra's first large-scale strike since 1933.

With no negotiation breakthrough in sight, picket lines are expected to be manned again on Friday with customs officers, police, teachers and prison staff among those taking part.   The first major strike in 85 years was sparked by plans from the government of Antoni Marti to reform civil servant contracts.   He has assured officials "will not do an hour more" work under the reforms and that 49 million euros would be allocated for the next 25 years to supplement civil servant salaries.   But government workers are unconvinced with unions warning the reforms could risk their 35 hour working week and pay.

Customs officers involved in the strike interrupted traffic on the Andorran-Spanish border this week, according to unions, while some 80 percent of teachers have walked out of classes.   Strikers have occupied the government's main administrative building and held noisy protests outside parliament calling for Marti's resignation.    "We have started collecting signatures to demand the resignation of the head of government and now nobody will stop us," Gabriel Ubach, spokesman for the public service union, told reporters.
Date: Mon 27 Sep 2017
Source: Contagion Live [edited]

A recent Dispatch article published in the Centers for Disease Control and Prevention (CDC)'s Emerging Infectious Diseases journal, offers insight into a large norovirus outbreak that sprung up in Spain in 2016 that had been linked with bottled spring water. The Public Health Agency of Catalonia (ASPCAT) reported a staggering 4136 cases of gastroenteritis from 11-25 Apr 2016. Of the 4136 cases, 6 individuals required hospitalization. The CDC defines a "case-patient" as an "exposed person who had vomiting or diarrhoea (3 or more loose stools within 24 hours)," as well as 2 or more of the following symptoms: nausea, stomach pain, or fever.

ASPCAT investigators traced back the outbreak to contaminated bottled spring water in office water coolers. The water came from a source in Andorra, a small independent principality located between Spain and France. Norovirus is a "very contagious virus," according to the CDC, and it is common for individuals to become infected by eating contaminated food. Although it is possible to be infected by consuming contaminated drinking water, this mode of transmission is "rare in developed countries," according to the article.

The investigators collected water samples from a total of 4 19-L water coolers in 2 different offices located in Barcelona, "from which affected persons had drunk; samples 1 and 2 came from 2 water coolers in one office, while samples 3 and 4 came from 2 water coolers in another office. Using "positively charged glass wool and polyethylene glycol precipitation for virus concentration," the investigators tested the samples.

"We detected high RNA levels for norovirus genotype I and II, around 103 and 104 genome copies/L, in 2 of the 4 water cooler samples concentrated by glass wool filtration and polyethylene glycol precipitation," according to the article. The investigators noted that a drawback of using molecular methods is that they are not able to differentiate between particles that are infectious and those that are not. Therefore, they "predicted the infectivity of norovirus in the concentrated samples by treating the samples with the nucleic acid intercalating dye PMA propidium monoazide and Triton X surfactant before RT-qPCR," which allowed them to "distinguish between virions with intact and altered capsids."

In those 2 water samples, they found high genome copy values -- 49 and 327 genome copies/L for norovirus genotype I and 33 and 660 genomes copies/L for norovirus genotype II. This was not an unexpected finding, due to the large number of infected individuals associated with the outbreak. Through "PMA/Triton treatment before RT-qPCR assays," the investigators found that the proportion of infected virions accounted for 0.3% to 5.6% of the total number of physical particles in the water samples, "which was enough to cause gastrointestinal illness."

The investigators also analyzed faecal samples collected from infected individuals who worked at the office in which the 1st 2 water samples were collected. They detected the following genotypes in those faecal samples: GI.2 and GII.17. In the faecal samples collected from the other office, they isolated the following genotypes: GII.4/Sydney/2012, GI.2, GII.17, and GII.2.

"We hypothesize that the spring water was contaminated by all 4 strains (GI.2, GII.2, GII.4, and GII.17) but levels of viral contamination for each genotype were not homogeneous in all bottled coolers," the investigators wrote. "We may have detected only the GII.4 genotype in water samples 1 and 2 because of a higher concentration of this specific genotype or because of bias caused by the sampling, concentration, and molecular detection procedures."

The investigators admit one limitation to their study: the small number of water samples collected and analyzed. They attribute this to the fact that on 15 Apr 2016, 4 days after the onset of the outbreak, the company that produced the drinking water recalled over 6150 containers of water "of suspected quality" as a precautionary measure. The recall prevented the investigators from collecting more samples to assess, according to the article.

Although the exact cause of the contamination has not yet been identified, the investigators posit that "the high number of affected persons from 381 offices that received water coolers, and the many different genotypes found in some patients' faecal specimens" suggest that the spring aquifer had been contaminated by "sewage pollution," and the Andorra Ministry of Health and Welfare banned further use of the spring.

The investigators suggest that assessing commercially-produced mineral waters for different harmful pathogens, such as norovirus would be beneficial. They note, however, that creating, enhancing, and managing such "virus surveillance systems" would be costly. Thus, the investigators suggest taking a "balanced approach to keep both the cost and the time required for the analyses within feasibility limits."  [Byline: Kristi Rosa]
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[The interesting article published in the September 2017 issue of Emerging Infectious Diseases is:
Blanco A, Guix S, Fuster N, et al: Norovirus in bottled water associated with gastroenteritis outbreak, Spain, 2016. Emerg Infect Dis. 2017; 23(9): 1531-34; https://wwwnc.cdc.gov/eid/article/23/9/16-1489_article. - ProMED Mod.LL]

[Catalonia and Andorra can be located on the HealthMap/ProMED-mail map at http://healthmap.org/promed/p/1341. - ProMED Sr.Tech.Ed.MJ]
Date: Thu, 26 Dec 2013 22:25:05 +0100 (MET)

ANDORRA LA VELLA, Andorra, Dec 26, 2013 (AFP) - A Spanish skier and a French snowboarder have died in avalanches in different mountain ranges in Europe, officials said Thursday.

The 27-year-old skier, a woman from Barcelona, died Wednesday while going off-piste alone in the Soldeu resort in Andorra, in the Pyrenees mountains between France and Spain, a resort manager told AFP.   Although she was rescued within 10 minutes, after her glove was spotted on the surface, she was unable to be revived despite a helicopter dash to hospital.

In the Italian Alps, close to the border with France, a 24-year-old Frenchman who was snowboarding with three friends on a closed run died Thursday when an avalanche swept over him in the resort town of Les Arnauds.   Local officials said he succumbed to multiple injuries, asphyxia and hypothermia.

Avalanches are common in Europe's ski resorts at this time of year, when early snows are heavy with moisture, and several deaths occur each winter.   Last Sunday, a 35-year-old Frenchman died in an avalanche in the Alps near the Italian border while on a three-day trek with a friend.
Date: Fri 7 Feb 2003 From: Jaime R. Torres Source: EFE Salud, Thu 6 Feb 2003 (translated by Maria Jacobs) [edited] -------------------------------------------------- Close to 300 students in one school and 173 tourists staying in 7 hotels in the Principality of Andorra have been affected by outbreaks of gastroenteritis that, according to local authorities, are not related to each other. Monica Codina, Minister of Health, stated that the outbreak that has affected almost 300 children and 8 adults in the San Ermengol school was detected last Monday [3 Feb 2003] but that it may have started Wednesday or Thursday of the previous week. The epidemiological surveys of a group of pre-school and grammar school students that may also be affected have not been performed yet. Also pending are the results of the microbiological tests of the food and water served in the school dining room, but the minister has indicated that the probable cause of the outbreak is the fact that water pitchers were filled with hoses directly from the faucet. The Minister stated that this outbreak of gastroenteritis is not related to the one that affected 173 tourists, most of them young people on holiday, who where staying in 7 hotels of the Principality. The government is also investigating the cause of this outbreak and has indicated that an anomaly in the system that supplies water to the hotels was detected, requiring a process of chlorination, which has not been carried out due to the heavy snowfall of the past few days. * * * * * * * * * * [The suspicion that defective water supplies may be responsible for all of these independent outbreaks suggests that the etiologic agent may be an enterovirus, hepatitis A virus, or non-viral, rather than one of the noroviruses associated with sudden-onset viral gastroenteritis. Information on the outcome of diagnostic tests in progress would be welcomed. - ProMed Mod.CP]
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Puerto Rico

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Tue, 24 Sep 2019 07:27:34 +0200 (METDST)

Miami, Sept 24, 2019 (AFP) - A strong 6.0 magnitude struck off the northwest coast of Puerto Rico late Monday, the United States Geological Survey said, although no casualties or damage were reported.   The quake struck 62km northwest of San Antonio at 11:23 pm local time (03:20 GMT) at a depth of 10km, the agency said.  San Antonio is home to Rafael Hernandez Airport, a key air link to the mainland US.    In 2010 nearby Haiti was struck by a devastating 7.0 magnitude earthquake that killed more than 250,000 people and crippled the nation's infrastructure.
Date: Mon, 12 Feb 2018 05:54:19 +0100

San Juan, Feb 12, 2018 (AFP) - Most of San Juan and a strip of northern Puerto Rico municipalities were plunged into darkness Sunday night after an explosion at a power station, five months after two hurricanes destroyed the island's electricity network.

The state electric power authority (AEE) said the blast was caused by a broken-down switch in Rio Piedras, resulting in a blackout in central San Juan and Palo Seco in the north.   "We have personnel working to restore the system as soon as possible," the AEE said.   San Juan's mayor, Carmen Yulin Cruz, said on Twitter that emergency services and local officials attended the scene in the neighbourhood of Monacillos, but no injuries were reported.

Meanwhile, the Puerto Rican capital's airport said it was maintaining its schedule using emergency generators.   The blackout comes as nearly 500,000 of AEE's 1.6 million customers remain without power since Hurricanes Irma and Maria struck the US territory in September 2017.   AEE engineer Jorge Bracero warned on Twitter that the outage was "serious," and advised those affected that power would not be restored until Monday.
Date: Wed, 13 Dec 2017 03:08:12 +0100
By Leila MACOR

Fajardo, Puerto Rico, Dec 13, 2017 (AFP) - Until Hurricane Maria hit Puerto Rico, Jose Figueroa did brisk business renting kayaks to tourists itching to see a lagoon that lights up by night thanks to millions of microorganisms.   Today, things are so dire he's considering selling water to motorists stopped at red lights.   "Now we are trying to survive," the 46-year-old tour guide said.

It used to be that visitors had to reserve a month in advance to get one of his kayaks and paddle around in the dark on the enchanting, bioluminescent body of water called Laguna Grande.   But tourists are scarce these days as the Caribbean island tries to recover from the ravages of the storm back in September.   "We do not know if we will have any work tonight," Figueroa said. "Last week, we worked only one day."    He and another employee of a company called Glass Bottom PR are cleaning kayaks on the seaside promenade of Fajardo, a tourist town in eastern Puerto Rico whose main attraction is the so-called Bio Bay.

The year started off well for Puerto Rico, with the global success of the song "Despacito" by local musicians Luis Fonsi and Daddy Yankee.   The catchy tune helped promote the US commonwealth island of 3.4 million people, which is saddled with huge debts and declared bankruptcy in May.    But the hurricane turned what should be an island bustling with tourists into one with deserted beaches, shuttered restaurants and hotels full of mainland US officials working on the rebuilding of the island.   "What few tourists we have are the federal officials themselves," said Figueroa.

- Locals only -
The grim outlook spreads up and down the seaside promenade of Fajardo, where many restaurants are closed because there is no electricity.   On this particular day around noon, the only restaurant open is one called Racar Seafood. It has its own emergency generator.   "We get by on local tourists," said its 61-year-old owner, Justino Cruz.   "Our clients are local -- those who have no electricity, no generator, cold food or no food."

Puerto Rico's once-devastated power grid is now back up to 70 percent capacity, but this is mainly concentrated in the capital San Juan.   So while inland towns that depend on tourism are struggling mightily, things are getting better in San Juan as cruise ships are once again docking.   On November 30, the first cruise ship since the storm arrived with thousands of vacationers on board. They were received with great fanfare -- quite literally, with trumpet blaring and cymbals crashing.

- Pitching in to help -
The World Travel & Tourism Council, based in London, says tourism accounted for about eight percent of Puerto Rico's GDP in 2016, or $8.1 billion.   Hurricane Maria's damage has been uneven. Although some tour guides now have no work and many eateries are shut down, hotels that have their own generators are doing just fine.   Thanks to the thousands of US government officials and reconstruction crew members that came in after the storm, the hotels that are open -- about 80 percent of the total -- are pretty much full.

These people are starting to leave the island this month but hotels may receive tourists around Christmas, at least in San Juan, where power has for the most part been restored.   The hurricane "undoubtedly cost billions in lost revenue," said Jose Izquierdo, executive director of the Puerto Rico Tourism Company.    But Izquierdo nevertheless says he is "optimistic" and suggests an alternative: put tourists to work as volunteers in the gargantuan reconstruction effort that the island needs.   "We want to look for travellers who want to travel with a purpose, who might have the commitment to help rebuild," said Izquierdo.

The program, called "Meaningful Travel" and launched in mid-November, organizes trips on which residents, Puerto Ricans living abroad and tourists are invited to help the island get back on its feet.   "The plan aims to create empathy with this tourist destination," said Izquierdo.    "We want to be like New Orleans after Katrina, where 10 years after the hurricane, tourism is the driving force of its economy. We want to build that narrative of recovery," he added.   "There are different ways in which the world wants to help Puerto Rico. The best way is to visit us."
Date: Thu, 9 Nov 2017 12:39:04 +0100
By Marcos PÉREZ RAMÍREZ

San Juan, Nov 9, 2017 (AFP) - Andrea Olivero, 11, consults her classmate Ada about an exercise during their daily English class at San Juan's Sotero Figueroa Elementary School. The task: list the positive and negative aspects of Hurricane Maria's passing almost two months ago.

The girls only have to look around. There is no electricity and they "roast" in the heat, Andrea says. At the back of the room, computers and televisions collect dust.   "We would like to move past the topic of the hurricane a bit. It is already getting repetitive," Andrea told AFP.   She is one of more than 300,000 pupils in the public education system, although only half of schools are functioning. Barely 42 per cent of Puerto Ricans have electricity seven weeks after Maria struck, killing at least 51 in the American territory.

The lack of power has prompted disorienting timetable changes on the tropical island, to avoid both the hottest hours of the day and the use of dining facilities.   "The children are very anxious. We manage to make progress in lessons and they change the hours again. Everything is messed up and we fall behind," English teacher Joan Rodriguez explained.   "We can't use the computers to illustrate classes," she said. "They are reading the novel "Charlotte's Web," and we wanted to do exercises comparing it to the film version. But we cannot use the television.

- Suspicions -
From October 23, some directors reopened their schools in the western region of Mayaguez and San Juan.   But last Thursday, the Department of Education ordered their closure, insisting they must be evaluated by engineering and architectural firms, then certified by the US Army Corps of Engineers.   One of those schools was Vila Mayo, also in San Juan. The community presumed it would open, as it had been used as a shelter, its electrical infrastructure had been inspected and it had not suffered structural damage.

But Luis Orengo, the education department's director in San Juan, told protesters outside the school it was closed as inspectors' findings had not reached the central government.   "This is unacceptable! The school is ready to give classes but they don't want to open it. Our children cannot lose a year," fumed Enid Guzman, who protested with her 11-year-old son, Reanny De la Cruz.   There are suspicions the stalled reopening of schools is, in part, related to the prior closure of 240 schools over the past year during Puerto Rico's long-running financial crisis.   The fiscal difficulties have seen the island's population drop over the past decade by 14 percent, leading in turn to a fall in school enrolment.

Before the storms, 300 schools were at risk of closure -- and for the president of Puerto Rico's federation of teachers, Mercedes Martinez, the government's aim is clear.   "Secretary (Julia) Keleher seems to have an orchestrated plan to close schools," she said, referring to the education secretary. "Why do you have to wait 30 days to get a certification so a school can open?"   Keleher has announced she expects most schools to be open by the middle of November.
Date: Tue 24 Oct 2017
Source: KFOR Oklahoma News4 [edited]

Puerto Rico has reported at least 76 cases of suspected and confirmed leptospirosis, including a handful of deaths, in the month after Hurricane Maria, said Dr. Carmen Deseda, the state epidemiologist for Puerto Rico.

Two deaths involved leptospirosis confirmed through laboratory testing, and "several other" deaths are pending test results, Deseda said. The 76 cases, up from 74 last week, also include one patient with confirmed leptospirosis who is currently hospitalized.

The island typically sees between 63 and 95 cases per year, she said. Health officials had expected that there would be a jump after the hurricane. "It's neither an epidemic nor a confirmed outbreak," Public Affairs Secretary Ramon Rosario Cortes said at a news conference Sunday [22 Oct 2017]. "But obviously, we are making all the announcements as though it were a health emergency."

Leptospirosis may be treated with antibiotics, but many people recover on their own. "The majority of leptospirosis cases is a mild, subclinical disease with no complications," Deseda said. "But one out of 10 people who have leptospirosis develop severe illness." In the 1st stage of leptospirosis, symptoms vary widely from fever and headache to red eyes and rashes. Some people may have no symptoms at all. But a small number will develop dire complications: meningitis, kidney and liver damage, bleeding in the lungs and even death.

Doctors are required to report any potential leptospirosis cases to health authorities, Deseda said. Those cases must then be tested to confirm the bacteria, since the symptoms can be difficult to tell apart from other illnesses. After that, health officials may look for patterns or clusters and determine whether there is an outbreak.

The lab tests on the suspected cases have been sent to the US Centers for Disease Control and Prevention, Deseda said. The turnaround time is about 5-6 days.

Doctors on the island have expressed concerns about burgeoning health crises amid hospitals that are overwhelmed, undersupplied and sometimes burning hot. Influenza is another concern on the horizon, Deseda said. Drinking water is also hard to come by on many parts of the island.

Dr. Raul Hernandez, an internist in San Juan, told CNN that people were drinking water from whatever sources they could find, such as rivers and creeks. If that water contains urine from a [leptospirosis-infected rat], those people will be at risk, he said.

Deseda said people should be discouraged from walking barefoot, drinking or swimming in potentially leptospirosis-contaminated waters.

"These diseases are everywhere, and there's a way to prevent them," she said.
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[Leptospirosis is a zoonotic, spirochetal infection that occurs worldwide and is transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. _Leptospira_ may survive in contaminated fresh water or moist soil for weeks to months. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.

Parts of Puerto Rico saw more than 30 inches of rain and consequent flooding with recent Hurricane Maria. A map showing the estimated rainfall across Puerto Rico with this hurricane is available at <https://twitter.com/NWSSanJuan/status/910983698597777409/photo/1?ref_src=twsrc%5Etfw&ref_url>.

With continued absence of potable water, inadequate sanitation, and flooding in the streets for a large proportion of the population in Puerto Rico, food- and water-borne diseases, like leptospirosis, will be a major problem. - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
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Gibraltar

United Kingdom and Gibraltar (England, Wales, Scotland, Northern Ireland) US Consular Information Sheet
June 03, 2008
COUNTRY DESCRIPTION:
The United Kingdom of Great Britain and Northern Ireland is a highly developed constitutional monarc
y comprised of Great Britain (England, Scotland and Wales) and Northern Ireland.
Read the Department of State Background Notes on the United Kingdom for additional information.
Gibraltar is a United Kingdom Overseas Territory bordering Spain and located at the southernmost tip of Europe at the entrance to the Mediterranean Sea.
It is one of thirteen former British colonies that have elected to continue their political links with London.
Tourist facilities are widely available.

ENTRY/EXIT REQUIREMENTS:
A visa is not required for tourist or business visits to the UK of less than six months in duration.
Visitors wishing to remain longer than one month in Gibraltar should regularize their stay with Gibraltar immigration authorities.
Those planning to visit the UK for any purpose other than tourism or business, or who intend to stay longer than six months, should consult the website of the British Embassy in the United States at http://britainusa.com for information about current visa requirements.
Those who are required to obtain a visa and fail to do so may be denied entry and returned to their port of origin.
The British government is currently considering reducing the visa-free period from six months to 90 days.
Travelers should be alert to any changes in legislation.
The U.S. Embassy cannot intervene in UK visa matters.
In addition to the British Embassy web site at http://britainusa.com, those seeking current UK visa information may also contact UK consular offices via their premium rate telephone service at 1-900-656-5000 (cost $3/minute) or 1-212-796-5773 ($12 flat fee).
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
The United Kingdom is politically stable, with a modern infrastructure, but shares with the rest of the world an increased threat of terrorist incidents of international origin, as well as the potential, though significantly diminished in recent years, for isolated violence related to the political situation in Northern Ireland (a part of the United Kingdom).
On July 7, 2005, a major terrorist attack occurred in London, as Islamic extremists detonated explosives on three underground trains and a bus in Central London, resulting in over 50 deaths and hundreds of injuries.
Following the attacks, the public transportation system was temporarily disrupted, but quickly returned to normal.
A similar but unsuccessful attack against London’s public transport system took place on July 21, 2005.
UK authorities have identified and arrested people involved in these attacks.
Similarly, those involved in terrorist incidents in London and Glasgow during the summer of 2007 were identified and arrested.
Like the US, the UK shares its national threat levels with the general public to keep everyone informed and explain the context for the various increased security measures that may be encountered. UK threat levels are determined by the UK Home Office and are posted on its web site at http://www.homeoffice.gov.uk/security/current-threat-level/.
Information from the UK Security Service, commonly known as MI5, about the reasons for the increased threat level and actions the public can take is available on the MI5 web site at http://www.mi5.gov.uk/.
On August 10, 2006, the Government of the United Kingdom heightened security at all UK airports following a major counterterrorism operation in which individuals were arrested for plotting attacks against US-bound airlines.
As a result of this, increased restrictions concerning carry-on luggage were put in place and are strictly enforced.
American citizens are advised to check with the UK Department for Transport at http://www.dft.gov.uk/transportforyou/airtravel/airportsecurity/ regarding the latest security updates and carry-on luggage restrictions.
The British Home Secretary has urged UK citizens to be alert and vigilant by, for example, keeping an eye out for suspect packages or people acting suspiciously at subway (called the “Tube” or Underground) and train stations and airports and reporting anything suspicious to the appropriate authorities.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.
For more information about UK public safety initiatives, consult the UK Civil Contingencies Secretariat web site at http://www.ukresilience.gov.uk.
The political situation in Northern Ireland has dramatically improved since the signing of the Good Friday Agreement in 1998, the announcement by the Irish Republican Army (IRA) on July 28, 2005, that it would end its armed campaign, and the agreement to set up a power-sharing government on May 8, 2007.
The potential remains, however, for sporadic incidents of street violence and/or sectarian confrontation. American citizens traveling to Northern Ireland should therefore remain alert to their surroundings and should be aware that if they choose to visit potential flashpoints or attend parades sporadic violence remains a possibility. Tensions may be heightened during the summer marching season (April to August), particularly during the month of July around the July 12th public holiday.

The phone number for police/fire/ambulance emergency services - the equivalent of "911" in the U.S. - is “999” in the United Kingdom and “112” in Gibraltar.
This number should also be used for warnings about possible bombs or other immediate threats.
The UK Anti-Terrorist Hotline, at 0800 789 321, is for tip-offs and confidential information about possible terrorist activity.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings, Travel Alerts, as well as the Worldwide Caution can be found.
Recent communications from U.S. Embassy London to the local American citizen community, called Warden Messages, can be found on the U.S. Embassy's American Citizens' Services web site at http://london.usembassy.gov/cons_new/acs/index.html.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet, A Safe Trip Abroad.
CRIME:
The United Kingdom and Gibraltar benefit from generally low crime rates and rates decreased slightly in 2007 in significant categories, including violent crime.
The crime situation in the UK is similar to the United States, with typical incidents including pick-pocketing; mugging; “snatch and grab” thefts of mobile phones, watches and jewelry; and theft of unattended bags, especially at airports and from cars parked at restaurants, hotels and resorts.
Pickpockets target tourists, especially at historic sites, restaurants, on buses, trains and the London Underground (the “Tube,” or subway).
Thieves often target unattended cars parked at tourist sites and roadside restaurants, looking for laptop computers and hand-held electronic equipment, especially global positioning satellite equipment.
Walking in isolated areas, including public parks, especially after dark, should also be avoided, as these provide advantageous venues for muggers and thieves.
At night or when there is little foot traffic, travelers should be especially careful using the underground pedestrian tunnels.
As a general rule, either walk the extra distance to use a surface crossing or wait until there are other adult pedestrians entering the tunnel.

