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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: 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:
Date: Thu, 19 Oct 2017 16:37:27 +0200
By Ricardo ARDUENGO, con Nelson DEL CASTILLO en San Juan y Leila MACOR en Miami

Utuado, Puerto Rico, Oct 19, 2017 (AFP) - It's been a month since Hurricane Maria ripped through Puerto Rico and Samuel de Jesus still can't drive out of his isolated, blacked-out town.   In fact, much of the US territory in the Caribbean is still a crippled mess four weeks after that fierce Category Four storm.

The bridge connecting Rio Abajo to the rest of the island was swept away when Maria slammed the island on September 20. For two weeks Rio Abajo, located in a mountainous region in central-western Puerto Rico, was cut off and forgotten, without power or phone service.   "We didn't know what to do. We were literally going crazy," said de Jesus, 35.   "Those were difficult, desperate days. We could not find a way out, and the hurricane caused extensive damage," he told AFP.

During the two long weeks following Maria, the 27 families living in Rio Abajo saw their supplies quickly deplete.   De Jesus, who has diabetes, needed to keep his insulin refrigerated. The storm blew away the island's already decrepit power grid, so people resorted to emergency generators.   "But I was running out of gasoline to run the generator," he said.   A helicopter now makes regular deliveries of food, water and medicine because with the bridge washed out, there is no other way in or out of town.

People can't wade across the river because it is contaminated with human waste after a pipe broke when the bridge went.   Some brave souls use a precarious ladder rigged to get across the water, but for most people it is too dangerous.   We need a bridge "to take out our vehicles and leave in case of emergency, or if there is a landslide," he said.   Where the bridge once stood, residents set up a system of ropes, pulleys and buckets to move supplies over the river, which has been contaminated with sewer water since the hurricane.   Over the remains of the bridge locals hung the single-star, red, white and blue flag of Puerto Rico and a sign that reads "the campsite of the forgotten."

- Desperate need for electricity -
Puerto Rico Governor Ricardo Rossello visited the surrounding municipality of Utuado on Wednesday to deliver supplies, but he did not stop in Rio Abajo.   "Utuado is certainly one of the most severely affected municipalities in all of Puerto Rico," Rossello said.   "Our commitment is to give it support and aid during the whole road to recovery."   Eighty-one percent of Puerto Rico remains blacked out one month after Maria struck. Clean water for drinking, cooking and bathing is scarce, too.

Puerto Ricans' main obstacle to getting back to some semblance of normality is the slowness of the Puerto Rico Electric Power Authority in getting the power grid back up and running.   The lack of power has paralyzed a key industry -- pharmaceutical production -- and most businesses including restaurants are closed or operating at great cost through the use of diesel powered generators.

This nightmare comes about a year after the US government established an external fiscal control board for the island after it declared bankruptcy because of 73 billion dollars in debt.   Economist Joaquin Villamil told AFP that damage from Hurricane Maria is estimated at 20 billion dollars -- four times that of Hurricane Georges in 1998, when measured in 2016 dollars.

Villamil said reconstruction money provided by the Federal Emergency Management Agency and from insurance companies will have a positive impact on the island's economy in the second half of fiscal 2018 and in fiscal 2019, but this boost will just be temporary.   "From an economic point of view there is not much net gain," said Villamil, who works for a consulting firm called Estudios Tecnicos.   He said the economy has been shrinking since 2006 and Maria will delay any prospect of recovery.   It will take at least until 2026 to get back to the GDP level of 2006, he added.

Making things worse, people are leaving the island for the mainland US. Forecasts are that the population now at 3.4 million will go down to 3.1 million or even less by 2026, said Villamil.   The government of Florida estimates that since October 3 -- the day a state of emergency to deal with an influx of Puerto Ricans was declared -- more than 36,000 people from the island have poured in.
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Yemen

Yemen - US Consular Information Sheet
July 21, 2008
COUNTRY DESCRIPTION:
The Republic of Yemen was established in 1990 following unification of the former Yemen Arab Republic (North) and the People's Democratic Republic of Yemen (South). I
lamic and traditional ideals, beliefs, and practices provide the foundation of the country's customs and laws. Yemen is a developing country and modern tourist facilities are widely available only in major cities. Read the Department of State Background Notes on Yemen for additional information.

ENTRY/EXIT REQUIREMENTS: Passports and visas are required for travel to Yemen. Visas may be obtained at Yemeni Embassies abroad; all travelers to Yemen can also potentially obtain entry visas at ports of entry. Travelers to Yemen are no longer required to have an affiliation with and arrange their travel through a Yemeni-based individual or organization to enter Yemen. However, individuals may be asked for supporting evidence of their character, purpose of visit and length of stay. Upon arrival at ports of entry, travelers may be issued a visa valid for a maximum of three months.
Yemeni law requires that all foreigners traveling in Yemen obtain exit visas before leaving the country. In cases of travelers with valid tourist visas and without any special circumstances (like those listed below), this exit visa is obtained automatically at the port of exit as long as the traveler has not overstayed the terms of the visa.
In certain situations, however, foreigners are required to obtain exit visas from the Immigration and Passport Authority headquarters in Sanaa. These cases may include, but are not limited to, foreigners who have overstayed the validity date of their visa; U.S.-citizen children with Yemeni or Yemeni-American parents who are not exiting Yemen with them; foreigners who have lost the passport containing their entry visa; foreign residents whose residence visas are based on their employment or study in Yemen, marriage to a Yemeni citizen, or relationship to a Yemeni parent; or foreign residents who have pending legal action (including court-based "holds" on family members' travel). The loss of a passport can result in considerable delay to a traveler because Yemeni law requires that the traveler attempt to recover the passport by placing an advertisement in a newspaper and waiting a week for a response. All minor/underage U.S. citizens should be accompanied by their legal guardian(s) and/or provide a notarized letter in Arabic of parental consent when obtaining exit visas to depart Yemen. In all of these more complex cases, obtaining an exit visa requires the permission of the employing company, the sponsoring Yemeni family member, the sponsoring school or the court in which the legal action is pending. Without this permission, foreigners -- including U.S. Citizens -- may not be allowed to leave Yemen.
American women who also hold Yemeni nationality and/or are married to Yemeni or Yemeni-American men often must obtain permission from their husbands for exit visas. They also may not take their children out of Yemen without the permission of the father, regardless of who has custody (see Special Circumstances section below).
For more details, travelers can contact the Embassy of the Republic of Yemen, Suite 705, 2600 Virginia Avenue NW, Washington, DC 20037, telephone 202-965-4760; or the Yemeni (Mission to the U.N., 866 United Nations Plaza, Room 435, New York, NY 10017, telephone (212) 355-1730. Visit the Yemeni Embassy home page for more visa information at http://www.yemenembassy.org/.
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 Department of State is concerned that al-Qa‘ida and its affiliates are actively engaged in extremist-related activities in Yemen and the Arabian Peninsula. The Department remains concerned about possible attacks by extremist individuals or groups against U.S. citizens, facilities, businesses and perceived interests.

On March 18, 2008, three mortar rounds landed in the vicinity of the U.S. Embassy in Sanaa. Yemeni students at a nearby school and Yemeni government security personnel posted outside the embassy were injured in the attack. On April 6, 2008, an expatriate residential compound in the Hadda neighborhood of southwestern Sanaa was attacked by mortar fire, and on April 30, 2008, suspected extremists fired two mortar rounds that exploded near the Yemen Customs Authority and the Italian Embassy. No injuries were reported in either incident. A group calling itself al-Qa'ida in Yemen may be responsible for all three attacks. Following the attacks against the Embassy and the residential compound, the Department of State ordered the departure of all American non-emergency embassy staff and family members on April 7, 2008.
On January 18, 2008, suspected al-Qa’ida operatives ambushed a tourist convoy in the eastern Hadramout Governorate, killing two Belgians. On July 2, 2007, suspected al-Qa’ida operatives carried out a vehicle-borne explosive device attack on tourists at the Belquis Temple in Marib, which resulted in the deaths of eight Spanish tourists and two Yemenis. The targeting of tourist sites by al-Qa’ida may represent an escalation in terror tactics in Yemen. On February 3, 2006, 23 convicts, including known affiliates of al-Qa’ida, escaped from a high-security prison in the capital city, Sanaa. Among the al-Qa’ida associates were individuals imprisoned for their roles in the 2000 bombing of the USS Cole and the 2002 attack on the French oil tanker Limburg. In the weeks following the escape, some prisoners voluntarily turned themselves in to authorities; to date, however, some escapees remain at large. Two of the escapees were killed in vehicle-based suicide attacks on oil facilities near Mukalla and Marib on September 15, 2006. Those attacks were followed by the arrest the next day in Sanaa of four suspected al-Qa’ida operatives, who had stockpiled explosives and weapons. On December 5, 2006, a lone gunman opened small arms fire outside of the Embassy compound during the early morning hours. The assailant, wounded by host-nation security personnel and subsequently arrested, was the sole casualty. It appears that, although the gunman was influenced by extremist ideology, he worked alone in planning and executing the attack.
Americans should avoid areas where demonstrations are taking place. A 2005 demonstration against an increase in the fuel price led to two days of widespread demonstrations and rioting throughout Sanaa and other cities. Those demonstrations resulted in a large amount of property damage, looting, and several roadblocks.
In late 2007 and throughout 2008, there has been an increase in anti-government demonstrations in southern Yemen, including the cities of Aden, Taizz, Ibb, and Mukalla, as well as surrounding regions. Some of these demonstrations have resulted in injuries and deaths. Americans should be aware of the potential for further demonstrations when traveling in these areas.
Throughout the country, U.S. citizens are urged to exercise particular caution at locations where large groups of expatriates have gathered. From time to time, the U.S. Embassy in Sanaa may temporarily close or suspend public services as necessary to review its security posture and ensure its adequacy.
In addition, U.S. citizens are urged to avoid contact with any suspicious, unfamiliar objects, and to report the presence of such objects to local authorities. Vehicles should not be left unattended and should be kept locked at all times. Americans in Yemen are urged to register and remain in contact with the American Embassy in Sanaa for updated security information (see section on Registration/Embassy location below).
Yemeni government security organizations have arrested and expelled foreign Muslims, including Americans, who have associated with local Muslim organizations considered to be extremist by security organs of the Yemeni government. Americans risk arrest if they engage in either political or other activities that violate the terms of their admission to Yemen.
Travel on roads between cities throughout Yemen can be dangerous. Armed carjacking, especially of four-wheel-drive vehicles, occurs in many parts of the country, including the capital. Yemeni security officials advise against casual travel to rural areas. The U.S. Embassy sometimes restricts the travel of its own personnel to rural areas, while the Government of Yemen also sometimes places restrictions on Americans traveling outside Sanaa. Please check with the Embassy for the latest restrictions.
Travel is particularly dangerous in the tribal areas north and east of Sanaa. Armed tribesmen in those areas have kidnapped a number of foreigners in attempts to resolve disputes with the Yemeni government. Hostilities between tribesmen and government security forces in the Sadah governorate north of Sanaa have flared up on several occasions since 2005. Serious fighting occurred in the city of Benni Hashish from late May through early June 2008. Americans are urged to avoid this region during periods of conflict.
Travel by boat through the Red Sea or near the Socotra Islands in the Gulf of Aden presents the risk of pirate attacks. If travel to any of these areas is necessary, travelers may reduce the risk to personal security if such travel is undertaken by air or with an armed escort provided by a local tour company.
Other potential hazards to travelers include land mines and unexploded ordnance from the 1994 civil war. This is of particular concern in areas where fighting took place in the six southern provinces. However, most minefields have been identified and cordoned off.
Americans are most vulnerable to terrorist attacks when they are in transit to and from their residences or workplaces, or visiting locations where large groups of expatriates have gathered. All Americans are reminded to vary their routes and times, remain vigilant, report suspicious incidents to the Embassy, avoid areas where large groups of expatriates have gathered, lock car windows and doors, and carry a cell phone.
Based on previous abductions of foreigners in Iraq, Afghanistan and Kuwait, the Embassy recommends that Americans with doubts about the identity of security or police personnel on the roads remain in their vehicles, roll up their windows, and contact the Embassy. For additional information on travel by road in Yemen, see the Traffic Safety and Road Conditions section below.
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 and Travel Alerts, including the Travel Warning for Yemen, 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: The most serious crime problem affecting travelers to Yemen is carjacking. Travelers have rarely been victims of petty street crime.
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.

