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Antigua and Barbuda

Antigua and Barbuda - US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
Antigua and Barbuda is a dual island nation known for its beaches, and is a favorite destination for yachtsmen.
Tourist facilities are widely avai
able.
English is the primary language.
Banking facilities and ATMs are available throughout the island.
Read the Department of State Background Notes on Antigua and Barbuda for additional information.

ENTRY/EXIT REQUIREMENTS:
All Americans traveling by air outside the United States are required to present a passport or other valid travel document to enter or re-enter the United States.
This requirement will be extended to sea travel (except closed loop cruises), including ferry service, by the summer of 2009.
Until then, U.S. citizens traveling by sea must have government-issued photo identification and a document showing their U.S. citizenship (for example, a birth certificate or certificate of nationalization), or other WHTI compliant document such as a passport card for entry or re-entry to the U.S.
Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted.
We expect cards will be available and mailed to applicants in spring 2008.
The card may not be used to travel by air and is available only to U.S. citizens. Further information on the Passport Card is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.
We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

Immigration officials are strict about getting exact information about where visitors are staying, and will often request to see a return ticket or ticket for onward travel, as well as proof of sufficient funds to cover the cost of the visitor’s intended stay.
There is a departure tax payable when departing the country.
For further information on entry requirements, travelers can contact the Embassy of Antigua and Barbuda, 3216 New Mexico Avenue NW, Washington, DC
20016, telephone (202) 362-5122, or consulates in Miami.
Additional information may be found on the home page of the Antigua and Barbuda Department of Tourism at http://www.antigua-barbuda.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:
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 Worldwide Caution, Travel Warnings, and Travel Alerts 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:
Petty street crime does occur, and valuables left unattended on beaches, in rental cars or in hotel rooms are vulnerable to theft.
There has been an increase in crime in Antigua, including violent crimes, in the last six months.
However, this increase has not, for the most part, affected visitors to the island.
The Government of Antigua and Barbuda has taken steps to improve the effectiveness of the police in responding to crimes.
As everywhere, visitors to Antigua and Barbuda are advised to be alert and maintain the same level of personal security used when visiting major U.S. cities.

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:
There are many qualified doctors in Antigua and Barbuda, but medical facilities are limited to a public hospital and a private clinic and are not up to U.S. standards.
The principal medical facility on Antigua is Holberton Hospital, on Hospital Road, St. John's (telephone (268) 462-0251).
There is no hyperbaric chamber; divers requiring treatment for decompression illness must be evacuated from the island, to either Saba or Guadeloupe.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services, and U.S. medical insurance is not always valid outside the United States.
U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States.

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

Traffic in Antigua and Barbuda moves on the left.
Major roads are generally in good condition, but drivers may encounter wandering animals and slow moving heavy equipment.
There is relatively little police enforcement of traffic regulations.
Buses and vans are frequently crowded and may travel at excessive speeds.
Automobiles may lack working safety and signaling devices, such as brake lights.

Please refer to our Road Safety page for more information.
For specific information concerning Antigua and Barbuda driving permits, vehicle inspection, road tax, and mandatory insurance, contact the Antigua and Barbuda national tourist organization offices in New York via e-mail at info@antigua-barbuda.org.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Antigua and Barbuda’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Antigua and Barbuda’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:
Like all Caribbean countries, Antigua can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
Please see 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 Antigua and Barbuda laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Antigua and Barbuda 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 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 Antigua and Barbuda are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov/, and to obtain updated information on travel and security within Antigua and Barbuda.
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 Bridgetown in located in the Wildey Business Park in suburban Wildey, south and east of downtown Bridgetown.
The main number for the Consular Section is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
The web site for Embassy Bridgetown is http://barbados.usembassy.gov/. Hours of operation are 8:30 a.m. - 4:00 p.m., Monday-Friday, except local and U.S. holidays.

The U.S. Consular Agent, Rebecca Simon, in Antigua provides passport, citizenship and notarial services, and assists Americans in distress.
The Consular Agency is located in Suite #2, Jasmine Court, Friars Hill Rd, St. John’s, Antigua.
Contact information is as follows: telephone 1-268-463-6531, cellular 1-268-726-6531, or e-mail ANUWndrGyal@aol.com. The mailing address is P.O. Box W-1562, St. John’s, Antigua. The Consular Agent is available by appointment only.
The office is closed for local and U.S. Holidays.
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This replaces the Country Specific Information for Antigua and Barbuda dated April 2, 2007, to update sections on Entry/Exit Requirements, Safety and Security, Medical Facilities and Health Information, Traffic Safety and Road Conditions, and Crime.

Travel News Headlines WORLD NEWS

Date: Wed, 21 Mar 2018 18:14:27 +0100
By Gemma Handy

St. John's, Antigua and Barbuda, March 21, 2018 (AFP) - Voters in the hurricane-wracked twin island nation of Antigua and Barbuda headed to the polls Wednesday to elect a new government after Prime Minister Gaston Browne called snap elections.   Browne's Antigua Barbuda Labour Party, which has led the eastern Caribbean country since 2014, is widely expected to secure a second consecutive term.   The prime minister announced general elections on February 24, 15 months before a constitutionally mandated deadline, giving opposition parties less than four weeks to prepare.

And there will be no polling stations on Barbuda, which was battered by Hurricane Irma in September.    As a result, the estimated 400 Barbudans who have since returned home will have to travel to Antigua to cast their ballot. The government has promised to pay for related transport, accommodation and meal expenses.   Just over 51,000 Antiguans and Barbudans are eligible to vote. Voter turnout was around 90 percent in 2014.

Browne says the government wants to protect half a billion US dollars worth of developments currently under construction in the tourism-dependent country, and provide investors with stability.    One of the most prominent -- and controversial -- projects is a $250 million mega resort being built by Hollywood star Robert De Niro on Barbuda which was devastated by Hurricane Irma in September.   Lowering the cost of living in the country of 100,000 people is high on the
agenda.

- Ruling party dominates -
Browne, a former businessman and banker, has pledged to reduce electricity bills, along with the cost of land, and provide more affordable housing, under the slogan "Rebuilding Together." His wife Maria is also running for a seat on an ABLP ticket.   On Sunday, thousands of Browne's supporters donned the party's red colours and walked alongside a motorcade in an event that culminated in a public rally.   The "Delivering Hope" campaign of the main opposition group, the United Progressive Party (UPP), cites revitalization of the tourism and agricultural sectors as key priorities.

Fifty-three candidates will vie for seats in the 17 single-member constituencies -- of which the ABLP currently holds 14 -- in a first-past-the-post system.    The ruling party is alone in presenting a full slate of 17 candidates. The UPP, led by former finance minister Harold Lovell, has put forward 16.    A new party, the Democratic National Alliance, headed by current lawmaker and former UPP representative Joanne Massiah has registered 13 candidates.    There is a handful of smaller parties, a single independent runner and one representing the Barbuda People's Movement (BPM) contesting the small island's sole seat.