In London, travelers should use only licensed “black taxi cabs,” or car services recommended by their hotel or tour operator.
Unlicensed taxis or private cars posing as taxis may offer low fares, but are often uninsured and may have unlicensed drivers.
In some instances, travelers have been robbed and raped while using these cars.
You can access 7,000 licensed “Black Cabs” using just one telephone number – 0871 871 8710. This taxi booking service combines all six of London’s radio taxi circuits, allowing you to telephone 24 hours a day if you need to “hail a cab.” Alternatively, to find a licensed minicab, text “HOME” to 60835 on your mobile phone to get the telephone number to two licensed minicab companies in the area. If you know in advance what time you will be leaving for home, you can pre-book your return journey.
The “Safe Travel at Night” partnership among the Metropolitan Police, Transport for London, and the Mayor of London maintains a website with additional information at http://www.cabwise.com/.
Travelers should not leave drinks unattended in bars and nightclubs.
There have been some instances of drinks being spiked with illegal substances, leading to incidents of robbery and rape.
Due to the circumstances described above, visitors should take steps to ensure the safety of their U.S. passports.
Visitors in England, Scotland, Wales, Northern Ireland, and Gibraltar are not expected to produce identity documents for police authorities and thus may secure their passports in hotel safes or residences.
Abundant ATMs that link to U.S. banking networks offer an optimal rate of exchange and they preclude the need to carry a passport to cash travelers’ checks.
Travelers should be aware that U.S. banks might charge a higher processing fee for withdrawals made overseas.
Common sense personal security measures utilized in the U.S. when using ATMs should also be followed in the UK.
ATM fraud in the UK is becoming more sophisticated, incorporating technologies to surreptitiously record customer ATM card and PIN information.
Travelers should avoid using ATMs that look in any way “temporary” in structure or location, or that are located in isolated areas.
Travelers should be aware that in busy public areas, thieves use distraction techniques, such as waiting until the PIN number has been entered and then pointing to money on the ground, or attempting to hand out a free newspaper.
When the ATM user is distracted, a colleague will quickly withdraw cash and leave.
If distracted in any way, travelers should press the cancel transaction button immediately and collect their card before speaking to the person who has distracted them.
If the person’s motives appear suspicious, travelers should not challenge them but remember the details and report the matter to Police as soon as possible.
In addition, travelers should not use the ATM if there is anything stuck to the machine or if it looks unusual in any way.
If the machine does not return the card, report the incident to the issuing bank immediately.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate at the opening of the next business day.
The U.S. Embassy or Consulate only issues replacement passports during regular business hours.
If you are the victim of a crime while overseas, report it to local police.
The nearest U.S. Embassy or Consulate will also be able to assist by helping you to find appropriate medical care, contacting family members or friends, and explaining how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

Visit the “Victim Support” web site, maintained by an independent UK charity to helps people cope with the effects of crime: http://www.victimsupport.org.uk/
See our information for Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
While medical services are widely available, free care under the National Health System is allowed only to UK residents and certain EU nationals.
Tourists and short-term visitors will be charged for medical treatment in the UK.
Charges may be significantly higher than those assessed in the United States.
Hiking in higher elevations can be treacherous.
Several people die each year while hiking, particularly in Scotland, often due to sudden changes in weather.
Visitors, including experienced hikers, are encouraged to discuss intended routes with local residents familiar with the area, and to adhere closely to recommendations.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
If your medical insurance policy does not provide overseas coverage, you may want to purchase a short-term policy for your trip.
The Department of State provides a list of travel insurance companies that can provide the additional insurance needed for the duration of one’s trip abroad in its online at medical insurance overseas.
Remember also that most medical care facilities and medical care providers in the UK do not accept insurance subscription as a primary source of payment.
Rather, the beneficiary is expected to pay for the service and then seek reimbursement from the insurance company.
This may require an upfront payment in the $10,000 to $20,000 range

Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning the United Kingdom is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

UK penalties for driving under the influence of even minimal amounts of alcohol or drugs are stiff and often result in prison sentences.
In contrast to the United States and continental Europe, where traffic drives on the right side of the road, in the UK, it moves on the left.
The maximum speed limit on highways/motorways in the UK is 70MPH.
Motorways generally have a hard shoulder (breakdown lane) on the far left, defined by a solid white line.
It is illegal to stop or park on a hard shoulder unless it is an emergency.
In such cases, you should activate your hazard lights, get out of your vehicle and go onto an embankment for safety.
Emergency call boxes (orange telephone booths with “SOS” printed on them) may be found at half-mile intervals along the motorway.
White and blue poles placed every 100 yards along the motorway point in the direction of the nearest call box.
Emergency call boxes dial directly to a motorway center.
It is best to use these phones rather than a personal cell phone, because motorway center personnel will immediately know the location of a call received from an emergency call box.
Roadside towing services may cost approximately £125.
However, membership fees of automotive associations such as the RAC or AA (Automobile Association) often include free roadside towing service.
Visitors uncomfortable with, or intimidated by, the prospect of driving on the left-hand side of the road may wish to avail themselves of extensive bus, rail and air transport networks that are comparatively inexpensive.
Roads in the UK are generally excellent, but are narrow and often congested in urban areas.
If you plan to drive while in the UK, you may wish to obtain a copy of the Highway Code, available at http://www.highwaycode.gov.uk.
Travelers intending to rent cars in the UK should make sure that they are adequately insured.
U.S. auto insurance is not always valid outside the U.S., and travelers may wish to purchase supplemental insurance, which is generally available from most major rental agents.
The city of London imposes a congestion charge of £8 (eight pounds sterling, or approximately U.S. $16.00) on all cars entering much of central London Monday through Friday from 7:00 a.m. to 6:30 p.m.
Information on the congestion charge can be found at http://www.cclondon.com.
Public transport in the United Kingdom is excellent and extensive.
However, poor track conditions may have contributed to train derailments resulting in some fatalities.
Repairs are underway and the overall safety record is excellent.
Information on disruptions to London transportation services can be found at http://www.tfl.gov.uk and information about the status of National Rail Services can be found at http://www.nationalrail.co.uk.
Many U.S. pedestrians are injured, some fatally, every year in the United Kingdom, because they forget that oncoming traffic approaches from the opposite direction than in the United States.
Extra care and alertness should be taken when crossing streets; remember to look both ways before stepping into the street.
Driving in Gibraltar is on the right-hand side of the road, as in the U.S. and Continental Europe.
Persons traveling overland between Gibraltar and Spain may experience long delays in clearing Spanish border controls.
Please refer to our Road Safety Overseas page for more information.
For specific information concerning United Kingdom driving permits, vehicle inspection, road tax and mandatory insurance, refer to the United Kingdom’s Department of Environment and Transport web site at http://www.dft.gov.uk, the Driving Standards Agency web site at http://www.dsa.gov.uk or consult the U.S. Embassy in London’s web site at http://london.usembassy.gov/.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the UK’s air carrier operations.
For further information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
The legal drinking age in the UK is generally lower than in the U.S. and social drinking in pubs is often seen as a routine aspect of life in Britain. Parents, organizers of school trips, and young travelers should be aware of the impact that this environment may have when combined with the sense of adventure that comes with being abroad.
Please see our Students Abroad web site as well Studying Abroad to help students plan a safe and enjoyable adventure.
The UK has strict gun-control laws, and importing firearms is extremely complicated. Travelers should consider leaving all firearms in the United States.
Restrictions exist on the type and number of weapons that may be possessed by an individual.
All handguns, i.e. pistols and revolvers, are prohibited with very few exceptions.
Licensing of firearms in the UK is controlled by the Police.
Applicants for a license must be prepared to show 'good reason' why they require each weapon.
Applicants must also provide a copy of their U.S. gun license, a letter of good conduct from their local U.S. police station and a letter detailing any previous training, hunting or shooting experience. Background checks will also be carried out.
Additional information on applying for a firearm certificate and/or shotgun certificate can be found on the Metropolitan Police Firearms Enquiry Teams web site at http://www.met.police.uk/firearms-enquiries/index.htm.
A number of Americans are lured to the UK each year in the belief that they have won a lottery or have inherited from the estate from a long-lost relative.
Americans may also be contacted by persons they have “met” over the Internet who now need funds urgently to pay for hospital treatment, hotel bills, taxes or airline security fees.
Invariably, the person contacted is the victim of fraud.
Any unsolicited invitations to travel to the UK to collect winnings or an inheritance should be viewed with skepticism.
Also, there are no licenses or fees required when transiting a UK airport, nor is emergency medical treatment withheld pending payment of fees.
Please see our information on International Financial Scams. Please read our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating British law, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the UK are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.
Many pocketknives and other blades, and mace or pepper spray canisters, although legal in the U.S., are illegal in the UK and will result in arrest and confiscation if detected.
A UK Metropolitan Police guide to items that are prohibited as offensive weapons is available at http://www.met.police.uk/youngpeople/guns.htm.
A UK Customs Guide, detailing what items visitors are prohibited from bringing into the UK, is available at http://customs.hmrc.gov.uk/channelsPortalWebApp/downloadFile?contentID=HMCE_CL_001734.
Air travelers to and from the United Kingdom should be aware that penalties against alcohol-related and other in-flight crimes (“air rage”) are stiff and are being enforced with prison sentences.
Please also see our information on customs regulations that pertain when returning to the US.

CHILDREN'S ISSUES:
For information on intercountry adoption and international parental child abduction, see the Office of Children’s Issues.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the United Kingdom are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within the United Kingdom.
By registering, Americans make it easier for the Embassy or Consulate to contact them in case of emergency, and to relay updated information on travel and security within the United Kingdom.
The Embassy and Consulates regularly send security and other information via email to Americans who have registered.
As noted above, recent communications from U.S. Embassy London to the local American citizen community, called Warden Messages, can be found on the embassy’s web site.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
The Consular Section also disseminates a newsletter every month.
Those wishing to subscribe to the monthly consular newsletter in London should send a request by email to SCSLondon@state.gov.
The U.S. Embassy is located at 24 Grosvenor Square, London W1A 1AE; telephone: in country 020-7499-9000; from the U.S. 011-44-20-7499-9000 (24 hours); Consular Section fax: in country 020-7495-5012; from the U.S. 011-44-20-7495-5012, and on the Internet at http://london.usembassy.gov.
The U.S. Consulate General in Edinburgh, Scotland, is located at 3 Regent Terrace, Edinburgh EH7 5BW; Telephone: in country 0131-556-8315, from the U.S. 011-44-131-556-8315.
After hours: in country 01224-857097, from the U.S. 011-44-1224-857097.
Fax: in country 0131-557-6023; from the U.S. 011-44-131-557-6023.
Information on the Consulate General is included on the Embassy’s web site at http://london.usembassy.gov/scotland.
The U.S. Consulate General in Belfast, Northern Ireland, is located at Danesfort House, 228 Stranmillis Road, Belfast BT9 5GR; Telephone: in country 028-9038-6100; from the U.S. 011-44-28-9038-6100.
Fax:
in country 028-9068-1301; from the U.S. 011-44-28-9068-1301.
Information on the Consulate General is included on the Embassy’s web site at: http://london.usembassy.gov/nireland.
There is no U.S. consular representation in Gibraltar.
Passport questions should be directed to the U.S. Embassy in Madrid, located at Serrano 75, Madrid, Spain, tel (34)(91) 587-2200, and fax (34)(91) 587-2303.
The web site is http://madrid.usembassy.gov.
All other inquiries should be directed to the U.S. Embassy in London.
* * *
This replaces the Consular Information Sheet dated December 12, 2007, to update the sections on Entry Requirements, Safety and Security, Crime, Victims of Crime, Medical Facilities, Medical Insurance, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu 24 Aug 2017
Source: Gibraltar Chronicle [edited]
<http://chronicle.gi/2017/08/tiger-mosquito-found-in-gibraltar-but-no-cause-for-concern-officials-say/>

An aggressive species of mosquito known to transmit viral diseases has been detected in Gibraltar, but public health officials insist there is no cause for alarm. Public Health Gibraltar and the Environmental Agency confirmed that the mosquito of the species _Aedes albopictus_, also known as the tiger mosquito, has been found in Gibraltar.

Last June [2017] after 9 months of intensive surveillance, officials said no tiger mosquito had been found in Gibraltar. But this has now changed after the 1st tiger mosquito was found in the urban dome   stic environment within Gibraltar. "This finding alone does not however materially alter any health risks in Gibraltar and there is no immediate cause for public concern," the government said in a statement. Public Health Gibraltar was first alerted in January 2016 to the discovery of the mosquito in Malaga and Algeciras [in Andalusia, Spain]. Since then, together with the Environmental Agency, it began working with international experts to mount surveillance in Gibraltar.

World Health Organization experts visited Gibraltar and gave advice on setting traps and monitoring locations, but no tiger mosquito had been detected until now. The tiger mosquito is not native to Gibraltar and has not been previously found here. It is common in other countries where it transmits viral diseases like Zika, dengue, and chikungunya. It is a domestic species, breeds in water in urban areas -- water butts, blocked drains, rainwater gullies -- and is able to reach high abundance around residential areas.

It is also a day-time mosquito, that aggressively bites humans. "Health risks to the public only arise if the virus causing these diseases is also present, which is not the case in Gibraltar," the government said.  "The virus can, however, be imported by travellers returning from an overseas country and if this happens, there is a risk of spread, but only if the mosquito bites within a small window period of about a week after the fever starts."

Public Health Gibraltar has been raising awareness of travel risk amongst travellers through its publication A Factsheet for Travellers and recommends the following precautions:
- before travelling to affected areas, consult your doctor or seek advice from a travel clinic, especially if you have an immune disorder or severe chronic illness;
- if you are pregnant or are considering pregnancy, consider postponing non-essential travel;
- when staying in a mosquito-prone area, wear mosquito repellents and take mosquito bite prevention measures;
- if you have symptoms within 3 weeks of return from an affected country, contact your doctor;
- if you have been diagnosed with any of the diseases Zika, dengue, or chikungunya, take strict mosquito bite prevention measures for 10 days after the fever starts.
========================== 
[The appearance of _Aedes albopictus_ in Gibraltar is not surprising. A map of the distribution of this species as of April this year (2017) shows it present around the Mediterranean Basin and up to Gibraltar on the west (<https://ecdc.europa.eu/en/publications-data/aedes-albopictus-current-known-distribution-europe-april-2017>).

Now it has been found in Gibraltar. The concerns are real about transmission of dengue, chikungunya, and Zika viruses should populations of _Ae. albopictus_ become established. In 2015 there were a few locally acquired cases of dengue in the south of France. This also happened on a larger scale in Emilia Romagna, Italy, when a viraemic man introduced chikungunya virus into Italy and sparked an outbreak.

One hopes that mosquito surveillance will continue in Gibraltar, perhaps be intensified, and help guide vector control efforts. - ProMED Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/517>.]
Date: Wed, 1 Jun 2011 01:46:48 +0200 (METDST)

GIBRALTAR, June 1, 2011 (AFP) - A fuel tank exploded and caught fire near a cruise ship in the British territory of Gibraltar Tuesday, injuring at least 15 people, most of them on the vessel, local officials and the ship's owners said. The blast was probably caused by a spark from welding operations, Chief Minister Peter Caruana told Radio Gibraltar. But police were not ruling out any possibility including that of an attack, he added. Flames several metres high could be seen coming out of the tank with dense black smoke billowing across the port as firefighters directed jets of water at the blaze from tugboats. The fire continued late into the night, with Radio Gibraltar reporting more explosions were heard. The tank was close to the giant cruise ship, Independence of the Seas, which had arrived in Gibraltar Tuesday morning. The ship made an emergency departure immediately after the blast Tuesday afternoon.

The Gibraltar government and the ship's owners, Royal Caribbean International, both said 12 people on the ship had been hurt. Gibraltar officials said one of the passengers had suffered a fractured arm. Two Spanish welders working on the tank were injured, including one who was in critical condition in a burns unit at a hospital in the southern Spanish city of Seville, Radio Gibraltar said. A police officer was also slightly injured in the rescue attempt, police said. "The lid of the tank was blown off by the blast," a police spokesman said. The statement from Royal Caribbean International said: "Immediately after the explosion, the ship retracted the gangway and moved a safe distance from the dock. "Twelve guests sustained minor injuries and have received medical treatment onboard." The boat was on a two-week cruise, having left the southern English port of Southampton on Saturday, the company added.

Air services to Gibraltar were suspended and offices in the port area evacuated. The police spokesman said the possibility of adjacent tanks overheating and exploding could not be ruled out. Caruana described it as a serious incident but said there was "no cause for concern". "Once it was established that there were welding operations going on, on top of the very tank at the time it exploded, (that) makes that a frontrunner for a likely explanation, but all possibilities are being kept open," he told Radio Gibraltar. "The police are obviously keeping their minds open to the possibility of maybe a security incident. It's looking unlikely but all possibilities are being looked into if only to be excluded."

"The plan is to allow it to carry on burning itself off," he said later Tuesday, but warned that the wind was due to change during the night, which could bring the smoke over land. Spanish tugs from a private company were helping the local fire services, he added. One witness said he was in his office nearby when he heard three loud explosions. "We started running out and saw one of the main tanks set alight. My concern was the poor people who were working there," he told Radio Gibraltar. The public was being advised to keep away from the area and keep windows closed due to the smoke. Gibraltar is a 6.5-square-kilometre (2.6-square-mile) British territory of around 30,000 people off the tip of southern Spain. Madrid ceded it to London in 1713 under the Treaty of Utrecht, but it has long fuelled tensions between the two countries.
Date: Tue, 10 Aug 2010 20:08:15 +0200 (METDST)

GIBRALTAR, Aug 10, 2010 (AFP) - Gibraltar on Tuesday condemned as "illegal" a proposal by the neighbouring Spanish town of La Linea to impose a tax on cars entering or leaving the tiny British territory by road.   The decision comes amid thorny relations between Madrid and London over the disputed British possession off the tip of southern Spain.

La Linea mayor Alejandro Sanchez on Monday announced the "congestion charge" of no more than five euros (6.5 dollars) on cars crossing into and out of Gibraltar, saying the measure will be imposed in October once it is passed by the town council.   He said lorries carrying debris and other materials used in Gibraltar to reclaim land from the sea will pay more, but the exact amount has not yet been determined.   Sanchez, a member of Spain's conservative opposition Popular Party, said the tax is needed partly to compensate the municipality for austerity measures imposed by the socialist government in Madrid.   La Linea residents would be exempt, but it was not clear if Gibraltarians would also have to pay.

The Gibraltar government reacted angrily and said it has contacted the Spanish authorities over the decision.   "The confused statements by the mayor of La Linea in respect of the proposed toll describe a litany of illegalities under EU Law and probably also under Spanish law," it said in a statement.   "The mayor of La Linea is clearly engaged in a political manoeuvre with his central government, which is unlikely to allow the proposal.

"The mayor's proposals are wholly unacceptable both legally and politically and in the unlikely event that these measures should be introduced, the (Gibraltar) government will take appropriate steps."   Spain ceded Gibraltar to Britain in 1713 under the Treaty of Utrecht but has retained first claim on the tiny peninsula should Britain renounce sovereignty.

"The Rock" has long fuelled tensions between Spain and Britain, with Madrid arguing the 6.5-square-kilometre (2.6-square-mile) territory that is home to roughly 30,000 people should be returned to Spanish sovereignty.   But its people overwhelmingly rejected an Anglo-Spanish proposal for co-sovereignty in a referendum in 2002.   In recent months British and Spanish naval and police boats have engaged in a series of cat and mouse games in the waters off Gibraltar, which lies at the strategic western entrance to the Mediterranean.
Date: Thu 23 Oct 2008
Source: Panorama.gi [edited]
---------------------------------
During the last 10 weeks, Gibraltar has experienced an outbreak of measles. "We have so far been notified of over 250 cases and notifications are still coming in at around 4-6 cases per day," said the Gibraltar Health Authority [GHA], who believe that the actual numbers are greater as many people with mild attacks have chosen not to report them. While the majority of infections in the outbreak have been mild, some have been severe and a few patients including babies have needed intensive care.  Measles is an unpleasant disease with fever, sore throat, streaming eyes, diarrhoea, and rash. Most people recover within a week or so, but complications like fits, bacterial infection, or pneumonia can develop. Long-term complications can also arise in very young children.

Says the GHA: It is important that all persons with symptoms suggestive of measles should report the illness to their doctor to enable complications to be detected at an early stage. In addition to medical advice, persons with the illness should follow general hygiene practices such as limiting contact with other people, carefully discarding soiled tissues, and washing their hands. Anyone who has had measles infection is immune for life and cannot get measles again. There is no basis for the rumour that some people have had measles twice. It is possible that infection with rubella (German measles, a different disease) may have caused the confusion. Vaccination with the MMR [measles, mumps, and rubella] vaccine is the only way to prevent measles infection.

[So far], the 250 cases have been in persons who are unvaccinated or partly vaccinated (one dose only). Not a single case has occurred in a person who has had a full course of MMR vaccine. MMR vaccine has been available free to children [from] Gibraltar's health service since 1989, although the boosters were only introduced in 2002. It is also a very safe and effective vaccine, with an impressive track record," they say. Gibraltar Health Authority adds that it is continuing to advise all parents of children who have not had the MMR vaccine to immunise their children. There had been some difficulties in obtaining vaccine recently due to an international shortage, but fresh supplies have now been received. The course consists of 2 injections, approximately 3 months apart. Please note that BOTH the doses are needed for adequate immunity. They add: If your child has received only one dose, either now or in the past, he or she could still be at risk. Arrangements have been made to offer additional  vaccination to all unimmunised children as follows: During October and November [2008], the Child Welfare Clinics (primary care centre) will be open on Mondays (2:00 pm to 4:00 pm), Wednesdays (9:00 am to 11:00 am) and Fridays (9:00 am to 11:00 am) for immunisations. Appointments are not necessary.
-------------------------------
[The Rock of Gibraltar is located at the entrance of the Mediterranean. Gibraltar is connected to Spain by a sandy isthmus, by a ferry to Morocco, and by flights to London. By virtue of its geographical position and political status Gibraltar is vulnerable to introduction of infectious disease from diverse sources. No information has been provided regarding the source of the measles virus responsible for this outbreak. In this respect it will be relevant to determine the genotype of the measles virus involved (see comment in ProMED-mail "Measles - Gibraltar 20080814.2529"). The outbreak has escalated from the 17 cases reported on 14 Aug 2008 to the current 250 cases. Despite the availability of free MMR vaccination it is clear that there is an appreciable number of unimmunised individuals in the community who remain susceptible to measles virus infection. It is encouraging that efforts are underway to expand vaccine coverage.


and the HealthMap/ProMED-mail interactive map at <http://healthmap.org/promed?g=2411586&amp;v=36.133,-5.35,7>. - ProMed Mod.CP]
Date: Wed, 16 Apr 2008 14:56:40 +0200 (METDST) GIBRALTAR, April 16, 2008 (AFP) - Animal rights groups have expressed outrage over a plan by Gibraltar's government to cull its famous Barbary Apes, which are posing a hazard as they roam the town in search of food. The government of the tiny British territory off Spain's southern coast plans to cull 25 of the simians, whose population has exploded to around 200. The mischievous primates climb over cars and pull out antennas, open rubbish bags and rifle through handbags left unattended in the popular tourist destination. Officially, the management of the apes is the responsibility of the Gibraltar Ornithological and Natural History Society (GONHS), on contract from the government. But the society said it has not approved the cull. "Our policy is that culling can be a population management solution but only in extreme cases when there is no other more suitable option," GONHS general secretary Dr. John Cortes said on Tuesday. "We would only ever recommend a cull after very careful assessment of the situation from a veterinary and a genetic point of view." However, Environment Minister Ernest Britto said a licence has been issued for the cull and two of the apes have already been given lethal injections. Helen Thirlway, the head of Britain's International Primate Protection League, said the government was failing to manage the apes "in a responsible manner." "There have been many advances and pilot studies in recent years on different methods of controlling free-roaming monkeys," she was quoted as saying in the local media Wednesday. "We are more than happy to work with the government of Gibraltar and with GONHS to help them develop more efficient, alternative solutions, but this needless slaughter has to stop." According to legend, if the apes disappear, Britain will lose control of Gibraltar. When wartime British prime minister Winston Churchill heard their population was low, British consuls in North Africa -- from where the apes originally came -- were tasked with sending new young simians to the Rock. At one time, the apes were looked after by the British army stationed in Gibraltar, which selected a place up the Rock where they were fed daily to keep them from loitering downtown. Spain ceded Gibraltar to Britain in 1713, but has retained a constitutional claim should Britain renounce sovereignty. The vast majority of the 30,000 people want to retain their links with Britain.
More ...

Afghanistan

Afghanistal US Consular Information Sheet March 03, 2009


COUNTRY DESCRIPTION:


Afghanistan has made significant progress since the Taliban were deposed in 2001, but still faces daunting challenges, including de

eating terrorists and insurgents, recovering from over three decades of civil strife, dealing with years of severe drought and rebuilding a shattered physical, economic and political infrastructure. Coalition and NATO forces under ISAF work in partnership with Afghan security forces to combat Taliban and al-Qa’ida elements who seek to terrorize the population and challenge the government. Violence in 2008 reached unprecedented levels, as both ISAF/Afghan forces and the Taliban initiated more battles than ever before. President Hamid Karzai was sworn in as President of the Islamic Republic of Afghanistan on December 7, 2004 and the Afghan Parliament was subsequently convened in late 2005. The government is working to develop a more effective police force, a more robust legal system, and sub-national institutions that work in partnership with traditional and local leaders to meet the needs of the population. The U.S. works closely with the international community to provide coordinated support for these efforts. An Afghanistan-hosted Peace Jirga with Pakistan resulted in a commitment to cooperate in combating terrorism, facilitate the return of Afghan refugees, and support regional economic activity. Read the Department of State Background Notes on Afghanistan for additional information.


ENTRY/EXIT REQUIREMENTS:


 A passport and valid visa are required to enter and exit Afghanistan. Afghan entry visas are not available at Kabul International Airport or any other ports of entry in Afghanistan. American citizens who arrive without a visa are subject to confiscation of their passport and face heavy fines and difficulties in retrieving their passport and obtaining a visa, as well as possible deportation from the country. Americans arriving in the country via military air usually have considerable difficulties if they choose to depart Afghanistan on commercial air, because their passports are not stamped to show that they entered the country legally. Those coming on military air should move quickly after arrival to legalize their status if there is any chance they will depart the country on anything other than military air. Visit the Embassy of Afghanistan web site at http://www.embassyofafghanistan.org for the most current visa information. The Consular office of the Embassy of Afghanistan is located at 2233 Wisconsin Avenue NW, Suite 216, Washington, DC 20007, phone number 202-298-9125. Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.


SAFETY AND SECURITY:


The latest Travel Warning for Afghanistan emphasizes that the security situation remains critical for American citizens. The Taliban and associated insurgent groups, al-Qaida network terrorist organizations, and narco-traffickers oppose the strengthening of a democratic government. These groups aim to weaken or bring down the Government of Afghanistan and to drive Westerners out of the country. They do not hesitate to use violence, including targeting civilians. Terrorist activities may include, but are not limited to bombings -- including improvised explosive devices and car bombs -- assassinations, carjackings, rocket attacks, assaults and kidnappings. There were over 120 suicide attacks in 2008. There is an ongoing threat to attack and kidnap U.S. citizens and Non-Governmental Organization (NGO) workers throughout the country. In 2008,, more than 30 NGO workers were killed (six foreigners) and at least 78 NGO staff members (seven foreigners) were abducted. Over 25 other foreign civilians, including journalists, were kidnapped. Kabul continues to experience suicide bombings against Afghan government personnel and installations, Afghan and coalition military assets, and international civilians. Riots -- sometimes violent -- have occurred in response to various political or other issues. Crime, including violent crime, remains a significant problem. Official Americans' use of the Kabul-Jalalabad, Kabul-Kandahar highways and other roads throughout the country is often restricted or completely curtailed because of security concerns. Insurgents continue to use roadside and car bombs to conduct attacks and abductions along major highways. Millions of unexploded land mines and other ordinance present a constant danger. The country faces a difficult period in the near term, and American citizens could be targeted or placed at risk by unpredictable local events. Americans should not come to Afghanistan unless they have made arrangements in advance to address security concerns. The absence of records for ownership of property, differing laws from various regimes and the chaos that comes from decades of civil strife have left property issues in great disorder. Afghan-Americans returning to Afghanistan to recover property, or Americans coming to the country to engage in business, have become involved in complicated real estate disputes and have faced threats of retaliatory action, including kidnapping for ransom and death. Large parts of Afghanistan are extremely isolated, with few roads, mostly in poor condition, irregular cell phone signals, and none of the basic physical infrastructure found in Kabul or the larger cities. Americans traveling in these areas who find themselves in trouble may not even have a way to communicate their difficulties to the outside world. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.