The local equivalent to the "911" emergency line in Yemen is 199, but operators do not speak English.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Lack of modern medical facilities outside of Sanaa and Aden and a shortage of emergency ambulance services throughout the country may cause concern to some visitors. Doctors and hospitals often expect immediate cash payment for health services. An adequate supply of prescription medications for the duration of the trip is important. While many prescription drugs are available in Yemen, a particular drug needed by a visitor may not be available.
The U.S. Embassy in Sanaa strongly advises all American citizens residing in or traveling to Yemen to ensure that they have received all recommended immunizations (see below).
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/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Yemen.

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 Yemen is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Based on previous abductions of foreigners in Iraq, Afghanistan and Kuwait, the Embassy recommends that Americans with doubts about the identity of security or police personnel on the roads remain in their vehicles, roll up their windows, and contact the Embassy. For additional information addressing security concerns for Americans in Yemen, please see the Safety and Security section above.
Travel by road in Yemen should be considered risky. Within cities, minivans and small buses ply somewhat regular routes, picking up and dropping off passengers with little notice or regard for other vehicles. Taxis and public transportation are widely available but the vehicles may lack safety standards and equipment. Embassy personnel are advised to avoid public buses for safety reasons. Despite the presence of traffic lights and traffic policemen, drivers are urged to exercise extreme caution, especially at intersections. While traffic laws exist, they are often not enforced, and/or not adhered to by motorists. Drivers sometimes drive on the left side of the road, although right-hand driving is specified by Yemeni law. No laws mandate the use of seat belts or car seats for children. The maximum speed for private cars is 100 kilometers per hour (62.5 miles per hour), but speed limits are rarely enforced. A large number of under-age drivers are on the roads. Many vehicles are in poor repair and lack basic parts such as functional turn signals, headlights and taillights. Pedestrians, especially children, and animals on the roads constitute a hazard in both rural and urban areas. Beyond the main inter-city roads, which are usually paved and in fair condition, the rural roads in general require four-wheel-drive vehicles or vehicles with high clearance.
Yemeni security officials advise against casual travel to rural areas. The U.S. Embassy sometimes restricts the travel of its own personnel to rural areas, while the Government of Yemen also sometimes places restrictions on Americans traveling outside Sanaa. Please check with the Embassy for the latest restrictions.
Travelers should take precautions to avoid minefields left over from Yemen's civil wars. Traveling off well-used tracks without an experienced guide could be extremely hazardous, particularly in parts of the south and the central highlands.
Penalties for driving under the influence of alcohol or drugs, and reckless driving which causes an accident resulting in injury, are a fine and/or prison sentence. If the accident results in death, the driver is subject to a maximum of three years in prison and/or a fine. Under traditional practice, victims' families negotiate a monetary compensation from the driver proportionate to the extent of the injuries -- higher if it is a fatality.
Please refer to our Road Safety page for more information and visit the web site of Yemen’s national tourism office at http//yementourism.com.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Yemen, the U.S. Federal Aviation Administration (FAA) has not assessed Yemen’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.
SPECIAL CIRCUMSTANCES: Photography of military installations, including airports, equipment, or troops is forbidden. In the past, such photography has led to the arrest of U.S. citizens. Military sites are not always obvious. If in doubt, it is wise to ask specific permission from Yemeni authorities.
Travelers should be aware that automated teller machines (ATMs) are being introduced in major cities but are still not widely available in Yemen. Credit cards are not widely accepted. The Government of Yemen may not recognize the U.S. citizenship of persons who are citizens of both Yemen and the United States. This may hinder the ability of U.S. consular officials to assist persons who do not enter Yemen on a U.S. passport. Dual nationals may also be subject to national obligations, such as taxes or military service. For further information, travelers can contact the nearest embassy or consulate of Yemen.
American citizens who travel to Yemen are subject to the jurisdiction of Yemeni courts, as well as to the country's laws, customs, and regulations. This holds true for all legal matters including child custody. Women in custody disputes in Yemen may not enjoy the same rights that they do in the U.S., as Yemeni law often does not work in favor of the mother. Parents planning to travel to Yemen with their children should bear this in mind. Parents should also note that American custody orders might not be enforced in Yemen.
American women who also hold Yemeni nationality, and/or are married to Yemeni or Yemeni-American men, are advised that if they bring their children to Yemen they may not enjoy freedom of travel should they decide they want to leave Yemen. Such women often must obtain permission from their husbands for exit visas. They also may not take their children out of Yemen without the permission of the father, regardless of who has custody (See Entry/Exit Requirements section above).
American students and workers in Yemen sometimes report that the sponsors of their residence permits seize their U.S. passports as a means of controlling their domestic and international travel. While the sponsors say they seize the passports on behalf of local security services, there is no law or instruction from Yemeni passport or security offices requiring that passports be seized.
Please see 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 Yemeni laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession or use, or trafficking in illegal drugs in Yemen are severe, and convicted offenders can expect long jail sentences and heavy fines. The use of the mild stimulant "qat” or “khat" is legal and common in Yemen, but it is considered an illegal substance in many other countries, including the United States. 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 Yemen 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 Yemen. 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 Dhahr Himyar Zone, Sheraton Hotel District, PO Box 22347. The telephone number of the Consular Section is (967)(1) 755-2000, extension 2153 or 2266. The fax number is (967) (1) 303-175. The after-hours emergency number is (967) (1) 755-2000 (press 0 for extension) or (967) 733213509. The Embassy is open from Saturday through Wednesday.
* * *
This replaces the Country Specific Information for Yemen dated December 27, 2007, to update the sections on Entry/Exit Requirements, Safety and Security, Information for Victims of Crime, Criminal Penalties and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 29 May 2019
Source: World Health Organization [edited]

Outbreak update - Cholera in Yemen, 27 May 2019
-----------------------------------------------
The Ministry of Public Health and Population of Yemen reported 16,827 suspected cases and 18 associated deaths during epidemiological week 20 (13-19 May 2019). 15 per cent of cases were severe. The cumulative total number of suspected cholera cases from 1 Jan 2018 to 28 Apr 2019 is 704 986, with 1114 associated deaths (case fatality rate [CFR] 0.16%). Children under 5 represent 22.6% of total suspected cases during 2019. The outbreak has affected 22 of 23 governorates and 295 of 333 districts in Yemen.

>From week 8 in 2019, the trend of weekly reported suspected cholera cases started increasing and peaked at more than 29 500 cases in week 14. During weeks 15 to 20, case numbers declined, although it is too early to conclude a downward trend. The decline may be attributed to enhanced outbreak control efforts such as community engagement and WaSH [water, sanitation, and hygiene] activities, and scaling up WHO and partners' response, including establishing additional DTCs [diarrhea treatment centres] and ORCs [oral rehydration corners].

The governorates reporting the highest number of suspected cases of cholera in 2019 are Amanat Al Asimah (55 065), Sana'a (41 094), Al Hudaydah (34 814), Ibb (31 725), Dhamar (29 889) and Amran (27 727).

Of a total 6144 samples tested since January 2019, 3264 were confirmed as cholera-positive by culture at the central public health laboratories. During this reporting period, the governorates reporting the highest number of positive cultures are Amanat Al Asimah (995), Taizz (741) and Sana'a (367).

WHO continues to provide leadership and support for activities with health authorities and partners to respond to this ongoing cholera outbreak, including case management, surveillance and laboratory investigations, hotspot mapping and oral cholera vaccination campaign planning, water sanitation and hygiene (WaSH), and risk communication.
===================
[The numbers reported in this continuing catastrophe are difficult to wrap one's head around. Given the low case fatality rate reported, it is likely that many of the cases of diarrhoea are not cholera. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Mon 12 May 2019
Source: WHO/EMRO, Epidemic and Pandemic Prone Diseases, Outbreaks, Cholera [edited]

Outbreak update - Cholera in Yemen, 12 May 2019
-----------------------------------------------
The Ministry of Public Health and Population of Yemen reported 18,171 suspected cases of cholera with 13 associated deaths during epidemiological week 18 (29 Apr-5 May) of 2019. 15% of cases were severe. The cumulative total number of suspected cholera cases from 1 Jan 2018 to 28 Apr 2019 is 668 891 with 1081 associated deaths (CFR 0.16%). Children under 5 represent 22.7% of total suspected cases during 2019. The outbreak has affected 22 of 23 governorates and 294 of 333 districts in Yemen.

From week 8 [18-24 Feb] in 2019, the trend of weekly reported suspected cholera cases started increasing and reached a peak of more than 29 500 cases in week 14 [1-7 Apr 2019]. During weeks 15 to 18 [8 Apr-5 May 2019] new case numbers began to fall, although it is too early to conclude a downward trend. The decline may be attributed to enhanced efforts to control the outbreak such as enhancement in the community engagement and WaSH [water, sanitation, and hygiene] activities, and scaling up of response by WHO and partners, including establishing of additional DTCs [diarrhoea treatment centres] and ORCs [oral rehydration corners]. Another factor is the 1st round of the OCV [oral cholera vaccination] campaign which took place in April 2019 in 3 districts of Amanat Al Asimah governorate, reaching 1 088 101 people (88% of the target).

The governorates reporting the highest number of suspected cases of cholera during 2019 were Amanat Al Asimah (50 166), Sana'a (36 527), Al Hudaydah (30 925), Ibb (26 421), Dhamar (26 421), and Arman (25 244).

Of a total 5610 samples tested since January 2019, 2920 have been confirmed as cholera-positive by culture at the central public health laboratories. During this reporting period the governorates which reported the highest number of positive culture were Amanat Al Asimah (893), Taizz (704), and Sana'a (342).

WHO continues to provide leadership and support for activities with health authorities and partners to respond to this ongoing cholera outbreak, including case management, surveillance and laboratory investigations, hotspot mapping and OCV campaign planning, water, sanitation, and hygiene (WaSH) and risk communication.
========================
[The numbers reported in this continuing catastrophe are difficult to wrap one's head around. - ProMED Mod.LL]

[Maps of Yemen: <
Date: Fri, 19 Apr 2019 16:36:32 +0200

Khokha, Yemen, April 19, 2019 (AFP) - Oxfam has warned that war-torn Yemen risks a "massive resurgence" of cholera, with around 195,000 suspected cases of the disease recorded so far this year.   "Fears that the world's worst cholera outbreak could be set for a massive resurgence are growing," the relief organisation said Thursday.   It said aid agencies were struggling to reach suspected cases.

In a statement, Oxfam pointed to "fighting and restraints on access, including checkpoints and permit requirements imposed by the warring parties", and warned the coming rainy season was likely to accelerate the spread of the disease.   The water-borne bacterial infection has claimed more than 3,000 lives in Yemen since the outbreak began in 2016, according to Oxfam.