Polling stations opened at 6:00 am (1000 GMT) and are due to close at 6:00 pm. Alcohol sales are restricted during those hours and all public schools are closed, as many are serving as polling stations.   Teams representing the Caribbean Community (CARICOM) are observing the elections.   On its path through the Caribbean in September, Irma caused "absolute devastation" on Barbuda where up to 30 percent of properties were demolished, and 95 percent damaged, Browne had said at the time.    After a 10-year hiatus, voters returned Browne's Labour Party to power during the last ballot four years ago, when he pledged to economically transform the country.   The country became fully independent from Britain in 1981.
Date: Sun, 25 Feb 2018 08:04:27 +0100

Georgetown, Guyana, Feb 25, 2018 (AFP) - Antigua and Barbuda, a hurricane-ravaged Caribbean tourist destination, will go to the polls next month more than a year earlier than scheduled, the prime minister said on Saturday.   The two-island nation's parliamentary elections were scheduled for June 2019, but will now be held on March 21, Gaston Browne said.   Voters will select the 17 members of Antigua and Barbuda's House of Representatives, its lower house. Members of the Senate are appointed.   "Our primary focus for calling elections early is not about politics but is about your development. God forbid for there to be change in government," Browne said on radio.

After a 10-year hiatus, voters returned Browne's Labour Party to power during the last ballot in 2014, when he pledged to economically transform the country.   On Saturday, Browne said there had been "significant gains" since and that the government wanted to guard against unpredictability in the investment climate.   He cited cheaper housing for ordinary people, better roads, two Marriott-branded hotels, as well as a new airport on the island of Barbuda, which was battered last year by Hurricane Irma.   On its path through the Caribbean in September, Irma caused "absolute devastation" on Barbuda where up to 30 percent of properties were demolished, and 95 percent damaged, Browne had said at the time.    Labour has ruled Antigua and Barbuda almost continuously since 1949. The country became fully independent from Britain in 1981.
Date: Sat, 9 Sep 2017 18:35:21 +0200
By Gemma Handy

Codrington, Antigua and Barbuda, Sept 9, 2017 (AFP) - Homes, shops and government buildings were destroyed when Hurricane Irma slammed the Caribbean island of Barbuda this week, while a huge stretch of its once glorious 11-mile west coast beach has been wiped out.   Destruction was so widespread that authorities have ordered the entire population of 1,800 to evacuate as Hurricane Jose approached the island over the weekend. 

By mid-day Saturday Jose, a Category Four hurricane, was tracking towards the north-west and no longer expected to hit Barbuda, but it remained under a Tropical Storm warning.   Authorities on Barbuda -- one of the two islands that make up the nation of Antigua and Barbuda -- have only begun to measure the damage caused when Irma struck the island as a powerful Category Five hurricane overnight Tuesday to Wednesday.   "Terrifying," "horrific" and the "worst damage seen in a lifetime" were some of the descriptions from residents as they emerged from their shelters after Irma's passage.    A child died when Irma, the strongest storm ever recorded to form in the Atlantic, struck the island.   Authorities said 30 percent of properties were demolished by the monster storm.

- Surviving in a wardrobe -
Barbudans swapped tales of hiding in wardrobes and showers as 157 mile (252 kilometer) per hour wind from Irma ripped off roofs, uprooted trees and knocked down walls.   Sira Berzas, 40, spent more than an hour huddled in a wardrobe with a friend after Irma tore the roof off the home they were hiding in.   "I have never been so scared in my life. Jackie and I were holding on to each other and basically saying our goodbyes," Berzas told AFP.

When the eye of the hurricane came, she said, "we ran outside in our underwear screaming for help. Luckily there was a police truck which took us to a safer building."   In the rush to safety "we had to leave Jackie's kitten behind," said Berzas, who lost her Pink Sand Beach home, bar and restaurant to the disaster.   Thankfully Houdini lived up to his name. The kitten was later found crouched in a corner of the ruined house, trembling but alive.

- Fleeing Hurricane Jose -
Hundreds of Barbudans were transported on Friday to Antigua via a Venezuelan military plane for safety ahead of Hurricane Jose.   Many have family to visit on the sister island, but others had no idea where they would stay when they arrived.   "I don't know where we are going when we get to Antigua -- or how we will get there," said Beautymey John, who was on a dock waiting to board a boat to safety with her five children.   "I would rather stay here, it doesn't feel right to leave. We have to try and start again," she told AFP.

Other Barbudans also said they were determined to rebuild their homes and livelihoods.   Teacher Maurice George, 30, said the small bag he was taking to Antigua contained the bare essentials, but vowed to return as soon as the secondary school he works in reopens.   "It is heart-breaking to see our island looking like this," he said.   "But where some people see devastation, I see an opportunity to rebuild," he added.
Date: Sat, 19 Mar 2016 13:18:00 +0100

Washington, March 19, 2016 (AFP) - A 6.0-magnitude earthquake hit off the coast of the Caribbean island nation of Antigua and Barbuda Saturday, US experts said, but caused no tsunami warning or immediate reports of damage or injury.   The strong quake, which hit at 1126 GMT, struck at a depth of 24 kilometres (15 miles) with its epicentre located 153 kilometres northeast of the capital of Saint John's, according to the US Geological Survey.
Date: Mon 14 Dec 2015
Source: Antigua Observer [edited]

Prison sources are still complaining that, despite the alleged outbreak of chicken pox at Her Majesty's Prison (HMP), not much has been done to ensure that the virus does not affect more people who either work there or are in custody. A source said since Observer media reported on the incident, last Thu 10 Dec 2015 that there has been another suspected case, bringing the number of affected persons to 19.

The source explained that this occurred even while the other 18 infected persons were already in isolation in the chapel in the prison yard. That source is suggesting that health authorities should to go into the jail to "clean it and spray out the cells" because the virus, according to research, can be picked up from contaminated surfaces.

An official at HMP, who is not authorized to speak with the media, said although the affected inmates are being housed in the chapel away from the rest of the prison population, they are still able to come and go to other parts of the jail, including the washroom and for breaks. Another source indicated that most of the affected persons are on remand and it is highly likely they will be released at any time, and then the virus would likely spread to communities outside the prison walls.

Observer media was unable to reach the prison boss, Superintendent Albert Wade, for comment.