CRIME:


 A large portion of the Afghan population is unemployed, and many among the unemployed have moved to urban areas. Basic services are rudimentary or non-existent. These factors may directly contribute to crime and lawlessness. Diplomats and international relief workers have reported incidents of robberies and household burglaries as well as kidnappings and assault. Any American citizen who enters Afghanistan should remain vigilant for possible banditry, including violent attacks.


INFORMATION FOR VICTIMS OF CRIME:


The loss or theft abroad of a U.S. passport should be reported immediately to the local police and to the U.S. Embassy in Kabul. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Embassy in Kabul for assistance. The Embassy staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to provide a list of attorneys if needed. The local equivalent to the "911" emergency line in Afghanistan is: 119 Please see our information on Victims of Crime, including possible victim compensation programs in the United States.


CRIMINAL PENALTIES:


While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Afghanistan’s laws, even unknowingly, may be expelled, arrested or imprisoned. During the last several years, there have been incidents involving the arrest and/or detention of U.S. citizens. Arrested Americans have faced periods of detention—sometimes in difficult conditions—while awaiting trial. Penalties for possession or use of, or trafficking in illegal drugs in Afghanistan are severe, and convicted offenders can expect long jail sentences and heavy fines. Another sensitive activity is proselytizing. Although the Afghan Constitution allows the free exercise of religion, proselytizing is often viewed as contrary to the beliefs of Islam and considered harmful to society. Proselytizing may lead to arrest and/or deportation. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.


SPECIAL CIRCUMSTANCES:


Because of the poor infrastructure in Afghanistan, access to banking facilities is limited and unreliable. Afghanistan's economy operates on a "cash-only" basis for most transactions. Credit card transactions are not available. International bank transfers are limited. Some ATM machines exist at Standard Charter Bank and Afghan International Bank (AIB) in the Wazir Akbar Khan neighborhood of Kabul, but some travelers have complained of difficulties using them. International communications are difficult. Local telephone networks do not operate reliably. Most people rely on satellite or cellular telephone communications even to make local calls. Cellular phone service is available locally in Kabul and some other cities, but can be unreliable. Injured or distressed foreigners could face long delays before being able to communicate their needs to family or colleagues outside of Afghanistan. Internet access through local service providers is limited. In addition to being subject to all Afghan laws, U.S. citizens who are also citizens of Afghanistan may also be subject to other laws that impose special obligations on Afghan citizens. U.S. citizens who are also Afghan nationals do not require visas for entry into Afghanistan. The Embassy of Afghanistan issues a letter confirming your nationality for entry into Afghanistan. However, you may wish to obtain a visa as some Afghan-Americans have experienced difficulties at land border crossings because they do not have a visa in their passport. For additional information on dual nationality in general, see the Consular Affairs home page for our dual nationality flyer. U.S. citizens are encouraged to carry a copy of their U.S. passport with them at all times, so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available. As stated in the Travel Warning, consular assistance for American citizens in Afghanistan is limited. Islam provides the foundation of Afghanistan's customs, laws and practices. Foreign visitors -- men and women -- are expected to remain sensitive to the Islamic culture and not dress in a revealing or provocative manner, including the wearing of sleeveless shirts and blouses, halter-tops and shorts. Women in particular, especially when traveling outside of Kabul, may want to ensure that their tops have long sleeves and cover their collarbone and waistband, and that their pants/skirts cover their ankles. Almost all women in Afghanistan cover their hair in public; American women visitors should carry scarves for this purpose. Afghan customs authorities may enforce strict regulations concerning temporary importation into or export from Afghanistan of items such as firearms, alcoholic beverages, religious materials, antiquities, medications, and printed materials. American travelers have faced fines and/or confiscation of items considered antiquities upon exiting Afghanistan. It is advisable to contact the Embassy of Afghanistan in Washington for specific information regarding customs requirements. Travelers en route to Afghanistan may transit countries that have restrictions on firearms, including antique or display models. If you plan to take firearms or ammunition to another country, you should contact officials at that country's embassy and those that you will be transiting to learn about their regulations and fully comply with those regulations before traveling. Please consult http://www.customs.gov for information on importing firearms into the United States. Please see our Customs Information sheet.


MEDICAL FACILITIES AND HEALTH INFORMATION:


Well-equipped medical facilities are few and far between throughout Afghanistan. European and American medicines are available in limited quantities and may be expensive or difficult to locate. There is a shortage of basic medical supplies. Basic medicines manufactured in Iran, Pakistan, and India are available, but their reliability can be questionable. Several western-style private clinics have opened in Kabul: the DK-German Medical Diagnostic Center (www.medical-kabul.com), Acomet Family Hospital (www.afghancomet.com), and CURE International Hospital (ph. 079-883-830) offer a variety of basic and routine-type care; Americans seeking treatment should request American or Western health practitioners. Afghan public hospitals should be avoided. Individuals without government licenses or even medical degrees often operate private clinics; there is no public agency that monitors their operations. Travelers will not be able to find Western-trained medical personnel in most parts of the country outside of Kabul, although there are some international aid groups temporarily providing basic medical assistance in various cities and villages. For any medical treatment, payment is required in advance. Commercial medical evacuation capability from Afghanistan is limited and could take days to arrange. Even medevac companies that claim to service the world may not agree to come to Afghanistan. Those with medevac insurance should confirm with the insurance provider that it will be able to provide medevac assistance to this country. There have been outbreaks of Avian Influenza in poultry in Afghanistan, to include the areas of Nangahar, Laghman, and Wardak provinces, and in the city of Kabul, however, there have been no reported cases of the H5N1 virus in humans. Updates on the Avian Influenza situation in Afghanistan are published on the Embassy’s web site at http://kabul.usembassy.gov/information_for_travelers.html. For additional information on Avian Influenza, please refer to the Department of State's Avian Influenza Fact Sheet available at http://travel.state.gov/travel/tips/health/health_1181.html Tuberculosis is an increasingly serious health concern in Afghanistan. For further information, please consult the CDC's Travel Notice on TB. http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx| The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Afghanistan. However, if one has questions, please inquire directly with the Embassy of Afghanistan at http://www.embassyofafghanistan.org before you travel. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site. For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site. Further health information for travelers is available from the WHO.


MEDICAL INSURANCE:


The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas. TRAFFIC


SAFETY AND ROAD CONDITIONS:


 While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Afghanistan is provided for general reference only, and may not be totally accurate in a particular location or circumstance. All drivers face the potential danger of encountering improvised-explosive devices and land mines that may have been planted on or near roadways. An estimated 5-7 million landmines and large quantities of unexploded ordinance exist throughout the countryside and alongside roads, posing a danger to travelers. Robbery and kidnappings are also prevalent on highways outside of Kabul. The transportation system in Afghanistan is marginal, although the international community is constructing modern highways and provincial roads. Vehicles are poorly maintained, often overloaded, and traffic laws are not enforced. Vehicular traffic is chaotic and must contend with numerous pedestrians, bicyclists and animals. Many urban streets have large potholes and are not well lit. Rural roads are not paved. Please refer to our Road Safety page for more information.


AVIATION SAFETY OVERSIGHT:


As there is no direct commercial air service to the United States by carriers registered in Afghanistan, the U.S. Federal Aviation Administration (FAA) has not assessed Afghanistan’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa. U.S. Government personnel are not authorized to travel on Ariana Afghan Airlines or any other airline falling under the oversight of the Government of Afghanistan’s Civil Aviation Authority, owing to safety concerns; however, U.S. Government personnel are permitted to travel on international flights operated by airlines from countries whose civil aviation authorities meet international aviation safety standards for the oversight of their air carrier operations under the FAA’s International Aviation Safety Assessment (IASA) program.


CHILDREN'S ISSUES:


 For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction. R


EGISTRATION / EMBASSY LOCATION:


Americans living or traveling in Afghanistan are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site and to obtain updated information on travel and security within Afghanistan. Americans without internet access may register directly with the U.S. Embassy. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located in Kabul on Great Massoud (Airport) Road, local phone number 0700-108-001 or 0700-108-002, and for emergencies after hours 0700-201-908. The web site is http://kabul.usembassy.gov/ * * * * * This replaces the Country Specific Information dated June 16, 2008 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Information for Victims of Crime, Criminal Penalties, Special Circumstances, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Mon 2 Dec 2019
Source: China.org.cn, Xinhua News Agency report [edited]

One fresh polio case had been detected in Afghanistan's southern Kandahar province, a local newspaper reported on [Mon 2 Dec 2019].

"With this new case, the total number of polio cases in 2019 reaches 22 in the country. The latest polio case has been reported from Kandahar city, capital of Kandahar province which permanently paralyzed an 18-month-old child," Daily Afghanistan-e-Ma reported.

The paper added that polio is a crippling and potentially fatal infectious disease.

"Most of the Afghan children affected by poliovirus this year [2019] are living in areas where kids do not have access to health facilities and regular anti-polio vaccination campaign. However, this time a child has been affected in a large city where anti-polio vaccination had been conducted repeatedly this year," the report said.

There is no cure for polio and the polio vaccine is the only safe and effective way to protect children.

The ongoing conflicts have been hindering the efforts to stamp out the infectious disease in the mountainous country.
===================
[The addition of 3 newly confirmed cases of polio (all 3 due to WPV1, as per End Polio Pakistan <https://www.endpolio.com.pk/polioin-pakistan/polio-cases-in-provinces>) in Pakistan and one newly confirmed case of polio in Afghanistan brings the total number of WPV1 associated cases with date of onset in 2019 to 116 (94 in Pakistan and 22 in Afghanistan). The key question here is whether Afghanistan and Pakistan, with all the challenges in vaccinating the susceptible populations due to a variety of anti-vaccination impediments, will be able to interrupt transmission of the WPV1 in both countries simultaneously.

Maps of Afghanistan:
and <http://healthmap.org/promed/p/137>. - ProMED Mod.MPP]
Date: Sun 1 Sep 2019
Source: MENAFN - Afghanistan Times [edited]

Two new polio cases have surfaced separately in capital city of Tirinkot and Chora district of southern Uruzgan [Oruzgan] province, a statement from the relevant ministry said [Sun 1 Sep 2019].

A 30-month-old child and another 6-month-old infant were permanently paralyzed as a result of the polio virus.

According to a statement issued by the Ministry of Public Health (MoPH), the total number of polio cases in 2019 reached 15 with the 2 new cases, saying all of these cases had been reported from inaccessible areas.

"Of the 15 polio cases this year [2019], 14 have been reported from the southern region of Afghanistan,' the statement said, adding "7 positive cases came from [Oruzgan], 5 from Helmand, and 2 other from Kandahar."

Only 1 out of 12 polio cases was reported from eastern Kunar province while the rest happened in the southern zone.

"Access to health services is the right of every citizen of the country," said Dr Ferozuddin Feroz, the Minister of Public Health. "We are deeply concerned about the increasing polio cases and the number of children who still don't have consistent and proper access to vaccination," he added.

He said the virus could spread further in the country and more children would be affected and paralyzed by polio virus.

He called upon people to 'work together and protect innocent children against polio and facilitate a safe and secure environment for our frontline workers in order to enable them administer vaccine drops to children in every nook and cranny of the country."

Polio is a crippling and potentially fatal infectious disease. There is no cure and the vaccine is the only safe and effective way to protect children.

The polio vaccine is safe and harmless for new-born children whether they are sick or not. It is very important that new-borns and sick children get the vaccine because they may have lower immunity which makes them more susceptible to the virus.

Polio vaccination has also been strongly endorsed by national and global Islamic scholars.
========================
[As I mentioned in the moderator comment of the last post (Poliomyelitis update (71): global (Pakistan, Congo DR) http://promedmail.org/post/20190901.6651501), "While there have been no newly confirmed cases reported from Afghanistan this week nor have there been positive environmental samples reported from either Pakistan or Afghanistan, it doesn't mean the virus is not still circulating, just that there aren't new confirmations." Unfortunately there were cases under investigation.

As correctly stated in the media report above, the addition of these 2 newly confirmed cases brings the number of confirmed WPV1 cases reported by Afghanistan during 2019 to date to 15.

Oruzgan is located in the central part of Afghanistan, sharing southern and southwestern borders with Kandahar and Helmand provinces where other polio cases have been reported this year (2019) as well (<http://www.lib.utexas.edu/maps/middle_east_and_asia/afghanistan_admin-2009.jpg>).

HealthMap/ProMED-mail map of Afghanistan:
Date: Mon, 19 Aug 2019 13:26:06 +0200 (METDST)

Jalalabad, Afghanistan, Aug 19, 2019 (AFP) - Scores of people including children were wounded Monday after a series of explosions shook the eastern Afghan city of Jalalabad, as the country's independence day was marred by bloodshed.

As many as 10 blasts were reported in and around the city in Nangarhar province, authorities said, and casualty numbers rose as the day wore on.   "The explosions were caused by IEDs in different parts of the city and as groups of people were celebrating independence day," the Nangarhar governor's spokesman Attaullah Khogyani said, referring to improvised explosive devices.   Jalalabad is the scene of frequent bomb attacks, and the surrounding terrain is home to both Taliban fighters and the Islamic State group's local affiliate.

At least 52 people were wounded, Khogyani said. Zaher Adel, a spokesman for a local hospital, said 66 wounded people had been brought in. An AFP correspondent saw children among the victims.   This year's August 19 celebrations mark 100 years of Afghan independence from British influence.   The day was supposed to be one of national pride and unity, but was overshadowed by an IS suicide attack Saturday on a crowded Kabul wedding hall that killed at least 63 people.

In Kabul, locals took to the streets to wave the black-red-and-green Afghan flag, but several public events to commemorate the date were scrapped as Kabul mourns and due to fears of a fresh attack.    "We postponed the celebrations to honour the victims, but we will definitely take revenge for our people," Afghan President Ahraf Ghani said.   "We will avenge the blood of our people, every drop of it."

Mayhem from Afghanistan's war continues to wreak havoc on Afghans every day, even though the US and the Taliban are in final negotiations for a deal that would see US troops begin to quit Afghanistan and could potentially lead to a reduction in violence.
Date: Sun, 18 Aug 2019 11:47:26 +0200 (METDST)
By By Emal Haidary and Mushtaq Mojaddidi

Kabul, Aug 18, 2019 (AFP) - Joy and celebration turned into horror and carnage when a suicide bomber targeted a packed Afghan wedding hall, killing at least 63 people in the deadliest attack to rock Kabul in months, officials and witnesses said Sunday.   The massive blast, which took place late Saturday in west Kabul, came as Washington and the Taliban finalise a deal to reduce the US military presence in Afghanistan and hopefully build a roadmap to a ceasefire.   The groom recalled greeting smiling guests in the afternoon, before seeing their bodies being carried out hours later.

The attack "changed my happiness to sorrow", the young man, who gave his name as Mirwais, told local TV station Tolo News.   "My family, my bride are in shock, they cannot even speak. My bride keeps fainting," he said.   "I lost my brother, I lost my friends, I lost my relatives. I will never see happiness in my life again."   Interior ministry spokesman Nasrat Rahimi said at least 63 people had been killed and 182 injured.   "Among the wounded are women and children," Rahimi said. Earlier he stated a suicide bomber carried out the attack.

Afghan weddings are epic and vibrant affairs, with hundreds or often thousands of guests celebrating for hours inside industrial-scale wedding halls where the men are usually segregated from the women and children.   "The wedding guests were dancing and celebrating the party when the blast happened," recounted Munir Ahmad, 23, who was seriously injured and whose cousin was among the dead.   "Following the explosion, there was total chaos. Everyone was screaming and crying for their loved ones," he told AFP from his bed in a local hospital, where he is being treated for shrapnel wounds.

Images from inside the hall showed blood-stained bodies on the ground along with pieces of flesh and torn clothes, hats, sandals and bottles of mineral water. The huge blast ripped parts of the ceiling off.   The wedding was believed to be a Shia gathering. Shia Muslims are frequently targeted in Sunni-majority Afghanistan, particularly by the so-called Islamic State group, which is also active in Kabul but did not immediately issue any claim of responsibility.

Wedding guest Hameed Quresh told AFP the young couple were saying their vows when the bomb went off.    "We fainted following the blast, and we don't know who brought us to the hospital," sobbed Quresh, who lost one brother and was himself wounded.   Another guest told Tolo that some 1,200 people had been invited. With low security, weddings are seen as easy targets.   The attack sent a wave of grief through a city grimly accustomed to atrocities. President Ashraf Ghani called it "barbaric", while Afghanistan's chief executive Abdullah Abdullah described it as a "crime against humanity".

- Withdrawal deal expected -
The attack underscores both the inadequacy of Afghanistan's security forces and the scale of the problem they face. While the police and army claim they prevent most bombings from ever happening, the fact remains that insurgents pull off horrific attacks with chilling regularity.   On July 28, at least 20 people were killed when attackers targeted Ghani's running mate Amrullah Saleh as he campaigned in presidential elections.    The incident showed how even amid tight security and known threats, insurgents can conduct brazen attacks.   The issue also goes to the heart of a prospective deal between the US and the Taliban that would see Washington begin to withdraw its approximately 14,000 soldiers from Afghanistan.

The deal relies on the Taliban providing guarantees they will stop jihadist groups such as Al-Qaeda and IS from using Afghanistan as a safe haven. Saturday's attack suggests any such promise would be tough to keep.   The "Taliban cannot absolve themselves of blame, for they provide platform for terrorists," Ghani said.   Few believe such a deal will bring quick peace.

Many Afghans fear the Taliban could return, eroding hard-won rights for women in particular and leading to a spiralling civil war.   Meanwhile, in the northern province of Balkh, 11 members of the same family were killed when their car hit a roadside bomb, officials said. The provincial governor blamed the Taliban for planting the device.
Date: Mon, 1 Jul 2019 11:19:17 +0200

Kabul, July 1, 2019 (AFP) - At least one person was killed and dozens wounded in a Taliban-claimed attack which saw a powerful car bomb rock Kabul early Monday, followed by gunmen who battled special forces in an area housing military and government buildings.   Many children were among the wounded, according to a hospital statement, after the rush-hour explosion sent a plume of smoke into the air above the Puli Mahmood Khan neighbourhood of the Afghan capital and shook buildings up to two kilometres (1.2 miles) away.

AFP reporters could hear gunshots and multiple smaller explosions as fighting between the gunmen and special forces continued more than four hours after the attack began.   "At first, a car bomb took place and then several attackers took over a building. The area is cordoned off by the police special forces and (they) are bringing down the attackers," interior ministry spokesman Nasrat Rahimi said.    He later said that at least one attacker had been killed.   Health ministry spokesman Wahidullah Mayar said that at least one person had been killed and 65 wounded -- including nine children -- and warned that casualties could rise.   "Among the wounded, many children who were going to school," said the Twitter account of the Emergency Hospital in Kabul, where many victims were taken.   Some social media images purportedly taken at the hospital showed wounded, stunned children in school uniforms, still clutching books as they arrived for treatment.

The Taliban claimed the attack, which came just two days after the insurgents began a seventh round of talks with the US in Qatar as Washington eyes a breakthrough before Afghanistan's September presidential election.   Militant spokesman Zabiullah Mujahid released a statement saying the insurgents had targeted a defence ministry building in the area, which was quickly blocked off by Afghan forces and ambulances, with helicopter gunships seen overhead as firing continued.   Authorities have not confirmed the target.    "We were sitting inside the office when the world turned upside down on us," Zaher Usman, an employee at a branch of the culture ministry, which he said stands just 150 metres (yards) from the blast.

- Brief lockdown -
"When I opened my eyes, the office was filled with smoke and dust and everything was broken, my colleagues were screaming," Usman told AFP by telephone.   Shams Amini, a spokesman for the Afghan Football Federation, told AFP that the blast occurred near their HQ gates, and said some colleagues had been injured.   Nearby Shamshad TV station, which was attacked in 2017, aired images of broken glass and damage to its offices. "I was terrified," Shamshad anchor Hashmat Stanikzai told AFP.

The explosion came as the US was set to begin a third day of negotiations with the militants in Doha. There was no immediate confirmation if they would go ahead after the blast.   With the attack still ongoing, the Taliban spokesman in Doha again insisted that the insurgents will not negotiate with Kabul.   "Once the timeline for the withdrawal of foreign forces is set in the presence of international observers, then we will begin the talks to the Afghan sides, but we will not talk to the Kabul administration as a government," Suhail Shaheen tweeted. 

The insurgents have long refused to negotiate with the Western-backed government, whom they deem puppets.   The talks have so far centred on four issues -- counter-terrorism, the foreign troop presence, an intra-Afghan dialogue and a permanent ceasefire.   A potential deal would see the US agree to withdraw its troops after more than 17 years in Afghanistan, igniting deep concerns among Afghans who fear Washington will rush for the exits and allow the militants to return to some semblance of power.   In return, the Taliban would guarantee the country would never again become a safe haven for violent extremism, as happened with Al-Qaeda before the September 11, 2001 attacks.   However, US officials have insisted that "nothing is agreed until everything is agreed", including intra-Afghan talks.
More ...

Grenada

Grenada US Consular Information Sheet
March 30, 2007
COUNTRY DESCRIPTION:
Grenada is a developing Caribbean island nation.
The capital is St. George’s. Tourism facilities vary, according to price and area. Read the Department of Sta
e Background Notes on Grenada for additional information.
ENTRY/EXIT REQUIREMENTS: Although Grenada has its own entry requirements, the Intelligence Reform and Terrorism Prevention Act of 2004 requires all U.S. citizen travelers to and from the Caribbean to have a valid, unexpired passport to depart or enter the United States by air. Effective January 23, 2007, U.S. citizens, including infants and children, must have a valid, unexpired U.S. passport, or a “passport card” (which is now under development) when departing or entering the U.S. by air.
IMPORTANT NEW INFORMATION:The new passport requirement will be extended to all land border crossings as well as sea travel no later than June 1, 2009.
We strongly encourage all American citizen travelers to apply for a U.S. passport or “passport card” well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports. Until the passport requirement is in place for sea travel, U.S. citizens traveling by ship to Grenada may refer to our Foreign Entry Requirements brochure for documentation that is acceptable for travel to and from Grenada.
There is no visa requirement for stays up to three months. There is an airport departure fee of US$20 for adults and US$10 for children between the ages of five and twelve.
See our Foreign Entry Requirements brochure for more information on Grenada and other countries.

For additional information concerning entry/exit requirements, travelers may contact the Embassy of Grenada, 1701 New Hampshire Avenue, N.W., Washington, D.C. 20009, telephone: (202) 265-2561, Fax: (202) 265-2468: e-mail: grenada@oas.org, or the Consulate of Grenada in New York.
Read our information on dual Nationality and the prevention of international child abduction. Also, please see our Customs Information.
SAFETY AND SECURITY:
For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site, where the current Worldwide Caution Public Announcement, Travel Warnings and Public Announcements can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Street crime occurs in Grenada.
Tourists have been victims of armed robbery especially in isolated areas and thieves frequently steal credit cards, jewelry, U.S. passports and money.
Mugging, purse snatching and other robberies may occur in areas near hotels, beaches and restaurants, particularly after dark.
Visitors should exercise appropriate caution when walking after dark or when using the local bus system or taxis hired on the road.
It is advisable to hire taxis to and from restaurants.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care is limited.
U.S. citizens requiring medical treatment may contact the U.S Embassy in St. George’s for a list of local doctors, dentists, pharmacies and hospitals.
Serious medical problems requiring hospitalization and/or medical evacuation to the U.S. can cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services.
Pharmacies are usually well stocked, and prescription medicine is available, but travelers are advised to bring with them sufficient prescription medicine for the length of their stay as occasionally there are temporary shortages of medicines; most pharmacies will check with others in the area to see if they can get what is needed.

Grenada chlorinates its water, making it generally safe to drink.
However, during especially heavy rains, quality control can slip, particularly in the city of St. George’s.
It is recommended that visitors to Grenada request bottled water, which is widely available and relatively inexpensive.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s Internet site at http://www.cdc.gov/travel.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Grenada is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic moves on the left in Grenada; the majority of vehicles are right hand drive. Grenada’s roads, paved and unpaved, are mostly narrow and winding, with many blind corners and narrow or no shoulders.
Road surfaces often deteriorate; especially in the rainy season (June –November) before maintenance work begins.
Driving conditions in Grenada, including road conditions, increasing numbers of vehicles, and sometimes undisciplined minibus drivers all require caution and reduced speed for safety.
The Government of Grenada has a seat belt law; drivers and passengers found not wearing seat belts are subject to a fine of EC$1,000 (US$400).
Getting a local temporary drivers license, based on valid U.S. drivers license plus EC$30 (US$12), is highly recommended.
In the event of an accident, not having a valid local driver’s license may result in a fine, regardless of who is at fault.
Rental vehicle companies are widely available; most of them will assist in applying for temporary driving licenses.
The adequacy of road signage varies, but is generally poor to nonexistent.
For specific information concerning Grenada driver’s permits, road safety, vehicle inspection, road tax and mandatory insurance, please contact the Grenada Board of Tourism in New York at 317 Madison Avenue, Suite 1704, New York, N.Y. 10017, telephone 1-800-927-9554, (212) 599 0301; Fax: 212-573-9731; e-mail: gbt@caribsurf.com or www.grenadagrenadines.com
Please refer to our Road Safety Page for more information.
Visit the website of the country’s national tourist office at www.grenadagrenadines.com.
Additional general information can be found on Grenada’s Internet website at: http://www.grenadaconsulate.org.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Grenada’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Grenada’s air carrier operations.
For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Recovery efforts have been made from the damage caused by Hurricane Ivan in September 2004 and Hurricane Emily in July 2005.
All utilities have been restored.
Cruise ships have returned and all the main shopping areas are open.
While the majority of hotels are up and running, there is still one major resort (Le Source), which remain closed.
The resort’s management hopes to have the hotel open by the time Cricket World Cup 2007 Super Eight games take place in Grenada (alternate days April 10-21).

The February 1 merger of Liat and Caribbean Star airlines has reduced the number of daily flights between Grenada and the other Eastern Caribbean islands from six to three.
Travelers coming into the region from the U.S. and elsewhere should verify in advance directly with Liat that they have a valid reservation.
Some travelers making reservations from outside the region have arrived in the Eastern Caribbean and discovered that the reservation they thought they had on Liat, is not recognized by the airline, resulting in delayed travel as well as additional hotel costs.