At a medical centre for the displaced in the government-held western town of Khokha, Qassem Suleiman had brought his son Alaa for tests after a serious case of diarrhoea.   Doctor Wadah al-Tiri told AFP that several patients had been transferred to Aden while others had been treated at the Khokha centre.   He said a tent was to be set up for suspected cases.

The doctor said Yemen badly needed international aid to combat the epidemic.   The UN's humanitarian coordination office OCHA said last month that children under the age of five make up nearly a third of this year's cases.   The spike, which comes two years after Yemen suffered its worst cholera outbreak, was concentrated in six governorates including in the Red Sea port of Hodeida and Sanaa province, both combat zones, it said.

Yemen's conflict, which pits Iran-linked rebels against a regional pro-government alliance led by Saudi Arabia, has left some 10,000 people dead since 2015 and pushed millions to the brink of famine.   Aid groups say the actual death toll could be five times as high.    The war has created the perfect environment for cholera to thrive, as civilians across the country lack access to clean water and health care.
Date: Fri 5 Apr 2019
Source: Associated Press [edited]

Cholera is surging once again in Yemen, with the UN reporting that the number of suspected cases has doubled in March 2019 over previous months and doctors in overwhelmed health facilities fearing it could rival a 2017 outbreak that spiraled into the world's worst flare-up. The surge underscores how Yemen, which has endured multiple outbreaks of cholera amid 4 years of civil war, still isn't able to stop its spread.

At al-Sabeen Hospital in the capital of Sanaa, beds are full and patients sleep in tents in a courtyard. Some of them wait for treatment by lying on cardboard under trees, with IVs dangling from the branches. "We receive cases around the clock. Sometimes 3 to 4 cases a minute," said Dr. Ismail al-Mansouri. "The hospital is under heavy pressure, as it receives patients from across the country." Even the doctors are not immune: al-Mansouri and several other staff have caught cholera. On 28 Mar 2019, one of their colleagues, a well-loved pediatrician, died of the disease.

Two other outbreaks since 2016 caused more than 1.4 million suspected cases and killed more than 3000 people. Most of those stemmed from an outbreak that began in April 2017 and grew into the world's biggest. The spread has slowed since late 2018, although it never stopped. Now, seasonal rains that began earlier than usual in 2019 have caused a spike in the disease.

There were 76,152 new suspected cases and 195 deaths in March 2019, compared with about 32,000 cases in February 2019 and 39 000 in January 2019. The March toll brought the number of those believed to have died from cholera this year [2019] to nearly 300. The rates in March 2019 are comparable with the 1st weeks of 2017, when cases jumped to 10 000 and 20 000 a week. It accelerated to 50 000 a week at its height and went on to infect more than 1 million people before waning in mid-2018. "The outbreak this year [2019] is much worse and the situation is very dangerous," said Adel al-Alamni, head of the cholera treatment center at al-Sabeen.

In a statement last week, the WHO said it was "doing everything possible to avoid the 2017 scenario." But it noted it faces restrictions on access and "bureaucratic hurdles" to bringing in supplies. Speaking to the Associated Press on Fri 5 Apr 2019, WHO spokesman Christian Lindmeier said rates of cholera fatality overall this year are still lower than in 2017, but the situation is exacerbated because of the early rains and because "infrastructure is more destroyed than it used to be."

Cholera is spread primarily by water and food tainted with faeces. It usually can be treated if caught early, but it can kill swiftly by dehydrating its victims through vomiting and severe diarrhea. The destruction wreaked by Yemen's civil war has created prime conditions for cholera's spread. The conflict is between Shiite rebels known as Houthis who control the northern part of the country and a Saudi-led coalition backing the internationally recognized government, based in the south.

Fighting and airstrikes have damaged sewage systems and water stations. Most people don't have access to clean water, particularly the more than 3 million driven from their homes by the war. The main water treatment facility outside Sanaa has broken down. Sewage water is often used to irrigate fields, potentially infecting food supplies, and it leaks into wells, the main source of water. Health services and trash collection have further broken down because about 1 million government employees have largely gone unpaid since the Central Bank was moved in 2016 from Houthi-controlled Sanaa to the southern city of Aden. Nearly half the prewar health facilities are no longer working, often because they were damaged by airstrikes.

The cholera adds to what is already the world's worst humanitarian crisis. Nearly two-thirds of Yemen's 23 million people are in need of some sort of aid and possibly tens of thousands have died of malnutrition, preventable diseases and epidemics. The surge in cholera has been centered in districts around Sanaa and other parts of the north. The relief agencies Doctors Without Borders and Save the Children warned last week of an "alarming spike" with 1000 children infected with suspected cholera every day.

Most of the patients at al-Sabeen Hospital are children under 10 years of age, al-Mansouri said. Among the most recent deaths were 2 pregnant women, along with their unborn babies. Among the dead was al-Mansouri's colleague who had treated children during the recent waves of cholera. His colleagues and family believe he was infected as he did his morning rounds, checking the dozens of patients in his care, before having breakfast at the hospital cafe. He died of kidney failure, a common complication from cholera.

Health workers dealing with cholera patients have not received vaccinations, al-Mansouri said, noting doctors are left without protection. Infection control in health facilities is almost nonexistent because of the lack of resources, making staff vulnerable, he said. Hardly anyone in Yemen has been vaccinated against cholera. UN officials have said agencies largely have been unable to bring in vaccines because of the difficulty in delivering them amid the conflict. The only vaccination campaign so far took place in a few districts in 2018 and covered 400,000 people.  [Byline: Ahmed Al-Haj]
========================
[The numbers reported in this continuing catastrophe are difficult to wrap one's head around. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Wednesday 27th March 2019
http://www.emro.who.int/yem/yemen-news/two-years-since-world-largest-outbreak-of-acute-watery-diarrhoea-and-cholera-yemen-witnessing-another-sharp-increase-in-reported-cases-with-number-of-deaths-continuing-to-increase.html

Two years since world-largest outbreak of acute watery diarrhoea and cholera, Yemen witnessing another sharp increase in reported cases with number of deaths continuing to increase
From Geert Cappelaere, UNICEF Regional Director in the Middle East and North Africa and Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean

MUSCAT / AMMAN / CAIRO, 26 March 2019 – “In Yemen, since the beginning of the year until 17 March, nearly 109 000 cases of severe acute watery diarrhoea and suspected cholera were reported with 190 total associated deaths since January. Nearly one third of the reported cases are children under the age of 5. This comes 2 years since Yemen witnessed the world-largest outbreak when more than 1 million cases were reported.

“We fear that the number of suspected cholera cases will continue to increase with the early arrival of the rainy season and as basic services, including lifesaving water systems and networks have collapsed. The situation is exacerbated by the poor status of sewage disposal systems, the use of contaminated water for agriculture, unreliable electricity to store food and families’ displacement as they flee escalating violence especially in Hudaydah and Tai’z.

“Our teams in Yemen are working day and night with a wide network of local partners to respond and stop the further spread and transmission of the diseases. Focusing on 147 priority districts, additional health, water, hygiene and sanitation supplies are being mobilized. Rapid response teams have been deployed. A total of 413 diarrhoea treatment centres and oral rehydration centres are operational in all 147 priority districts. Partners are repairing water and sanitation systems. In the past weeks, we scaled up chlorination activities to disinfect water in 95 priority districts and provided fuel and spare parts to keep going water supply and sanitation networks. A round of oral cholera vaccine campaign reached over 400 000 people in several districts. Meanwhile, community-based awareness raising reached 600 000 people in house-to-house campaigns since early 2019 to provide families with hygiene practices and improve reporting symptoms and seeking treatment.

“UNICEF and WHO are committed to continue scaling up the response to assist immediately the people affected and to prevent the disease from spreading further. We are doing everything possible to avoid the 2017 scenario including the timely use of proven effective measures, including oral cholera vaccination. However, we face several challenges, including the intensification of fighting, access restrictions and bureaucratic hurdles to bring lifesaving supplies and personnel to Yemen.

“UNICEF and WHO are calling to lift all restrictions on our humanitarian operations to respond to the spread of the disease and other areas. Our humanitarian teams must have full access to reach every child, every woman, every man in need of medical and other humanitarian assistance.

“Above all, we jointly reiterate the calls for the fighting to end. It is time for the 4-year long war to come to an end. If not, Yemen will continue to be trapped in a web of diseases, malice and sink deeper in endless humanitarian disasters, with the most vulnerable paying the highest price.

For further information, please contact:

Inas Hamam
Mobile: +2 01000 157 385
E-mail: hamami@who.int

Tarik Jašarević
Mobile: +41 793 676 214
E-mail:  jasarevict@who.int
More ...

Pakistan

Pakistan - US Consular Information Sheet
October 02, 2008
COUNTRY DESCRIPTION:
Pakistan is a parliamentary federal republic in South Asia, with a population of nearly 170 million people. Following successful elections in February 2008, Pak
stan has a coalition government led by Prime Minister Yousef Gilani. Pakistan is a developing country, with some tourist facilities in major cities but limited in outlying areas. The infrastructure of areas of Kashmir and the Northwest Frontier Province was devastated as a result of the October 8, 2005 earthquake and is not yet recovered. Read the Department of State Background Notes on Pakistan for additional information.

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ENTRY/EXIT REQUIREMENTS: All U.S. citizens traveling to Pakistan for any purpose are required to have valid U.S. passports and Pakistani-issued visas. Further information on entry requirements can be obtained from the Embassy of Pakistan at 3517 International Court Avenue NW, Washington, DC 20008; telephone: 202-243-6500; e-mail: info@pakistan-embassy.org; web site: http://www.pakistan-embassy.org/.

Travelers may also contact one of the Consulates General of Pakistan in:
Boston: 20 Chestnut Street, Needham, MA 02492; telephone: (781) 455-8000; fax: (617) 266-6666; email: pakistan@tiac.net
Chicago: 333 North Michigan Ave., Suite 728, Chicago, IL, 60601; telephone: (312) 781-1831; fax: (312) 781-1839; email: parepchicago@yahoo.com
Houston: 11850 Jones Road, Houston, TX, 77070; telephone: (281) 890-2223; fax: (281) 890-1433; email: parephouston@sbcglobal.net
Los Angeles: 10850 Wilshire Blvd., Suite 1100, Los Angeles, CA 90024; telephone: (310) 441-5114; fax: (310) 441-9256; email: info@pakconsulatela.org
New York: 12 East 65th St., New York, NY 10021; telephone: (212) 879-5800; fax: (212) 517-6987; web site: www.pakistanconsulateny.org
If a traveler plans to stay longer than the time listed on the visa, he or she must extend the stay with the local passport office of the Ministry of Interior. Visit the Embassy of Pakistan web site at http://www.pakistan-embassy.org/ 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:
A number of extremist groups within Pakistan continue to target American and other Western interests and high-level Pakistani government officials. Terrorists and their sympathizers have demonstrated willingness and capability to attack targets where Americans are known to congregate or visit. Terrorist actions may include, but are not limited to, suicide operations, bombing -- including vehicle-borne explosives and improvised explosive devices -- assassinations, carjacking, assault or kidnapping. U.S. Government personnel are not permitted to stay at or frequent major hotels in Islamabad, Karachi, Lahore and Peshawar.

Government personnel have also been advised to restrict the number and frequency of trips to public markets, and to avoid public restaurants in Islamabad, Karachi, and Peshawar.