In the meantime, Attorney General Steadroy "Cutie" Benjamin, who has responsibility for the prison, has given assurance that prison authorities have taken adequate steps to control the spread of chickenpox.
======================
[Outbreaks of chickenpox are not uncommon in closed communities where contagious virus can spread rapidly. Chickenpox is a very contagious disease caused by varicella-zoster virus (VZV), a herpes virus. It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox or received the chickenpox vaccine. Chickenpox spreads in the air through coughing or sneezing. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters and can be transmitted by touching surfaces that have recently be contaminated by open lesions as well. Chickenpox most commonly causes an illness that lasts about 7-10 days.

The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn into scabs. The rash may 1st show up on the face, chest, and back, then spread to the rest of the body, including inside the mouth, eyelids, or genital area. It usually takes about a week for all the blisters to become scabs. Some people who have been vaccinated against chickenpox can still get the disease. However, the symptoms are usually milder with fewer blisters and mild or no fever. About 25 to 30 percent of vaccinated people who get chickenpox will develop illness as serious as chickenpox in unvaccinated persons.

Chickenpox vaccine is safe and effective at preventing the disease. Most people who get the vaccine will not get chickenpox. If a vaccinated person does get chickenpox, it is usually mild -- with fewer blisters and mild or no fever. The chickenpox vaccine prevents almost all cases of severe disease (for further information, see: <http://www.cdc.gov/chickenpox/index.html>). - ProMed Mod.LL]

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

Madagascar - US Consular Information Sheet
November 06, 2008
COUNTRY DESCRIPTION:
Madagascar is a developing island nation off the east coast of Africa.
The primary languages are French and Malagasy.
French is less spoken outside
of major cities.
Facilities for tourism are available, but vary in quality.
Travelers seeking high-end accommodations should make reservations in advance.
Read the Department of State Background Notes on Madagascar for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
Visas are available at all airports servicing international flights, but travelers who opt to obtain a visa at an airport should expect delays upon arrival.
Visas obtained at the airport cannot be extended.
Most international flights arrive in Antananarivo, but there are some limited international flights to/from the nearby islands of Comoros, Mayotte and Reunion from airports in Mahajanga, Toamasina (Tamatave), Nosy Be, Tolagnaro (Ft. Dauphin) and Antsiranana (Diego Suarez).
There are also direct flights between Italy and Nosy Be.
Evidence of yellow fever immunization is required for all travelers who have been in an infected zone within 6 months of their arrival in Madagascar.

Travelers may obtain the latest information and details on entry requirements from the Embassy of the Republic of Madagascar, 2374 Massachusetts Avenue NW, Washington, DC
20008; telephone (202) 265-5525/6; or the Malagasy Consulate in New York City, (212) 986-9491.
Honorary consuls of Madagascar are located in Philadelphia, and San Diego.
Overseas, inquiries may be made at the nearest Malagasy embassy or consulate.
Visit the Embassy of Madagascar’s web site at http://www.embassy.org/madagascar 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:
There are random police vehicle checkpoints throughout Madagascar, so all visitors should carry photo identification (i.e., U.S. passport) in the event of police questioning.
These check points are routine in nature, and should not result in vehicle and/or person searches as long as valid identification is shown.
Political demonstrations occur from time to time.
There have been incidents of violence during demonstrations, but these have not been directed against Americans.
Travelers should maintain security awareness at all times and should avoid political gatherings and street demonstrations.
Certain large gatherings such as concerts or scenes of accidents also may pose a threat to foreigners.

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, 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 United States 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 major concerns for visitors to Antananarivo are crimes of opportunity such as pick pocketing, purse snatching and residential and vehicular theft.
Although these incidents are generally non-violent, incidents involving violence by assailants do occur and are on the rise, particularly when the victim resists, and especially when multiple persons confront the victim.
The Embassy has received reports of physical attacks against foreigners, including Americans, particularly in coastal tourist areas.
A number of these attacks resulted in serious injuries and in some cases, fatalities.
Criminal elements in Antananarivo and throughout Madagascar are becoming bolder when selecting their victims, and are also committing more crimes in areas that are considered to be “safe” – those that are generally well lit and well traveled by pedestrians and vehicles.

To reduce the risk of being victimized, travel in groups and avoid wearing expensive jewelry or carrying high cost electronic items (iPods, digital cameras, or high end cell phones) with you in public. Valuable items should never be left in an unattended vehicle or at a hotel (unless locked in the hotel safe). Walking at night, whether alone or in a group is not considered safe in urban areas, including in the vicinity of Western-standard hotels, restaurants and night clubs. Visitors are strongly discouraged from traveling outside of Antananarivo after dark due to banditry, lack of lighting, and poor road conditions. In the last six months there have been several incidents involving nighttime criminal activity that targeted vehicles outside of town.
These events have involved villages designing a “trap” of sand, a tree log or some other substance or condition that makes the only viable road impassible.
Local villagers then “assist” the stranded vehicle and expect monetary compensation. Others have involved armed criminals who stage a “breakdown” that blocks the roadway, forcing the victimized driver to slow down, and hence become more vulnerable.

Criminal gangs comprised of felons, ex-military and police from the former regime are known to commit home invasions and kidnappings, sometimes targeting foreigners.
Organized gangs of bandits are known to patrol areas where foreigners, who are perceived to be wealthy, tend to congregate.
Crimes such as burglary and robbery do occur in areas outside the capital and the threat of confrontational and violent crime has increased in rural and isolated areas throughout the last year.
Specifically, Amboasary, a town in the southeast, has experienced a surge in armed robberies targeting not-governmental organizations (NGOs).
However, Americans visiting Madagascar should not expect to experience any hostility or aggression solely because of their citizenship.

In major cities, the National Police is charged with maintaining peace and security. Outside of major cities, the Gendarmerie is primarily responsible for these duties. Due to lack of resources available to both law enforcement agencies, police response to victims of a crime is often limited, slow and ineffective.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to local police and to the nearest U.S. embassy or consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds can 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.
During an emergency, visitors to Antananarivo can contact local police at telephone numbers 117 and 22-357-09/10 or 22-227-35. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Standards of healthcare throughout Madagascar are well below U.S. standards.
However, there are foreign physicians in Antananarivo representing a broad range of specialties, but their training is variable and often not to U.S. standards.
The hospitals in Antananarivo vary greatly in standards of care.
Medical care outside of Antananarivo is generally well below the care available in the capital city.
Caution and good judgment should be exercised when seeking hospital and medical services.
The Embassy maintains a list of hospitals and specialists.
A Seventh Day Adventist dental clinic offers emergency procedures and x-ray facilities.
Some medications, generally of French origin, are available in Antananarivo.
If you need to refill a prescription from home, it is important to carry a prescription from your doctor listing the medicine's generic name.
There is limited availability of both prescription and over the counter medications, and outside of Antananarivo, medications may not be available.
Travelers should have a supply of any needed medication sufficient for the entire length of a visit before arriving in Madagascar.
Americans who will be carrying medications with them to Madagascar may wish to contact the Malagasy Embassy in Washington, D.C. regarding any restrictions on imports.