Grenada experiences tropical storms during the hurricane season, from June through November. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
It is difficult to cash personal U.S. checks in Grenada.
If accepted, they will take approximately six weeks to clear by a local bank. Major credit cards are widely accepted, and ATM facilities are available at most banks.
Most hotels and restaurants take U.S. currency; however, change will be in local currency.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Grenada laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Grenada are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
For more information, please see our information on criminal penalties.
CHILDREN'S ISSUES:
For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues website.
REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Grenada are encouraged to register with the U.S. Embassy through the State Department’s travel registration website , and to obtain updated information on travel and security within Grenada.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located on the main road to Lance Aux Epines after the Christian Scientist Church, and is approximately 15 minutes from the Point Salines International Airport. Telephone: 1-(473) 444-1173/4/5/6; Fax: 1-(473) 444-4820; Internet e-mail: usemb_gd@caribsurf.com. Embassy hours are 8:00 am to 12:30 pm, Monday to Friday except local and American holidays.
*

*

*
This replaces the Consular Information Sheet dated October 13, 2006, to update all sections.

Travel News Headlines WORLD NEWS

Date: Mon 7 Mar 2016
Source: Outbreak News Today [edited]

Two weeks ago, health officials in Grenada reported on a chickenpox outbreak that affected 17 students at St. George's Anglican Junior School. The school was closed for the week to monitor and treat affected students.

This pustulovesicular rash represents a generalized herpes outbreak due to the Varicella-zoster virus (VZV) pathogen/CDC.

Last week, the Ministry of Health screened over 400 students from the St. George's Anglican School. The exercise saw a team of qualified nursing personnel conducting screening and evaluation of students at the St. George's Anglican Junior and Senior Schools.

A total of 255 and 183 students from the junior and senior schools respectively were examined on the compound as the institution reopened its doors following the completion of sanitation and cleaning operations.

During the screening/examination at the school, several students with skin lesions, fever, cold, headaches and skin rashes were identified and were not given clearance for a return to the classroom. Some of the students were referred to the doctor, and others were requested to be observed at home.

Meanwhile, the ministry will undertake a daily monitoring of the school, conduct education sessions with teachers and undertake another medical evaluation of students, in particular the ones that are to be observed at home and referred.

Chickenpox is a common, usually benign childhood disease caused by the varicella-zoster virus (VZV), a member of the herpes family. This virus causes 2 distinct diseases; varicella (chickenpox) is the primary infection, and later when VSV reactivates, herpes zoster (shingles).

Chickenpox is highly contagious and is spread by coughing and sneezing, by direct contact and by aerosolization of the virus from skin lesions. You can also get it by contact with the vesicle secretions from shingles.

The disease is characterized by fever and a red, itchy skin rash that usually starts on the abdomen, back or face and then spreads to nearly all parts of the body. The rash begins as small red bumps that appear as pimples or insect bites. They then develop into thin-walled blisters that are filled with clear fluid which collapse on puncture. The blisters then break, crust over, and leave dry brown scabs.

The chickenpox lesions may be present in several stages of maturity and are more abundant on covered skin rather than exposed. Lesions may also be found in the mouth, upper respiratory tract and genitals.

Chickenpox is contagious from 1-2 days before the rash forms and continues until all the lesions are crusted over (usually about 5 days).

This disease is more serious in adults than in children. Complications of chickenpox are rare, but include pneumonia, encephalitis and secondary bacterial infections.

Infection with this virus usually gives lifelong immunity, although 2nd attacks have been documented in immunocompromised people. The viral infection remains latent, and disease may recur years later as shingles.

According to the Centers for Disease Control and Prevention (CDC), the chickenpox vaccine is the best protection against chickenpox. The vaccine is made from weakened varicella virus that produces an immune response in your body that protects you against chickenpox. The chickenpox vaccine was licensed for use in the United States in 1995.  [Byline: Robert Herriman]
===================
[A map of Grenada can be found at <http://healthmap.org/promed/p/34>. - ProMED Mod.LK]
Date: Sat 28 Aug 2010
Source: Spice Grenada.com, The New Today [edited]
<http://www.spicegrenada.com/index.php?option=com_content&view=article&id=2505:dengue-fever-is-present&catid=546:august-28th-2010&Itemid=143>

After weeks of speculation among the population that there are dengue cases on the island, the officials within the Ministry of Health confirmed last week that 39 people in Grenada had come down with the fever. Head of the Epidemiology Unit within the Ministry of Health, Dr Alister Antoine, told reorters last week Tuesday [24 Aug 2010] that every parish, including Carriacou, has been affected by dengue fever, with the youngest case being a 2 year old and the oldest being 72.

He said: "In total, we have 20 males and 19 females. The figures we have now are what we have just confirmed with the lab, meaning that there were 17 new cases diagnosed during the 1st week in August [2010]." According to Dr Antoine, there was a noted increase in infection during the months of July and August. As compared to only one case in February, 6 by June, and with the number jumping to 15 in July.

"People should be making it difficult for the mosquitoes to breed, just make it difficult by cleaning up the place," he said. Presently there are 2 types of [dengue virus] strains recorded in Grenada -- type 1 and type 2, and there have been 2 cases of DHF both of which were mild and were treated successfully.
========================
[A HealthMap/ProMED-mail interactive map showing the location of Grenada in the southern Caribbean can be accessed at <http://healthmap.org/r/05Pe>. - ProMed Mod.TY]
Date: Mon, 3 Sep 2007 11:53:29 +0200 (METDST) MIAMI, Sept 3, 2007 (AFP) - A potentially catastrophic class-five Hurricane Felix ripped across the warm waters of the Caribbean early Monday towards Honduras and Belize after damaging homes and power lines in Grenada. The storm was so powerful that it tossed around a US 'hurricane hunter' data gathering airplane and forced it to abort its mission, the Miami Herald reported. At 0900 GMT the center of Felix was located some 445 kilometers (275 miles) south-southeast of Kingston, Jamaica, packing winds of 270 kilometers (165 miles) per hour, with higher gusts, the Florida-based National Hurricane Center said in its latest advisory. The hurricane was moving west at around 33 kilometers (21 miles) per hour, and "on this track the center of Felix will be near the coasts of extreme northeastern Nicaragua and northeastern Honduras early on Tuesday morning," the Hurricane Center said. Felix is then forecast to head for Belize and Mexico's Yucatan peninsula, where it could make landfall on Wednesday. No casualties were reported since Felix became the second hurricane of the Atlantic storm season on Saturday, though one person was reported missing in northern Venezuela. In just 15 hours on Sunday, Felix jumped from a Category Two storm with winds at 160 kilometers (100 miles) per hour to a rare Category Five hurricane, the most powerful on the Saffir-Simpson scale. The speed at which Felix reached maximum strength was one of the fastest ever recorded, Hurricane Center specialists said. Felix was so powerful that one of the US National Oceanic and Atmospheric Administration's 'hurricane hunter' airplanes was caught in a rapid updraft-downdraft cycle as it gathered data, the Miami Herald reported. The violent cycle placed four times the weight of gravity on those aboard the plane. "Four Gs can put a fair strain on the aircraft, and it also got some very heavy hail that can rip the paint off the plane," Hurricane Center forecaster James Franklin told the newspaper. The airplane, a modified Orion P-3 that normally carries 14 people, was ordered backto its base at Saint Croix, one of the US Virgin Islands, Franklin said. The storm, nourished by the warm Caribbean ocean, was expected to maintain its strength as it followed the general path that another Category Five storm, Hurricane Dean, took just last week. Though extremely powerful, Felix "has a very small wind field," the Hurricane Center said. "Hurricane force winds extend outward up to 45 kilometers (30 miles) from the center, and tropical storm force winds extend outward up to 185 kilometers (115 miles)," the Hurricane Center said. The Honduran government early Monday warned officials along its Caribbean coast to prepare for the hurricane. Hurricane conditions "are also possible over extreme northeastern Nicaragua," the Hurricane Center said. In Venezuela civil defense officials said a person went missing as beaches were evacuated in Puerto Cabello, 120 kilometers (75 miles) west of Caracas, where Felix generated high winds, heavy rains and up to three meter (10 foot) swells. There were no immediate reports of damage as the storm skimmed just north of the Paraguana peninsula, site of Venezuela's main oil refineries. Meanwhile Jamaica, which lay well to the north of Felix's track, was under a tropical storm watch as it prepared to hold elections Monday, already postponed from one week ago by Hurricane Dean. Warnings for Aruba, Bonaire and Curacao were discontinued as Felix swiped the popular tourist destinations in the Netherlands Antilles after wreaking some damage in Grenada, ripping roofs, downing power lines and knocking radio and TV stations off the air. Last week, Dean, also reaching category five, swept through the Caribbean with severe winds and rains, leaving a wide swathe of damage and a death toll of 30 from Martinique to Mexico.
Date: Thu, 14 Jul 2005 17:59:59 +0200 (METDST) MIAMI, July 14 (AFP) - Hurricane Emily, the Atlantic's second big storm of the season, headed west, gathering strength Thursday, the National Hurricane Center said, just after its predecessor Dennis carved a trail of death and destruction across the region. Packing 100-mile-per-hour (160-kilometer-per-hour) winds and growing stronger, Emily -- now a Category Two hurricane on the Saffir-Simpson intensity scale, on which five is the top-force storm -- lashed Grenada and headed toward Hispaniola island. Shared by the Dominican Republic and Haiti, Hispaniola's southern coast was grazed last week by Dennis, leaving at least 40 people dead in Haiti. Dennis went on to kill 16 in Cuba and one man in Jamaica. Emily was expected to produce heavy rain across much of the southern Caribbean and northern Venezuela, as well as the Netherlands Antilles. "These rains could produce life-threatening flash floods and mudslides," the center warned. In Grenada, where 30,000 people -- one-third of the permanent population -- remain homeless 10 months after Hurricane Ivan, there were widespread fears about the new storm. There were no immediate reports of fatalities in Grenada Thursday, though authorities said they were inspecting damage. At 1500 GMT, the storm's center was about 560 miles (905 kilometers) southeast of Santo Domingo in the Dominican Republic, moving west-northwest near 18 miles (30 kilometers) per hour, the US center said. "Additional strengthening is forecast during the next 24 hours," the center added. The government of the Dominican Republic has issued a tropical storm watch from Punta Salinas westward to the Haitian border. And the government of Haiti has issued a tropical storm watch from the border with the Dominican Republic to Port-au-Prince. In Haiti, civil protection agency spokesman Jeffe Delorges said after Dennis roared past last Thursday that 23 bodies were found in the southwestern town of Grand-Goave. Most were killed when a bridge collapsed. Another 10 were killed in the Grande-Anse region, also in the southwest, along with five in the southeast and two in the southern city of Cayes. The agency estimates that about 15,000 people are without homes or means to feed themselves, with hundreds of houses completely destroyed. It said there had been widespread flooding and damage to plantations. The Haitian government announced emergency aid totaling the equivalent of 30,000 dollars. Cuban President Fidel Castro said in a televised address late Monday that the toll from Dennis had climbed to 16 and that Dennis destroyed or damaged 120,000 homes and caused more than 1.4 billion dollars in damage. Castro also read from a lengthy list of agricultural devastation: "The entire crop of citrus fruits was lost -- 200,000 tonnes of grapefruit fell from the trees, as did 160,000 tonnes of oranges. "At hundreds of dollars per tonne, that's a huge loss for our exports," he said. Dennis, the first hurricane of the season, was estimated to have caused a further one billion to five billion dollars in insured losses in the United States, according to Risk Management Solutions.
Date: Thu, 7 Oct 2004 03:19:49 +0200 (METDST) by Laura Bonilla POINT SALINES, Grenada, Oct 6 (AFP) - US Secretaty of State Colin Powell flew over the Caribbean island state of Grenada on Wednesday to survey the damage caused by Hurricane Ivan and vowed to bring more help to this devastated spice island. The hurricane killed 39 people and destroyed 90 percent of the tiny island's buildings when it blasted across the Caribbean on September 7, causing an estimated 800 million dollars in damage. This island of 90,000 people is heavily dependent on tourism and nutmeg production, which together account for 40 percent of the economy. The United States has given one million dollars in aid to Grenada and pledged an additional 3.6 million, US officials said. The island will receive additional help in a 100-million-dollar emergency aid package that US President George W. Bush has requested from Congress for Caribbean nations hit by a wave of hurricanes this storm season, Powell said. "We'll do everything we can to expedite the flow of that money," Powell said in a news conference at the airport in Point Salines, the island's southernmost point, after surveying the destruction from his plane's cockpit. "There's an urgent need to reconstruct the economy as well as rebuilding houses and rebuilding schools," Powell said, noting that Grenada's schools, homes, farms and power system were hit by the hurricane. Residents are receiving food and water, "but it'll be a continuing challenge," he said. Shelters need to be built for people who remain homeless, the infrastructure needs to be repaired and power needs to be restored, he said. Only one-third of the island has electricity. Grenada's Prime Minister Keith Mitchell said his government's priority is to reopen schools, which remain closed. "After the devastation arrived we've gone through quite a lot in every respect," Mitchell said. He told Powell: "You understood what was happening, you had a good grasp of the problems that we've faced." From an airplane, much of the island appeared still in ruins. Some areas appeared deserted, while some buildings looked as if they had been eaten up by a raging blaze and palm trees stood leafless. "When those roofs went away, there was water damage done in all of these homes, in some cases destroying a family's entire possessions, all that they owned," Powell said. "What makes this situation so difficult for Grenada is that not only was their infrastructure hit -- schools, housing, roads, the power system -- but their means of production and the economic base of the country," he said. The nutmeg industry -- Grenada is world's second producer of the aromatic seed -- was devastated, and it takes five to 10 years for its evergreen trees to regrow, Powell said. "We want to see if there are things we can do to help with that or perhaps diversify the agricultural sector," he said.
More ...

Nepal

General:
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Nepal is regarded as a developing nation which has a great variability of facilities for the tourist depending on the location throughout the country. It is a mountainous country and many travellers to th
s region undertake long arduous treks. It is wise to ensure that your general health will be sufficient for the trip you plan under normal circumstances. Talking your itinerary through with other experienced travellers to this region will be important before you finally book your holiday. The climate varies throughout the year with their monsoon season typically stretching from May to October. During this time significant flooding can occur and the high humidity leads to increased numbers of mosquitoes. Travel to the Terai plains during this period leads to the greatest risk of mosquito borne disease.
Safety & Security:
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The security situation throughout Nepal has caused quite a degree of concern throughout the past few years. There has been a general increased level of robberies and this has involved tourists on a number of occasions. Those trekking in Nepal are strongly advised to travel with reputable organised groups who will have checked the local situation out carefully before departure. It is very inadvisable to trek alone in Nepal. This is particularly true in the Rasuwa District of the Langtang Area. Airport security in Katmandu has been improved since the hijacking of Indian Airlines flight IC814 in December 1999 but take care of your belongings at all times and never carry anything for strangers no matter how plausible their reason may be.
Health Facilities:
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The level of Western health facilities in Katmandu and Pokhara are excellent but expensive. Outside of the main city the level of healthcare can be very limited. It is essential that all tourists ensure that they have adequate travel insurance which will cover accidents and evacuation by helicopter. Cover for cancelled flights and loss of belongings is also extremely important. The CIWEC Medical Clinic in Katmandu provides an excellent medical service for travellers and their web page gives extensive advice on travelling throughout Nepal.Telephone numbers Katmandu 228531, or 241732. Web site: www.ciwec-clinic.com
Food & Water Facilities:
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Katmandu is a large city with a large population and much squalor. The main tourist hotels provide a good degree of hygiene for travellers but those undertaking trekking holidays will leave this relative health security and head to regions of the country where food and water hygiene are very poor. It is essential that all food consumed is freshly prepared and well cooked. Cold vegetables or salads should be avoided as the risk of diseases like amoebiasis and giardiasis is very high. All water should be checked for a smell of chlorine and if this is not present then it should not be used for either drinking or brushing your teeth. Even bottled water from any source outside of the main hotels should be treated with suspicion as in many cases it will be plain untreated tap water.
Rabies risks in Nepal:
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This viral disease is usually transmitted by the bite (lick or scratch) from any infected warm blooded animal. Usually humans are infected by dogs but cats and monkeys are also frequently implicated. In many of the temples of Nepal there will be a multitude of monkeys and it may be difficult to avoid contact. If you are exposed then urgent medical attention will be required and this will often mean a rapid return to Katmandu. Never treat this disease lightly and always ensure that any contact is followed up as soon as possible.
Altitude Problems:
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Arriving into Katmandu at 4,500ft usually presents no major difficulty for travellers. However, depending on the actual trek which is proposed you may put yourself at risk of exhaustion, dehydration and altitude sickness. The better tour companies will tailor the actual trek to the abilities of those taking part but try not to allow yourself become attached to a group which will push your health to extremes. Many treks will take travellers to heights reaching 18,000ft.
Malaria risk in Nepal:
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The main risk of malaria in Nepal will be for those visiting the Terai region. Even here, the significant risk occurs during the monsoon season and for a period afterwards. However, malaria transmission is reported from other regions of the country and this will need to be talked through in depth before you leave home.
Mosquito Borne diseases:
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Apart from malaria there are two other significant mosquito borne diseases which occur in regions of Nepal. Dengue Fever and Japanese B Encephalitis are both frequently implicated in outbreaks and both diseases can cause severe illness even death. Avoiding mosquito and sandfly bites at all times is essential.
Road & Climbing Safety:
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The road conditions throughout rural Nepal are poor and care will be required at all times. Many mountainous passes are impassible during the monsoon season and can even be very hazardous at other times throughout the year. In Katmandu the roads are congested, pollution is a significant problem and walkways may be non existent in many places. If undertaking a trek it is important to make sure your general health is sufficient and that you have adequate clothing and shoes to suit both the expected and unexpected.
Local Laws & Customs:
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The Nepalese customs are very strict regarding importation and exportation of many goods including valuable metals, articles of archeological or religious importance, drugs, arms and communication equipment. Imprisonment can quickly follow any infringement of their rules. Women are advised to dress modestly and generally it is wiser to avoid inappropriate clothing in public such as shorts, sleeveless tops etc.
Vaccination for Nepal:
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Unless you are entering Katmandu from tropical Africa there are no essential vaccines for entry or exit. We used to receive reports of buses being stopped coming overland from India and for all on board to have evidence of Cholera vaccination. However, this does not appear to be a current problem. Nevertheless, for your own personal health it is recommended that travellers are covered against the following diseases;
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Poliomyelitis (childhood booster)
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Tetanus (childhood booster)
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Typhoid (food and water borne disease)
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Hepatitis A (food and water borne disease)
For those undertaking a longer more rural trip other vaccines may need to be considered including Hepatitis B, Rabies, Japanese B and Meningitis.
Summary:
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Tourists will need to ensure the highest level of personal care while visiting Nepal at all times. Many of the conditions and situations mentioned above occur frequently in those who forget the basic commonsense rules about travelling healthy.

Travel News Headlines WORLD NEWS

Kathmandu. 6 Sep 2019

If laboratory tests carried out at Sukraraj Tropical and Infectious Disease Hospital today [6 Sep 2019] are anything to go by, roughly 50% of those who visit the hospital with fever and muscle pain are dengue-infected. According to the hospital, of the 372 blood tests done today [6 Sep 2019], 175 tested positive for dengue. "There has been a significant rise in the number of dengue-infected patients at the hospital. Unless people are aware and start working on their own, it is difficult to prevent the infection," said Anup Bastola, spokesperson and consultant tropical medicine physician at Sukraraj Tropical and Infectious Disease Hospital.

- Kathmandu. 19 Sep 2019.The cases of dengue fever are on the rise in Bhaktapur, indicating that it is gradually taking an epidemic turn. In the past 2 weeks, 197 people have been diagnosed with dengue in the district.
12th September 2019
Communication from a medical colleague based in Kathmandu
=======================
Dear friends,  I would like to alert you to a dengue outbreak in Nepal including in Kathmandu. It started in May 2019 in eastern Nepal but has come to Kathmandu in a big way in the past 2 weeks or so. Government figures (http://www.edcd.com.np/) indicates total of 5095 cases in Nepal including 1170 cases from Kathmandu. The government figures underestimate the problem due to underreporting issues. Kathmandu hospitals seem stretched to capacity due to dengue visits and admissions.

This problem is new to Kathmandu as we have had only sporadic cases of dengue in previous years. The public in Kathmandu has never taken mosquito bites seriously since we have not had major vector borne diseases in the past. We hope that the current dengue outbreak has peaked and will slow down once we get cooler nights from end September - early October.

If you have travellers coming this way, please alert them to this and send them with insect repellents and information on mosquito protection measures. DEET is not readily available and other repellent supplies have been depleted. 

Thank you. 
Prativa
======================
Dr. Prativa Pandey
Medical Director
CIWEC Hospital I Travel Medicine Center
prativapandey@ciwec-clinic.com
+977
98510-36742 I
http://www.ciwec-clinic.com/
Date: Sat, 13 Jul 2019 09:52:36 +0200

Kathmandu, July 13, 2019 (AFP) - Floods and landslides triggered by torrential monsoon rains have killed at least 40 people across South Asia in the last two days, officials said Saturday.   The monsoon, which lasts from June to September, causes widespread death and destruction across South Asia each year.   In Nepal, 27 people have died in floods and landslides after heavy rains hit the country's eastern region and the southern plains.

Bishwaraj Pokharel, spokesperson for Nepal Police, added that another 11 people were injured and 15 others reported missing.    Three of the victims were killed when a wall collapsed in the capital Kathmandu.   "Our first priority is life saving rescue and all our resources have been deployed," Home Ministry official Umakanta Adhikari told AFP.

Police used boats to bring people to safety as rivers swelled, inundating their settlements, while parents were seen wading across chest-high waters carrying children on their shoulders.    Nepal's weather department issued a high alert for the southern Sapta Koshi river on Saturday and sent SMS warnings to people in the area.

In neighbouring India 11 deaths have been recorded in the north-eastern states of Assam and Arunachal Pradesh, officials said Friday.  Monsoon floods have inundated 21 districts in Assam, affecting thousands, officials said Friday.

In Bangladesh aid groups were providing rations to Rohingya refugees in the southeast of the country with the UN World Food Programme saying Friday that two people including a child had died.   Last year, more than 1,200 people were been killed across South Asia in monsoon storms with India's Kerala suffering its worst floods in nearly 100 years.
Date: Mon, 27 May 2019 13:48:42 +0200

Kathmandu, May 27, 2019 (AFP) - Nepalese police arrested suspected Maoist activists after three deadly bomb blasts in Kathmandu as a general strike disrupted daily life in much of the South Asian nation on Monday, police said.   Amid a high alert after Sunday's attacks, which were blamed on an outlawed Maoist group, police blew up several suspicious packages.   The group broke away from the country's main communist party, which is now in power, and called the general strike to protest against the death of one of its leaders in police custody.

Police said at least 13 officials from the Maoist group had been arrested on Sunday night and early Monday in different parts of the country.   "Security agencies dealt with suspicious objects found in different areas, mostly outside the capital," said police spokesman Bishwa Raj Pokharel.   While some schools and offices remained closed in Kathmandu, "the effect of the general strike is nominal in the Kathmandu valley but very few vehicles are working outside the capital," the spokesman added.    Four men were killed and seven people injured in three explosions in Kathmandu on Sunday.

A blast inside a shop killed three people, one died in an explosion at a nearby house, whilst two men carrying explosives on a motorbike were among those injured.   There was no immediate claim of responsibility but police said they suspected the Maoist group whose pamphlets were found in a house where one of the explosions took place.

Nepal has enjoyed relative calm since the end of a decade-long civil war in 2006. But some former guerrillas have formed a new group accusing their former leaders of betraying their revolutionary cause.   The group was banned after it was implicated in an explosion that killed one person outside a telecom company office in February.
Date: Sun, 26 May 2019 19:09:29 +0200

Kathmandu, May 26, 2019 (AFP) - Four men died and seven were injured Sunday in three separate explosions in Kathmandu, Nepali police said.   There was no immediate claim of responsibility but police said they suspect involvement of a Maoist splinter group whose pamphlets were found in a house where one of the explosions took place.   A powerful blast inside a shop killed three people and injured four, while the explosion at a home about four kilometres away left one dead and another injured.

Two more were injured when an explosive they were carrying on a motorcycle in the outskirts of Kathmandu exploded.   Security personnel also defused explosives in other areas.    "We are investigating all incidents and have stepped up the security," police spokesman Bishwa Raj Pokharel told AFP.   Pokharel said that seven people have been arrested so far.    The incidents come on the eve of a nationwide strike called the same Maoist splinter group, protesting death of their cadre in a police encounter over a week ago.

Nepal has enjoyed a relatively peaceful environment since the end of a decade-long civil war which concluded with a peace deal struck in 2006.   But some former guerrillas, have broken away, accusing its leaders of betraying their original revolutionary ideals.   In February, the group was implicated in an explosion that killed one person outside the office of a telecom company Ncell, part of Malaysia-based Axiata Group Berhad.    The government outlawed the group following the incident, banning their activities.
More ...

Romania

Romania US Consular Information Sheet
March 02, 2009
COUNTRY DESCRIPTION:
Romania joined NATO in 2004 and the European Union in 2007.
Read the Department of State Background Notes on Romania for additional information.

ENTR
/EXIT REQUIREMENTS:
A valid passport is required.
U.S. citizen visitors are granted 90 days of stay without a visa within a given six-month period.
For stays longer than 90 days, an extension of stay may be obtained in Romania from the Romanian Immigration Office in the area of residence.
An exit visa must be obtained in cases of overstay.
The Romanian Government is enforcing visa regulations more vigorously and a record of visa overstay can result in the assessment of large fines and the denial of entry without a visa for a specified time.
Visit the Embassy of Romania web site for the most current visa information or contact the Romanian Embassy at 1607 23rd St. NW, Washington, D.C. 20008, telephone number (202) 232-4747, or the Romanian Consulates in Los Angeles, Chicago, or New York City.
.

Foreigners are required to carry identification documents at all times. Americans who obtained a temporary or permanent stay permit must be able to present the document upon the request of any “competent authorities.”
Foreigners who do not have a stay permit should present their passports.
(The Embassy recommends carrying a copy of the relevant document).