In September 2008, over fifty people, including three Americans, were killed and hundreds were injured when a suicide bomber set off a truck filled with explosives outside a major international hotel in Islamabad. In August 2008 gunmen stopped and shot at the vehicle of an American diplomat in Peshawar. In March 2008, a restaurant frequented by westerners in Islamabad was bombed, killing one patron and seriously injuring several others, including four American diplomats. On March 2, 2006, an American diplomat, his locally employed driver, and three others were killed when a suicide bomber detonated a car packed with explosives in front of the U.S. Consulate General in Karachi. Fifty-two others were wounded in the attack.

Sectarian and extremist violence has resulted in fatal bomb attacks in Islamabad, Rawalpindi, Karachi, Peshawar, Quetta, Lahore, and other Pakistani cities since 2006. Since 2007, over 1,000 bombings have killed more than 1,000 people throughout Pakistan and injured many more. Rallies, demonstrations, and processions occur from time to time throughout Pakistan on very short notice and have often taken on an anti-American or anti-Western character. Because of the possibility of violence, Americans are urged to avoid all public places of worship and areas where Westerners are known to congregate.

During the Islamic (Shi’a) religious observance of Moharram, rivalries and hostilities often increase.

In 2007 and 2008, several American citizens throughout Pakistan were kidnapped for ransom or for personal reasons. Kidnappings for ransom are particularly common in some parts of Pakistan, such as the Northwest Frontier Province and Sindh Province.

It is best to avoid public transportation. For security reasons, U.S. Mission personnel are prohibited from using taxis or buses. (See the Traffic Safety and Road Conditions section below.)

Women are advised to dress conservatively, with arms and legs covered, and avoid walking around alone. It is unwise for anyone to travel on the streets late at night. Visitors to Pakistan should attempt to maintain a low profile, blend in, be aware of their surroundings, and seek security with their family or sponsoring organization.

Northern Areas – While we continue to discourage non-essential travel to Pakistan, we advise Americans wishing to trek in Gilgit, Hunza or Chitral to use only licensed guides and tourist agencies. While overall crime is low, there have been occasional assaults on foreign visitors.

Northwest Frontier Province - The Federally Administered Tribal Areas (FATA) along the Afghan border, and certain areas within the Northwest Frontier Province (NWFP), are designated as tribal areas and are not subject to normal government jurisdiction. The Government of Pakistan requires all citizens of countries other than Pakistan and Afghanistan to obtain permission from the Home and Tribal Affairs Department prior to visiting these locations. The permit may stipulate that an armed escort must accompany the visitor. Even in the settled areas of the NWFP there is occasional ethnic, sectarian, and political violence. There have been dozens of bombings in Peshawar of varying sophistication since September 2006. Members of the Taliban and Al-Qaida are known to be in the FATA, and may also be in the settled areas.

Kashmir - While direct military hostilities between India and Pakistan across the Line of Control (LOC) are infrequent, militant groups engaged in a long-running insurgency on the Indian side of the LOC are reported to have bases and supporters operating from the Pakistani side. Most of these groups are anti-American, and some have attacked Americans and other Westerners. The Government of Pakistan restricts access to many parts of this region and requires that visitors obtain a permit from the Ministry of Interior before traveling.

Punjab Province - Violence has increased in Punjab Province. Since September 2007, several suicide operations have taken place, including attacks in Rawalpindi and Lahore. As a precaution against these possible dangers, U.S. citizens are cautioned to avoid public transportation and crowded areas. The Wagah border crossing into India near Lahore remains open daily (from 9:30 a.m. to 3:30 p.m.) for travel to and from India if the passport holder has a valid visa for both countries. Visitors are advised to confirm the current status of the border crossing prior to commencing travel.

Sindh Province - In Karachi and Hyderabad, there has been recurring violence characterized by bombings, violent demonstrations and shootings. An October 2007 suicide attack on former Prime Minister Benazir Bhutto killed more than 130 and injured approximately 375 people in Karachi. In the aftermath of her December 2007 death, rioting in Karachi led to multiple deaths and injuries, as well as widespread property damage. In May 2008, clashing groups of lawyers burned buildings and vehicles in several areas of the city, resulting in at least 11 fatalities. Americans and other westerners continue to be a particular target of hostility and occasional anti-Western mob violence. The Consulate General in particular has been the target of several major terrorist attacks or plots in recent years, including the deadly March 2006 suicide attack described above. Non-essential travel to these cities is strongly discouraged. In rural Sindh Province, the security situation is hazardous, especially for those engaged in overland travel. The Government of Pakistan recommends that travelers limit their movements in Sindh Province.

Balochistan Province - The Province of Balochistan, which borders both Iran and Afghanistan, is notorious for narcotics and other forms of cross-border smuggling. Members of the Taliban and Al-Qaida are also believed to be present there. Tribal unrest sometimes turns violent. Because provincial police presence is limited, travelers wishing to visit the interior of Balochistan should consult with the province’s Home Secretary. Advance permission from provincial authorities is required for travel into many areas. Local authorities have detained travelers who lacked proper permission. Quetta, the provincial capital, has experienced an increase in bombings, occasional gun battles in the streets, and the imposition of curfews. Terrorist attacks against Pakistani government installations and infrastructure have been reported throughout 2005 and 2006.

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 Pakistan, 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: Crime is a serious concern for foreigners throughout Pakistan. Carjacking, armed robberies, house invasions, and other violent crimes occur in many major urban areas. Petty crime, especially theft of personal property, is common. American travelers to Pakistan are strongly advised to avoid traveling by taxi and other forms of public transportation, and have members of their host organizations or families meet them at the airport.

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 http://www.cybercrime.gov/18usc2320.htm
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.

The local equivalent to the “911” emergency line in Pakistan is: 15
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Adequate basic non-emergency medical care is available in major Pakistani cities, but is limited in rural areas. Facilities in the cities vary in level and range of services, resources, and cleanliness, and Americans may find them below U.S. standards; facilities in rural areas are consistently below U.S. standards. Medical facilities require prepayment and do not accept credit cards.

Water is not potable anywhere in Pakistan and sanitation in many restaurants is inadequate. Stomach illnesses are common.

Effective emergency response to personal injury and illness is virtually non-existent in Pakistan. Ambulances are few and are not necessarily staffed by medical personnel. Any emergency case should be transported immediately to a recommended emergency receiving room. Many American-brand medications are not widely available, but generic brands from well-known pharmaceuticals usually are. The quality of the locally-produced medications is uneven.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Pakistan.
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.

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 noted above, emergency medical care in Pakistan is very limited. Medical evacuations from Pakistan may cost in excess of $45,000 for uninsured travelers requiring emergency assistance. 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 Pakistan is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic in Pakistan moves on the left, opposite of U.S. traffic. In addition to this source of potential confusion, travel by road in Pakistan has a variety of other risks. Roads are crowded, drivers are often aggressive and poorly trained, and many vehicles, particularly large trucks and buses, are badly maintained. Donkeys, cattle, horse carts, and even the occasional camel can pose roadside hazards in some areas. Roads, including most major highways, also suffer from poor maintenance and often have numerous potholes, sharp drop-offs and barriers that are not sign-posted. Drivers should exercise extreme caution when traveling at night by road, as many vehicles do not have proper illumination or dimmers nor are most roads properly illuminated or signed. Driving without experienced local drivers or guides is not recommended.

It is best to avoid public transportation. For security reasons, U.S. Mission personnel are prohibited from using taxis or buses. (See Safety and Security section above.)

Please refer to our Road Safety page for more information. Visit the website of Pakistan’s national tourist office at http://www.tourism.gov.pk/ and the national authority responsible for road safety at http://www.nha.gov.pk/.

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

SPECIAL CIRCUMSTANCES:
Pakistan is largely a cash economy. Personal checks are not commonly accepted. Most Pakistanis do not use checking accounts for routine transactions. Outside major cities, even credit cards and travelers’ checks are generally not accepted, and there have been numerous reports of credit card fraud. There are bank branches as well as registered moneychangers in all international airports. ATMs can also be found in major airports. English is widely spoken by professional-level airport staff.

Please see 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 Pakistani laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Pakistan 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: 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 Pakistan 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 Pakistan. 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 in Islamabad is located at Diplomatic Enclave, Ramna 5; telephone: (92-51) 208-0000; Consular Section telephone: (92-51) 208-2700; fax: (92-51) 282-2632; website: http://islamabad.usembassy.gov/
The U.S. Consulate General in Karachi, located at 8 Abdullah Haroon Road, closed its public operations indefinitely due to security concerns. U.S. citizens requiring emergency assistance should call the Consular Section in Karachi; telephone: (92-21) 520-4200; fax: (92-21) 568-0496; web site: http://karachi.usconsulate.gov/
The U.S. Consulate in Lahore is located on 50 Sharah-E-Abdul Hamid Bin Badees (Old Empress Road), near Shimla Hill Rotary; telephone: (92-42) 603-4000; fax: (92-42) 603-4200; web site: http://lahore.usconsulate.gov/; email: amconsul@brain.net.pk
The U.S. Consulate in Peshawar is located at 11 Hospital Road, Cantonment, Peshawar; telephone: (92-91) 526-8800; fax: (92-91) 528-4171; web site: http://peshawar.usconsulate.gov/
* * *
This replaces the Country Specific Information dated August 7, 2008 to update the section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Thu 13 Jun 2019
Source: Ary News [edited]

Another polio case on [Thu 13 Jun 2019] surfaced in Shangla, a district of Khyber Pakhtunkhwa, ARY News reported.

Sources in Health Ministry said that poliovirus had been confirmed in a 2-year-old boy in Shangla area of KP, bringing the total number of polio cases in the country to [23] this year [2019]. Sources further added that samples of the child were sent for tests on [30 May 2019].

It is worth to note here that Poliovirus is creating havoc in Pakistan and Afghanistan. The virus has been eliminated from the rest of the countries of the world.

With another polio case, the total number for the current year cases has jumped to 23 in Pakistan, out of which, 10 cases were reported in KP, 7 in tribal districts and 3 each in Sindh and Punjab provinces.

The extensive environmental surveillance established by the Pakistan Polio Eradication Programme in previous months detected the polio virus in sewage of 12 cities. According to result shared by the National Emergency Operations Centre (NEOC), the presence of virus was confirmed in sewage samples collected in March 2019 from cities of Peshawar, Lahore, Karachi, Rawalpindi, Mardan, Bannu, Waziristan, Hyderabad, Kambar and Sukkur.
========================
[Confirmed cases reported from Pakistan continue to climb. As mentioned in the above media report (and confirmed on the End Polio Pakistan website: <http://www.endpolio.com.pk/polioin-pakistan/polio-cases-district-wise-2019>), with the addition of this newly confirmed case, there have been 23 cased of paralytic disease associated with WPV1 infection in Pakistan this year (2019), and global total of 31 (including the 8 confirmed cases in Afghanistan).

As cases have been reported since April [2019] when there was a major campaign, it is likely the pockets of vaccine refusals persist.

Shangla is located in northern KP province, sharing a western border with Swat district, a southern border with Buner district, a northern border with Kohistan district and an eastern border with Batagram and Tor Ghar districts (see <https://reliefweb.int/sites/reliefweb.int/files/resources/pak215_pakistan_districts_v5_a0_20181203.pdf>).

The HealthMap/ProMED map of Pakistan:
Date: Mon, 3 Jun 2019 10:02:02 +0200

Islamabad, June 3, 2019 (AFP) - British Airways landed back in Pakistan Monday, in a major vote of confidence from a Western airline after suspending operations due to security fears over a decade ago.   The British carrier -- which halted services in 2008 following the deadly Marriott Hotel bombing in Islamabad -- is running three weekly flights from London's Heathrow airport to Pakistan's capital, Islamabad.

Britain is home to more than a million people of Pakistani origin, making it the largest Pakistani diaspora community in Europe.   "Britain's flag carrier is back. The two countries, so close in so many ways, take a step closer," British High Commissioner to Pakistan, Thomas Drew, said in a statement.     "It is of course tribute to the great improvements in the security situation in Pakistan in recent years."   BA had six weekly flights to Islamabad before the Marriott attack, which killed more than 50 people and triggered a major drawdown by embassies and international agencies over safety concerns.

Struggling Pakistan International Airlines had until Monday been the only carrier with direct flights between the two countries.   Since the Marriott attack, the country has been largely dependent on Middle Eastern airlines such as Emirates and Etihad, with most international flights routed through the Gulf.   "Usually I take the connecting flights so this was a very refreshing experience and looking forward to going back as well," Sana Khan, a doctor based Britain, told AFP after touching down in Islamabad.

Hong Kong-based Cathay Pacific was one of the last major international carriers to cease operations in Pakistan after dozens were killed during a 2014 siege at Karachi airport by Taliban militants.   Pakistan has battled homegrown militancy for nearly 15 years, with tens of thousands of people killed.   But the country has seen a dramatic turnaround recently, with security largely stabilised following several military offensives along the Afghan border and crackdowns on insurgents in urban centres.

Many Western countries continue to have travel advisories in place to warn their citizens of the potential for kidnapping and bomb attacks, especially in areas near the Afghan border.  British Airways's return also comes as Pakistan continues to restrict large swathes of its eastern airspace following a confrontation with India in February, effectively closing off major international flight routes in and out of Islamabad and Lahore headed east while also disrupting Indian flights.   A Pakistani security official said the restrictions would continue until at least June 15.
Date: Thu 30 May 2019 Source: UrduPoint [edited] <https://www.urdupoint.com/en/pakistan/new-polio-case-reported-from-bannu-figure-re-634345.html>
The National Institute of Health [NIH] on Thursday [30 May 2019] confirmed polio virus present in a 1.5 year old child in the Bizan Khel area of Bannu district, taking the [number] of polio cases to 14 in Khyber Pakhtunkhwa and 20 across the country. According to the health official, [the father] brought his child to the hospital, where his test was sent to NIH for laboratory testing and was found positive.
The uncle of the affected child said that his nephew didn't get vaccinated against the crippling disease until [this] date.
The health official said that during the year 2019, it was the 14th case reported from KP province, while as many as 20 cases were reported from across the country during the 1st 5 months of the year [2019].  [byline: Zeeshan Aziz] =======================
[The addition of this case represents the 20th case of WPV1 reported by Pakistan this year (2019) and, combined with the case reported by Afghanistan (see above report), the 28th case of WPV1-associated paralysis reported with a date of onset since 1 Jan 2019.
A map showing the districts and provinces of Pakistan can be found at <http://lh3.ggpht.com/_s-MnWDlTdQw/SpEcAeGQa7I/AAAAAAAAA8I/_2CYyw4EG_g/s1600-h/image7.png>.
Bannu district borders with North Waziristan to the northwest, Karak to the northeast, Lakki Marwat to the southeast, and South Waziristan to the southwest. (<https://en.wikipedia.org/wiki/Bannu_District>. - ProMED Mod.MPP]
Date: Sun, 26 May 2019 15:44:20 +0200
By Nasir JAFFRY

Islamabad, May 26, 2019 (AFP) - Pakistan said on Sunday over 600 people, most of them children, had tested HIV positive in a city in the southern Sindh province.   Concern grew after hundreds of people were allegedly infected by a doctor using a contaminated syringe in Rato Dero city and surrounding villages of Larkana district.    "Some 681 people, of which 537 were children from two to 12 years of age, had been tested positive for HIV until yesterday in Rato Dero," special health advisor Zafar Mirza told a press conference in Islamabad.

He said 21,375 people had been screened in Rato Dero, adding that the increase in the number of patients testing positive for HIV was "a matter of grave concern" for the government.   One cause being investigated by Pakistani authorities is the use of "unsafe syringes" on patients.   Mirza said: "Initial investigations reveal that used syringes are being re-packed, which may not only grow significantly the number of HIV cases but also other diseases."   The federal government is providing 50,000 HIV screening kits to Sindh.

- 'Drastic measures' -
Provincial health officials have also noted that patients are at particular risk of contracting diseases or viruses at these clinics, where injections are often pushed as a primary treatment option.   "The government will get to the bottom of the outbreak and fully assist the provincial government to provide treatment to all patients," Mirza said, adding that a team of experts from the World Health Organization was also scheduled to arrive soon to assist Pakistani authorities in ascertaining the cause of the HIV virus in the area.   "Prime Minister Imran Khan is going to unveil drastic measures to prevent the disease once we ascertain the cause of the spread of disease," he said. 

Parents in the area fear their children's futures have been irreparably harmed after contracting HIV, especially in a country whose masses of rural poor have little understanding of the disease or access to treatment.   Nisar Ahmed, the father of one of the affected baby girls aged just one, told AFP: "We are told to go to Larkana for medicine. I curse the doctor who has spread this disease to every child.   "Four of the children of my village have already been diagnosed HIV positive."   Pakistan was long considered a low prevalence country for HIV, but the disease is expanding at an alarming rate, particularly among intravenous drug users and sex workers.

With about 20,000 new HIV infections reported in 2017 alone, Pakistan currently has the second fastest growing HIV rates across Asia, according to the UN.   "According to some government reports, around 600,000 quack doctors are operating across the country and around 270,000 are practising in the province of Sindh," according to UNAIDS.   Pakistan's surging population also suffers the additional burden of having insufficient access to quality healthcare following decades of under-investment by the state, leaving impoverished, rural communities especially vulnerable to unqualified medical practitioners.
Date: Fri 24 May 2019
Source: New York Times [edited]

Paralysis cases spiked after a vaccination drive was derailed by false rumors that dozens of children had collapsed and died.  After serious setbacks in April [2019] led to a cluster of new polio cases, Pakistan is revamping its vaccination strategy in a renewed effort to wipe out the virus. The country is one of just 3 -- along with Afghanistan and perhaps Nigeria -- in which polio is still endemic. Eradication of the virus in Pakistan is crucial to the drive to rid the world of polio, once and for all.

Now, vaccination teams will take a friendlier approach, ask fewer questions, make fewer follow-up visits, and stop recording extensive details about the families they visit, Pakistan's polio eradication program announced. Families were intimidated by the questions, and vaccinators spent too much time filling out the registration forms introduced in 2016, said Babar Atta, the polio coordinator in the prime minister's office, according to local media.

A new vaccination drive is scheduled for the 2nd week of June [2019]; thousands of teams will spread out around the country trying to reach almost 40 million children under age 10. Many vaccinators will go house to house, while others will look for families with young children in refugee camps, in train and bus stations, and at highway checkpoints.

Pakistan has had 17 [now 19 reported] cases of polio paralysis this year [2019]; it had only 3 by this date last year [2018] and only 12 in all of 2018.

In mid-April [2019], widespread panic among parents in Peshawar and the surrounding northern tribal areas forced the suspension of a national immunization drive. A scaremongering video had spread on Twitter, purporting to show students collapsing after getting an expired batch of vaccine. The video seemed obviously fake. The boys in it flop prone across a hospital bed on cue after the speaker waves his hand; one even makes a funny face on camera. Also, expired vaccine -- if it was expired -- is harmless.

Nonetheless, "our TV channels found it profitable to cover this nonsense," Aziz Memon, a textile executive who leads Rotary International's involvement in Pakistan's anti-polio campaign, said in an interview in New York. "It became a national event."

Rumors spread that 50 children had died; mosques used their loudspeakers to tell parents to rush their children to medical care. Hospitals were swamped as more than 25 000 children arrived.

"No one had died," Mr. Memon said. "But we had to call everything off."

Local politics were behind the scare, he said. District elections were underway, and the conservative Jamaat-e-Islami party was trying to discredit the polio campaign, which is supported by Prime Minister Imran Khan's Tehreek-e-Insaf party. The man speaking in the video was arrested.

To restore confidence, Mr. Memon added, the district health and communications ministers appeared on television, giving vaccine drops to their own children.

Because suspicion of the campaign remains high in some areas -- vaccinators have been accused of marking targets for American drones -- interactions with families will now be briefer and less intrusive. Residents will be asked only how many children are in the household and whether they have been vaccinated.

In Pakistan, extended families often live in large compounds; previously, they were asked about all couples inside, whether they were married, how many children each couple had, and who was pregnant. Sometimes the police arrested families who refused vaccinations.

"That was not helpful," Mr. Memon said. "If you drag people to the police station, they feel insulted. Now, we will have a friendly chat. You don't have to challenge the refusers; you give them a pep talk and encourage the religious leaders to persuade them."

In early April [2019], a campaign worker trying to persuade a family to vaccinate was shot dead, apparently by an 18-year-old family member who then fled to nearby Afghanistan. As compensation, Rotary International gave the family of the campaign worker, Wajid Ali, 32 [years old], about USD 3300 [about PKR 500 000], and the local government promised his brother a job.

In an encouraging sign, Mr. Memon said, the polio virus is no longer found in sewage samples in Karachi, Pakistan's biggest city, so transmission there may have been halted.

Polio transmission has never been interrupted in Pakistan and Afghanistan; most of the cases are in the mountainous districts along the border, where government control is weak.

Nigeria has not had a confirmed polio paralysis case since 2016, but it takes at least 3 years without confirmed cases despite vigorous surveillance before a country is declared polio free [see comment below].  [Byline: Donald G. McNeil Jr.]
More ...

Djibouti

Djibouti - US Consular Information Sheet
May 30, 2006

COUNTRY DESCRIPTION: Djibouti is a developing African country located on the Gulf of Aden. It is a multi-party democracy with a legal system based on French civil law (Djibouti was a Fr
nch colony until 1977), though modified by traditional practices and Islamic (Sharia) law. Although exact statistics are unavailable, unemployment is estimated in excess of 50% of the working-age population. About two-thirds of the country's 650,000 residents live in the capital, also called Djibouti. Modern tourist facilities and communications links are limited in the city of Djibouti and are virtually non-existent outside the capital. Read the Department of State Background Notes on Djibouti for additional information.

ENTRY/EXIT REQUIREMENTS: A passport, visa, and evidence of yellow fever vaccination are required. Travelers may obtain the latest information on entry requirements from the Embassy of the Republic of Djibouti, 1156 15th Street, N.W., Washington, D.C. 20005, telephone (202) 331-0270, or at the Djibouti Mission to the United Nations, 866 United Nations Plaza, Suite 4011, New York, N.Y. 10017, telephone (212) 753-3163. Overseas, inquiries may be made at the nearest Djiboutian embassy or consulate. In countries where there is no Djiboutian diplomatic representation, travelers may sometimes obtain visas at the French Embassy. See our Foreign Entry Requirements brochure for more information on Djibouti and other countries. Visit the Embassy of Djibouti web site at www.embassy.org/embassies/dj.html for the most current visa information.
American journalists or any American connected with the media must contact the U.S. Embassy's Public Affairs section prior to travel to facilitate entry into Djibouti. If you are unclear whether this applies to you, please contact the U.S. Embassy for more information.