Ambulance services are available in Antananarivo with Polyclinique Ilafy at 22-425-66/69 or 033 11 458 48 / 032 07 409 38; Espace Medical at 22-625-66, 22-219-72, or 032-02-088-16 (cellular); and CDU (Centre de Diagnostic Medical d’Urgences) at 22 329 56 or 032 07 822 28 or 033 11 822 28.
However, due to traffic jams, response times are often dangerously slow.

Malaria is prevalent, particularly in the coastal regions.
Using preventive measures and malaria prophylaxis is strongly recommended.
Rabies is endemic and there are many street dogs.
It is recommended travelers have the pre-exposure vaccination series prior to arrival in Madagascar.
If bitten by an animal, the effected area should immediately be washed with soap and running water for ten minutes.
Seek medical care immediately.
Plague is also endemic to Madagascar.
While the reported HIV prevalence rate is low, particularly by African standards, Madagascar suffers from a very high reported incidence of other sexually transmitted diseases.

The East African Indian Ocean islands have seen a rise in the cases of Chikungunya.
As with Malaria, Chikungunya and Dengue are transmitted by mosquitoes.
Every effort should be made to use repellants, proper clothing and barriers that discourage/prevent mosquito bites.
The CDC web site contains further information on chikungunya at http://www.cdc.gov/ncidod/dvbid/chikungunya/ and dengue at http://www.cdc.gov/ncidod/dvbid/dengue/.
Travelers should drink bottled water or carbonated beverages.
Local water is not generally potable.
Water purification tablets may be used as necessary.
Bottled water is readily available in Antananarivo but is less so outside the city.
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.
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 Madagascar is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In Madagascar, one drives on the right side of the road, generally yielding the right of way to vehicles coming in from the left.
Some major intersections and traffic circles have police directing traffic.
If a policeman has his back to you at an intersection, you are required to stop.
Laws make seatbelt use mandatory and prohibit cell phone use while driving, even with a hands-free attachment.
Child safety seats and motorcycle helmets are not required in Madagascar.
If you are caught driving under the influence of alcohol, your car will be impounded for a few days and you will have to pay a fine.
If you are involved in an accident involving injuries and/or deaths, there is a mandatory court case.
The losing party of the court case must then pay all costs.

Except for Antananarivo’s main streets and a few well-maintained routes to outlying cities, many roads are in various states of disrepair.
Some may be impassable during the rainy season.
Night travel by private or public transportation outside Antananarivo is strongly discouraged due to poor lighting and road conditions.
Roads tend to be narrow and winding with many one-lane bridges and blind curves.
Most vehicles tend to drive in the center of the road unless another vehicle is present.
It is common to find livestock or human-drawn carts in the middle of the road, even at night.
Local practice is to blow the horn before going around a curve, to let others know of one's presence.
Few pedestrian crosswalks or working traffic signals exist.

Travel within Antananarivo can be difficult with poor road signage, streets congested with pedestrians, bicycles, animal carts, and vehicular traffic, and an abundance of one-way streets.
Taxis are plentiful and are generally reasonably priced.
Bargain for the fare prior to getting into a vehicle.
Most accidents are pedestrian-related, due to narrow roads and lack of sidewalks on many streets.
When traveling between cities, travelers must have clear directions as there are rarely signs indicating where one must turn to reach a destination.
Conditions of rural roads can degrade significantly and with little notice during the rainy season.

Rental cars generally come with a driver who is responsible for maintaining the vehicle and sometimes acts as a tour guide.
Public transportation is unreliable and vehicles are poorly maintained.
Rail services are extremely limited and unreliable.
The Ministry of Public Works, telephone (20) 22-318-02, is Madagascar's authority responsible for road safety.
During an emergency, visitors to Antananarivo can contact local police by dialing 117, 22-227-35, 22-357-09/10.
American citizens can also call the U.S. Embassy at 22-212-57/58/59 if assistance is needed in communicating with law enforcement officials.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Madagascar, the U.S. Federal Aviation Administration (FAA) has not assessed Madagascar’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
Domestic and international air services operate regularly but are subject to delays and occasional breakdowns.
Air Madagascar often changes in-country flight schedules based on demand; flights that are not full may be cancelled with little or no prior warning to passengers.
Overbooking is also common.
Reconfirmation of tickets prior to flight day is recommended, especially when flying from provincial airports.
SPECIAL CIRCUMSTANCES:
It is advisable to contact the Embassy of Madagascar in Washington or one of Madagascar's consulates in the United States for specific information regarding customs requirements.
In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines.
Taking photographs of airports or military installations is prohibited.

Madagascar is renowned for its natural resources.
These include a wide variety of gemstones.
The Government of Madagascar recently imposed restrictions on the export of precious gems; before purchasing or transporting any gemstones it is advisable to seek clarification of the applicable laws.

Madagascar is primarily a cash-driven economy.
Although some high-end establishments catering to tourists accept credit cards, normally only Visa-logo cards, most shops and restaurants are cash only.
Although the government changed the local currency from the Malagasy Franc (FMG) to the Ariary several years ago, many Malagasy still think in terms of FMG.
When talking about prices, it is important to quantify whether the price is in Ariary or FMG. (1 Ariary = 5 FMG).
A few ATMs are available in large cities.
Dollars are not widely accepted. 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 Malagasy laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Malagasy 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 as well as in Madagascar.
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 Madagascar 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 Madagascar.
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 14-16 Rue Rainitovo, Antsahavola, Antananarivo.
The mailing address is B.P. 620, Antsahavola, Antananarivo, Madagascar; telephone [261] (20) 22-212-57; fax [261] (20) 22-345-39.
The Embassy’s web site is located at http://www.antananarivo.usembassy.gov/
*

*

*
This replaces the Country Specific Information dated June 2, 2008, to update the section on Crime.

Travel News Headlines WORLD NEWS

Date: Thu 9 May 2019
Source: UN OCHA, ReliefWeb, UN Children's Fund (UNICEF) report [abridged, edited]

Madagascar: humanitarian situation report, quarter 1 - 2019
-----------------------------------------------------------
Highlights
----------
- Madagascar is facing an unprecedented measles epidemic due to low measles vaccination coverage (58 per cent nationwide). As of 3 Apr 2019 there were 122 840 registered cases, and 1233 reported deaths. The measles epidemic affects 107 out of 114 districts across all 22 regions of Madagascar.

- For the 1st quarter of 2019, UNICEF vaccinated over 1.9 million children under 5 years against measles. UNICEF also prepositioned emergency stocks consisting of medicines and basic equipment in 5 targeted regions.