U.S. visa information for Romanians and other foreign citizens can be found on the web site of the U.S. Embassy in Bucharest
or the Department’s travel website.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about custom regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
American citizens are reminded to exercise caution, remain vigilant with regard to their personal security, and monitor media reports.
Prior police notice is required for public demonstrations and police oversight is routinely provided.
Nonetheless, even demonstrations intended to be peaceful can turn confrontational and possibly escalate into violence.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.
Information on specific demonstrations can be found on the Embassy web site on the demonstration notices page.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada or, for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves overseas, see the Department of State’s A Safe Trip Abroad.

CRIME:
While most crimes in Romania are non-violent and non-confrontational, crimes do occur in which victims suffer personal harm.
Crimes against tourists, including robbery, mugging, pickpocketing and confidence schemes, remain a problem in Romania.
Organized groups of thieves and pickpockets, sometimes including minors, operate in train stations and on trains, subways, and buses in major cities.
A number of thefts and assaults have occurred on overnight trains, including thefts from passengers in closed compartments.
The Embassy recommends using the highest class available for train travel, and suggests traveling with at least one other person. As is always the case, travelers should never leave personal belongings unattended, maintaining control over them at all times.

The Embassy has received reports of bar/night club scams.
These scams involve unsuspecting patrons being charged exorbitant prices when they receive their bar bills.
Another scam involves patrons of “adult” establishments (strip clubs) who are charged for the female worker’s drinks or time while talking to the customers.
Because strip clubs frequently are fronts for organized crime, the Embassy recommends avoiding these establishments.
Patrons may be forced to pay the bills or risk physical confrontation.
If you find yourself in this situation, you should pay the bill and make a police report once the incident is over.

Money exchange schemes targeting travelers are common in Romania.
Some of these ploys have become rather sophisticated, involving individuals posing as plainclothes policemen, who approach the potential victim, flash a badge, and ask for the victim's passport and wallet.
In many of these cases, the thieves succeed in obtaining passports, credit cards, and other personal documents.

Credit card and Internet fraud remain among the most common crimes affecting foreigners in Romania.
Romania is largely a "cash only" economy.
While an increasing number of businesses accept credit cards, travelers are advised to use cash for goods and services rendered due to the prevalence of credit card fraud.
Vendors have been known to misuse credit card information by making illegal purchases on a customer’s account.
To make a credit card purchase, a PIN is usually required.
There are an increasing number of ATMs located throughout major cities, and increasingly sophisticated identity theft rings are targeting them.
Travelers should try to use ATMs located inside banks and check for any evidence of tampering with the machine before use.
Travelers' checks are of limited use but may be used to purchase local currency at some exchange houses.

Americans should exercise caution when traveling to Romania to meet individuals known only through contact over the Internet.
A significant number of confidence scams have been uncovered involving Romanians who contact their prospective American victims through chat rooms or personal advertisements. They generally identify themselves as young Romanian women and develop a “relationship” with their victim over time.
Variations of this scam have emerged but money extortion remains the ultimate goal.
Americans who suspect they may have fallen victim to this kind of scam should contact American Citizens Services at the U.S. Embassy.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to the local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you understand the local criminal justice process and find an attorney if needed.

The local equivalent to the "911" emergency line in Romania is: 112.
English speaking operators are available.
Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Romania’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Romania are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

Under Romanian law, engaging in sexual conduct with a minor under the age of 15 or a minor between the ages of 15 and 18 where the adult has abused the minor’s trust or had influence/authority over the minor is a crime punishable with a 3-10 year prison sentence.
Engaging in illicit sexual conduct with someone who has a physical or psychological disability is punishable with a 3-12 year prison sentence.
Distribution of obscene materials depicting minors is a crime punishable with a 1-5 year prison sentence.
Prostitution is illegal in Romania, regardless of the age of the participants.

SPECIAL CIRCUMSTANCES:
Abandoned dogs are commonplace in Romania and generally tolerated.
Strays are often fed and are seen frequently on a daily basis especially in or near parks.
Some statistics report one dog bite hourly in Bucharest, the capital city. Because the immunization status of stray dogs is unknown, precautions to prevent rabies are recommended.
See the CDC’s web site for more details.
If you encounter dogs that appear aggressive, it is best to change your path to avoid contact with them.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at the U.S. Department of Justice, Computer Crime and Intellectual Property Section.

Romania's customs authorities may enforce strict regulations concerning temporary importation into or export from Romania of items such as firearms, antiquities, and medications.
Romanian law allows travelers to bring cash into or out of Romania; however, sums larger than 10,000 Euros or the equivalent must be declared.
Travelers are advised to contact the Embassy of Romania in Washington or one of Romania's consulates in the United States for specific information regarding customs requirements.

DISASTER PREPAREDNESS:
Romania is situated in a seismically active region and has a history of devastating and deadly earthquakes.
While responsibility for caring for disaster victims, including foreigners, rests with Romanian authorities, disaster preparedness is also a personal responsibility.
Additional information is available from the U.S. Embassy in Bucharest.
General information about natural disaster preparedness is available from the U.S. Federal Emergency Management Agency (FEMA).

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care in Romania is generally not up to Western standards, and basic medical supplies are limited, especially outside major cities.
Some medical providers that meet Western quality standards are available in Bucharest and other cities but can be difficult to identify and locate.
Travelers seeking medical treatment should therefore choose their provider carefully.
A list of hospitals and physicians is available on the website of the U.S. Embassy in Bucharest.
Information regarding health threats or other medical issues affecting visitors to Romania can also be found at this site. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Romania.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site.
For
information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) website
Further health information for travelers is available from the WHO.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

Americans who wish to extend their stay in Romania must present proof of health insurance that applies overseas for the duration of their intended stay in Romania.
Useful information on medical emergencies abroad, including overseas insurance programs, is provided on the Department of State's web page, Medical Information for Americans Traveling Abroad.
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Romania is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic accidents are arguably the single most dangerous threat for American citizens visiting Romania. The World Economic Forum ranks Romania 126 out of 134 states for road quality.
Currently Romania has a total of only 270 kilometers of freeways.
While major streets in larger cities and major inter-city roads are generally in fair to good condition, many other roads are in poor repair, unpaved, badly lighted, or narrow, or lack marked lanes.
Part of the problem is that the infrastructure has failed to keep pace with the dramatic increase in motor vehicles since 1990.

Roads, especially in the mountains, can be particularly dangerous when wet or covered with snow or ice.
Pedestrians, animals, cyclists, and horse-drawn carts share many roads with motor vehicles and can be extremely difficult to see, particularly at night in rural areas.
Vehicles often block sidewalks, forcing pedestrians to walk in the streets.
Maintain vigilance when driving to avoid hitting those who are walking in the streets.
Cross the street only in crosswalks and always look both ways before crossing.
Crosswalks are generally poorly marked and drivers may ignore crosswalks even if there is a traffic light.

Driving practices in Romania can be aggressive and/or inattentive.
Combined with the substandard road conditions noted above, the result is a significant traffic mortality rate.
According to the European Union Road Federation, Romania has the highest per vehicle rate of traffic fatalities of any country in the E.U.
It is essential for drivers to practice defensive driving techniques.


Romanian traffic laws are very strict.
The traffic police can confiscate any form of driver's license or permit for 1-3 months, and payment of fines may be requested at the time of the infractions.
Some examples when this might occur are failure to yield the right of way, failure to stop at a red light or stop sign, or failure to yield to pedestrians at crosswalks.
While, in theory, drivers must yield to pedestrians at all marked pedestrian crosswalks, many of these are poorly maintained, difficult to see, and sometimes located in unexpected places for foreign drivers.
Pedestrians must take extreme caution when crossing any road.

Romanian traffic laws provide for retention of a driver’s license by the police and possible imprisonment for driving under the influence of alcohol or for causing an accident resulting in injury or death.
There is zero tolerance for driving under the influence of alcohol and police are required to give breathalyzer tests on the scene to all drivers involved in an accident.
Refusal to take a breathalyzer test will result in criminal penalties regardless of whether or not alcohol was involved.

U.S. driver's licenses are only valid in Romania for up to 90 days.
Before the 90-day period has expired, U.S. citizens must either obtain an international driving permit in addition to their U.S. driver's license or a Romanian driver's license.
Wearing a seat belt is mandatory.
Children under 12 years of age may not be transported in the front seat.

Unless otherwise marked with road signs, speed limits are as follows:
·


Inter-city traffic on highways

o
130 km/hr for cars and motorcycles (80 miles/hr)

o
110 km/hr for vans (65 miles/hr)

·


Urban traffic - 50 km/hr (30 miles/hr)

·


Express and European roads

o
100 km/hour for cars and motorcycles (60 miles/hr)

o
90 km/hour for vans (55 miles/hr)

·


All other roads

o
90 km/hr for cars and motorcycles (55 miles/hr)

o
80 km/hr for vans (50 miles/hr)

·


Motor vehicles with trailers and drivers with less than one year of driving experience have speed limits 20 km/hr (or 12 miles) slower than those listed above.

Inter-city travel is generally done via trains and buses, which vary in terms of quality, safety, cost, and reliability.
Pickpockets pose a danger on night trains and in train stations.
Inter-city travel by taxi is much more expensive, and safety depends on the quality of the driver.
Many older taxis are not equipped with seat belts.
To avoid being overcharged, passengers should request the taxi by phone through a reputable company and make sure the taxi has an operational meter or agree upon a price before entering the taxi.
The meter rate per km is posted on both sides of the taxi vehicle.

The host country authority responsible for road safety is the Traffic Police of the Romanian Ministry of Interior.
Emergency roadside help and information may be reached by dialing 9271 for vehicle assistance and towing services.
For ambulance services, fire brigade, or police, dial 112.

Please refer to our Road Safety page and the Bucharest Metropolitan Police Department web site for more information.
Also visit the website of Romania’s national tourist office.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Romania’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Romania’s air carrier operations.
For more information, travelers may visit the FAA's web site.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
In 2005, Romania banned intercountry adoptions except by biological grandparents.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Romania are encouraged to register with the U.S. Embassy through the State Department’s travel registration website, and to obtain updated information on travel and security within Romania.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located at Strada Tudor Arghezi 7-9, telephone (40) 21-200-3300.
In emergencies, an after-hours duty officer may be reached by calling (40) 21-200-3433.
Consular services for U.S. citizens are performed at the Consular Section located at Strada Filipescu 26 (formerly Strada Snagov), one block from the U.S. Embassy at the corner of Strada Batistei.
The Consular Section can be reached through the Embassy operator at (40) 21-200-3300, and faxes can be sent to (40) 21 200-3381 or 200-3578.
*

*

*
This replaces the Country Specific Information sheet dated July 18, 2008 to update the information on Safety and Security, Crime, Traffic Safety and Road Conditions, Special Circumstances, and Disaster Preparedness.

Travel News Headlines WORLD NEWS

Date: Sun 12 Aug 2018
Source: Outbreak News Today [edited]

In a follow-up on the West Nile virus (WNV) situation in Romania, the National Center for Communicable Disease Surveillance and Control reported (computer translated) since the start of surveillance on [2 May 2018], 23 meningitis/meningo-encephalitis have been reported due to West Nile virus infection and a death in the case of a 79-year-old patient who had comorbidities.

Officials say the cases in Romania are sporadic and there is currently no risk of an epidemic.

In addition to Romania (23), in 2018, as of [9 Aug 2018], the EU Member States reported 231 human cases. Italy reported 123 cases, Greece 59 cases, Hungary 23 cases, and France 3 cases. The EU neighbouring countries reported 104 human cases. Serbia reported 102 cases and Kosovo reported 2 cases.

To date, a total of 17 deaths due to West Nile fever have been reported by Serbia (9), Italy (3), Greece (3), Kosovo (1), and Romania (1).
=======================
[In view of the increase in number of WNV cases, the Ministry of Health has advised Romanians to avoid exposure to mosquitoes, to wear shirts and long pants, and to use special window nets so as to minimise the danger of mosquitoes accessing their homes, at the same time maximising their personal health security measures. - ProMED Mod.UBA]

[A HealthMap/ProMED-mail map showing Romania and the other countries mentioned in the report above can be seen at
<http://healthmap.org/promed/p/122>. - ProMed Sr.Tech.Ed.MJ]
Date: 27 Jul 2018
Source: Balkaneu [edited]

Five citizens in Romania have been diagnosed with meningitis caused by the West Nile virus.  The Romanian Ministry of Health recommends to local authorities to take pest control measures as soon as possible to prevent the spreading of the virus, stiri.tvr.ro reported, adding that 80 percent of the people that were infected or get infected have no symptoms.

The only signs and tangible proof that something might be seriously wrong are high fever and headaches. In this case, specialists suggest an immediate visit to the nearest clinic, hospital, or local health centre.

Romanians are advised to avoid exposure to mosquitoes, to wear shirts and long pants, and to use special window nets so as to minimise the danger of mosquitoes accessing their homes, and at the same time, maximize their personal health security measures.  [Byline: Lida Filippakis]
========================
[West Nile virus (WNV) is a significant human, equine and wild bird health problem in the Americas, Europe and the Middle East.

Most WNV infections in people are asymptomatic, and only one infected person in 5 develops fever, headache, body aches, joint pains, vomiting, diarrhoea, or rash. Most individuals recover completely, but fatigue and weakness can last for weeks or months. About one person in 150 will develop neurological disease affecting the central nervous system such as encephalitis or meningitis, and some die [<https://www.cdc.gov/westnile/symptoms/index.html>].

Suspected outbreaks of West Nile virus (WNV) infection have been reported in Romania since the 1950s. Outbreaks of encephalitis, which were serologically confirmed to be caused by WNV infection, were recorded in 1955 in central Transylvania, followed by an outbreak in 1964 in Banat county (central Romania). The largest outbreak of WNV infection in Europe to date was in Romania, when in 1996, over 800 clinical cases of neuro-invasive disease were reported, 393 of which were confirmed for WNV. A total of 17 deaths were reported in this outbreak. The majority of cases were resident (and probably infected) in the capital, Bucharest.

Following this outbreak, Romania implemented a surveillance system for WNV infection. The epidemiological situation until 2009 was characterised by sporadic cases reported from the southern part of the country (south of the Carpathian Mountains). Data from studies conducted between 1997 and 2000 show that 39 confirmed cases were detected. National surveillance data indicate that between 1997 and 2004, a total of 82 neuroinvasive cases were reported in this area (unpublished data; Romanian National Institute of Public Health). Another major outbreak was reported in 2010  [<https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/1104_MIR_West_Nile_outbreak_Romania.pdf>].

There have been studies in Romania that provide evidence that wild birds are involved in local West Nile disease enzootic and epizootic cycles. This, in turn, allows virus maintenance and spread and also enhances the chance of new outbreaks [<https://www.ncbi.nlm.nih.gov/pubmed/26824796>]. This indicates that the virus is in circulation in the country, resulting in periodic outbreaks among humans similar to the one reported above. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Date: Thu, 19 Apr 2018 05:38:24 +0200
By Mihaela RODINA

Boldesti-Scaieni, Roumanie, April 19, 2018 (AFP) - Measles still claims young lives in Romania, where nearly 40 children have died in an outbreak that many blame on parents being misled by scare stories that vaccinating them is dangerous.   Some 12,000 people have contracted measles since late 2016 in the European Union's second-poorest country, 46 of them died.

Among the dead, 39 were children under the age of three who had not been vaccinated, making Romania one of the worst affected countries in the ongoing measles outbreak in Europe.   "People are mistrustful because they read all sorts of things on the internet," said Dr Silvana Dan, from the southern regional Prahova Public Health Authority, citing persistent rumours that vaccination causes autism.   A girl aged just 11 months died in the region in March after her parents refused to vaccinate her.

Measles is a highly contagious viral disease that affects children in particular but it has largely been brought under control.   The World Health Organization (WHO) says deaths caused by measles plunged from 550,100 in 2000, to just under 90,000 in 2016.   Paradoxically, and to the horror of health authorities worldwide, this very success has seen the public let down its guard and question whether vaccination is now really necessary.

Local officials say health workers are "on the barricades," doing all they can to get the message across, especially in rural areas, that measles is a killer which can be stopped.   It is not straightforward.   "The reasons for people not being vaccinated are different in different population groups," local WHO representative Miljana Grbic told AFP.   "Our research shows that there are specificities such as convenience of services, education, support of family doctors, community support and peer support that play a big role here," Grbic said.

- Roma especially vulnerable -
In Valea Seaca, some 250 kilometres (150 miles) northeast of Prahova, another baby girl of just 10 months died of measles in February.   "Her parents refused, in writing, to have their children vaccinated after seeing reports on television that vaccines kill," local mayor Ioan Pravat told AFP.   The National Centre for the Supervision and Control of Transmissible Diseases says most measles cases are found in more vulnerable, disadvantaged communities, Roma for the most part, who often do not have access to a family doctor or if they do, only ask them for help in an emergency.

The local authorities hope that Roma health workers can help ease that problem.   Aurelia Oprisan, one of them, makes her rounds every day in Boldesti-Scaieni, to the south, knocking on doors to spread the vaccination message.   "Many people are negatively influenced by the press so I tell them that what they are hearing is not true," Oprisan told AFP.   There are signs this approach may be working.   "I don't want to lie to you. At the beginning I, too, was afraid because I had heard that there could be problems, like causing paralysis," said Anisoara Iorga.   "But then I did get my children vaccinated and they had no problems at all."

- Progress but below target -
If there is progress overall, there is also still a way to go.   The WHO recommends a vaccination rate of 95 percent for effective control. But in Romania, it is 87 percent for the first inoculation and only 75 percent for the second, according to the latest official figures from 2016.   Some critics say the authorities share part of the blame because the supply of vaccine is irregular and insufficient.

Stung into action, the government has pledged to improve vaccination rates by making 10 child vaccines compulsory but debates on a draft law submitted last year have made little progress.   "We have received lots of amendments which we are in the process of analysing," said Florin Buicu, a doctor and Social Democrat MP who chairs parliament's health committee.

Many of these have been submitted by anti-vaccine groups who have become increasingly active, Buicu said.   Medical professionals are outraged.   "We have to defend the scientific work (underlying vaccines) while information which has no such basis is taken as the truth," said Dr Alexandru Rafila, head of Romania's microbiology society.
Date: Mon 16 Oct 2017
Source: Romania Insider [edited]

Almost 400 new measles cases have been confirmed in the last month in Romania, according to data from the National Center for Supervision and Control of Transmissible Diseases, quoted by News.ro.

This has brought the total number of confirmed measles cases in the country to more than 9600 since the authorities officially announced the outbreak of this epidemic, at the end of September 2016.

Half of the new cases in the last month have been reported in Brasov county, and a high number of new cases were also reported in Cluj, Satu Mare and Harghita counties.

Overall, in the last 2 years, over 1000 cases were confirmed in Timis county (1228), Caras-Severin county (1112), and Arad county (1014), all in Western Romania.

Since the start of the measles epidemic, 34 people died in Romania because of the disease. Nine deaths were reported Timis county, 6 in Arad, 7 in Dolj, 3 in Caras-Severin, and 1 in Bihor, Cluj, Calarasi, Neamt, Satu Mare, Vaslui, Galati, Mures, and Bucharest, each.

The disease has spread to 41 counties. Tulcea is the only county in Romania where no measles case has been officially recorded yet.

This July [2017], the Romanian Ministry of Health started a vaccination campaign against measles with the involvement of local authorities, which have to identify the children who have not been vaccinated yet and the places where they will be immunized.
=====================
[A HealthMap/ProMED-mail map of Romania can be found at
Date: Mon 16 Oct 2017 at 9:52:16 AM EDT
Source: Outbreak News Today [edited]

Since January 2016, some 19,000 measles cases were reported in Europe, including 44 deaths. (In 2016, 12 deaths occurred in Romania and one in the UK. In 2017, 31 deaths were reported from Romania, Italy [4], Bulgaria [1], Germany [1], Portugal [1], France [1] and Spain [1].)

The list of countries affected is long, with only Latvia, Liechtenstein, Malta and Norway not reporting any cases in 2017.

The most heavily affected continue to be Romania (9539 cases, including 34 deaths with more than 7500 reported in 2017), Italy (4617 cases, including 4 deaths this year), and Germany (891 cases in 2017).

Of all measles cases reported across the one-year period from 1 Sep 2016-31 Aug 2017 with known vaccination status, 87% were not vaccinated.

The latest available figures on vaccination coverage collected by WHO (2016) show that the vaccination coverage for the 1st dose of measles was below 95% in 18 of 30 EU/EEA countries; for the 2nd dose of measles, it was below 95% in 20 of 27 EU/EEA countries reporting 2nd dose coverage data.

According to the European Centre for Disease Prevention and Control (ECDC), in order to achieve the measles elimination goal, the vaccination coverage rates for children targeted by routine vaccination programmes should increase in a number of countries, as the vaccination coverage of the 2nd dose must be at least 95% to interrupt measles circulation and achieve herd immunity.
=====================
[A Google map of Europe may be found at <bit.ly/2t5juKQ>. - ProMED Mod.LK]
More ...

Syria

Syria US Consular Information Sheet
August 13, 2008

COUNTRY DESCRIPTION:
Since March 1963, the Syrian Arab Republic has been ruled by an authoritarian regime dominated by the Socialist Ba'ath Party.
While the ruling Ba'ath party
spouses a largely secular ideology, Islamic traditions and beliefs provide a conservative foundation for the country's customs and practices.
Syria has a developing, centrally-planned economy with large public (30%), agricultural (25%), and industrial (20%) sectors.
Tourist facilities are available, but vary in quality depending on price and location.
Read the Department of State Background Note http://www.state.gov/r/pa/ei/bgn/3580.htm on Syria for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and a visa are required.
Visas must be obtained prior to arrival in Syria from a Syrian diplomatic mission located in the traveler’s country of residence, although the Syrian visa policy with respect to American diplomats and citizens is currently under review.
Foreigners who wish to stay 15 days or more in Syria must register with Syrian immigration authorities by their 15th day.
Syrian-American men or American men of Syrian origin, even those born in the United States, may be subject to compulsory military service unless they receive a temporary or permanent exemption from a Syrian diplomatic mission abroad prior to their entry into Syria.
(Please see the section on Special Circumstances below.)
Syria charges a departure tax for all visitors except those on diplomatic passports.
As of July 1, 2008, the tax is 1,500 Syrian Pounds if departing from the airport; 500 Syrian Pounds if departing via one of the land borders.

The Syrian government rigidly enforces restrictions on prior travel to Israel, and does not allow persons with passports bearing Israeli visa or entry/exit stamps to enter the country.
Syrian immigration authorities will not admit travelers with Israeli stamps in their passports, Jordanian entry cachets or cachets from other countries that suggest prior travel to Israel.
Likewise, the absence of entry stamps from a country adjacent to Israel, which the traveler has just visited, will cause Syrian immigration officials to refuse admittance.
Entry into Syria via the land border with Israel is not possible.
American-citizen travelers suspected of having traveled to Israel have been detained for questioning.

Syrian security officials are also sensitive about travel to Iraq.
There have been instances in which Americans, especially those of Arab descent, believed to have traveled to Iraq were detained for questioning at ports of entry/exit.
Americans seeking to travel to Iraq through Syria have also on occasion been turned around and/or detained.
On a number of occasions the border between Iraq and Syria has been closed without notice, stranding Americans on either side of the border.
Children under the age of eighteen whose fathers are Syrian or of Syrian descent must have their fathers' permission to leave Syria, even if the parents are separated or divorced and the mother has been granted full custody by a Syrian court.
Women in Syria are often subject to strict family controls.
On occasion, families of Syrian-American women visiting Syria have attempted to prevent them from leaving the country.
This can be a particular problem for young single women of marriageable age.
Although a woman does not need her husband's explicit consent every time she wishes to leave Syria, a Syrian husband may take legal action to prevent his wife from leaving the country, regardless of her nationality.
Once such legal orders are in place, the U.S. Embassy cannot help American citizens leave Syria.
Visit the Embassy of the Syrian Arab Republic, 2215 Wyoming Ave. NW, Washington, DC
20008, telephone (202) 232-6313 or check the Syrian Embassy's home page at http://www.syrianembassy.us for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY: Syria is included on the Department of State's List of State Sponsors of Terrorism.
A number of the terrorist groups that have offices in Syria oppose U.S. policies in the Middle East.
On September 12, 2006, the U.S. Embassy in Damascus was attacked by assailants using improvised explosives, gunfire, and two vehicles laden with explosives.
On February 4, 2006, mobs protesting caricatures of the Prophet Mohammed destroyed the Norwegian and Chilean embassies and severely damaged the Danish and Swedish diplomatic missions.
On April 27, 2004 there was a violent clash in which three people died in an area of Damascus where many foreign citizens reside.
It has never been clear whether the shootout with Syrian security forces involved common criminals or terrorists.
In 1998 and 2000, mobs attacked the U.S. Ambassador’s Residence and the U.S. Embassy, respectively.
In 1997, twenty-two people were killed when a public bus was bombed in downtown Damascus.
All of these attacks serve as reminders that Syria is not immune from political or purely criminal violence.
Americans traveling through the area should remain aware that U.S. interests and citizens might be targeted.
Security personnel may at times place foreign visitors under surveillance.
Hotel rooms, telephones, and fax machines may be monitored, and personal possessions in hotel rooms may be searched.
Taking photographs of anything that could be perceived as being of military or security interest may result in problems with authorities.
Additionally, Americans should be aware that conversations on the topics of political, religious and other freedoms are not seen as merely healthy debate in Syria and could lead to arrest.
Note that possession of specific-use electronic devices including GPS, short-wave or handheld radio equipment, or similar devices in Syria is illegal.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ website at http://travel.state.gov, where the current Travel Warnings, including the Travel Warning for Syria, Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada or, for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
While a few cases of theft, burglary and assault have been reported to the Embassy, crime is generally not a serious problem for travelers in Syria.
It is important to note, however, that Syria is not crime free. Specifically, incidents of credit card and ATM fraud, and physical harassment of women, are on the rise.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to the local police, please contact the U.S. Embassy for assistance.
The Embassy staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalents for the “911” emergency line in Syria are:
110 for ambulance, 113 for fire and 112 for the police.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Basic medical care and medicines are available in Syria's principal cities, but not necessarily in outlying areas.
Serious illnesses and emergencies may require evacuation to a Western medical facility.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.
Some HIV/AIDS entry restrictions exist for visitors to or foreign residents of Syria.
There are no special immunizations required for entry to Syria.
AIDS tests are mandatory for foreigners’ ages 15 to 60 who wish to reside in Syria.
The AIDS test must be conducted in Syria at a facility approved by the Syrian Ministry of Health.
A residence permit will not be issued until the absence of the HIV virus has been determined.
Foreigners wishing to marry Syrian nationals in Syria must also be tested for HIV.
Syria usually will not give visas or residency permits to students wishing to study religion or Arabic in private religious institutions.
Please verify this information with the Embassy of Syria at http://www.syrianembassy.us/ before you travel.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Syria is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in Syria is hazardous and requires great caution.
Although drivers generally follow traffic signs and signals, they often maneuver aggressively and show little regard for vehicles traveling behind or to the sides of them.
Lane markings are usually ignored.
Vehicles within Syrian traffic circles must give way to entering traffic, unlike in the United States.
At night, it is very hard to see pedestrians, who often walk into traffic with little warning.
Outside major cities it is common to find pedestrians, animals and vehicles without lights on the roads at night.
Pedestrians must also exercise caution.
Parked cars, deteriorating pavement, and guard posts obstruct sidewalks, often forcing pedestrians to walk in the street.
Vehicles often do not stop for pedestrians, and regularly run red lights or “jump” the green light well before it changes.