See Entry and Exit Requirements for more information pertaining to dual nationality and the prevention of international child abduction . Please refer to our Customs Information to learn more about customs regulations

SAFETY AND SECURITY: Djibouti enjoys a stable political climate. However, its international borders are porous and lightly patrolled. In particular, Somalia, Djibouti's neighbor to the south, is considered by many to be a haven for terrorists and other insurgent elements. In addition, tensions exist between neighboring Ethiopia and Eritrea due to the unsettled nature of their long-running border dispute. Civil unrest or armed conflict in neighboring countries could disrupt air travel to and from Djibouti or otherwise negatively affect its security situation.
Terrorism continues to pose a threat in East Africa. U.S. citizens should be aware of the potential for indiscriminate attacks on civilian targets in public places, including tourist sites and other sites where Westerners are known to congregate.
Travelers should exercise caution when traveling to any remote area of the country, including the borders with Eritrea, Ethiopia, and Somalia. Djiboutian security forces do not have a widespread presence in those regions. In recent years, acts of sabotage have occurred along the Djibouti-Ethiopia railway. Although Americans were not specifically targeted in any of these attacks, U.S. citizens should exercise caution.
Demonstrations have become more frequent due to the recent increase in energy prices. Americans are advised to avoid all demonstrations as they may become violent.
Americans considering seaborne travel around Djibouti's coastal waters should exercise extreme caution, as there have been several recent incidents of armed attacks and robberies at sea by unknown groups. These groups are considered armed and dangerous. When transiting in and around the Horn of Africa and/or the Red Sea near Yemen, it is strongly recommended that vessels convoy in groups and maintain good communications contact at all times. Marine channels 13 and 16 VHF-FM are international call-up and emergency channels and are commonly monitored by ships at sea. 2182 Mhz is the HF international call-up and emergency channel. In the Gulf of Aden, transit routes farther offshore reduce, but do not eliminate, the risk of contact with suspected assailants. Wherever possible, travel in trafficked sea-lanes. Avoid loitering in or transiting isolated or remote areas. In the event of an attack, consider activating the Emergency Position Indicating Radio Beacons. Due to distances involved, there may be a considerable delay before assistance arrives. Vessels may also contact the Yemeni Coast Guard 24-hour Operations Center at 967 1 562-402. Operations Center staff members speak English.
U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times for readily available proof of identity and U.S. citizenship if questioned by local officials. Police occasionally stop travelers on the main roads leading out of the capital to check identity documents.

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., 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: Accurate crime statistics are not available, but crime appears to be on the rise. Petty thefts and pickpockets are common, and a few home invasions have been reported. Major crimes involving foreigners are rare, but are increasing in frequency. In the past year the number of murders has increased in Djibouti, involving mainly Djiboutian and third country nationals (TCNs). This increase in crime is possibly linked to declining economic conditions and a deepening resentment toward the increasing number of TCN workers brought in to assist with major construction projects in Djibouti.

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: Adequate medical facilities in the capital of Djibouti are limited and medicines are often unavailable. Medicines that are available are extremely expensive. Medical services in some outlying areas may be completely nonexistent. Motorists especially should be aware that in case of an accident outside the capital, emergency medical treatment would depend almost exclusively on passersby. In addition, cell phone coverage in outlying areas is often unavailable, making it impossible to summon help.
Malaria and dengue fever are prevalent in Djibouti. Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what anti-malarial drugs they have been taking.

In 2005, polio was found in all of Djibouti's neighbors (Somalia, Ethiopia, Eritrea and Yemen) and health professionals strongly suspect it is present in Djibouti. The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV) at 2, 4, and 6-18 months and 4-6 years of age. Adults who are traveling to polio-endemic and epidemic areas and who have received a primary series with either IPV or oral polio vaccine should receive another dose of IPV. For adults, available data does not indicate the need for more than a single lifetime booster dose with IPV.

In May 2006, avian influenza was confirmed in three chickens and one human in Djibouti. For more information about this illness, see the Department of State's Avian Flu Fact Sheet .

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 . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .

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 Djibouti is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

The Djiboutian Ministry of Defense and the national police force share responsibility for road safety in Djibouti. While Djibouti has been declared a "mine-safe" country, this indicates landmines have been identified and marked, not that they have been removed. Landmines are known to be present in the northern districts of Tadjoureh and Obock. In addition, there may be mines in the Ali Sabieh district in the south. Travelers should stay on paved roads and should check with local authorities before using unpaved roads.
The two main international routes to the capital city via Dire Dawa, Ethiopia, and Yoboki, Djibouti, are both in poor condition due to heavy truck traffic, whose presence demands that drivers remain vigilant. Major roads outside the capital are paved but lack guardrails. Railroad crossings are often not clearly marked.
Roads are often narrow, poorly maintained, and poorly lit. Drivers and pedestrians should exercise extreme caution. Excessive speed, unpredictable local driving habits, pedestrians and livestock in the roadway, and the lack of basic safety equipment on many vehicles are daily hazards. Speed limits are posted occasionally but are not enforced. The leafy narcotic khat is widely used, particularly in the afternoons, creating another traffic hazard. Travelers should be aware that police set up wire coils as roadblocks on some of the major roads, and these may be difficult to see at night.
The only means of public inter-city travel is by bus. Buses are poorly maintained and their operators often drive erratically with little regard for passenger safety.
Please refer to our Road Safety page for more information. Visit the web site of Djibouti's national tourist office and national authority responsible for road safety at .

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Djibouti, the U.S. Federal Aviation Administration (FAA) has not assessed Djibouti's Civil Aviation Authority for compliance with ICAO international aviation safety standards. For more information, travelers may visit the FAA's Internet website at .

SPECIAL CIRCUMSTANCES: Although the narcotic khat is legal and widely chewed in Djibouti, it is considered an illegal substance in many countries, including the United States.
Djiboutians are generally conservative in dress and manner, especially in rural areas.
Photography of public infrastructure (including, but not limited to, public buildings, seaports, the airport, bridges, military facilities or personnel) is not allowed in Djibouti. Use extreme caution when photographing anyone or anything near prohibited areas. Photographic equipment will be confiscated, and the photographer may be arrested.
Djibouti is a cash-based economy and credit cards are not widely accepted. Reliable automated teller machines (ATMs) are not available. Changing money on the street is legal, but be aware of possible scams as well as personal safety considerations if people observe you carrying large amounts of cash. The exchange rate on the street will be similar to that at a bank or hotel. It is important that the U.S. banknotes that you carry have a date of 2003 or newer because some currency exchanges will not accept U.S. paper money older than 2003.

Djiboutian customs authorities may enforce strict regulations concerning temporary importation into or export from Djibouti of firearms. It is advisable to contact the Embassy of Djibouti in Washington, D.C., for specific information regarding customs requirements.

Please see our information on 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 Djiboutian law, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Djibouti 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: 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 Djibouti are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website and to obtain updated information on travel and security within Djibouti. Americans withoutInternet 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 Plateau du Serpent, Boulevard Marechal Joffre, Djibouti City. The mailing address is Ambassade Americaine, B.P. 185, Djibouti, Republique de Djibouti. The telephone number is (253) 35-39-95. The fax number is (253) 35-39-40. Normal working hours are Sunday through Thursday, 7:30 a.m. to 4:00 p.m.
* * *
This replaces the Consular Information Sheet dated November 2, 2005, to update sections on Safety and Security, Crime, Medical Facilities and Health Information, Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 26 Feb 2018 08:27:14 +0100

Djibouti, Feb 26, 2018 (AFP) - President Ismael Omar Guelleh's ruling party claimed a resounding victory in Friday's parliamentary elections in Djibouti, taking nearly 90 percent of seats after the opposition largely boycotted the poll.   Mohamed Abdallah Mahyoub, a senior member of Guelleh's UMP party and campaign spokesman, told AFP late Sunday the party had won 58 out of 65 parliamentary seats, an increase of three since the last vote in 2013.   There was no immediate figure for turnout among the tiny Horn of Africa nation's 194,000 registered voters.   Guelleh has ruled Djibouti since 1999 and was last re-elected in 2016 with 87 percent of the vote.

The UMP's victory has helped by the badly-divided opposition with two parties -- MRD and RADDE and a faction of a third party, ARD -- refusing to put forward any candidates, saying the elections would neither be fair nor transparent while others accused the election commission of bias.   The UMP claimed every seat outside of the capital and all but seven seats in Djibouti city with the remainder going to the UDJ party.   The law stipulates that 25 percent of seats must go to women, an increase from just 10 percent in the outgoing parliament. According to Mahyoub, this threshold was nearly met as 15 women won parliamentary seats, 14 of them from the UMP.
Date: Thu, 12 Jun 2014 16:56:37 +0200 (METDST)

GENEVA, June 12, 2014 (AFP) - Nearly a quarter of the population in drought-hit Djibouti is in desperate need of aid, with malnutrition and a dramatic lack of water causing a mass exodus from rural areas, the UN said on Thursday.   "Persistent and recurring droughts have resulted in a general lack of water for both people and livestock," said the UN's Djibouti coordinator Robert Watkins.   The crisis, which has dragged on since 2010, has left a full 190,000 of the country's 850,000 residents in need of humanitarian assistance.   They include 27,500 refugees, mainly from neighbouring Somalia, Watkins told reporters in Geneva.

Yet the crisis in Djibouti has received little international attention, with a UN appeal for aid last year reaching only a third of its target -- the lowest level of funding for any such appeal worldwide.   The appeal comes amid warnings from Britain on Thursday that Somalia's Al-Qaeda-linked Shebab insurgents were planning further attacks in the tiny and traditionally tranquil Horn of Africa country.   Shebab suicide bombers hit a crowded restaurant in Djibouti last month, killing at least one, in an attack apparently linked to the country's participation in the African Union force in Somalia.   Djibouti's port also serves as a key base for international anti-piracy operations off the Somali coast.

Watkins also said on Thursday that some 60,000 migrants -- most of them Ethiopians trying to reach the Gulf for work -- were also in need of aid inside Djibouti.   Last year alone, 100,000 passed through the country, he said. Most migrants come on foot, staggering alongside the roads in the extreme heat.   "Many die from dehydration," he said.   Foreigners are not the only ones on the move in the country, where most people still live off livestock which have been hard-hit by the drought.   "There has been a huge exodus of people living in rural areas," Watkins said, adding that the population in the capital Djibouti City had more than doubled since 2010, now home to 85 percent of the population.

Nationwide, a full 18 percent of the population is considered acutely malnourished, rising to 26 percent in some areas -- well above the 15-percent emergency threshold, Watkins said.   Sixty percent of the country's population was also suffering from diarrhoeal diseases, he said.   Watkins said he hoped the lack of interest from funders would change, pointing out that a new appeal last month for $74 million (55 million euros) was already 13 percent funded, with contributions from the United States, the EU and Japan among others.
Date: Mon, 26 Nov 2012 18:20:54 +0100 (MET)

RIYADH, Nov 26, 2012 (AFP) - The United Nations said on Monday that the number of people in Arab countries infected with HIV more than doubled to 470,000 in the eight years to 2009. "The number of adults and children living with HIV has more than doubled between 2001 and 2009 from 180,000 to 470,000," according to data from UNAIDS, the UN programme on HIV and AIDS. New HIV infections increased from 43,000 in 2001 to 59,000 in 2009, it said at a meeting in Riyadh on combatting AIDS, organised by the Arab League and the Saudi government. The number of deaths from AIDS also surged from about 8,000 in 2001 to 24,000 in 2009.

In Djibouti and Somalia, the percentage of infected people represents 2.5 percent and 0.7 percent of the countries' respective populations. "These figures are very worrying and need an immediate response," it said in an Arabic-language statement. The figures appear in contrast with the global trend. UNAIDS said last week that 25 low- and middle-income countries had managed to at least halve their rate of new HIV infections since 2001, representing a reduction of 700,000 new HIV infections. Globally, new HIV infections fell to 2.5 million last year from 2.6 million in 2010 and represented a 20-percent drop from 2001, it said.
Date: Wed 23 Nov 2011
Source: IC Publications [edited]

Authorities in Djibouti have reported a serious outbreak of a potentially fatal diarrhea infection in the capital [Djibouti], with 2 deaths since October 2011 and 127 new cases this month [November 2011], the WHO said on Tuesday [22 Nov 2011]. WHO said 5000 cases of acute watery diarrhea (AWD) have already been reported this year [2011] compared to 2000 in the Red Sea port in 2010.

Poor hygiene and sanitation along with recent rainfall in some areas had led to the contamination of already limited and unsafe water supplies, according to the UN health agency, which said the drought in the Horn of Africa had exacerbated the situation.

"The effects of the recurring drought on several parts of Djibouti and neighbouring countries have resulted in a malnourished, poorer and more vulnerable population," a WHO statement said. [WHO] is working with the Djibouti ministry of health to train health workers and set up treatment centres.
Date: Tue, 22 Nov 2011 12:16:01 +0100 (MET)

GENEVA, Nov 22, 2011 (AFP) - Authorities in Djibouti have reported a serious outbreak of a potentially fatal diarrhoea infection in the capital, with two deaths since October and 127 new cases this month, the WHO said on Tuesday. The World Health Organization said 5,000 cases of Acute Watery Diarrhoea (AWD) have already been reported this year compared to 2,000 in the Red Sea port in 2010.

Poor hygiene and sanitation along with recent rainfall in some areas had led to the contamination of already limited and unsafe water supplies, according to the UN health agency, which said the drought in the Horn of Africa had exacerbated the situation. "The effects of the recurring drought on several parts of Djibouti and neighbouring countries have resulted in a malnourished, poorer and more vulnerable population," a WHO statement said. The body is working with the Djibouti ministry of health to train health workers and set up treatment centres.

Last week the UN rights agency reported an outbreak of cholera among Somali refugees in Kenya's huge Dadaab refugee camp, with one death. The WHO said on Tuesday that all five camps were affected by AWD but no cases had been reported in Kenya outside the camps. AWD is rife in south central Somalia where more than 53,000 cases were reported this year, resulting in 795 deaths, the agency said.
More ...

World Travel News Headlines

Date: Sun, 16 Jun 2019 12:02:50 +0200

Patna, India, June 16, 2019 (AFP) - Severe heat has left dozens dead over a 24-hour period in India's Bihar state, as the country enters a third week of searing temperatures, officials said Sunday.   The deaths occurred in three districts of the poor northern state, where temperatures have hovered around 45 degrees Celsius (113 Fahrenheit) in recent days, senior health official Vijay Kumar told AFP.

Forty-nine people died in three districts of the Magadh region that has been hit by drought, he said.   "It was a sudden development on Saturday afternoon. People affected by heatstroke were rushed to different hospitals," Kumar added.   "Most of them died on Saturday night and some on Sunday morning during treatment."   Kumar said about 40 more people were being treated at a government-run hospital in Aurangabad.   "Patients affected by heat stroke are still being brought, the death toll is likely to increase if the heatwave continues."

Most of the victims were aged above 50 and were rushed to hospitals in semi-conscious state with symptoms of high fever, diarrhoea and vomiting.   Twenty-seven people died in Aurangabad district, 15 in Gaya and seven in Nawada district, officials said.    State Chief Minister Nitish Kumar has announced a compensation of 400,000 rupees ($5,700) for the family of each victim.   Harsh Vardhan, India's health minister, said people should not leave their homes until temperatures fall.    "Intense heat affects brain and leads to various health issues," he said.

Large parts of northern India have endured more than two weeks of sweltering heat. Temperatures have risen above 50 degrees Celsius (122 Fahrenheit) in the desert state of Rajasthan.   A heatwave in 2015 left more than 3,500 dead in India and Pakistan.   In 2017, researchers said South Asia, which is home to one fifth of the world's population, could see heat levels rise to unsurvivable levels by the end of the century if no action is taken on global warming.
Date: Sun, 16 Jun 2019 01:30:52 +0200

Wellington, June 15, 2019 (AFP) - A powerful 7.4 magnitude earthquake stuck near the uninhabited Kermadec islands northeast of New Zealand Sunday, the US Geological Survey said as authorities monitored for signs of a tsunami.   New Zealand's civil defence organisation said it was monitoring the situation and if a tsunami was generated it would take at least two hours to reach the country.   The Pacific Tsunami Warning Center said "hazardous tsunami waves from this earthquake are possible within 300 km of the epicentre along the coasts of the Kermadec islands."   The earthquake struck at 10:55am (2255 GMT Saturday) some 928 kilometres (575 miles) north-northeast of the New Zealand city of Tauranga in North Island at a depth of 34 km.
Date: Sun, 16 Jun 2019 00:59:42 +0200

Wellington, June 15, 2019 (AFP) - A magnitude 6.1 earthquake struck Sunday centred 97 kilometres (60 miles) north-east of Ohonua, on the Pacific island of Tonga, the US Geological Survey reported.   The quake hit at 2156 GMT Saturday with an epicentre depth of 10 kilometres, the US global quake monitor said.   The Pacific Tsunami Warning Centre issued no alerts, and there were no immediate reports of damage or casualties.   The reported epicentre lies within the so-called Pacific Ring of Fire, an area of regular seismic activity.   In February 2018, a 7.5 magnitude earthquake in Papua New Guinea killed 150 people and destroyed hundreds of buildings.
Date: Sun, 16 Jun 2019 00:19:43 +0200

Geneva, June 15, 2019 (AFP) - A woman has drowned in Lake Geneva when her sightseeing boat sank as a violent storm battered parts of Switzerland on Saturday, police said.   A man who was in the same boat was able to swim to another vessel from where he fired "two flares", Joanna Matta, police spokeswoman for the canton (region) of Geneva, told AFP.   The man told officers that the woman had been "passing through Geneva" and that the storm had taken them "by surprise", Matta said.   Three police boats and emergency services rushed to the scene. Police divers later retrieved the woman's body from the lake.

The victim, whose nationality remains unknown, was then taken to a hospital in Geneva where she was declared dead.   In a separate incident, the storm also damaged some of the 465 boats taking part in the 81st edition of the Bol d'Or, an annual regatta on Lake Geneva, the event's press service said.   Heavy rain and strong winds lashed the participants on Saturday afternoon, causing boats to capsize although nobody was injured.

However, the storm broke the mast of the ultra-fast "Real Team" catamaran, which had been in the lead and was forced to pull out of the race.   The bad weather struck western Switzerland on Saturday afternoon, bringing hail and winds reaching up to 110 kilometres (70 miles) per hour, according to the national forecaster MeteoSwiss.   In the neighbouring French region of Haute-Savoie the storm also caused damage and left a 51-year-old German tourist dead after a tree came down at a campsite.
Date: Sat, 15 Jun 2019 16:27:09 +0200

Windhoek, June 15, 2019 (AFP) - Drought-hit Namibia has authorised the sale of at least 1,000 wild animals -- including elephants and giraffes -- to limit loss of life and generate $1.1 million for conservation, the authorities confirmed Saturday.   "Given that this year is a drought year, the [environment] ministry would like to sell various type of game species from various protected areas to protect grazing and at the same time to also generate much needed funding for parks and wildlife management," environment ministry spokesman Romeo Muyunda told AFP.

The authorities declared a national disaster last month, and the meteorological services in the southern African nation estimate that some parts of the country faced the deadliest drought in as many as 90 years.    "The grazing condition in most of our parks is extremely poor and if we do not reduce the number of animals, this will lead to loss of an animals due to starvation," Muyunda said.

In April, an agriculture ministry report said 63,700 animals died in 2018 because of deteriorating grazing conditions brought on by dry weather.   Namibia's cabinet announced this week that the government would sell about 1,000 wild animals.   They include 600 disease-free buffalos, 150 springbok, 65 oryx, 60 giraffes, 35 eland, 28 elephants 20 impala and 16 kudus -- all from national parks.   The aim is to raise $1.1 million that will go towards a state-owned Game Products Trust Fund for wildlife conservation and parks management.

The government said there were currently about 960 buffalos in its national parks, 2,000 springbok, 780 oryx and 6,400 elephants.   The auction was advertised in local newspapers from Friday.   Namibia, a country of 2.4 million people, has previously made calls for aid to assist in the drought emergency that has already affected over 500,000 people.   In April the government announced that it will spend about $39,400 (35,200 euros) on drought relief this year to buy food, provide water tankers and provide subsidies to farmers.
Date: Fri, 14 Jun 2019 18:27:56 +0200
By Rosa SULLEIRO

Sao Paulo, June 14, 2019 (AFP) - A nationwide strike called by Brazil's trade unions disrupted public transport and triggered road blocks in parts of the country Friday, ahead of protests against far-right President Jair Bolsonaro's pension reform.   Hours before the opening match of the Copa America in Sao Paulo, some metro lines in the country's biggest city were paralyzed as professors and students also prepared to take to the streets over the government's planned education spending cuts.    It will be the latest mass demonstration against Bolsonaro since he took office in January, but the timing could not be worse for the embattled president as Brazil prepares to play Bolivia in South America's showcase football tournament.

Bolsonaro was expected to attend the opener at Morumbi stadium where police sharpshooters will be deployed as part of increased security for the competition.    One of Brazil's main trade unions estimated 45 million workers had taken part in the strike.   Some 63 cities had been affected by the stoppage, with more than 80 cities recording demonstrations, G1 news site said.   The number of protesters is expected to balloon in the afternoon with demonstrations planned in Brazil's major cities.   Protesters have already blocked some roads in several cities, including Rio de Janeiro and Sao Paulo, where G1 said police had used tear gas to disperse demonstrators and clear the streets.   Brazilians were divided over the partial strike.   "This current government wants to destroy everything that we built decades ago so that's why I'm in favor (of the strike) and I am fighting against social inequality," Vania Santos, 49, told AFP in Rio.    In Sao Paulo, Flavio Moreira opposed the stoppage, however, saying it "hurts the commercial part" of the city.

- Pension savings cut -
Bolsonaro's proposed overhaul of Brazil's pension system -- which he has warned will bankrupt the country if his plan is not approved -- is seen as key to getting a series of economic reforms through Congress.    But the changes, including an increase in the retirement age and workers' contributions, have faced resistance from trade unions and in the lower house of Congress, where Bolsonaro's ultraconservative Social Liberal Party has only around 10 percent of the seats.    A pared-back draft of the reform presented to Congress on Thursday -- which reduces expected savings from 1.2 trillion reais ($300 billion) in 10 years to around 900 billion reais -- did little to appease union leaders, who vowed to go ahead with the shutdown.   Such savings are seen as vital to repairing Brazil's finances and economy, which were devastated by a 2015-2016 crisis.