- The nutritional status of the population of southern Madagascar remains precarious. The October 2018 Integrated Food Security Phase Classification (IPC) results revealed that 970 000 people would be in a food security crisis or emergency between November 2018 and March 2019. From January to March 2019, a total of 6767 severely malnourished children were treated in the UNICEF programme. While, 17 365 mothers were trained in nutrition screening techniques.

- More than 59 166 people gained access to safe water through ongoing water trucking supported by UNICEF and the rehabilitation of 129 boreholes and construction of six new boreholes.

Situation overview and humanitarian needs
-----------------------------------------
Measles
-------
The measles outbreak, which began on 3 Sep 2018, has resulted in 122,840 cases as of 3 Apr 2019. It is a nationwide epidemic, with cases reported across all 22 regions in Madagascar. The epidemic has a national attack rate which is currently 33 042 cases per 1 million inhabitants; demonstrating a high rate of spread. Of concern, measles cases have been exported to Comoros and La Reunion. This epidemic is occurring in a context of poor immunization performance. 2/3 of cases are either unvaccinated or their vaccination status is unknown. There have been 1233 deaths reported among the people with measles. Of these, 640 deaths have been notified in health facilities, and 593 at the community level, of which 191 are measles related and 402 non-classified by the community agents.

In Madagascar, there are basic measures to combat measles as well as good testing expertise, particularly through the Pasteur Institute of Madagascar (IPM). However, due to an overall weak health system, the country does not have the capacity to react to health emergencies of this scale without additional international support.
==================
[HealthMap/ProMED-mail map of Madagascar:
Date: Thu 28 Mar 2019
Source: Outbreak News Toady from International Federation of Red Cross and Red Crescent Society [abridged, edited]

Number of people to be assisted: 1,946,656 people in the 10 targeted districts
- Direct targets: 524,868 children for immunization
- Indirect targets: 1,421,788 for sensitization

Host National Society presence of volunteers: Malagasy red Cross Society (MRCS) with 12 000 volunteers across the country. Some 1030 volunteers 206 NDRT/BDRTs, 10 full-time staff will be mobilized through the DREF in the 10 districts.

Red Cross Red Crescent Movement partners actively involved in the operation: International Federation of Red Cross and Red Crescent Societies (IFRC), International Committee of the Red Cross (ICRC), German Red Cross, Danish Red Cross, Luxembourg Red Cross, French Red Cross through the Indian Ocean Regional Intervention Platform (PIROI).

Other partner organizations actively involved in the operation:
Ministry of Health, WHO, UNICEF

Situation.
In July 2018, the 1st case of measles was notified in the urban health centre of the district of Antananarivo Renivohitra in Madagascar. According to WHO, from 4 Oct 2018 to 7 Jan 2019, 19 539 measles cases and 39 "facility-based" deaths (case fatality ratio: 0.2%) were reported by the Ministry of Public Health (MoH) of Madagascar. Cases were reported from 66 of 114 total districts in all 22 regions of Madagascar.

In February 2019 (weeks 7-8), an overall 774 new cases were recorded in 3 newly affected districts including Andilamena (145 cases in week 7 and 167 cases in week 8); Mahajanga II (142 cases in week 7 and 241 cases in week 8) and Mahanoro (22 cases in week 7 and 57 cases in week 8). Despite stabilizing in some areas, the above-mentioned spikes show that the epidemic is progressing, and the epidemic is now posing significant risk to remote and hard to reach communities as seen in the table below, which summarizes the rate at which the disease has been spreading, with 7288 new cases in March 2019 (weeks 9-12).

Indeed, from the onset of the outbreak until 20 Mar 2019, some 117,075 cases have been recorded with 638 deaths notified by health facilities, while 567 deaths have been reported within the communities (114 deaths related to measles and 453 unrelated deaths as per community volunteers). As per Ministry of Health (MoH), about 56% of cases are unvaccinated or of unknown vaccine status. Most cases have been reported in children under 9 years old. Some 105 districts are currently in epidemic situation in the overall 22 regions of the country. The increase in cases can be seen in graphs in the pdf listed above.

Madagascar has not suffered any measles outbreaks in the last 13 years (since 2005) and was already on the road to eliminating measles.
========================
 [See full report in pdf above. - ProMED Mod.LK]
Date: Wed 13 Mar 2019
Source: Outbreak News Today [abridged, edited]

The number of measles deaths has topped 1100 in Madagascar. In an update on the measles epidemic in Madagascar, UN health officials report 6607 cases of measles, including 41 deaths, in the week ending 24 Feb [2019]. Cases are reported in children aged 1 to 14 years. Of 114 districts in all 22 regions, 104 are in the epidemic phase, officials report.
=======================
[The number of cases and deaths from measles in Madagascar is horrifying, even more so since the disease is vaccine-preventable. There is no information on how the health sector in the country is responding, but clearly the clinics are overburdened during this devastating outbreak. - ProMED Mod.LK]

[HealthMap/ProMED-mail map of Madagascar:
Date: Sat 9 Mar 2019
Source: Outbreak News Today [edited]

Plague is endemic in Madagascar, and a seasonal upsurge, predominantly of the bubonic form, usually occurs yearly between September and April. According to the general secretary of the Madagascar Ministry of Health, between 300 and 600 suspected cases are reported each year, with about 30 cases of pulmonary plague and 10 to 70 deaths.

Since August 2018, Madagascar health officials have reported 105 human plague cases. Of these, 91 cases were identified as bubonic plague, while 14 were pneumonic plague. Of the bubonic plague cases reported to date, 19 people have died; 12 of the 14 pneumonic plague cases also perished.

The districts that include confirmed cases of plague are Manandriana, Tsiroanomandidy, Ambositra, Midongy Atsimo, Ambalavao, Befotaka, Ambatofinandrahana, Miarinarivo, Anjozorobe, Faratsiho, Fianarantsoa, Moramanga, Ankazobe, Arivonimamo, Betafo, and Mandoto.

Plague is an infectious disease caused by the bacterium _Yersinia pestis_. It is found in animals throughout the world, most commonly rats but also other rodents like ground squirrels, prairie dogs, chipmunks, rabbits, and voles. Fleas typically serve as the vector of plague. Human cases have been linked to the domestic cats and dogs that bring infected fleas into the house.

People can also get infected through direct contact with an infected animal, through inhalation, and, in the case of pneumonic plague, person to person. _Y. pestis_ [infection] is treatable with antimicrobials if started early enough.
=======================
[Plague infections on Madagascar have been relatively quiet since the dramatic outbreak in 2017.

The following paragraph is from Chanteau S, Ratsifasoamanana L, Rasoamanana B, et al. Plague, a re-emerging disease in Madagascar. Emerg Infect Dis 1998;4(1):101-4, PMID: 9452403; available at <http://wwwnc.cdc.gov/eid/article/4/1/98-0114_article.htm>.  "Between 1930 and 1990, bubonic plague had 'virtually disappeared' on the island due to efficient pest-control and good health management. However since 1990, an annual 200 cases are being reported and bubonic plague takes on epidemic form, especially in the port of Mahajanga, each year. In the capital city of Antananarivo, more cases are also being notified each year since 1990. Madagascar (pop. 13 million) has accounted for 45% of all the cases of plague in Africa."

Fatalities related to plague usually are caused by spread of the organism from the bubo (the very painful infected lymph node that drains the area where the flea bite occurred) to the bloodstream. The bacteraemia can cause a coagulopathy, producing the purpura seen in the "black plague", and also may spread to the lungs causing a haemorrhagic pneumonia. It is the pneumonia that can facilitate person-to-person transmission.

Madagascar was the location of the isolation of multi-antimicrobial resistant _Yersinia pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et al. Multidrug resistance in _Yersinia pestis_ mediated by a transferable plasmid. N Engl J Med. 1997;337(10):677-80, PMID: 9278464; available at <http://www.nejm.org/doi/full/10.1056/NEJM199709043371004>). The strain was resistant to chloramphenicol, streptomycin, and tetracycline but sensitive to fluoroquinolones and trimethoprim as well as other aminoglycosides. This was an ominous observation; however, it is not clear whether this naturally occurring strain has persisted or spread. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Madagascar:
Date: Sun 10 Mar 2019
Source: Medical Xpress [abridged, edited]

[F] is aged 2 but weighs no more than a 4 month old, the terrible result of her battle with measles, which is cutting a deadly swathe through Madagascar. Widespread malnutrition and low rates of immunisation on the Indian Ocean island have ramped up the killing power of the highly infectious virus. In the last 6 months, nearly 1000 children have been killed by a resurgent disease that vaccination once appeared to have tamed.

Between last September [2018] and February [2019], there were more than 79,000 cases of measles in Madagascar, 926 of which were fatal, according to the World Health Organization (WHO).

The Anivorano-nord clinic has had 510 patients suffering from "kitrotro" and "kisaosy", the local names for measles. Roughly 100 patients were hospitalised, but only 4 lost their lives, according to official statistics. In Madagascar, where 47% of children under 5 are malnourished, the disease has proved particularly dangerous. "It's often said that malnutrition makes a bed for measles," said Vincent Sodjinou, a WHO representative. "The most serious cases are often reported in malnourished children."

The paediatric ward at Antsiranana's military hospital, north of Anivorano, has been overwhelmed. "Normally we only treat one measles case here every 2 months," said head of medicine Ravohavy Setriny Mahatsangy. "We've had 444 just since December [2018]. The people prefer traditional healers who often advise them to refuse any hospitalisation," said Dr Said Borohany, a health ministry official. "And most villages are hours away from basic medical centres."

The other viable solution, vaccinations, has been complicated by the lack of funds available for such a programme. Until now the nation's vaccination programme has administered only a single dose, when WHO recommends 2. The UN agency estimates that 5.6 million doses would be needed to contain the epidemic. But Madagascar is USD 1.6 million (EUR 1.42 million) short of the USD 11.2 million [EUR 9.96 million] needed to fund such an operation.

Newly elected president, Andry Rajoelina, has promised to vaccinate all children aged between 6 months and 9 years.
More ...

World Travel News Headlines

Date: Tue, 21 May 2019 12:37:30 +0200

Khartoum, May 21, 2019 (AFP) - Sudanese protest leaders called on their supporters Tuesday to prepare for a general strike after talks with the country's military rulers stalled on who will lead an agreed three-year transition.   Protest leaders had reached agreement with the ruling military council on the other main aspects of the transition.   But early on Tuesday, the generals who overthrew veteran president Omar al-Bashir last month baulked at protesters' demands for a civilian head and a civilian majority for an agreed new sovereign council to lead the transition.

"In order to achieve a full victory, we are calling for a huge participation in a general political strike," said the Sudanese Professionals Association, which took the lead in organising the four months of nationwide protests that led to Bashir's ouster.   "The strike is our revolutionary duty and the participation in the sit-in ... is a crucial guarantee to achieve the goals of the revolution."

Protest leader Madani Abbas Madani told AFP the preparations for a "general political strike and civil disobedience" were already under way.   "Whenever we will decide on applying these plans, we will make an announcement," said Madani, a prominent leader of protest umbrella group the Alliance for Freedom and Change.   The two sides launched what had been billed as a final round of talks on the transition late on Sunday.

The military council has faced pressure from Western government and the African Union to agree to a civilian-led transition -- the central demand of the thousands of demonstrators who have spent weeks camped outside army headquarters in Khartoum.   When talks broke up early on Tuesday, neither side said when they would resume.

Protest leader Siddiq Yousef told reporters they had been suspended.   "The main point of dispute that remains is concerning the share of representatives of the military and the civilians in the council and who will be the head of the new body," the two sides said in a joint statement.   The military council has been pushing for its chairman General Abdel Fattah al-Burhan to head the new sovereign council but protest leaders want a civilian.
Date: Tue, 21 May 2019 05:22:30 +0200
By John WESSELS with Samir TOUNSI in Kinshasa

Butembo, DR Congo, May 21, 2019 (AFP) - People in Ebola-hit eastern DR Congo are struggling to come to terms with high-security burials that are part of a hard-pressed strategy to roll back the disease.   Anyone who dies of the highly infectious haemorrhagic fever has to be buried in carefully-controlled conditions designed to minimise the risk of infection from body fluids.   But that means ceremonies are carried out in sanitised conditions, with relatives and friends kept at a distance -- for many, a traumatic break with traditions that demand the body of a loved-one be seen or touched.   "We're astonished she's being buried like this," said Denise Kahambu as she watched the specially-prepared burial in Butembo of her 50-year-old cousin, Marie-Rose.   "They said she died of Ebola," she said sceptically.   First declared last August, the epidemic has now claimed nearly 1,200 lives -- 200 of them in May alone.    The outbreak is the second deadliest on record, after an epidemic that killed more than 11,300 people in West Africa in 2014-16.

The burial in Butembo followed strict precautions. A pick-up truck delivered the coffin to the burial site, where a grave had been prepared, as the family stood by at a distance.   Gloved Red Cross workers handled the burial, which took place in silence and without a religious ceremony.   A family member or loved one was allowed only to place a cross on the tomb, once they too had donned protective gloves.   Half a dozen police officers escorted the convoy and remained on guard throughout.    On Friday, two burial teams from the treatment centres were attacked by stone-throwing crowds at Butembo and Bunia, a little further north in Ituri province, according to the health ministry. One burial worker was injured.

- Culture shock -
"The custom is that the body of the deceased first returns to the home. And once people have mourned, they have the chance to touch the body for the last time," said Seros Muyisa Kamathe, a guide and interpreter in Beni and Butembo.   "Before going to the cemetery, you open the coffin so people can take one last look at the deceased."

And normally it would be the family and neighbours who would take responsibility for digging the grave -- and deciding where if should be.   Ebola experts say denial and resistance were familiar obstacles in the 2014-16 epidemic in the West African states of Guinea, Liberia and Sierra Leone.   The World Health Organization (WHO) has a 12-step protocol for dealing with burials so that handling of the remains is kept to a minimum, but it also emphasises the importance of respect and mourning.   "The burial process is very sensitive for the family and the community and can be the source of trouble or even open conflict," it acknowledges.    No burial should begin until family agreement has been obtained, and workers should engage with the community "for prayers to dissipate tensions
and provide respectful time," it says.

- Armed escorts -
The burial process is part of the notoriously time-consuming and labour-intensive task of combatting Ebola.   And in this troubled region, the challenge has been further complicated by bloody deadly attacks on Ebola treatment centres by local militias.   Suspicion, political infighting in the capital Kinshasa and militia violence provide a fertile breeding ground for the virus.   Sometimes local people cover the graves overnight as a sign of their opposition, the ministry said.   In Butembo, health workers need an armed escort when they go looking for cases of Ebola in some neighbourhoods, an AFP photographer noted during one outing Saturday evening.

WHO Director-General Tedros Adhanom Ghebreyesus, at the opening of the organisation's annual assembly on Monday, described the outbreak as "one of the most complex health emergencies any of us have ever faced."   "Unless we unite to end this outbreak we run the risk it will become more widespread and more expansive and more aggressive," he said.   "We are not just fighting a virus," Tedros insisted. "We're fighting insecurity. We're fighting violence. We're fighting misinformation... and we're fighting the politicisation of an outbreak."   On the plus side, health officials are keen to emphasise some important gains. More than 118,000 have been vaccinated against the virus, and no cases have been recorded in neighbouring Rwanda and Uganda.
Date: Mon, 20 May 2019 15:09:54 +0200

Milan, May 20, 2019 (AFP) - Alitalia has scrapped around half its flights scheduled for Tuesday after a call to strike by Italian pilots, cabin crew and ground staff.   The industrial action by employees of Alitalia, Blue Air and Blue Panorama was confirmed Monday over the future of the sector and specifically that of the troubled national carrier.   Alitalia has cancelled around half its flights on Tuesday, as well as some late Monday and early Wednesday. The company said it hoped to get 60 percent of passengers to their destination.

Unions lamented "on the one hand, a rising number of passengers and flights, and on the other a proliferation of bankruptcies", a statement said.   They are worried about Alitalia's future and want their jobs protected.   The Italian government earlier this month extended to June 15 a deadline for the state railway to submit a concrete takeover offer, following a request from Alitalia's administrators for more time.   Italy's state railway Ferrovie dello Stato (FS) floated a bid to buy Alitalia at the end of October, but it does not want to hold more than 30 percent in the airline.   The railway has been discussing a potential partnership with Atlanta-based Delta airlines, which is interested in a 15-percent stake.
Date: Sun, 19 May 2019 21:55:33 +0200

Giza, Egypt, May 19, 2019 (AFP) - A bomb blast hit a tourist bus near Egypt's famed Giza pyramids on Sunday, wounding some of them, including South Africans, in the latest blow to the country's tourism industry.   The roadside bomb went off as the bus was being driven in Giza, also causing injuries to Egyptians in a nearby car, medical and security sources said.   Security and medical sources in Egypt said 17 people were injured, without giving a breakdown of their nationalities. No deaths were reported.   South Africa said in a statement that the "bus explosion" injured three of its 28 citizens who were part of the tourist group.   They would remain in hospital while the rest would return home on Monday, said the statement from the department of international relations.   "A device exploded and smashed the windows of a bus carrying 25 people from South Africa and a private car carrying four Egyptians," the security source said.

Video footage captured by AFP showed the bus and car with broken windows on the side of the road.   According to the security source, the wounded were being treated for scratches caused by the broken glass.   Sunday's incident comes after three Vietnamese holidaymakers and their Egyptian guide were killed when a roadside bomb hit their bus as it travelled near the Giza pyramids outside Cairo in December.   It also comes just little more than a month before the African Cup of Nations hosted by Egypt is to kick off.   Egypt has been battling an insurgency that surged especially in the turbulent North Sinai region following the 2013 military ouster of Islamist president Mohamed Morsi, who was replaced by former army general Abdel Fattah al-Sisi.   In February 2018, the army launched a nationwide operation against militants, focusing mainly on the North Sinai region.

- Tourism recovery -
Some 650 militants and around 45 soldiers have been killed since the start of the offensive, according to separate statements by the armed forces.   Since first being elected in 2014, Sisi has presented himself as a bulwark against terrorism, promising stability and increased security.   Recently, the country's vital tourism industry has started to slowly rebound after suffering strong blows due to deadly attacks targeting tourists following the turmoil of the 2011 uprising that toppled longtime ruler Hosni Mubarak.   Figures by the official statistics agency showed that tourist arrivals reached 8.3 million in 2017, compared with 5.3 million the previous year.    Authorities have gone at great lengths to lure tourists back, touting a series of archaeological finds and a new museum next to the pyramids, as well as enhanced security at airports and around ancient sites.    But that figure was still far short of the record influx of 2010 when more than 14 million visitors flocked to see the country's sites.
Date: Sun, 19 May 2019 05:17:37 +0200

Tegucigalpa, May 19, 2019 (AFP) - Four Canadians and an American pilot died Saturday when their small plane plunged into the sea off the Honduran island of Roatan where they were vacationing, firefighters said.   The plane crashed near the town of Dixon Cove, a few minutes after taking off from the island's airport, rescuers said.   The dead were identified as Bradley Post, Bailey Sony, Tomy Dubler and pilot Patrick Forseth.

The other Canadian pilot, Anthony Dubler, briefly survived the crash but died at the Roatan hospital of his injuries.   The causes of the crash and the registration information for the aircraft were not immediately available.   It occurred as the tourists were headed toward the city of Trujillo, about 77 kilometres (48 miles) from Roatan.
Date: Fri, 17 May 2019 16:32:13 +0200

London, May 17, 2019 (AFP) - London warned British-Iranian dual nationals against all travel to Iran on Friday due to Tehran's "continued arbitrary detention and mistreatment" of such citizens.   The move comes as Britain continues to try to secure the release from jail of dual national Nazanin Zaghari-Ratcliffe.   Tehran has also recently sentenced an Iranian British Council employee, Aras Amiri, to 10 years in prison on charges of spying.   In a statement, the Foreign Office said British-Iranian dual nationals faced an "unacceptably higher risk of arbitrary detention and mistreatment" than nationals of other countries.   "The security forces may be suspicious of people with British connections, including those with links to institutions based in the UK, or which receive public funds from, or have perceived links to, the British government," the statement said.   British-Iranian mother Zaghari-Ratcliffe was arrested by Iranian authorities in 2016 as she was leaving Tehran.

Zaghari-Ratcliffe, who worked for the Thomson Reuters Foundation, was put on trial and is now serving a five-year jail sentence for allegedly trying to topple the Iranian government.   "Dual nationals face an intolerable risk of mistreatment if they visit Iran," Foreign Secretary Jeremy Hunt said.   "Despite the UK providing repeated opportunities to resolve this issue, the Iranian regime's conduct has worsened.   "Having exhausted all other options, I must now advise all British-Iranian dual nationals against travelling to Iran.   "The dangers they face include arbitrary detention and lack of access to basic legal rights, as we have seen in the case of Nazanin Zaghari-Ratcliffe, who has been separated from her family since 2016."   The Iranian government does not recognise dual nationality, meaning the Foreign Office's ability to provide consular support is limited.   Hunt added: "Regrettably, I must also offer a message of caution to Iranian nationals resident in the UK -- but who return to visit family and friends -- especially where the Iranian government may perceive them to have personal links to UK institutions or the British government."
Date: Fri, 17 May 2019 11:42:01 +0200

Nairobi, May 17, 2019 (AFP) - Flooding in Tanzania has killed five people and forced about 2,500 to flee their homes after a week of torrential rain in the country's south, an official said Friday.   Schools have closed in Kyela, a district on the border of Lake Malawi, and families fled to shelters after losing everything in the rising waters.   "The damage from these floods is enormous," Salome Magambo, the district's administrative secretary, told AFP.   "Since the beginning of the week we have reported five people killed and 2,570 homeless, some of whom are staying with friends or in schools and churches."

Food and medical services have been extended to those stranded, she added.   Farming land in the district known for its rice production has also been inundated, destroying crops and raising fears of food shortages in coming months.   In April 2018 at least 14 people were killed in torrential rains and flooding in Dar es Salaam, Tanzania's economic capital.
Date: Thu, 16 May 2019 23:41:35 +0200

Washington, May 16, 2019 (AFP) - The Church of Scientology said Thursday all the passengers from a cruise ship that was quarantined over a measles case had been cleared to leave.    "All passengers and crew (100%) of the Freewinds have been fully cleared of any possible risk of being infected by the measles or infecting others," the organization said in a statement.   "All passengers and crew are free to come and go as they wish," a spokesman added to AFP.

The infected individual was a member of the crew who, according to the Church, had fully recovered and was given a clean bill of health a week ago. She had been earlier confined on the ship.   The ship, which is based in Willemstad on the island of Curacao in the Dutch West Indies, was quarantined after its arrival in Saint Lucia on April 30.   It remained there for two days before returning to Willemstad on May 4 where local authorities ordered a fresh quarantine to give them time to confirm the passengers were either immunized or had no risk of contracting the virus.
Date: Thu, 16 May 2019 18:37:39 +0200

Bamako, May 16, 2019 (AFP) - Heavy floods claimed 15 lives Thursday in the Malian capital Bamako along with serious property damage, authorities said.   A statement said the flooding claimed a "provisional toll" of 15 dead and two injured.   "Teams are in place to rescue the distressed people," the government said, calling on residents to be "prudent" in the face of the disaster.   Flooding is common in Mali, located in the semi-desert Sahel region.
Date: Thu, 16 May 2019 04:40:13 +0200
By Ashraf KHAN

Rato Dero, Pakistan, May 16, 2019 (AFP) - Parents nervously watch as their children wait to be tested for HIV in a village in southern Pakistan, where hundreds of people have been allegedly infected by a doctor using a contaminated syringe.   Dispatched to keep order, police scan the anxious crowd as families hustle into one of five different screening rooms set up in the last month in the village of Wasayo, on the outskirts of Larkana in Sindh province.

Health officials say more than 400 people, many of them children, have tested HIV positive in recent weeks as experts warn of a surge in infection rates across Pakistan, due to the use of unsanitary equipment and rampant malpractice -- often at the hands of quack doctors.   Anger and fear continue to swell in the desperately poor village hit hard by the epidemic, which authorities say could be linked to either gross negligence or malicious intent by a local paediatrician.   "They are coming by the dozens," says a doctor at the makeshift clinic, beset by a lack of equipment and personnel to treat the surging number of patients.

Mukhtar Pervez waits anxiously to have her daughter tested, worrying a recent fever may be linked to the outbreak. For others, their worst fears have already become a reality.   Nisar Ahmed arrived at the clinic in a furious search for medicine after his one-year-old daughter tested positive three days earlier.   "I curse [the doctor] who has caused all these children to be infected," he says angrily.   Nearby Imam Zadi accompanies five of her children to be examined after her grandson tested positive.   "The entire family is so upset," she tells AFP.   Others worry 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.   "Who is she going to play with? And when she's grown up, who would want to marry her?" asks a tearful mother from a nearby village, who asked not to named, of her four-year-old daughter who just tested positive.  

- 'Helpless'-
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.   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.    "According to some government reports, around 600,000 quack doctors are operating across the country and around 270,000 are practicing in the province of Sindh," said UNAIDS in a statement.

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.   "For the sake of saving money, these quacks will inject multiple patients with a single syringe. This could be the main cause of the spread of HIV cases," said Sikandar Memon, provincial programme manager of the Sindh Aids Control Programme.

The large number of unqualified doctors along with the "reuse of syringes, unsafe blood transfusions, and other unsafe medical practices" have all led to the spike in HIV cases in recent years, explains Bushra Jamil, an expert on infectious diseases at the Aga Khan University in Karachi.   "Rampant medical malpractices without any effective checks and balances are causing repeated outbreaks in Pakistan," said Jamil.   Authorities investigating the outbreak in Sindh say the accused doctor has also tested positive for HIV.

From a ramshackle jail cell in the nearby city of Ratodero, he denied the charges and accusations he knowingly injected his patients with the virus, while complaining of being incarcerated with common criminals.   But for the parents of the newly diagnosed, the ongoing investigation means little if they are unable to secure access to better information and the necessary drugs that can help stave off the deadly AIDS virus.   "We are helpless. I have other children and I am afraid they might catch the disease," says another mother whose daughter recently tested positive for HIV.   "[Please] send some medicine for our children so that they can be cured. If not, all of our children will die, right?"