Please refer to our Road Safety page for more information.
For specific information concerning Syrian driving permits, vehicle inspection, road tax and mandatory insurance, contact the Syrian Embassy in Washington, D.C. at 2215 Wyoming Avenue NW, Washington, DC
20008, tel. 202-232-6313.
AVIATION SAFETY OVERSIGHT:
Sanctions resulting from the passage of the Syria Accountability Act prohibit aircraft of any air carrier owned or controlled by the Syrian government to take off from or land in the United States.
As there is no direct commercial air service to the United States by carriers registered in Syria, the U.S. Federal Aviation Administration (FAA) has not assessed Syria's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
The U.S. Embassy in Damascus has advised its employees to avoid travel on Syrian Arab Airlines (Syrian Air or SAA) whenever possible due to concerns regarding the airline's ability to maintain its airplanes.
SAA has, on its own initiative, grounded individual aircraft with significant maintenance or service issues; however, concerns persist that some planes still being flown may lack certain safety equipment or may have undergone repairs that have not been reviewed by the manufacturer.

SPECIAL CIRCUMSTANCES:
Syrian customs authorities may enforce strict regulations concerning temporary importation into or export from Syria of items such as weapons, narcotics, alcohol, tobacco, cheese, fruits, pharmaceuticals, modems, cosmetics, and some electrical appliances.
It is advisable to contact the Embassy of Syria in Washington, D.C. for specific information regarding customs requirements.
Please see our Customs Information.
U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times so that, if questioned by local officials, they will have proof of identity and U.S. citizenship readily available.
Although Syria is a signatory to the Vienna Convention on Consular Relations, Syrian officials generally do not notify the American Embassy when American citizens are arrested. When the American Embassy learns of arrests of Americans and requests consular access, individual police officials have, on their own initiative, responded promptly and allowed consular officers to visit the prisoners.
However, security officials have also in the past denied Embassy requests for consular access, especially in the case of dual citizens.
Foreign currencies can be exchanged for Syrian pounds only at government-approved exchange centers and licensed private banks.
Syrian pounds cannot be changed back into foreign currency.
Very few places in Syria accept credit cards.
Foreigners visiting Syria are required to pay hotel bills in US dollars or Euros.
Travelers’ checks are not accepted for payment in Syria, and banks will not cash them unless the traveler has an account at the bank in question.
There are no US-based banks operating in Syria.
There are six private banks operating in Syria, with branches and ATMs in most major cities.
These ATMs usually honor major debit/credit systems.
Funds may be transferred into Syria through Western Union.
Wiring of funds through private banks is possible only if the traveler already holds an account with the bank in Syria;, transferring funds through the Commercial Bank of Syria is not possible due to U.S. sanctions.
Syrian-American and Palestinian-American men who have never served in the Syrian military and who are planning to visit Syria are strongly urged to check with the Syrian Embassy in Washington, D.C. prior to traveling concerning compulsory military service. American men over the age of 18, even those who have never resided in or visited Syria, whose fathers are of Syrian descent, are required to complete military service or pay to be exempted.
Possession of a U.S. passport does not absolve the bearer of this obligation.
The fee for exemption from military service ranges from $5,000 to $15,000 USD, depending upon circumstances, for Syrian-American and Palestinian-American men who live abroad.
In January 2005 the Syrian government reduced mandatory military service from 30 months to 24 months.
It also announced that Syrians born outside of Syria and residing abroad until the age of 18 have the option of being exempted from their service by paying $2,000 USD.
Those born in Syria who left the country before reaching the age of 11, and have resided abroad for more than 15 years can be exempted by paying $5,000 USD.
Contact the Syrian Embassy in Washington, DC, for more information (See Entry/Exit Requirements section above).
President Bush signed an executive order on May 11, 2004, implementing sanctions in accordance with the Syria Accountability Act.
These sanctions prohibit the export to Syria of products of the United States other than food or medicine, and prohibit any commercial aircraft owned or controlled by the Syrian government from taking off from or landing in the United States.
Under the authority provided in Section 5(b) of the Act, the President has determined that it is in the national security interest of the United States to waive the application of these sanctions in certain cases and for certain products, as specified in the Department of Commerce's General Order No. 2.
For additional information about implementation of the Syria Accountability Act, consult the Department of Commerce web site at (http://www.bis.doc.gov/).
Since 1979, the United States has designated Syria a State Sponsor of Terrorism due to its support for groups such as Hizbollah and Palestinian terrorist groups.
The Terrorism List Government Sanctions Regulations prohibit U.S. persons from receiving unlicensed donations from the Syrian government.
Additionally, U.S. persons are prohibited from engaging in financial transactions which a U.S. person knows or has reasonable cause to believe pose a risk of furthering terrorists' acts in the United States.
For additional information about the Terrorism List Government Sanctions Regulations, consult the terrorism brochure on the U.S. Department of the Treasury, Office of Foreign Assets Control (OFAC) home page on the Internet at http://www.treas.gov/offices/enforcement/ofac/ or via OFAC's info-by-fax service at (202) 622-0077.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Syrian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Syria are strict and convicted offenders can expect prison sentences and heavy fines.
Penalties for possession of even small amounts of illegal drugs for personal use are severe in Syria.
Persons convicted in Syria for growing, processing, or smuggling drugs face the death penalty, which may be reduced to a minimum of 20 years’ imprisonment.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.
CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Syria are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site, and to obtain updated information on travel and security within Syria.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 2 Al-Mansour St., Abu Roumaneh, Damascus.
The international mailing address is PO Box 29, Damascus.
Mail may also be sent via the U.S. Postal Service to: American Embassy Damascus, Department of State, Washington, DC
20521-6110.
Telephone numbers are (963) (11) 3391-4444, fax number is (963)(11) 3391-3999, e-mail: acsdamascus@state.gov.
The government workweek in Syria is Sunday through Thursday; the private sector generally works Saturday through Thursday.
The U.S. Embassy is open Sunday through Thursday.
Additional information may be found on the Embassy web site at http://damascus.usembassy.gov
*

*

*
This replaces the Country Specific Information dated November 20, 2007 to update the sections on Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu 5 Dec 2019 6:11 PM EET
Source: Enab Baladi [edited]

[Leishmaniasis] is spreading widely among residents of Deir ez-Zor, and especially children. Some of the areas affected are controlled by the Kurdish self-administration while others are under the control of the Syrian regime. Medical sources counted hundreds of infected civilians and confirmed the disease's rapid spread.

According to Atef al-Tawil, a manager of the Leishmania & Environmental Health Programme at the Syrian regime's Ministry of Health, most infections in eastern Deir ez-Zor are spread among school children.

In a Facebook comment on a post by Twasol agency, al-Tawil claimed that cases of leishmaniasis were detected, at the end of November [2019], in primary schools in eastern Deir ez-Zor and its surrounding villages (al-Jalaa, al-Salihiyah, al-Tawtha, al-Abbas, al-Mujawdeh, al-Hasarat, al-Saial, al-Ghabrah).

According to al-Tawil, 455 infections of children were detected. A treatment team of 10 members was formed in the affected locations, to help control the disease to aid in early detection.

The Syrian Ministry of Health acted after several appeals by civilians residing in the area as they noticed the disease spreading among their children. Al-Tawil said that this rapid spread was due to the fact that all the infected people have lately returned to their original areas which lack medical centers.

Autonomous administration areas
-------------------------------
According to Euphrates Post network, leishmaniasis is also widely spread in areas controlled by the Syrian Democratic Forces (SDF). In its post on [Sun 1 Dec 2019], the network claimed that the spread of leishmaniasis is mostly concentrated in the eastern countryside of Deir ez-Zor.

According to the network, unofficial statistics by the SDF-affiliated local council shows more than 7000 leishmaniasis infections among children in al-Baghouz, Hajin, Diban, al-Sha'afa, al-Kishkiye, Abu Hamam, and Gharanij. The local councils' attempts of controlling the disease are still substandard, according to the Euphrates Post.

The network also quoted doctors and nurses calling for international organizations to interfere and provide hospitals and clinics with the required vaccine [there is no vaccine for leishmaniasis; ed.], and to train specialized medical staff in each clinic to deal with the disease.

The autonomous-administration-affiliated media center in Deir ez-Zor also confirmed the spread of leishmaniasis and pointed out that the authorities took actions, by the end of November [2019], to provide treatments.

According to the media center, special medical teams and cadres were distributed among the clinics to provide 12,000 ampoules of the required [medicine] to treat leishmaniasis with the support of the World Health Organization.

Leishmaniasis is a parasitic disease transmitted by the bite of infected female phlebotomine sandflies -- a very small yellow fly that is active at night and makes no sound when it bites -- and the main cause for its spread is dirt and lack of hygiene.  [Byline: Enab Baladi]
========================
[Deir ez-Zor is east and south of the locations in the previous ProMED reports (see below), indicating further increase in cases of cutaneous leishmaniasis beyond its historical concentration in western Syria (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861536/>) and beyond the area of the MENTOR initiative in northern Syria (<https://wwwnc.cdc.gov/eid/article/24/11/17-2146_article>).

Cutaneous leishmaniasis is endemic in Syria with its reservoir in rodents. It has been a problem throughout the Syrian civil war and in ISIS controlled areas during the war due to a breakdown in rodent and vector control. - ProMED Mod.EP]

[Maps of Syria:
Date: Mon, 2 Dec 2019 11:19:53 +0100 (MET)

Beirut, Dec 2, 2019 (AFP) - Regime air strikes Monday killed 10 civilians in Syria's last major opposition bastion, where deadly clashes between regime forces and armed groups have escalated in the past two days, a monitor said.   The raids also wounded 15 civilians in a market in the town of Maaret al-Numan in the jihadist-run province of Idlib, the Britain-based Syrian Observatory for Human rights said.
Date: Fri 21 Jun 2019
Source: WHO/EMRO (Regional Office for the Eastern Mediterranean) [edited]

Situation reports on Al-Hol camp, Al-Hasakah
--------------------------------------------
- Over the past 2 weeks, a total of 633 people have left the camp. This number includes 107 people who returned to their homes in north-east Syria. There were no new arrivals during the reporting period.
- 9 medical points are reporting regularly to the disease Early Warning And Response System (EWARS). Leishmaniasis, acute diarrhoea, bloody diarrhoea, and severe acute malnutrition (SAM) remain the most commonly reported diseases.
- 38 new cases of leishmaniasis were detected. All patients are being treated by a WHO-supported mobile team in coordination with the Al-Hasakeh Directorate of Health.
- 7 suspected cases of measles were reported. No new cases of tuberculosis were detected during the reporting period.
- 30 children with severe acute malnutrition with medical complications were admitted to Al-Hikmah hospital during the reporting period, of whom 22 were discharged, one died, and the remainder are still under treatment. Mortality rates related to severe acute malnutrition remain below the emergency threshold.
- 2 new static health care points have been established, bringing the total number to 12. There is still an acute shortage of health care points in the Foreign Annex.
- 35 water sources were tested for microbial contamination in Al-Hasakeh water national laboratory during the reporting period. All 35 samples tested negative for contamination. WHO continues to test the quality of water from different sources in the camp.
- Stool samples from patients with diarrhoea were tested for
_Salmonella_, _E. coli_, and cholera, with all samples testing negative. Blood samples from patients with suspected measles were also sent for testing, and all samples tested negative.
- Following intensive negotiations by WHO, the local authorities have given their approval in principle to evacuate a patient requiring advanced mental health treatment
===================
[Leishmaniasis has surged throughout Syria during the civil war on all sides and continues to be a health problem in the refugee population. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Syria:
Date: Wed, 22 May 2019 16:52:39 +0200
By Nazeer al-Khatib with Hashem Osseiran in Beirut

Maaret al-Numan, Syria, May 22, 2019 (AFP) - Syrian government air strikes killed 18 civilians, including a dozen people at a busy market, as fierce fighting raged for the jihadist-held northwest, a war monitor said on Wednesday.   Regime forces battled to repel a jihadist counteroffensive around the town of Kafr Nabuda that has left 70 combatants dead in 24 hours, the Syrian Observatory for Human Rights said.   The Hayat Tahrir al-Sham alliance, led by Syria's former Al-Qaeda affiliate, controls a large part of Idlib province as well as adjacent slivers of Aleppo, Hama and Latakia provinces.   The jihadist-dominated region is nominally protected by a buffer zone deal, but the government and its ally Russia have escalated their bombardment in recent weeks, seizing several towns on its southern flank.   At least 12 people were killed and another 18 wounded when regime warplanes hit the jihadist-held Idlib province town of Maarat al-Numan around midnight (2100 GMT) on Tuesday, the Observatory said.

The market was crowded with people out and about after breaking the daytime fast observed by Muslims during the holy month of Ramadan.   The bombardment blew in the facades of surrounding buildings, and ripped through the flimsy frames and canvas of stalls in the market square, an AFP photographer reported.    The bodies of market-goers were torn apart.   "Residents are still scared," stallholder Khaled Ahmad told AFP.   Three more civilians were killed on Wednesday by air strikes in the nearby town of Saraqib, the Observatory said.    Two others were killed in strikes on the town of Maaret Hermeh, it added.    Another civilian was killed in air raids on the town of Jisr al-Shughur, the monitor said.   The Britain-based Observatory relies on a network of sources inside Syria and says it determines whose planes carried out strikes according to type, location, flight patterns and munitions.

- 'Worst fears'-
The strikes came as heavy clashes raged in neighbouring Hama province after the jihadists launched a counterattack on Tuesday.   Fresh fighting on Wednesday took the death toll to 70 -- 36 regime forces and militia and 34 jihadists, the Observatory said.   It said the jihadists had recaptured most of Kafr Nabuda from government forces, who had taken control of the town on May 8.   State news agency SANA on Wednesday however said the army repelled a jihadist attack in the area, killing dozens of insurgents.

Russia and rebel ally Turkey inked the buffer zone deal in September to avert a government offensive on the region and protect its three million residents.   But President Bashar al-Assad's government upped its bombardment of the region after HTS took control in January.   Russia too has stepped up its air strikes in recent weeks.   The Observatory says nearly 200 civilians have been killed in the flare-up since April 30.   The United Nations said Wednesday that Idlib's civilian population once again faced the threat of an all-out offensive.   "A full military incursion threatens to trigger a humanitarian catastrophe for over 3 million civilians caught in the crossfire, as well as overwhelm our ability to respond," said David Swanson, a spokesman for the UN humanitarian office.   Swanson said more than 200,000 people have been displaced by the upsurge of violence since April 28.   A total of 20 health facilities have been hit by the escalation -- 19 of which remain out of service, Swanson said.   Collectively they served at least 200,000 people, he added.

- 'Break the status quo' -
The September deal was never fully implemented as jihadists refused to withdraw from a planned buffer zone around the Idlib region.   But it ushered in a relative drop in violence until earlier this year, with Turkish troops deploying to observation points around the region.   The Syrian government has accused Turkey of failing to secure implementation of the truce deal by the jihadists.   But Turkish Defence Minister Hulusi Akar accused the Syrian regime late Tuesday of threatening the ceasefire deal.   "The regime is doing all that it can to break the status quo including using barrel bombs, land and air offensives," Akar told reporters.   "Turkish armed forces will not take a step back from wherever they may be", he however added.   Earlier, the US State Department said it was assessing indications that the government had used chemical weapons on Sunday during its offensive in Idlib.   HTS accused government forces of launching a chlorine gas attack on its fighters in the northern mountains of Latakia.   But the Observatory said Wednesday it had "no proof at all of the attack".

7 May 2019, Cairo, Egypt: The World Health Organization (WHO) strongly condemns continuing attacks on health facilities in north-western Syria. Since 29 April, in just nine days, twelve health structures have been hit. 

On 5 May, three facilities were struck in one day alone, including two major hospitals that provide secondary healthcare in the area.  One of the structures, a surgical unit, was supported by WHO. Three health care workers lost their lives as a result of these attacks.  There are now no functioning hospitals in northern Hama, and emergency care is provided by only three surgical units supported by WHO.  Close to 300,000 civilians are affected.   

“These attacks against health facilities and other civilian infrastructure are a grave and totally unacceptable development,” said Dr. Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean Region. “International humanitarian law safeguards civilians, even in the most violent of conflicts. And according to the Geneva Convention, health facilities and civilians – especially the most vulnerable – must be protected.  Parties to the conflict in northern Hama and in Idleb are flagrantly disregarding those rules; and it is women, children, the elderly and other vulnerable groups who are suffering as a result.”   

The health facilities that were hit in northern Hama and southern Idleb provided a total of 30,000 consultations, 860 hospital admissions and 700 surgeries per month to a highly vulnerable population. 

“We are also deeply concerned about the people who have had to flee their homes and now have no access to basic health services. Over 150,000 people were displaced from northern Hama and southern Idleb in between 29 April and 4 May, doubling the total number of people displaced in the area in the last three months. Saving their lives is our main priority and this requires further strengthening available health services. What is of particular concern is the increasing risk for infectious disease outbreaks due to overcrowding in temporary settlements,” Dr Al-Mandhari added.

WHO continues – with health partners – to ensure the provision of key primary and secondary healthcare and has released emergency health supplies for almost 92,200 treatment courses, including for surgical and trauma care, secondary healthcare, and primary healthcare.

As the conflict in north-western Syria intensifies, WHO reminds all parties to the conflict that attacks on health facilities are a blatant violation of international humanitarian law. Health facilities must never be attacked or damaged, and health workers should be allowed to provide medical treatment and services to all people in need wherever they are.

More ...

Iraq

Iraq US Consular Information Sheet
2nd October 2008
COUNTRY DESCRIPTION:
In 2005, Iraqi citizens adopted a new constitution and participated in legislative elections to create a permanent, democratic government, and in May 2006, a new Gove
nment of Iraq (GOI), led by Prime Minister Nouri al-Maliki, was sworn in. Although the GOI has made political, economic and security progress, Iraq still faces many challenges, including overcoming three decades of war and government mismanagement that stunted Iraq's economy, sectarian and ethnic tensions that have slowed progress toward national reconciliation, and ongoing (even if abating) insurgent, sectarian, criminal, and terrorist violence. Conditions in Iraq are extremely dangerous. While Iraqi Security Forces now take the lead in providing security in most provinces, Multinational Force-Iraq (MNF-I) continues to assist the Iraqi government in providing security in many areas of the country. The workweek in Iraq is Sunday through Thursday. Visit the Department of State Background Notes on Iraq for the most current visa information.
ENTRY/EXIT REQUIREMENTS: Passports valid for at least six months and visas are required for most private American citizens. An Iraqi visa may be obtained through the Iraqi Embassy in Washington, D.C. Travelers should not rely on obtaining a visa upon arrival at an airport or port of entry in Iraq. Visitors to Iraq who plan to stay for more than 10 days must obtain a no-fee residency stamp. In Baghdad, the stamps are available for all visitors at the main Residency Office near the National Theater. Contractors in the International Zone may also obtain exit stamps at the Karadah Mariam Police Station (available Sunday and Wednesday, 10:00-14:00.). There is a 10,000 Iraqi dinar (USD 8) penalty for visitors who do not obtain the required residency stamp. In order to obtain a residency stamp, applicants must produce valid credentials or proof of employment, two passport-sized photos, and HIV test results. An American citizen who plans to stay longer than two months must apply at the Residency Office for an extension. Americans traveling to Iraq for the purpose of employment should check with their employers and with the Iraqi Embassy in Washington, D.C. for any special entry or exit requirements related to employment. American citizens whose passports reflect travel to Israel may be refused entry into Iraq or may be refused an Iraqi visa, although to date there are no reported cases of this occurring.
U.S. citizens who remain longer than 10 days must obtain an exit stamp at the main Residency Office before departing the country. In Baghdad, they are available for all visitors at the main Residency Office near the National Theater. Contractors in the International Zone may also obtain exit stamps at the Karadah Mariam Police Station (available Sunday and Wednesday, 10:00-14:00). Exit stamp fees vary from USD 20 to USD 200, depending on the length of stay, entry visa and other factors. Those staying fewer than 10 days do not need to get an exit stamp before passing through Iraqi immigration at the airport. Visitors who arrive via military aircraft but depart on commercial airlines must pay a USD 80 departure fee at the airport.
Note: For information on entry requirements for other countries, please go to the Entry/Exit Requirements section in the Country Specific Information Sheet for the country you are interested in at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1765.html. You may also contact the U.S. embassy or consulate of that country for further information.
Visit the Iraqi Embassy web site at http://www.iraqiembassy.us for the most current visa information. The Embassy is located at 1801 P Street NW, Washington, DC 20036; phone number is 202-742-1600; the fax is 202-333-1129.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
The risk of terrorism directed against U.S. citizens in Iraq remains extremely high. The Department of State continues to strongly warn U.S. citizens against travel to Iraq, which remains very dangerous.

Remnants of the former Baath regime, transnational terrorists, criminal elements and numerous insurgent groups remain active throughout Iraq. Multinational Force-Iraq (MNF-I) and Iraqi Security Forces (ISF)-led military operations continue, and attacks persist against MNF-I and the ISF throughout the country. Turkish government forces have carried out operations against elements of the Kongra-Gel (KGK, formerly Kurdistan Worker’s Party, or Partiya Karkeren Kurdistan (PKK)) terrorist group that are located along Iraq’s northern border. Despite recent improvements in the security environment, Iraq remains dangerous, volatile and unpredictable. Attacks against military and civilian targets throughout Iraq continue, including in the International (or “Green”) Zone. Targets include hotels, restaurants, police stations, checkpoints, foreign diplomatic missions, and international organizations and other locations with expatriate personnel. Such attacks can occur at any time. Kidnappings still occur; the most recent kidnapping of an American citizen occurred in July 2008. Improvised Explosive Devices (IEDs), Explosively Formed Penetrators (EFPs), and mines often are placed on roads, concealed in plastic bags, boxes, soda cans, dead animals, and in other ways to blend with the road. Grenades and explosives have been thrown into vehicles from overpasses and placed on vehicles at intersections, particularly in crowded areas. Rockets and mortars have been fired at hotels, and vehicle-borne IEDs have been used against targets throughout the country. Occasionally, U.S. Government personnel are prohibited from traveling to certain areas depending on prevailing security conditions. In addition to terrorist and criminal attacks, sectarian violence occurs often. Detailed security information is available on the Embassy's web site at http://iraq.usembassy.gov and at http://www.centcom.mil.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov where the current Travel Warnings, including the Travel Warning for Iraq, and Travel Alerts, as well as the Worldwide Caution, can be found. Travelers are also referred to the U.S. Embassy Baghdad’s Warden Notices which are available on the Embassy web site at http://iraq.usembassy.gov.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad and Tips for Traveling Abroad.
CRIME: The U.S. Embassy and MNF-I are working with Iraqi authorities to establish law enforcement and civil structures throughout the country. U.S. and British military personnel are providing police protection as well, as the security situation permits. Petty theft is common in Iraq, including thefts of money, jewelry, or valuable items left in hotel rooms and pick-pocketing in busy places such as markets. Carjacking by armed thieves is very common, even during daylight hours, and particularly on the highways from Jordan and Kuwait to Baghdad. Foreigners, primarily dual American-Iraqi citizens, and Iraqi citizens are targets of kidnapping. The kidnappers often demand money but have also carried out kidnappings for political/religious reasons.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. While U.S. Consular Services in Iraq are limited due to security conditions, the Embassy/Consulate staff can, for example, assist you to contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.See our information on Victims of Crime.There is no 911-equivalent emergency telephone number in Iraq.
MEDICAL FACILITIES AND HEALTH INFORMATION: Basic modern medical care and medicines are not widely available in Iraq. The recent conflict in Iraq has left some medical facilities non-operational and medical stocks and supplies severely depleted. The facilities in operation do not meet U.S. standards, and the majority lack medicines, equipment and supplies. Because the Baghdad International Airport has limited operations for security reasons, it is unlikely that a private medical evacuation can be arranged.
Iraq does not allow visitors with HIV/AIDS to enter the country. At this time there is no waiver available for this ineligibility. However, please inquire directly with the Embassy of Iraq at http://www.iraqiembassy.org before you travel for any changes.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://www.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.
AVIAN INFLUENZA: The WHO and Iraqi authorities have confirmed human cases of the H5NI strain of avian influenza, commonly known as the "bird flu." Travelers to Iraq and other countries affected by the virus are cautioned to avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals. In addition, the CDC and WHO recommend eating only fully cooked poultry and eggs. For the most current information and links on avian influenza, see the State Department's Avian Influenza Fact Sheet.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation as well as whether medical evacuation would be possible from Iraq. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Iraq is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
All vehicular travel in Iraq is extremely dangerous. There have been numerous attacks on civilian vehicles, as well as military convoys. Attacks occur throughout the day, but travel at night is exceptionally dangerous and should be avoided. There have been attacks on civilian vehicles as well as military convoys on Highways 1, 5, 10 and 15, even during daylight hours. Travelers are strongly urged to travel in convoys with at least four vehicles in daylight hours only. Travel in or through Ramadi and Fallujah, in and between al-Hillah, al-Basrah, Kirkuk, and Baghdad and between the International Zone and Baghdad International Airport, and from Baghdad to Mosul is particularly dangerous. Occasionally, U.S. Government personnel are prohibited from traveling to select areas depending on prevailing security conditions. There continues to be heavy use of Improvised Explosive Devices (IEDs) and/or mines on roads, particularly in plastic bags, soda cans, and dead animals. Grenades and explosives have been thrown into vehicles from overpasses, particularly in crowded areas. Travel should be undertaken only when absolutely necessary and with the appropriate security.
Buses run irregularly and frequently change routes. Poorly maintained city transit vehicles are often involved in accidents. Long distance buses are available, but are often in poor condition and drive at unsafe speeds. Jaywalking is common. Drivers usually do not yield to pedestrians at crosswalks and ignore traffic lights (if available), traffic rules and regulations. Roads are congested. Driving at night is extremely dangerous. Some cars do not use lights at night and urban street lights may not be functioning. Some motorists drive at excessive speeds, tailgate and force other drivers to yield the right of way. Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by air carriers registered in Iraq, the U.S. Federal Aviation Administration (FAA) has not assessed Iraq's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
There is credible information that terrorists are targeting civil aviation. Military aircraft arriving and departing from Baghdad International Airport (ORBI) have been subjected to small arms and missile fire. Travelers choosing to utilize civilian aircraft to enter or depart Iraq should be aware that, although there have been no recent attacks on civilian aircraft, the potential threat still exists. Official U.S. Government (USG) personnel are strongly encouraged to use U.S. military or other USG aircraft when entering or departing Iraq. All personnel serving in Iraq under Chief of Mission (COM) authority are prohibited from entering or departing ORBI on commercial airlines unless they receive COM approval, which is granted on a case-by-case basis for emergency purposes only. Other personnel not under COM authority must be guided by their own agencies. Personnel under COM authority assigned to the Erbil and Sulaymaniyah areas are permitted to use commercial flights in and out of Erbil on a case-by-case basis.