Economy minister Paulo Guedes, who is spearheading the government's reform agenda, has threatened to resign if the bill is not passed or is watered down significantly.   It caps a tumultuous six months for Bolsonaro, who has seen his popularity nosedive as he struggles to push his signature reform through a hostile Congress and keep Latin America's biggest economy from sliding back into recession.   More than 13 million people are unemployed, the latest data shows, with a record number giving up looking for a job.     Fighting between military and far-right factions of Bolsonaro's government has fueled chaos in his administration where his sons and right-wing writer and polemicist Olavo de Carvalho wield enormous influence.   Bolsonaro sacked his third minister on Thursday -- retired general Carlos Alberto dos Santos Cruz, who had been the government secretary and seen as a moderate voice.   That came on the same day Bolsonaro broke his silence to defend Justice Minister Sergio Moro, who has been accused of wrongdoing while serving as a judge in the sprawling Car Wash anticorruption investigation.
Date: Fri, 14 Jun 2019 06:02:40 +0200
By Clotilde RAVEL

Abidjan, June 14, 2019 (AFP) - "Cover your goods," Diakaria Fofana, a doctor of public health, warns food vendors as a thick cloud of insecticide spray wafts down a street in Abidjan, Ivory Coast's economic capital.   Men in protective clothes, goggles and masks are disgorging plumes of mosquito-killing chemicals in a bid to roll back an outbreak of dengue.   Two people have died and 130 have fallen ill since the fever returned to the West African state last month.

The toll, so far, is tiny compared with other tropical countries, especially in Southeast Asia, where the painful and sometimes deadly disease is an entrenched peril.   But tackling the outbreak is a major challenge for Ivory Coast, a poor country that is having to resort to time-honoured, labour-intensive methods of spraying and neighbourhood awareness campaigns to prevent its spread.   Female mosquitoes carrying the dengue virus transfer the pathogen when they tuck into a blood meal from someone. 

A vaccine does exist, but is not available in Ivory Coast because "it has many secondary effects (and) it's expensive"," explained Joseph Vroh Benie Bi, director of the National Institute for Public Hygiene (INHP).    Developed by French pharmaceutical group Sanofi Pasteur, the vaccine is recommended for use in people aged nine and older, and only for individuals who have already been infected.    Usually accompanied by flu-like symptoms, dengue makes some people very sick indeed, developing into a haemorrhagic fever that can cause difficulty breathing, heavy bleeding or even organ failure. While a first bout of dengue is rarely fatal, subsequent infections are usually worse.

- 'Fighting the mosquito' -
The UN's World Health Organization (WHO) says there are up to 100 million cases of dengue worldwide every year, and almost half the world's population lives in countries where the disease is endemic.   It kills more than 20,000 people each year. Southeast Asia and the Western Pacific are the worst-hit areas.   There is no cure, and the WHO recommends that patients take paracetamol, rest and drinking plenty of fluids.   Five new vaccines are in development, but in the meantime Fofana says: "The only effective means of fighting (dengue) is fighting the mosquito."   In Ivory Coast, most recorded cases have occurred in Abidjan.

Health workers are striving to enlist the public in tackling the mosquito, targeting its life cycle.   "The larvae multiply in stagnant water, for example inside used tyres," said Fofana, deputy director of the vector control unit at the INHP.   "People should never store water in buckets in the open air and they should regularly throw out the water in plates under houseplants."   But he faces an uphill job in a sprawling port city of 4.4 million people in the middle of the rainy season.   What's more, people who are infected, even without knowing it, and can bring the virus to new areas when they are bitten by local mosquitoes.    The WHO has set a goal to halve the number of dengue deaths by 2020, but incidence of the disease has increased 30-fold in the last 50 years.   "Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries," it says.

- 'Malaria's big brother' -
In Ivory Coast, where malaria accounts for a third of all medical consultations, many people self-medicate when they experience symptoms such as high fever, vomiting, nausea or aches and pains.   "This is a real problem, because the symptoms of malaria, dengue, typhus and yellow fever are similar. Doing a blood test is absolutely indispensable," said Fofana.   Treatment with the wrong medicines can worsen the situation, he stressed -- aspirin or ibuprofen can increase the risk of bleeding, for example.   In the meantime, the spraying goes on.    "We know the risks," said Bamba Segbe, an Abidjan resident watching the masked men in action. "It's not for nothing that we call dengue malaria's big brother."
Date: Thu, 13 Jun 2019 17:37:51 +0200
By Grace Matsiko

Mpondwe, Uganda, June 13, 2019 (AFP) - At the bustling Mpondwe border post, a woman crossing from the Democratic Republic of Congo into Uganda is whisked away to an isolation unit after a thermal scanner picks up her high temperature.   Health workers keep Mulefu Kyakimwa, a 32-year-old vegetable oil trader, under observation but later discharge her, once Ebola has been ruled out as the cause of her fever.

The border post is on high alert after a family with suspected Ebola escaped isolation on the Congolese side and entered Uganda, where two of them died this week.   The spread of the deadly virus to Uganda comes after months of efforts in a region of porous borders to contain an outbreak in Congo which has killed 1,400 people, according to the latest official data.    "Since the start of the outbreak, the total number of cases is 2,084, of which 1,990 have been confirmed and another 94 are probable," the Congolese health ministry said in its daily bulletin from Wednesday.   "In all, there have been 1,405 deaths -- 1,311 confirmed and 94 probable -- and 579 people have recovered," the bulletin said, adding that 132,679 people had been vaccinated.

- 'We expected it' -
Few people seem to be surprised that Ebola would eventually make its way to Uganda -- which has experienced outbreaks in the past.   "The outbreak is not a surprise. We expected it. People cross the borders all the time and interact a lot," said Dorcus Kambere, a 29-year-old Ugandan bar attendant who feels her job puts her at risk.

At Mpondwe -- where 25,000 people cross daily -- travellers undergo rigorous health checks to detect the lethal virus, which attacks the organs and leads to internal and external bleeding.   Soldiers carrying automatic rifles guide travellers through the screening process, making sure they wash their hands with disinfectant.   The travellers then pass through a shelter with a thermal scanner that feeds people's body temperatures into a computer.   "This is a situation we go through every day since the Ebola outbreak," said Ambrose Nyakitwe, 34, a Ugandan trader returning from the Congo side.   "It is good. I have a family. I have to see that they don't get affected," he added, after passing through the scan.   Outside the busy border post, business carries on as usual, with children swimming and playing in the muddy Lhubiriha river that draws a natural boundary between the two nations.

- 'Not safe' -
A woman serves pancakes with her bare hands from a bucket as pot-bellied money changers lounging next to her carry out their trade.   However, while some carry on seemingly oblivious to the dangers posed by the virus, others are increasingly suspicious.   "It is not safe. If they say people with Ebola crossed into Uganda, how sure are we there are not many who will infect us and are yet to be got?" asked Bernadette Bwiso, 41, a trader.    "Government must do a house-to-house search," she said.   Meanwhile, Nyakitwe is anxious about how the infected patients managed to cross into Uganda despite heightened surveillance.   A Congolese woman -- who is married to a Ugandan -- her mother, three children and their nanny had travelled to DRC to care for her ill father, who later died of Ebola.

The World Health Organization said 12 members of the family who attended the burial in Congo were placed in isolation in the DRC, but six "escaped and crossed over to Uganda" on June 9.   The next day, a five-year-old was checked into hospital in Bwera vomiting blood. Tests confirmed he had Ebola and the family was placed in an isolation ward.   His three-year-old brother was also confirmed to have Ebola, as was their grandmother who died late Wednesday.   Uganda and the RDC are discussing what can be done to intensify collaboration between the two countries to prevent the spread, the Congolese authorities said.

- No surveillance -
Uganda's health ministry said that the surviving travellers and the Ugandan father -- five people in total -- had agreed to be repatriated to DRC on Thursday for treatment and "family support and comfort" from relatives on the other side of the border.   However, three unrelated patients are still in a Ugandan hospital awaiting the result of Ebola tests.

Uganda's Health Minister Jane Ruth Aceng said challenges remained at "unofficial entry points" between Congo and Uganda, which share a porous 875-kilometre (545-mile) border.   These unauthorised border crossings, known as "panyas" in the local Lukonzo language, are often merely planks laid down across a point in the river, or through forests and mountains where there is no surveillance.   In a bid to contain the spread of the disease the Ugandan government has suspended market days and urged people to stop shaking hands and hugging.
Date: Thu, 13 Jun 2019 16:33:58 +0200

Madrid, June 13, 2019 (AFP) - Spain will launch a campaign to urge young people to "always carry a condom on them" as the number of sexually transmitted infections (STI) surges, the government said Thursday.   The news comes a week after the World Health Organization expressed alarm at the lack of progress on curbing STI or diseases (STD), with one expert warning of complacency as dating apps spur sexual activity.   In Spain, videos and ads will be posted from Monday on social networks, music platforms and media that 14- to 29-year-olds most follow, the health ministry said.   "It's normal that you want to do it in your parents' bed. What isn't normal is that you want to complicate your life," reads one ad, going on to show the number of new cases of HIV and other infections.

In a statement, the health ministry urged "everyone -- and particularly the young -- to always have a condom on them and use it."   "The use of condoms has dropped among the 15- to 18-year-olds over the last few years," Health Minister Maria Luisa Carcedo told reporters.   She said there was complacency over STI, including infection by the HIV virus that causes AIDS.   The campaign is a "first shock measure" to challenge the rise of STI among young people, the statement said.   The number of cases of gonorrhoea, for instance, has risen an average of more than 26 percent annually between 2013 and 2017, according to the ministry.

Syphilis "has risen less but in 2017, it reached its highest peak since the start of statistics in Spain: 10.61 infections per 100,000 residents compared to 2.57 in 1995."   The highest rates of chlamydia, meanwhile, are among 20- to 24-year-olds and particularly women, the ministry said.   In 2017, Spain registered close to 24,000 cases of infection by gonorrhoea, syphilis, chlamydia and LGV, a sexually-transmitted disease, according to the statement.
Date: Thu, 13 Jun 2019 15:12:32 +0200

Vilnius, June 13, 2019 (AFP) - Lithuanian temperatures have hit record June highs, meteorologists said Thursday, as a heatwave forced school closures and threatened to reduce harvests in the draught-hit Baltic region.   Kaisiadorys in central Lithuania was the hottest place at 35.7 degrees Celsius (96.2 degrees Fahrenheit) on Wednesday, the highest-ever temperature recorded for June in the country, weather forecaster Paulius Starkus told AFP.   Six people drowned in the Baltic EU state on Wednesday, the deadliest day of the year to date, while some schools put classes on hold or cut lessons short due to the heatwave.

Scientists say the extreme weather is in part a result of climate change.   "Lithuania used to have heatwaves but now they occur more often and are more intense due to climate change," Vilnius University climatologist Donatas Valiukas told AFP.   Starkus said a downpour with thunder and hail could follow in some areas on Thursday afternoon.   Agriculture Minister Giedrius Surplys told lawmakers that some areas were experiencing "a real climatic draught" threatening harvests, while hydrologists warned that river water levels posed a threat to fish.   Demand for air-conditioning has also soared in recent weeks.   Lithuania's hot weather is expected to last through the week, then temperatures may ease below 30 degrees Celsius starting Monday.   Fellow Baltic state Latvia is also experiencing unusual heat for June, with temperatures over 32 degrees Celsius.

In recent days, Latvia's western region of Kurzeme saw thunderstorms with hail damaging buildings, smashing greenhouses and tearing power lines.   Two people have been hospitalised in the northern Latvian town of Cesis after a tree fell on their camper van while they were inside.    Fellow Baltic state Estonia had a heatwave last week and is now experiencing rainy and windy weather.   Poland has also been experiencing high temperatures this month, which has resulted in increased air-conditioner use. The power transmission system operator PSE said that on Wednesday there was record electricity demand for a summer morning at nearly 24.10 gigawatts (GW).   Forty-two people have already drowned in Poland this month, according to the government security centre RCB.