SPECIAL CIRCUMSTANCES:
As of September 21, 2006, Iraqi law prohibits adult Iraqis and foreigners from holding and transporting more than U.S. $10,000 in cash out of Iraq. In addition, it permits adult Iraqi and resident foreigners to hold and transport no more than 200,000 Iraqi dinars to cover travel expenses. Iraqi law also prohibits taking more than 100 grams of gold out of the country. Iraqi customs personnel are taking action to enforce these laws and may pose related questions to travelers during immigration and customs exit procedures. (Civil customs personnel also will verify passport annotations related to any items such as foreign currency, gold jewelry, or merchandise that were declared by passengers upon entry into Iraq on Form-8.)
All U.S. citizens are reminded that it is their duty to respect Iraqi laws, including legal restrictions on the transfer of currency outside of Iraq. If you are detained at the airport or at any other point of exit regarding your attempt to transfer currency out of Iraq, you should contact – or ask that Iraqi authorities immediately contact -- the American Embassy.

Transporting large amounts of currency is not advisable. Almost all of the international companies working in Iraq have the capability to make payments to their employees and at least four Iraqi banks are also able to convert cash into an international wire transfer directed to a bank account outside Iraq. Branches of the Credit Bank of Iraq on Al-Sa’adoon St., Baghdad (creditbkiq@yahoo.com), Dar Es Salaam Bank (info@desiraq.com), Iraqi Middle East Investment Bank (coinvst@iraqimdlestbank.com) and Al-Warqaa Investment Bank (warkabank@hotmail.com) all have this capability. Please be aware that large wire transfers may require Central Bank of Iraq approval because of measures in place to combat money laundering. Such approvals can be obtained by the sending bank, if information on the origin of the funds and the reason for its transfer are provided. Additional information on banking in Iraq is available at the Central Bank of Iraq web site http://www.cbi.iq/.
Customs and MNF-I officers have the broad authority to search persons or vehicles at Iraq ports of entry. Officers may confiscate any goods that may pose a threat to the peace, security, health, environment, or good order of Iraq or any antiquities or cultural items suspected of being illegally exported. Goods that are not declared may be confiscated by an officer. Persons may also be ordered to return such goods, at their expense, to the jurisdiction from which they came. Please see our Customs Information.
The banking and financial infrastructure has been disrupted and is in the process of rebuilding. Hotels usually require payment in foreign currency. Automatic Teller Machines (ATMs) are extremely limited but the Trade Bank of Iraq (TBI) provides ATM services in dinars and U.S. dollars at the TBI head office in central Baghdad and two other locations (See http://www.tbiraq.com.)
Telecommunications are very poor. There is limited international phone service in Iraq at this time. Local calls are often limited to a neighborhood network. There are no public telephones in the cities; however, calls may be made from hotels, restaurants or shops. Limited cellular telephone service and Internet service are available in Iraq.
Due to security conditions, the Consular Section of the U.S. Embassy is able to provide only limited emergency services to U.S. citizens. Because police and civil structures are in the process of being rebuilt, emergency service and support will be limited.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Iraqi laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Iraq are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: The U.S. and international media have occasionally reported on the difficult situation faced by Iraq's children, and it is completely understandable that some American citizens want to respond to such stories by offering to open their homes and adopt these children in need. However Iraqi law does not permit full adoptions as they are generally understood in the United States. It is not possible to adopt Iraqi children at this time. For more information on this issue, please refer to our flyer Intercountry Adoptions – Iraq.
Iraq is not party to the Hague Convention on the Civil Aspects of International Child Abduction, nor are there any international or bilateral treaties in force between Iraq and the United States dealing with international parental child abduction. The security situation in Iraq limits consular access to children. For more information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION:
The Travel Warning on Iraq urges U.S. citizens to defer travel to Iraq. However, Americans living or traveling in Iraq despite that Warning are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Iraq. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. U.S. citizens may also contact the consular section of the U.S. Embassy in Baghdad, Iraq located in the International Zone via e-mail at baghdadacs@state.gov, via landline at 1-240-553-0581, extension 2413 (this number rings in Baghdad) or the U.S. Embassy's web site at http://iraq.usembassy.gov. The after-hours number in case of extreme emergency is GSM 1-914-822-1370 or Iraqna 07901-732-134.
* * * * * *
This replaces the Country Specific Information for Iraq dated January 22, 2008, to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Aviation Safety Oversight, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu 5 Jul 2018
Source: IraqiNews.com [edited]

Mosul, Iraq's former Islamic State (IS) capital, is witnessing a growing rate of scabies infections in its western region, medical workers reported as the city struggles to overcome destruction resulting from the war against the extremist group. Moamen Shahwani, a doctor at the health department in Mosul, was quoted by the Iraqi website Sky Press in a press statement that western Mosul has recorded 150 scabies cases, warning that parasites causing the disease are spreading in the city.

He attributed the spread of the disease to several factors, most importantly the return of displaced families to the regions, which are still scarred by the war against Daesh (IS) and the resulting waste matter. "Garbage, debris and remains of corpses are almost at every corner; moreover, there is a shortage in water, electricity and other essential services," Shahwani said.

The doctor noted that, besides registered cases, there are other unregistered ones, with infected persons seeking treatment at outpatient clinics or resorting to herbal medicines. "The disease is highly dangerous and rapidly progressing, and it is difficult to contain it in a short period [in] an environment that lacks the simplest services," he added.

Mosul was IS's capital and base of operations in Iraq. It was from its Grand Nuri Mosque that IS founder, Abu Bakr al-Baghdadi, proclaimed the group's rule. Iraqi forces recaptured the city last July [2017] after an operation that lasted for more than 8 months. Most of the city's infrastructure was demolished due to battles, and authorities continue to extract dead bodies from under the debris.  [Byline: Mohamed Mostafa]
====================
[Scabies is found worldwide and is an indicator of poor hygienic conditions, including lack of personal hygiene and clean clothes, crowded sleeping conditions and inadequate water resources. Thus, it is not surprising that scabies is found in Mosul under the present circumstances. More importantly, scabies can be an indicator of infections transmitted by human lice, like _Borrelia recurrentis_, _Rickettsia prowazekii_ and _Bartonella quintana_. Thus, those treating persons with severe febrile illness in Mosul should consider these infections. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Date: Tue 26 Jun 2018
Source: Rudaw [edited]
<http://www.rudaw.net/english/middleeast/iraq/26062018>

After 3 reported deaths caused by viral haemorrhagic fever in Iraq's Euphrates Valley, a rights group has called on the government to undertake measures to prevent the disease from spreading, while officials say: "The situation doesn't call for worry." "The Iraqi High Commission for Human Rights warns of spreading the viral haemorrhagic fever, which causes human deaths and has great dangers to public health and the economy of Iraq," read a statement from IHCHR on Tuesday [26 Jun 2018].

The virus is spread by mosquitoes, ticks, rodents, and bats into livestock and humans, or when humans butcher already-infected livestock. "We call on the Ministry of Health and Diwaniyah Health Department to fumigate animal sheds in the province and carry out rapid preventive measures to prevent the spreading of the disease to Iraq's provinces," added the rights group.

They call for butchers only to work at licensed locations and for the police and relevant administrations to issue instructions. Additionally, posters should be displayed, and seminars should be offered as part of an educational campaign. "After 2 people lost their lives due to the hemorrhagic fever in the Diwanyah province, our ministry has swiftly undertaken the necessary measures to prevent the disease and provide necessary medications," Sayf Badir, a spokesperson for the ministry, said in a statement.

A source from the Diwanyah Hospital told Baghdad Today of another death on Monday [25 Jun 2018], increasing the number to 3. The Provincial Council of Diwanyah held a meeting in the presence of the governor and the head of the province's police to discuss the issue. Dr. Sabah Mahdi, the director of the National Center for Containing and Preventing Diseases, said on Monday [25 Jun 2018] that the 1st recorded case of the disease in Iraq was in 1979. He revealed that there are continuous efforts by the veterinaries to spray pesticides on cattle fields.

"To prevent this disease, we advise all ranchers, laboratory employees, and veterinary employees to wear personal protection gear while dealing with animals," added Mahdi. "The preventive measures are continuous, and by following up on all the cases, the situation doesn't call for worry." The World Health Organization defines viral haemorrhagic fever as "a general term for a severe illness, sometimes associated with bleeding, that may be caused by a number of viruses." Symptoms are sudden and include fever, muscle ache, dizziness, neck pain, backache, headache, and sore eyes, among other symptoms. The mortality rate is 30 percent. There is no vaccine available for humans or animals. There have been no reported cases outside of Diwanyah.
======================
[If the virus is believed to be spread by mosquitoes, ticks, rodents, and bats into livestock and humans, the identity of the virus has not been determined. However, if it is transmitted to humans when they butcher livestock, that raises the possibility that the etiological agent is Congo-Crimean haemorrhagic fever (CCHF) virus.

Cases in Iraq would not be surprising because cases have occurred this year (2018) across the region, including Iran and Afghanistan, and was suspected in 2 fatal and 4 suspected cases in Iraq in 2010. Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick-borne Nairovirus in the family Bunyaviridae. It is a viral zoonosis (animal to human) caused by infection with a tick-borne virus.

The hosts of the CCHF virus are mostly wild and domestic animals, including cattle, sheep and goats. Human transmission may occur when human beings come into contact with infected ticks (through tick bites) or direct contact with blood or tissues of an infected animal. CCHF can be transmitted from one infected human to another by contact with infectious blood or body fluids. In humans, until the etiological agent is identified, effective prevention will be difficult. ProMED-mail would appreciate receiving the name of the virus involved and the laboratory tests used to identify it. - ProMED Mod.TY]

[HealthMap/ProMED-mail map: Qadisiyyah Governorate, Iraq:
<http://healthmap.org/promed/p/25538>]
Date: Mon 9 Oct 2017
Source: MedPage Today [edited]

US service members deployed to Iraq showed signs of having been infected with latent visceral leishmaniasis during their service, researchers said.

In one study, latent visceral leishmaniasis was identified in asymptomatic Operation Iraqi Freedom soldiers (10.2 percent of 88), potentially putting them at risk of activation of the disease if they are immunosuppressed, according to Edgie-Mark Co of the William Beaumont Army Medical Center in El Paso, Texas <https://academic.oup.com/ofid/article/4/suppl_1/S122/4295608/A-Stealth-Parasite-Prevalence-and-Characteristics>.

In another study, 20 veterans with asymptomatic latent visceral leishmaniasis had no active disease, although it was not clear how likely the condition was to resurface and cause serious health problems, reported Nate Copeland of the Clinical Trials Center at Walter Reed Army Institute in Bethesda, Maryland, and colleagues <https://academic.oup.com/ofid/article/4/suppl_1/S122/4295606/Clinical-Evaluation-of-Latent-Visceral>.

Both studies were presented at the annual ID Week meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

Leishmaniasis is spread by sand flies and is common in the Middle East. The zoonotic parasitic disease can cause chronic fever, weight loss, spleen problems, and pancytopenia. Bacterial infections, malnutrition, and severe bleeding can also occur. Researchers are concerned because visceral leishmaniasis, unlike the more common cutaneous form, can cause serious health problems.

"Visceral leishmaniasis can be severe, and even life-threatening if not recognized and treated appropriately," Copeland told MedPage Today.

He said that more than 20 cases of active visceral leishmaniasis were reported among US service members in the Iraq region from 2000-2013, along with hundreds of cutaneous cases.

The study by Copeland [et al.] checked 88 soldiers from the El Paso area who'd served in areas with endemic visceral leishmaniasis from 2002-2011 (86 percent male, median age 39). Via various tests, they found that 10.2 percent showed signs of asymptomatic visceral leishmaniasis.

"If you have a healthy immune system, it shouldn't be an issue. That's what your immune system does, it suppresses the disease," Co told MedPage Today. "But once you have conditions that weaken the system, that's when the disease reactivates." HIV, treatment with immunosuppressant drugs, and the use of steroids could put these soldiers at risk of emergence of active disease, he said.

"Reactivation has been reported in the literature among immunocompromised patients such as solid organ transplants patients and rheumatologic patients with immunosuppressive treatment," said Kanokporn Mongkolrattanothai of Children's Hospital of Los Angeles, who has treated leishmaniasis patients.

Mongkolrattanothai, who was not involved with the studies, told MedPage Today that the new studies are "useful" in light of the life-threatening nature of visceral leishmaniasis.

In the study of 20 soldiers with active visceral leishmaniasis (all male, median age 38.5), "the majority tested positive with a test showing a good cell-mediated immune response, which is essential for control of the _leishmania_ parasites," Copeland said. "These service members were all counseled on the clinical syndrome of visceral leishmaniasis as well as potential risk factors for activation based on what is known at this time."

These patients will be able to visit for re-checks every 1 or 2 years, Copeland said, "but if they remain asymptomatic they likely do not need further care in light of being a healthy and immune-competent group."

Tests revealed that another 2 service members showed signs of genetic material from leishmania parasites in their blood. "While they are also without symptoms, we are following them very closely, every 3-6 months, and monitoring their levels of parasite," Copeland said. "We have also been doing some evaluation as to whether these individuals have any evidence of an immunodeficiency allowing them to have parasites circulating in their blood stream."

"Neither service member is being treated at this point, " he said, "because there are definite known risks to treatment, but no clearly defined benefit to treating people without symptoms. [But] if they were to develop symptoms, there would be a very low threshold to treat them."

The next steps are to understand the risk to service members of latent visceral leishmaniasis infection and gain insight into risk factors for activation, he said.

"In tuberculosis, we have a very similar disease, conceptually," he said. "You have a parasite that most often causes no problems in healthy people exposed, but a certain subset go on to active disease early on after exposure, and others reactivate months to years later, often as a result of some risk factor."

"While we are not sure if the later reactivation is the case in leishmaniasis, we are concerned it may be," Copeland added. "In tuberculosis, there is clear evidence that if you treat those with latent infection, especially those with risk factors for reactivation, you can decrease the risk of future active disease. So that begs the question, would the same be true in leishmaniasis? In other words, can we treat these asymptomatic people now and prevent them from ever getting disease?"  [Byline: Randy Dotinga]
========================
[We know very little about latent Leishmaniasis in healthy subjects. There is no doubt that the exposure to leishmaniasis in the US armed forces in Iraq was extensive (see ProMED reports below from 2001 to 2004).

The tests described here respond with an Interferon-gamma response to stimulation with Leishmania antigens. The test may be false positive or negative and we have no data showing that even if the tests correctly identify people who have been exposed to Leishmania, they will eventually become ill with clinical visceral leishmaniasis.

The authors draw a comparison with tuberculosis. We know a lot more about latent tuberculosis but even here treating latent tuberculosis based on a positive quantiferon test in healthy, asymptomatic individuals is controversial. These people, if treated, are exposed to side effects and the benefit is not well quantified. It is a good rule in clinical medicine, that we treat patients and not laboratory results. Thus a sensible scenario would be to do follow up in Leishmania test positive, asymptomatic individuals.

For subjects with a confirmed (repeated) positive PCR for Leishmania in their blood or other samples like a bone marrow, the infection is no longer asymptomatic and should be treated accordingly, probably with liposomal amphotericin B. - ProMED Mod EP]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sun 24 Sep 2017
Source: Alghad Press [in Arabic, trans. Mod.NS, edited]

The Parliamentary Health and Environment Committee revealed on [Sun 24 Sep 2017] the spread of plague and called for a national campaign against rodents that are causing the disease.

The deputy head of the Parliamentary Health and Environment Committee, Fares Al-Barefkani, told Alghad Press that "new cases of plague have been identified, and the causes of the disease are known and are related to the poor municipal, disease control, sewage, and landfill services, in addition to widespread residential slums."

Al-Barefkani indicated that "there are a lot of residential slums that have emerged and are not under the control of Baghdad municipality and lack health services." He called for "a serious national campaign to combat rodents in the residential neighbourhoods that cause plague and provide medicines that help to eliminate the disease" and stressed that "there is a need to support Baghdad municipality and the health and the environment directorates to educate people on how to combat plague."

Al-Barefkani added that "the Parliamentary Health and Environment Committee does not have accurate data on the number of cases because we are in the process of follow-up in all the governorates."

On Tuesday [12 Sep 2017], the Ministry of Health denied some social media and other media reports about the occurrence of plague cases.
===================
[ProMED would again appreciate more information regarding whether plague cases have occurred in Iraq as it had been previously denied. If plague is present there, a program to eradicate rodents alone will not be effective in preventing human cases as the infected flea vector will seek other blood sources, such as humans.

This publication regarding the history of _Yersinia pestis_ in Iran also reviews the history of plague in other countries in the Middle East including Iraq:

Hashemi Shahraki A, Carniel E, Mostafavi E: Plague in Iran: its history and current status. Epidemiol Health. 2016 Jul 24; 38: e2016033; available at

"Throughout its history, Iraq has experienced multiple epidemics of plague. In 716 and 717 CE, a large outbreak known as al-Ashraf (the Notables) was recorded in Iraq and Syria. In an epidemic of bubonic plague in 1772 and 1773, many victims died in cities such as Basra (with 250 000 deaths) and Mosul. In 1801 CE, a large plague epidemic occurred in Mosul and Baghdad. A plague epidemic occurred again in Baghdad in 1908. From 1923 to 1924, approximately 90 cases of pneumonic plague were reported in Baghdad, and some plague outbreaks were reported in Basra." - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Tue 12 Sep 2017
Source: Alghad Press [in Arabic, trans. ProMED Mod.NS, edited]

The Ministry of Health denied on [Tue 12 Sep 2017] what has been circulated in some social media sites and other media sources about the occurrence of plague cases. The spokesman for the Ministry of Health, Saif Al-Bader, said in a statement that "after communicating with the relevant authorities and departments, it has been found that no deaths due to plague have occurred." He indicated that "this disease was eliminated from Iraq a long time ago and the health departments, whether in Baghdad or the other governorates, have not registered any cases in the whole country."

"The Ministry of Health is carrying out intensive campaigns to combat vectors of diseases, under the supervision and follow-up of the Communicable Diseases Control Center," Al-Bader added.

The director of the Communicable Diseases Control Center, Sabah Abdul-A'ayma, said that "the center continues to supervise all the teams from the different units of the center that are involved in the ongoing campaigns to fight disease carriers, especially in the areas that were mentioned in the rumors such as Al-Rusafa, Al-Saadoun, and Al-Batawin."

Abdul-A'ayma added that "the last campaign was carried out today [Tue 12 Sep 2017] as a team from the Communicable Diseases Control Center conducted an intensive rodent control campaign in the area of Al-Batawin, through the distribution of toxic baits and carrying out fumigation of rodent burrows in the region."

Abdul-A'ayma stressed that "these measures taken by the Communicable Diseases Control Center are aimed to reduce the spread of rodents, which are hard to control due to rapid reproduction as well as the presence of a poor environment from the accumulation of wastes and sewage that contributes to the spread of rodents."

Al-Bader pointed out that "the ministry calls on people not to believe these rumors that are aimed at spreading panic in society." He called on the media to adhere to the scientific standards and accuracy in the dissemination of any information affecting the health of the country, without reference to specialists particularly under the circumstances of the country's fight against terrorism.
========================
[ProMED would appreciate more information regarding whether plague cases have occurred in Iraq. If plague is present there, a program to eradicate rodents alone will not be effective in preventing human cases as the infected flea vector will seek other blood sources such as humans.

This publication regarding the history of _Y. pestis_ in Iran also reviews the history of plague in other countries in the Middle East including Iraq:

Hashemi Shahraki A, Carniel E, Mostafavi E: Plague in Iran: its history and current status. Epidemiol Health. 2016 Jul 24; 38: e2016033; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037359/>

"Throughout its history, Iraq has experienced multiple epidemics of plague. In 716 and 717 CE, a large outbreak known as al-Ashraf (the Notables) was recorded in Iraq and Syria. In an epidemic of bubonic plague in 1772 and 1773, many victims died in cities such as Basra (with 250 000 deaths) and Mosul. In 1801 CE, a large plague epidemic occurred in Mosul and Baghdad. A plague epidemic occurred again in Baghdad in 1908. From 1923 to 1924, approximately 90 cases of pneumonic plague were reported in Baghdad, and some plague outbreaks were reported in Basra." - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
More ...

World Travel News Headlines

Date: Fri, 6 Dec 2019 10:30:54 +0100 (MET)

Moscow, Dec 6, 2019 (AFP) - More than 50 polar bears have gathered on the edge of a village in Russia's far north, environmentalists and residents said, as weak Arctic ice leaves them unable to roam.   The Russian branch of the World Wildlife Fund said climate change was to blame, as unusually warm temperatures prevented coastal ice from forming.   The WWF said 56 polar bears had gathered in a one-square-kilometre (0.4-square-mile) area near the village of Ryrkaipy in Chukotka on the north-eastern tip of Russia.

There were concerns they could enter the village, home to fewer than 1,000 people, and patrols had been set up to monitor their movements.   "The number of human and predator encounters in the Arctic is increasing," the WWF said in statement.    "The main reason is the decline of sea ice area due to the changing climate. In the absence of ice cover, animals are forced to go ashore in search of food."

Residents had gathered walrus carcasses in the area to try to keep the bears from wandering into the village.   "We have created a feeding point with walrus carcasses that we gathered along the coast," Tatyana Minenko of the local "Bear Patrol" told news agency RIA Novosti.   "As long as there is no big freeze, the sea ice will not form and the bears will stay on the coast," she said.

Russia's weather service said temperatures in the region should fall from Saturday and that coastal ice should freeze by December 11.    Polar bears regularly visit areas inhabited by humans in Arctic Russia to search for food, often in rubbish tips.   But the number of visits has been growing as the melting of Arctic ice from climate change forces the bears to spend more time on land where they compete for food.
Date: Fri, 6 Dec 2019 10:28:26 +0100 (MET)
By Joseph Schmid

Paris, Dec 6, 2019 (AFP) - Travellers across France endured a second day of chaos on Friday as unions vowed to keep up their strike until President Emmanuel Macron backs down on controversial pension overhauls.   Rail operator SNCF said 90 percent of high-speed TGV trains were again cancelled, and several airlines dropped flights including Air France, EasyJet and Ryanair.

Nine of the capital's 16 metro lines were shut and most others severely disrupted, sparking some 350 kilometres (220 miles) of traffic jams in the Paris region, well above the usual 200 km, the traffic website Sytadin reported.   Many employees were unable to get to work and several schools again provided only daycare, though fewer teachers were on strike compared with Thursday when some 800,000 people demonstrated across the country according to the interior ministry.   Bike paths were crowded with bikes and electric scooters, with metro operator RATP sponsoring special deals for commuters with a range of ride-hailing companies and other transportation alternatives.

The walkout is the latest test for Macron after months of protests from teachers, hospital workers, police and firefighters as well as the "yellow vest" movement demanding improved living standards.   Unions say his "universal" pension system, which would eliminate dozens of separate plans for public workers, forces millions of people in both public and private sectors to work well beyond the legal retirement age of 62.   Health Minister Agnes Buzyn said Friday that the government had "heard" the protesters' anger and would meet with union leaders to discuss the reform on Monday.   The government has yet to lay out the details of its plan, and Buzyn told Europe 1 radio that "there is indeed a discussion going on about who will be affected, what age it kicks in, which generations will be concerned -- all that is still on the table".

- Macron 'determined' -
Yves Veyrier, head of the hardline FO union, warned Thursday the strike could last at least until Monday if the government did not take the right action.   But it remains to be seen if the protests will match the magnitude of the 1995 strikes against pension overhauls, when France was paralysed for three weeks from November to December in an action that forced the government to back down.

Macron, a former investment banker, has largely succeeded in pushing through a series of controversial reforms, including loosening labour laws and tightening access to unemployment benefits.   But this is the first time the various disgruntled groups have come together in protest.   So far Macron has not spoken publicly on the stoppages though a presidential official, who asked not to be named, said Thursday that the president was "calm" and "determined to carry out this reform" in a mood of "listening and consultation".

While most of Thursday's rallies were peaceful, police fired tear gas to disperse dozens of black-clad protesters smashing windows and throwing stones during the Paris march, with one construction trailer set on fire. Sporadic clashes were also reported in some other cities.   Many people were bracing for further disruptions over the weekend, including the prospect of fuel shortages as unions blocked most of the country's eight oil refineries.

The minimum pension age in France is 62, one of the lowest among developed countries, but there are 42 "special regimes" for railway workers, lawyers, opera employees and others offering earlier retirements and other benefits.   The government says a single system will be fairer for everyone while ensuring its financial viability while acknowledging that people will gradually have to work longer.
Date: Fri, 6 Dec 2019 04:23:51 +0100 (MET)

Sydney, Dec 6, 2019 (AFP) - Three hundred animals have been evacuated from a wildlife park north of Sydney as massive bushfires encircled Australia's largest city and foreign firefighters arrived to relieve beleaguered local forces.   Walkabout Wildlife Park said it had shipped out lizards, dingoes, peacocks and marsupials, as firefighters battled more than 100 fires up and down the eastern seaboard.   "This fire has been doing some crazy things, so we have to be prepared," general manager Tassin Barnard told AFP.

Prolonged drought has left much of eastern Australia tinder dry and spot fires have raged every day for the past three months, leaving firefighters struggling to cope.   New South Wales rural fire chief Shane Fitzsimmons said Friday that some US and Canadian firefighters had arrived to help out, easing the strain on the exhausted largely volunteer Australian force.

The incident-management and aviation specialists will help ease "fatigue and crew rotations" he said.   "We are not only appreciative of their presence here today, but of their sacrifice," said Fitzsimmons -- who has become a fixture on Australian television screens for weeks, updating the public on blazes in towns, national parks and backwaters.    "They are volunteering to sacrifice time from loved ones, from families, to give up that special time of the year around Christmas and New Year to come down here and lend us a hand," he said.

More than 600 homes have been destroyed and six people have died since the crisis began in September. That is many fewer than Australia's deadliest recent fire season in 2009 when almost 200 people died, but 2019's toll belies the scale of devastation.    Millions of hectares have burned -- the size of some small countries -- across a region spanning hundreds of kilometres (miles).   Bushfires are common in Australia but scientists say this year's season has come earlier and with more intensity due to a prolonged drought and climatic conditions fuelled by global warming.

The fires have taken a toll in Sydney and other major cities, which have been blanketed in toxic smoke for weeks and occasionally sprinkled with snow-like embers.   Fitzsimmons said he could not "overstate the effect that this profound drought is having" as he warned of a long, painful summer ahead.   "There is an absolute lack of moisture in the soil, a lack of moisture in the vegetation... you are seeing fires started very easily and they are spreading extremely quickly, and they are burning ridiculously intensely."
Date: Fri, 6 Dec 2019 03:03:18 +0100 (MET)
By Pierre-Henry DESHAYES

Half Moon Island, Antarctica, Dec 6, 2019 (AFP) - The swimsuit-clad tourists leap into the icy water, gasping at the shock, and startling a gaggle of penguins.   They are spectators at the end of the world, luxury visitors experiencing a vulnerable ecosystem close-up.   And their very presence might accelerate its demise.   Antarctica, a vast territory belonging to no one nation, is a continent of extremes: the coldest place on Earth, the windiest, the driest, the most desolate and the most inhospitable.   Now, it's also a choice destination for tourists.

All around Half Moon Island, off the Antarctic Peninsula, blocks of ice of all sizes float by on a calm sea, their varying forms resembling weightless origami shapes.    On this strip of land, that juts out of the Antarctic Polar and towards South America, visitors can see wildlife normally only viewed in zoos or nature documentaries along with spectacular icy landscapes.   The ethereal shades of white that play across the pillowy peaks change with the light, acquiring pastel hues at dawn and dusk.   "Purity, grandeur, a scale that's out of this world," says Helene Brunet, an awestruck 63-year-old French pensioner, enjoying the scene.    "It's unbelievable, totally unbelievable. It's amazing just to be here, like a small speck of dust."

AFP joined the 430 passengers on board the Roald Amundsen, the world's first hybrid electric cruise ship, on its maiden voyage in the Southern Ocean.    "It's not your typical beach, but it's awesome to do it," says a numb Even Carlsen, 58, from Norway, emerging from his polar plunge in the three-degree C (37.4 F) water.   When tourists go ashore, bundled up in neon-coloured windbreakers and slathered in SPF50 sunscreen, they have to follow strict rules: clean your personal effects so you don't introduce invasive species, keep a respectful distance from wildlife to avoid distressing them, don't stray from the marked paths and don't pick up anything.   "We mucked up the rest of the world. We don't want to muck up Antarctica too," says an English tourist, as she vacuums cat hair off her clothes before going ashore.

- 'Heart of the Earth' -
The Antarctic peninsula is one of the regions on Earth that is warming the fastest, by almost three degrees Celsius in the past 50 years, according to the World Meteorological Organization -- three times faster than the global average.    In March 2015, an Argentinian research station registered a balmy 17.5 degrees Celsius, a record.    "Every year you can observe and record the melting of glaciers, the disappearance of sea ice... (and) in areas without ice, the recolonisation of plants and other organisms that were not present in Antarctica before," said Marcelo Leppe, director of the Chilean Antarctic Institute.

Antarctica is "like the heart of the Earth," he added, saying that it expands and contracts like a heart beating, while the mighty current which revolves around the continent is like a circulatory system as it absorbs warm currents from other oceans and redistributes cold water.   The Antarctic Treaty, signed 60 years ago by 12 countries -- it now has 54 signatories -- declared the area a continent dedicated to peace and science, but tourism has gradually increased, with a sharp rise in the past few years.   Tourism is the only commercial activity allowed, apart from fishing -- the subject of international disputes over marine sanctuaries -- and is concentrated mainly around the peninsula, which has a milder climate than the rest of the continent and is easier to access.

Cruise ships have roamed the region for around 50 years, but their numbers only started to increase from 1990, as Soviet ice-breakers found new purposes in the post-Cold War era.   Some 78,500 people are expected to visit the region between November and March, according to the International Association of Antarctica Tour Operators (IAATO).   That's a 40-percent increase from last year, due in part to short visits by a few new cruise ships carrying more than 500 passengers, too many to disembark under IAATO regulations.     "Some might say 'Well, 80,000 people, that doesn't even fill a national stadium'... (and that it) is nothing like Galapagos which welcomes 275,000 a year," says IAATO spokeswoman Amanda Lynnes.    "But Antarctica is a special place and you need to manage it accordingly."

- 'Leave Antarctica to the penguins' -
It is Antarctica's very vulnerability that is attracting more and more visitors.   "We want to see this fantastic nature in Antarctica before it's gone," Guido Hofken, a 52-year-old IT sales director travelling with his wife Martina, says.    They said they had paid a supplement to climate compensate for their flight from Germany.

But some question whether tourists should be going to the region at all.   "The continent probably would be better off being left to penguins and researchers, but the reality is, that is probably never going to happen," said Michael Hall, professor and expert on polar regions at the University of Canterbury in New Zealand.   "Vicarious appreciation never seems to be enough for humans. So with that being the case, it needs to be made as low risk to the Antarctic environment and as low carbon as possible," said Hall.    "However, when the average tourist trip to Antarctica is over five tonnes of CO2 emissions per passenger (including flights), that is a serious ask."

Soot or black carbon in the exhaust gases of the scientific and cruise ships going to the region is also of concern, said Soenke Diesener, transport policy officer at German conservation NGO Nabu.   "These particles will deposit on snow and ice surfaces and accelerate the melting of the ice because the ice gets darker and will absorb the heat from the sun and will melt much faster," he told AFP.   "So the people who go there to observe or preserve the landscape are bringing danger to the area, and leave it less pristine than it was," he added.

- Responsible tourism -
Antarctic tour operators insist they are promoting responsible tourism.   The trend is for more intimate, so-called expedition cruises, in contrast to popular giant cruise liners elsewhere which are criticised for being invasive and polluting.   With greener ships -- heavy fuel, the most commonly used for marine vessels, has been banned in Antarctica since 2011 -- cruise companies have sought to make environmental awareness a selling point, occasionally earning them accusations of greenwashing.

Global warming, pollution and microplastics are the result of human activities on other, faraway continents, say tour operators.   Here, their motto is "Take nothing but photographs, leave nothing but footprints, keep nothing but memories".   But before they've even set foot on the cruise ships departing from South America -- the most common itinerary -- visitors to Antarctica will already have flown across the world, causing emissions that harm the very nature they have come so far to admire.

Most visitors hail from the Northern Hemisphere, and almost half are from the United States and China, IAATO says.   "I'm a tourist who feels a little guilty about taking a flight to come here," admits Francoise Lapeyre, a 58-year-old globetrotter om France.   "But then again, there are priorities. There are some trips I just won't take, because they leave a big footprint and they're not worth it.   "Crisscrossing the planet to go to a beach for example," she says.

- Don't mention climate change -
Like other expedition cruises where accessible science is part of their trademark, the Roald Amundsen, owned by the Hurtigruten company, has no dance floor or casino.  Instead, there are microscopes, science events and lectures about whales and explorers like Charles Darwin.   But they steer clear of climate change, which is only mentioned indirectly.   That's a deliberate decision as the subject has proven "quite controversial", said Verena Meraldi, Hurtigruten's science coordinator.   "We held several lectures dedicated specifically to climate change but it leads to conflicts. There are people who accept it as a fact, others who don't," she said.   Onboard, "passengers" are referred to as "guests" and "explorers" rather than "cruisers".   "Explorers" are typically older, well-heeled, often highly travelled pensioners who are handed walking sticks as they step ashore.   "My 107th country," says a Dane, stepping ashore onto Antarctica.

The Roald Amundsen "guests" choose between three restaurants, from street food to fine dining -- a far cry from the conditions endured by the Norwegian adventurer for whom the ship is named, who had to eat his sled dogs to survive his quest to reach the South Pole in 1911.   They have paid at least 7,000 euros ($7,700) each for an 18-day cruise in a standard cabin, and up to 25,000 euros ($27,500) for a suite with a balcony and private jacuzzi.   Other cruises are banking on ultra-luxury, with James Bond-like ships equipped with helicopters and submarines, suites of more than 200 square metres (2,153 square feet) and butler services.   With a seaplane to boot, the mega-yacht SeaDream Innovation will offer 88-day cruises "from Pole to Pole" starting in 2021. The two most expensive suites, with a price tag of 135,000 euros per person, are already booked.
 
- Worlds collide -
Outside, in the deafening silence, wildlife abounds.   All around are penguins, as awkward on land as they are agile in water. Massive and majestic whales slip through the waves, and sea lions and seals laze in the sun.   On Half Moon Island, chinstrap penguins -- so called because of a black stripe on their chin -- strut about in this spring breeding season, raising their beaks and screeching from their rocky nests.   "This is to tell other males 'This is my space' and also, maybe, 'This is my female'," ornithologist Rebecca Hodgkiss, a member of the Hurtigruten's scientific team, explains, as a group of tourists stroll around ashore.   The colony of 2,500 penguins has been gradually declining over the years, but it's not known if that is man's fault or they have just moved away, according to Karin Strand, Hurtigruten's vice president for expeditions.   Invisible to the naked eye, traces of humankind are however to be found in the pristine landscape.   Not a single piece of rubbish is in sight but microplastics are everywhere, swept in on ocean currents.   "We've detected them in the eggs of penguins for example," Leppe told AFP.

- Venice under water -
The Antarctic, which holds the world's largest reserve of freshwater, is a ticking time bomb, warn experts and studies.   They say that the future of millions of people and species in coastal areas around the world depends on what is happening here.   As a result of global warming, the melting ice sheet -- especially in the western part of the continent -- will increasingly contribute to rising sea levels, radically re-drawing the map of the world, says climate scientist Anders Levermann, of the Potsdam Institute for Climate Impact Research.   This meltwater will contribute 50 centimetres (almost 20 inches) to the global sea level rise by 2100, and much more after that, he said.   "For every degree of warming, we get 2.5 metres of sea level rise. Not in this century, but in the long run," he said.

Even if the international community meets its obligations under the Paris Agreement to limit global warming to under two degrees Celsius, sea levels will still rise by at least five metres.   "Which means that Venice is under water, Hamburg is under water, New York, Shanghai, Calcutta," he said.   It's impossible to predict when, but the scenario appears unavoidable, says Levermann.   In the same way that a cruise ship powering ahead at full speed can't immediately stop, sea levels will continue to rise even if all greenhouse gas emissions were to cease immediately, a study has said.

- Changing the world? -
The tourism industry says it hopes to make "ambassadors" out of Antarctica visitors.   "It's good for the animal life and for the protection of Antarctica that people see how beautiful this area is, because you cherish what you know and understand," said Hurtigruten chief executive Daniel Skjeldam.   Texan tourist Mark Halvorson, 72, says he is convinced.   "Having seen it, I am that much more committed to having a very high priority in my politics, in my own inner core convictions to being as environmentally friendly in my life as I can," he said.   So, do Guido and Martina Hofken see themselves as future "ambassadors of Antarctica"?    "Just a little bit, probably. But I don't think I will change the world," Guido Hofken concedes.    "The best thing would be for nobody to travel to Antarctica."
Date: Thu, 5 Dec 2019 16:37:37 +0100 (MET)

Paris, Dec 5, 2019 (AFP) - French rail operator SNCF said Thursday that it had cancelled 90 percent of all high-speed TGV trains and 70 percent of regional trains for Friday due to a strike over the government's pension reforms.   SNCF said that services would "still be very disrupted" on the second day of the biggest transport strike in the country in years, with the Eurostar service to Britain and the Thalys service to northern Europe set to be "very heavily disrupted".   In Paris, where only two of 16 metro lines were operating normally Thursday, public transport workers voted to remain on strike until Monday.

France's civil aviation authority meanwhile told airlines to cut 20 percent of their flights in and out of airports in Paris, Beauvais, Lyon, Marseille, Toulouse and Bordeaux on Friday, the same proportion as on Thursday.   Striking transport workers, air traffic controllers, teachers, fire fighters, lawyers and other groups all fear they will have to work longer or receive reduced pensions under the government's proposal to scrap 42 special pension schemes and replace them with a single plan.   Anticipating the worst travel chaos in years, many employees opted to work from home on Thursday. Those who did venture out travelled mainly by car, bicycle, electric scooter or on foot.
Date: Thu, 5 Dec 2019 12:19:45 +0100 (MET)
By Sofia CHRISTENSEN

Johannesburg, Dec 5, 2019 (AFP) - South African Airways was placed under a state-approved rescue plan on Thursday to avoid the embattled airline's collapse following a costly week-long strike last month.   Thousands of South African Airways (SAA) staff walked out on November 15 after the flag carrier failed to meet a string of demands, including higher wages and job in-sourcing.   The strike was called off the following week after SAA management and unions eventually clinched a deal.

But the walkout dealt a severe blow to the debt-ridden airline, which has failed to make a profit since 2011 and survives on government bailouts.   "The Board of SAA has adopted a resolution to place the company into business rescue," said a statement by South Africa's Public Enterprises Minister Pravin Gordhan, adding that the decision was also supported by the government.   "It must be clear that this is not a bailout," said Gordhan. "This is the provision of financial assistance in order to facilitate a radical restructure of the airline."   The business rescue process will be directed by an independent practitioner. It is meant to prevent a "disorderly collapse of the airline", he added.   Gordhan said the government would provide 2 billion rand ($136 million) to SAA in "a fiscally neutral manner".   Existing lenders will also provide a 2 billion rand loan guaranteed by the government.

- 'Financial challenges' -
South Africa is struggling to get state-owned companies back on track after nine years of corruption and mismanagement under former president Jacob Zuma.   Its national airline -- which employs more than 5,000 workers and is Africa's second largest airline after Ethiopian Airlines -- had been losing 52 million rand ($3.5 million) a day during the strike.   SAA's board said the business rescue, scheduled to start immediately, was decided after consultations with shareholders and the public enterprises department "to find a solution to our company's well-documented financial challenges".

"The considered and unanimous conclusion has been to place the company into business rescue in order to create a better return for the company's creditors and shareholders," said the SAA board of directors in a statement.   The rescue plan will include a "new provisional timetable" and ensure "selected activities... continue operating successfully".   With a fleet of more than 50 aircraft, SAA flies to over 35 domestic and international destinations.   "SAA understand that this decision presents many challenges and uncertainties for its staff," said the board.   "The company will engage in targeted communication and support for all its employee groups at this difficult time.

- 'Lesser evil' -
Unions told AFP they would comment later on Thursday.   They have agreed to a 5.9-percent wage increase backdated to April, but which would only start to be paid out next March depending on funding.   SAA had initially refused any pay rise.    The cash-strapped airline needs two billion rand ($136 million) to fund operations through the end of March. But it was unable to cover all of its staff salaries last month.    "Business rescue allows for the airline to continue to operate while it is being restructured, as opposed to liquidation," analyst Daniel Silke told AFP.   He said the rescue was a "lesser evil for SAA" and would save more jobs than a "shutdown".

But Silke still expected jobs to be cut as SAA attempted to reduce costs.   "Various divisions that make of SAA could be privatised," he said. "There will be a review of SAA aircraft and routes covered by SAA."   Unions had already demanded a three-year guarantee of job security following an announcement last month that almost 1,000 SAA employees could lose their jobs as part of another restructuring plan.   SAA pledged to defer that process to the end of January as part of the deal that ended the strike.
Date: Wed 4 Dec 2019
Source: Stock Daily Dish [edited]

Out of the 7 patients who were admitted to the hospital suspecting Nipah virus infection, one has been tested positive while the other 6 have been tested negative.

Kerala health minister K K Shailaja said at a press briefing in Kochi on Thursday [28 Nov 2019] that of "7 patients admitted to the hospital, one patient's result is positive for Nipah virus, while 6 patients' results are negative. No one has been discharged from the isolation ward. The source of the virus is not confirmed yet."

On the other hand, 2 persons suffering from high fever were put under observation at Trivandrum Medical College on Thursday [28 Nov 2019]. Their samples have been sent for examination.

On 4 Jun [2019], a 23-year-old-man had tested positive for Nipah virus infection, which killed 17 people in Kerala last year [2018].

As of now, a total of 15 people are under observation in the state.

Union minister for health and family welfare Dr Harsh Vardhan had said on 4 Jun [2019] that the centre had rushed a team of doctors to Kerala for investigation in the wake of the scare of Nipah virus. Vardhan had asserted that he was "very vigorously" following the situation.

Nipah virus is transmitted from animals [bats] to humans and then spreads through people to people, causing respiratory illness. Its symptoms include fever, muscle pain, headache, fever, dizziness, and nausea.

The Health Department in Karnataka issued a circular asking administration in Chamarajanagar, Mysuru, Kodagu, Dakshina Kannada, Uttara Kannada, Udupi, Shivamogga, and Chikkamagaluru districts to immediately convene interdepartmental coordination committee meetings, including the veterinary department, the Indian Medical Association, and the Indian Academy of Pediatrics.

Authorities in these 8 districts have been directed to identify 2 isolation beds to quarantine suspected human cases. They have been asked to keep all the logistics available at all levels, read the circular. The department has also asked district authorities to direct government and private hospitals to keep an eye on suspected cases.

Once a patient shows symptoms of Nipah, the hospitals have to monitor for acute encephalitis syndrome, check all vital parameters, and take a travel history of the patients.

The district hospitals should have an ICU with ventilator facilities and capacity to receive emergency cases, the circular read.

The department asked the districts to furnish a daily outbreak report regarding Nipah virus. It also directed authorities to sensitise health assistants and ASHA workers.
==================
[This is the 3rd case of Nipah virus infection [NVI] in Kerala state this year (2019). It is prudent that surveillance and patient-care capacity have been increased. Last year (2018), as of 17 Jul 2018, a total of 19 Nipah virus (NiV) cases, including 17 deaths, were reported from Kerala state: 18 of the cases were laboratory confirmed, and the deceased index case was suspected to have NVI but could not be tested. The 2018 outbreak was localized to 2 districts in Kerala state: Kozhikode and Malappuram.

The exact circumstances under which this or the previous confirmed Nipah virus cases this year (2019) acquired their infections are not stated in the above or in previous reports, nor is it stated whether these individuals had contact with flying fox fruit bats (_Pteropus giganteus_), the reservoir hosts of Nipah virus, or fruit that the bats may have contaminated. It is interesting to note that 12 of 36 fruit bats tested at the National Institute of Virology were positive for Nipah virus. Although Kerala health minister KK Shailaja officially had declared Ernakulam district Nipah-free, it may have been free of human cases but is unlikely to have been free of the virus in _Pteropus giganteus_ fruit bats. - ProMED Mod.TY]

[Maps of India:
Date: Wed 4 Dec 2019
Source: Stock Daily Dish [edited]

Bihar Health Minister Mangal Pandey on [Sat 30 Nov 2019] said the state government is doing its best to save children, as the death toll due to acute encephalitis syndrome [AES] in Muzaffarpur mounted to 73.

Pandey said doctors and nurses are being called in from Patna for additional help. "We are trying everything and anything that can save children's lives. Everything is being made available from medicines to doctors. We have even called doctors and nurses from AIIMS in Patna," he said. "There is a protocol regarding what kind of medicines and facilities should be given and we are doing the same. We are monitoring things regularly and trying to save our children."

Recalling the situation that prevailed 5 years ago, Pandey said a team that was formed to ascertain the cause of this disease concluded that sleeping empty stomach at night, dehydration due to humidity and eating lychee on empty stomach were some of the causes of encephalitis.

"Our government has tried to spread awareness which will be beneficial as well. Advertisement in newspapers, radio jingles, pamphlets and mic [microphone] announcements are going to spread awareness regarding the disease. Health ministry is also working on it," he said.

On being asked about spread of ASE in Gorakhpur last year [2018], he said, "From Gorakhpur to Muzaffarpur region, this disease had spread last year and the Union government had worked on this and we will continue to fight it now."

"This incident in Muzaffarpur is very saddening and we also feel bad when children of our nation die like this. Not the whole district is affected but a large part is suffering from it," he added.

From [1 Jan 2019], until now [5 Dec 2019], 220 children were admitted in Sri Krishna Medical College and Hospital in Muzaffarpur due to AES, out of which 62 lost their lives.

As per the data of SKMCH hospital, 235 children were admitted, of which 89 died; in 2013 - 90 children were admitted, of which 35 died; in 2014 - 334 children were admitted, of which 117 died; in 2015 - 37 children were admitted, of which 15 died; in 2016 - 31 children were admitted, of which 6 died; in 2017 - 44 children were admitted, of which 18 died; and in 2018 - 43 children were admitted, of which 12 died.

Meanwhile, Minister of State for Union ministry for home affairs, Nityanand Rai, visited Sri Krishna Medical College and Hospital to review the situation after the outbreak of AES.

Encephalitis is a viral disease, which causes mild flu-like symptoms such as high fever, convulsions and headaches and has been claiming lives in the district for the past few weeks.
======================
[The dates within which these AES cases have occurred is not stated. The urgency that has prompted Behar health officials to request the aid of physicians and nurses from adjoining Patna suggests that the AES outbreak is going on currently. The uncertainty about the etiology of AES continues. It is curious that the above report makes no mention of negative or positive tests for Japanese encephalitis among the AES patients, although that virus is endemic in northeastern India, including Bihar state. Neighboring Uttar Pradesh state has had JE cases as well this summer (2019) but has intensified its JE vaccination program.

The issue of the aetiology of AES has been under discussion for a long time. Lychee fruit contain toxins. Encephalopathy and hypoglycaemia have been associated with consumption of lychee fruit contains phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no. http://promedmail.org/post/20150201.3132842). However, the current cases cannot be due to lychee consumption, since the season for that fruit has passed.

AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in AES, but existing surveillance for AES does not include routine testing for dengue. Until the etiology (or etiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible.

Reference:
Ravi V, Hameed SKS, Desai A, et al. Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. Int J Infect Dis 2019;84 Suppl:19-24. <https://doi.org/10.1016/j.ijid.2019.01.008>.

Available at:

[Maps of India:
HealthMap/ProMED maps available
at:<http://healthmap.org/promed/p/364>, and Bihar, India:
Date: Thu 5 Dec 2019 6:11 PM EET
Source: Enab Baladi [edited]

[Leishmaniasis] is spreading widely among residents of Deir ez-Zor, and especially children. Some of the areas affected are controlled by the Kurdish self-administration while others are under the control of the Syrian regime. Medical sources counted hundreds of infected civilians and confirmed the disease's rapid spread.

According to Atef al-Tawil, a manager of the Leishmania & Environmental Health Programme at the Syrian regime's Ministry of Health, most infections in eastern Deir ez-Zor are spread among school children.

In a Facebook comment on a post by Twasol agency, al-Tawil claimed that cases of leishmaniasis were detected, at the end of November [2019], in primary schools in eastern Deir ez-Zor and its surrounding villages (al-Jalaa, al-Salihiyah, al-Tawtha, al-Abbas, al-Mujawdeh, al-Hasarat, al-Saial, al-Ghabrah).

According to al-Tawil, 455 infections of children were detected. A treatment team of 10 members was formed in the affected locations, to help control the disease to aid in early detection.

The Syrian Ministry of Health acted after several appeals by civilians residing in the area as they noticed the disease spreading among their children. Al-Tawil said that this rapid spread was due to the fact that all the infected people have lately returned to their original areas which lack medical centers.

Autonomous administration areas
-------------------------------
According to Euphrates Post network, leishmaniasis is also widely spread in areas controlled by the Syrian Democratic Forces (SDF). In its post on [Sun 1 Dec 2019], the network claimed that the spread of leishmaniasis is mostly concentrated in the eastern countryside of Deir ez-Zor.

According to the network, unofficial statistics by the SDF-affiliated local council shows more than 7000 leishmaniasis infections among children in al-Baghouz, Hajin, Diban, al-Sha'afa, al-Kishkiye, Abu Hamam, and Gharanij. The local councils' attempts of controlling the disease are still substandard, according to the Euphrates Post.

The network also quoted doctors and nurses calling for international organizations to interfere and provide hospitals and clinics with the required vaccine [there is no vaccine for leishmaniasis; ed.], and to train specialized medical staff in each clinic to deal with the disease.

The autonomous-administration-affiliated media center in Deir ez-Zor also confirmed the spread of leishmaniasis and pointed out that the authorities took actions, by the end of November [2019], to provide treatments.

According to the media center, special medical teams and cadres were distributed among the clinics to provide 12,000 ampoules of the required [medicine] to treat leishmaniasis with the support of the World Health Organization.

Leishmaniasis is a parasitic disease transmitted by the bite of infected female phlebotomine sandflies -- a very small yellow fly that is active at night and makes no sound when it bites -- and the main cause for its spread is dirt and lack of hygiene.  [Byline: Enab Baladi]
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[Deir ez-Zor is east and south of the locations in the previous ProMED reports (see below), indicating further increase in cases of cutaneous leishmaniasis beyond its historical concentration in western Syria (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861536/>) and beyond the area of the MENTOR initiative in northern Syria (<https://wwwnc.cdc.gov/eid/article/24/11/17-2146_article>).

Cutaneous leishmaniasis is endemic in Syria with its reservoir in rodents. It has been a problem throughout the Syrian civil war and in ISIS controlled areas during the war due to a breakdown in rodent and vector control. - ProMED Mod.EP]

[Maps of Syria:
Date: Tue 3 Dec 2019
Source: Twitter feed in Arabic [machine trans., edited]

Taiz health official: 24 laboratory-confirmed cases of West Nile virus and more than 300 suspected cases. #Republic_Yemen
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[Any information on the actual number of WNV cases, their lab confirmation, and public health response activities in this regard will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Yemen: