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Poland

Poland US Consular Information Sheet
September 10, 2008
COUNTRY DESCRIPTION:
Poland is a stable, free-market democracy, and has been a member of the European Union since 2004..
Tourist facilities are not highly developed in all areas,
and some services taken for granted in other European countries may not be available in some parts of Poland, especially in rural areas.
Read the Department of State Background Notes on Poland for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport is required.
Be sure to check your passport's validity -- Poland will not admit you if your passport is expired.
(Remember that U.S. passports for persons under 16 are valid for five, not ten, years).
On December 21, 2007, Poland joined the Schengen Zone.
U.S. citizens do not need visas for stays of up to 90 days for tourist, business, or transit purposes. That period begins when you enter any of the Schengen countries:
Austria, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, and Sweden.

Note:
Although European Union regulations require that non-EU visitors obtain a stamp in their passports upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function.
If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry.
Under local law, travelers without a stamp in their passports may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.

Polish immigration officials may ask travelers for proof of sufficient financial resources to cover their proposed stay in Poland, generally viewed as 100 zloty per day.
Additionally, citizens of non-EU countries, including the United States, should carry proof of adequate medical insurance in case of an accident or hospitalization while in Poland.
Polish immigration officials may ask for documentation of such insurance or proof of sufficient financial resources (at least 400 zloty per day) to cover such costs.
Those who lack insurance or access to adequate financial resources may be denied admission to Poland.
Medicare does not cover health costs incurred while abroad.

Poland requires Polish citizens (including American citizens who are or can be claimed as Polish citizens) to enter and depart Poland using a Polish passport.
Americans who are also Polish citizens or who are unsure if they hold Polish citizenship should contact the nearest Polish consular office for further information.

For further information on entry requirements, please contact the consular section of the Embassy of the Republic of Poland at 2224 Wyoming Avenue NW, Washington, DC 20008, tel. (202) 234-3800, or the Polish consulates in Chicago, Los Angeles or New York.
Visit the Embassy of Poland web site at http://www.polandembassy.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:
Poland remains largely free of terrorist incidents.
However, like other countries in the Schengen area, Poland’s open borders with its Western European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity.
Americans are reminded to remain vigilant with regard to their personal security.

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.

For the latest security information, Americans traveling abroad should regularly monitor the Bureau of Consular Affairs’
web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for overseas callers, 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).

CRIME:
While Poland generally has a low rate of violent crime, the incidence of street crime, which sometimes involves violence, is moderate.
Major cities have higher rates of crime against residents and foreign visitors than other areas.

Organized groups of thieves and pick-pockets operate at major tourist destinations, in train stations, and on trains, trams, and buses in major cities.
Thieves will target overnight trains.
Most pick-pocketing on trains occurs during boarding; in the most common scenario, a group of well-dressed young men will surround a passenger in the narrow aisle of the train, jostling/pick-pocketing him or her as they supposedly attempt to get around the passenger.
Keep an eye on cell phones; they are prized by thieves.
Beware of taxi drivers who approach you at the airport or who do not display telephone numbers and a company name; these drivers usually charge exorbitant rates.
Order your taxi by telephone and at the airport use only taxis in the designated taxi ranks.

Car thefts and car-jackings are significantly declining; however, theft from vehicles remains a constant concern.
Drivers should be wary of people indicating they should pull over or that something is wrong with their cars; when such drivers pull over to see if there is a problem, they may find themselves suddenly surrounded by thieves from a second vehicle.
Drivers encountering someone indicating that there is trouble with their car and the problem is not apparent should continue driving until they find a safe spot (a crowded gas station, supermarket, or even police station) to inspect their vehicles.
There also have been incidents of thieves opening or breaking passenger-side doors and windows in slow or stopped traffic to take purses or briefcases left on the seat beside the driver.
Those traveling by car should remember to keep windows closed and doors locked.
Extremist youth gangs are a threat, particularly in urban areas.
Verbal harassment and physical attacks have been directed against members of racial minorities or those who appear to be foreign, particularly those of Asian or African descent.

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 Poland is: 112
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Adequate medical care is available in Poland, but hospital facilities and nursing support are not comparable to American standards.
Physicians are generally well trained but specific emergency services may be lacking in certain regions, especially in Poland's small towns and rural areas.
Younger doctors generally speak English, though nursing staff often does not.
Doctors and hospitals often expect immediate cash payment for health services.
Medications are generally available, although they may not be specific U.S. brand-name drugs.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to, or foreign residents of, Poland.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site 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:
Polish immigration law requires travelers either to carry adequate medical insurance in case of accident or hospitalization while in Poland or to be able to document access to sufficient financial resources (at least 400 zloty per day) to cover such medical emergencies.
Failure to carry insurance or the inability to provide documentation of sufficient financial resources if requested may result in a traveler being denied admission to Poland.
Medicare does not cover Americans in Poland.

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

An International Driving Permit (IDP), obtained prior to departure from the U.S., must accompany a U.S. driver's license.
A U.S. driver's license without an IDP is insufficient for use in Poland, and Americans cannot obtain IDPs in Poland.
Only two U.S. automobile associations — the American Automobile Association (AAA) and the American Automobile Touring Alliance (AATA) — have been authorized by the U.S. Department of State to distribute IDPs.
Polish roadside services, while not at Western levels, are rapidly improving.
Polski Zwiazek Motorowy Auto-Tour has multilingual operators and provides assistance countrywide; they can be reached by calling 9281 or 9637 preceded by the city code (outside of Warsaw 022-9281).
The police emergency number is 997, fire service is 998, and ambulance service is 999.
Mobile phone users can dial 112 for emergency assistance.
Seat belts are compulsory in both the front and back seats, and children under the age of 10 are prohibited from riding in the front seat.
You must use Headlights at all times, day and night.
Using your cellular phone while driving is prohibited, except for “hands-free” models.

There has been a substantial increase in the number of cars on Polish roads.
Driving, especially after dark, is hazardous.
Roads are generally narrow, poorly lighted, frequently under repair (especially in the summer months), and are often also used by pedestrians and cyclists.
The Ministry of Infrastructure has a program called “Black Spot” (Czarny Punkt), which puts signs in places with a particularly high number of accidents and/or casualties.
These signs have a black spot on a yellow background, and the road area around the “black spot” is marked with red diagonal lines.

Alcohol consumption is frequently a contributing factor in accidents.
Polish laws provide virtually zero tolerance for driving under the influence of alcohol, and penalties for driving under the influence of alcohol (defined as a blood alcohol level of 0.02 or higher) include a fine and probation or imprisonment for up to two years. Penalties for drivers involved in accidents are severe, and can be imprisonment from six months to eight years

Within cities, taxis are available at major hotels and designated stands or may be ordered in advance. Some drivers accept credit cards and/or speak English.
Travelers should be wary of hailing taxis on the street, especially those that do not have a telephone number displayed, because these may not have meters, and many of them charge more.
Do not accept assistance from “taxi drivers” who approach you in the arrivals terminal or outside the doors at Warsaw Airport.
Travelers availing themselves of these “services” often find themselves charged significantly more than the usual fare.
Use only taxis at designated airport taxi ranks.

Please refer to our Road Safety page for more information.
Visit the web site of Poland's National Tourist Office at http://www.polandtour.org and, that of Poland's Ministry of Transport responsible for road safety at http://www.mt.gov.pl.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Poland’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Poland'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:
Visitors importing more than 10,000 Euros should, as part of the arrivals process, complete a form to declare currency, traveler's checks, and other cash instruments.
This form should be stamped by Polish Customs and retained by the traveler for presentation on departure.
Undeclared cash may be confiscated upon departure, and visitors carrying undeclared cash may be prosecuted.
Most banks now cash traveler's checks, ATMs are readily available, and credit cards increasingly accepted.
Polish customs authorities may enforce strict regulations concerning the export of items such as works of art, particularly those created before 1953.
Works produced by living artists after 1953 may be exported with permission from the Provincial Conservator of Relics.
Some works of art produced after 1953 may still be subject to a ban on exportation if the artist is no longer living and the work is considered of high cultural value.
If you are importing an item or work of art like those described above, even if only temporary (e.g., for an exhibit or performance) you should declare it to customs upon entry and carry proof of ownership in order to avoid problems on departure.
Contact the Polish Embassy in Washington, D.C., or one of the Polish consulates in the United States for specific information regarding customs requirements.
Please see our Customs Information.

Poland does not recognize (although it does not prohibit) dual nationality.
A person holding Polish and U.S. citizenship is deemed by Poland to be a Pole and subject to Polish law.

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 Polish laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use or trafficking in illegal drugs in Poland 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 Poland 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 Poland.
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 Warsaw is located at Aleje Ujazdowskie 29/31.
The Consular Section entrance is located around the corner at Ulica Piekna 12.
The Embassy's telephone number is (48) (22) 504-2000.
This number can be called 24 hours/day: for emergencies after business hours, press “0.”
The Embassy's fax number is (48) (22) 504-2688 and the fax number for the Consular Section is (48)(22) 627-4734 (consular fax only checked during normal business hours).
The U.S. Consulate General in Krakow is located at Ulica Stolarska 9.
The Consulate General's telephone number is (48) (12) 424-5100; fax (48)(12) 424-5103; after-hours cellular phone (for emergencies only) 601-483-348.
A Consular Agency providing limited consular services in Poznan is located at Ulica Paderewskiego 8.
The Consular Agency's telephone number is (48) (61) 851-8516; fax (48) (61) 851-8966.
The Embassy's web site is at http://poland.usembassy.gov/
* * *
This replaces the Consular Information Sheet dated March 5, 2008 to update the sections on Information for Victims of Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed, 20 Feb 2019 16:17:29 +0100

Prague, Feb 20, 2019 (AFP) - Czech authorities said Wednesday they would slap checks on beef imported from Poland after veterinarians found the dangerous Salmonella bacteria in a 700-kilogramme batch of Polish beef.   "Tests have shown the presence of Salmonella enteritidis, which can cause serious diarrhoea and affect human health, in beef imported from Poland on February 13," Agriculture Minister Miroslav Toman told reporters.

Czech veterinary authorities have warned the European Commission and Polish authorities through a rapid warning system, he said, adding that they are also checking whether any of the meat has been consumed.   "The State Veterinary Administration (SVS) will immediately adopt an extraordinary measure -- all beef imported from Poland must be tested in a lab before hitting the market," Toman added.

SVS head Zbynek Semerad said meat from the 700-kilo (1,500-pound) batch had been distributed to five "places" in the Czech Republic and one in Slovakia.   "I will inform my Slovak counterpart. As far as we know, not all of the meat has been distributed to the end customer," Semerad said.   The case comes on the heels of a scandal which saw Poland export a total of 2.7 tonnes of suspect beef to around a dozen fellow EU members, triggering an EU probe.

The scandal erupted in January when the TVN24 commercial news channel aired footage of apparently sick or lame cows being butchered at a small slaughterhouse in northeast Poland in secret late at night when veterinary authorities were unlikely to visit.   Poland is a leading producer and exporter of meat in Europe, turning out around 600,000 tonnes of beef per year and exporting most of it mainly to the EU, according to meat producer associations.
Date: Sat 24 Nov 2018
Source: Radio Poland [edited]

Fourteen new measles cases have been registered around Warsaw over the last week, public broadcaster Polish Radio's IAR news agency reported on Fri [23 Nov 2018].

Meanwhile, Poland's health inspectorate said that measles infections were on the rise in Poland with 79 cases reported in the Mazowvian voivodship alone, since 10 Oct 2018.

Measles can cause deadly complications, especially in children under 5 and adults over 20.

The health inspectorate has urged people to vaccinate children against measles, mumps and rubella, adding that the growing rate of measles infection is concerning, considering that Poland's measles vaccination is very effective.
Date: Wed, 25 Jul 2018 15:30:29 +0200

Warsaw, July 25, 2018 (AFP) - Polish health authorities said Wednesday they had closed scores of beaches along the country's Baltic Sea coast due to a massive toxic algae bloom triggered by a heat wave.

"Swimming is prohibited on eight beaches along the open sea and about twenty beaches in Gdansk Bay because of the appearance... of cyanobacteria," Tomasz Augustyniak, health inspector for the northing Gdansk province, told AFP referring to blue-green algae.   "The algae is toxic and poses a health risk," he said, adding that the week-old bloom was "particularly intense" due to a long stretch of hot weather.

Polish television this week broadcast aerial footage showing a green carpet of algae covering the sea.    Run-off containing nitrates and phosphates from farm fertilisers and sewage have seeped into the Baltic, triggering large algal blooms in recent years, Augustyniak said.   Dying algae also triggers complex organic processes that suck the oxygen out Baltic waters leading to "dead zones" where no marine life can exist.

Scientists termed oxygen loss in the Baltic "unprecedentedly severe" in a study published this month in the European Geosciences Union journal Biogeosciences.   They note that as a relatively small, shallow and enclosed sea, the Baltic has a very limited ability to flush out pollutants into the waters of the North Sea, making it an extremely vulnerable ecosystem.   Encircled by nine countries -- Estonia, Denmark, Finland, Germany, Latvia, Lithuania, Poland, Russia and Sweden -- the Baltic has an estimated 16 million people living along its shores.
Date: Sun, 15 Jul 2018 15:35:14 +0200

Warsaw, July 15, 2018 (AFP) - Two Hungarian tourists have admitted to trying to steal bricks from the ruins of a crematorium at the site of the former Nazi German death camp Auschwitz-Birkenau, according to police.   The 30-year-old woman and 36-year-old man were caught on Saturday when another pair of foreign tourists saw them stuffing the bricks into a bag and notified security.    "The man and woman were charged with theft of a cultural asset. They both admitted to wrongdoing," said regional police press officer Mateusz Drwal.   "They explained that they had wanted to bring back a souvenir and didn't realise the consequences of their actions," he told the Polish news agency PAP.

The Hungarian tourists were each fined 1,500 zloty ($400, 350 euros) and handed a suspended sentence of one year in jail.    Auschwitz-Birkenau has become a symbol of Nazi Germany's genocide of European Jews, one million of whom were killed at the camp between 1940 to 1945.   More than 100,000 others including non-Jewish Poles, Roma, Soviet prisoners of war and anti-Nazi resistance fighters also died there.
Date: Wed, 4 Jul 2018 12:29:01 +0200
By Michel VIATTEAU

Warsaw, July 4, 2018 (AFP) - A grey Ferrari comes to a halt in Warsaw and a young woman emerges. Wearing Chanel sunglasses and carrying a little dog, she enters the Raffles Europejski hotel, a symbol of the luxury that has returned to Poland.  Her destination is the historic pastry shop Lourse, which is located at the hotel, where guests pay between 250 and 4,000 euros ($290 and $4,700) a night and can count on perks like a personal butler.

The legendary Hotel Europejski, which was considered eastern Europe's best in the 19th century, has just reopened after five years of renovation work spearheaded by the Raffles brand.    Poland's first Hermes store could be housed at the site, a source told AFP, though the French luxury goods giant would only confirm that it was looking into a project "in Warsaw in late 2019, early 2020".    Luxury has become increasingly visible in Poland after a long absence due to the country's devastating losses during World War II and the policy of egalitarianism later touted by the communist regime.

Decades on, a new class of wealthy Poles has appeared, whose members include heads of successful family businesses, real estate agents and high-flying bankers.   Many of the elite live in the 44-floor Cosmopolitan apartment tower in the heart of Warsaw. Opened in 2014, the building boasts a minimalist design by German-American architect Helmut Jahn, who also designed the European Union's headquarters in Brussels.    Of the 100 most expensive real-estate sales in Warsaw between 2015 and 2017, 79 concerned flats in the Cosmopolitan building, said Karolina Kaim, president of Tacit Investment, the Polish firm that financed the building's construction.

- 'Vertical village' -
The apartments vary in price depending on the floor and view.    The most sought after units look out onto the Vistula River and the old part of town and cost nearly 10,000 euros per square metre -- a figure that may not shock Parisians or Londoners but is staggering to the average Pole who earns around 1,100 euros a month.   Most of the apartment owners are Polish but there are also a handful of foreigners living in the "vertical village", which cost more than 100 million euros to build, according to Kaim.    Residents include pop stars, football players and actors.

Other luxury symbols seen around town include high-end cars from brands such as Bentley, Ferrari, Lamborghini and Rolls-Royce.    Only a few years ago, the appearance of a sports car with the famous horse logo would have drawn a small crowd of onlookers, but today, Ferraris no longer stop traffic in Warsaw.    The Italian luxury car manufacturer has two Polish dealerships, one in the southern city of Katowice and another in the capital.    Their marketing head Karolina Szulecka prefers not to reveal sales figures but says that client interest is constantly on the rise.    Were it not for the company's policy of limiting production, Poles would snap up "10 or 15 percent more" Ferraris, she told AFP.

- On the rise -
From the collapse of communism, a new social group of entrepreneurs rapidly emerged, often former managers quick to buy shares in the newly privatised companies and develop them, or small entrepreneurs and artisans who swiftly adapted to the new conditions to create or grow a family business.   EU funds and foreign investment into the country followed and increased after Poland's 2004 EU entry.   Between 1990 and 2015, gross domestic product (GDP) more than doubled. Exports are growing and, according to International Monetary Fund forecasts, growth is expected to be just over four percent this year partly on "strong domestic consumption".   Today, Poland's wealthiest are often the third generation of those small business owner.

- A dozen Ferraris -
Meanwhile some Poles have many more than just one sports car.    A land developer, who declined to be identified, admitted he had three Ferraris parked in his garage, while the brand's biggest collector in Poland has 12. He also prefers to remain anonymous.    The general manager of the Bentley and Lamborghini dealerships in Poland, Piotr Jedrach, expects to sell around 50 British limousines in 2018 -- an increase on previous years thanks in part to the recent addition of an SUV model.

Prices start at around 230,000 euros.    As for Lamborghinis, displayed in Warsaw in a car dealership that looks more like a futuristic temple, they too are forecast to see a boost in sales, with 60 expected to sell in 2019, thanks to the SUV Urus.    The average Pole has nothing against the ultra wealthy.    "If I had that much money, I'd also buy myself a Ferrari," said Hanna Mrowiec, a retired middle manager who lives in a small one-bedroom apartment.    "But to have three? That's absurd. You can't drive three Ferraris at once," she told AFP.   Nevertheless, luxury in Poland generally remains discreet, more the purview of cultural sponsorship than bling-bling excess.

The Swiss owner of Raffles Europejski, Vera Michalski, paid for around 500 modern Polish works of art to adorn her hotel. She also lent some from her own collection.    As for the Cosmopolitan, there was an art exhibition earlier this year on the 42nd floor.    It featured work by the late painter and sculptor Wojciech Fangor, the only Pole to ever have a solo exhibition at the Guggenheim Museum in New York.   The Cosmopolitan exhibition was free for anyone to attend -- not just the happy few living there.
More ...

World Travel News Headlines

Date: Wed, 22 May 2019 16:52:39 +0200
By Nazeer al-Khatib with Hashem Osseiran in Beirut

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

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

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

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

- 'Break the status quo' -
The September deal was never fully implemented as jihadists refused to withdraw from a planned buffer zone around the Idlib region.   But it ushered in a relative drop in violence until earlier this year, with Turkish troops deploying to observation points around the region.   The Syrian government has accused Turkey of failing to secure implementation of the truce deal by the jihadists.   But Turkish Defence Minister Hulusi Akar accused the Syrian regime late Tuesday of threatening the ceasefire deal.   "The regime is doing all that it can to break the status quo including using barrel bombs, land and air offensives," Akar told reporters.   "Turkish armed forces will not take a step back from wherever they may be", he however added.   Earlier, the US State Department said it was assessing indications that the government had used chemical weapons on Sunday during its offensive in Idlib.   HTS accused government forces of launching a chlorine gas attack on its fighters in the northern mountains of Latakia.   But the Observatory said Wednesday it had "no proof at all of the attack".
Date: Wed, 22 May 2019 02:06:35 +0200
By Amelie BARON

Port-au-Prince, May 22, 2019 (AFP) - With no oxygen in intensive care or gloves in the emergency room, residents at Haiti's largest hospital have gone on strike to protest the filthy environment and demand six months of back pay.   "We have almost nothing when we talk about emergency services," said Emmanuel Desrosiers, 24, one of the doctors-in-training at the State University of Haiti Hospital (HUEH) that began the work stoppage Monday.    "When a patient arrives, when we should immediately take charge, we start by listing the things they or their family need to go buy."   The HUEH, known as the "general hospital," is where the most disadvantaged families in this impoverished Caribbean country crowd. Buying the medical supplies themselves is a financial headache, but private clinics are far too expensive.   In crumbling buildings in the center of Port-au-Prince, male and female patients are crowded together in tiny rooms, while trash cans overflow.   "We feel ridiculous when we give hygienic advice to patients," one resident said of the situation.

The residents' selflessness as they work in an unsanitary environment is compounded by the fact that they have not been paid since the start of their residency, nearly six months ago.   After five years of medical studies, the state is required to pay them 9,000 Haitian gourdes (HTG) per month -- only about $100, due to the devaluation of the national currency.   Nothing is being done about the hospital's disrepair, with those in charge waiting for a new building to be completed, according to resident Yveline Michel.   The new HUEH will have two floors and more than 530 beds once it's finished -- but it's unclear when that will be.   The project began after the January 2010 earthquake, which destroyed more than half the hospital. The United States, France and Haiti invested $83 million in a new hospital, which should have been completed by 2016.   Instead, there is little visible activity on the construction site, which can be seen through the windows of the current building.

Due to the heat, the windows are always open, letting in noise and dust from the street. There are only a few fans in the hospital rooms, which do little to combat the humidity or the flies.   "At any moment we could lose patients, but the state isn't doing anything to save their lives," said Michel, 25.   "We're striking for the population, since it should make these demands."   But some locals question the residents' position because the strike prevents the already struggling hospital from functioning.   Since the strike began, the poorest families in the area no longer know where to go for medical emergencies, as the residents are in charge of admitting patients.   "Due to the lack of resources and the unsanitary environment, there are always people dying in the hospital, so it's not the strike causing that," said Michel in response.
Date: Tue 21 May 2019
Source: Le Dauphin [in French, trans., edited]

Lovers of sushi, maki, sashimi, and other raw fish, beware of your stomach! 7 cases of fish tapeworm, better known as tapeworm [ProMED presumes it is Diphyllobothrium latum], have been reported in 2 years by the Rennes hospital in Ille-et-Vilaine [Brittany].

An exceptional number of cases was counted between July 2016 and September 2018, especially since no case had been detected for at least 20 years.

The infection is acquired by "eating raw or marinated fish which contains larvae of this parasite. The larvae will undergo several moults and develop in our digestive tract," explained Professor Florence Robert-Gangneux to our colleagues in France Bleu Armorique.

The parasite can measure up to 20 meters [66 ft] long and live 10 years in the body. The fish tapeworm can cause digestive disorders, deficiencies, although some patients do not notice.

The only solution to eliminate these parasites of the fish is freezing. This is what a 2004 European regulation imposes on restaurant owners serving raw fish. Freezing should be from -20 deg C [-4 deg F] during 24 hours or -35 deg C [-31 deg F] during 15 hours. And to get rid of the worm once ingested, it is necessary to undergo an unpleasant antiparasitic treatment, often on several occasions.
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[We presume it is the fish tapeworm _Diphyllobothrium latum_, which is a tapeworm found in freshwater fish (<https://www.cdc.gov/parasites/diphyllobothrium/index.html>). In saltwater fish the most common parasite is _Anisakis_, but this is not a tapeworm. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of France:
Date: Mon 20 May 2019
Source: El Pais [in Spanish, trans. Mod.TY, edited]

Tarija Departmental Health Services (SEDES) reported a new case of hantavirus [infection] in Padcaya municipality. The number of patients with this illness is within what is expected, because this season is when more people acquire the disease. Epidemiological surveillance is continuing in Arce province. The person who acquired this illness is male and is under medical care until his recuperation.

The head of the Epidemiological Unit of SEDES, Claudia Montenegro, stated that the patient is hospitalized in the San Juan de Dios Regional Hospital in Tarija awaiting his recuperation. The physician said that in Bermejo and Padcaya municipalities, the harvest of citrus fruit and sugar cane for production of sugar has begun, so there is a trend for the cases of this illness to increase. This is due to the large number of families that move to the countryside where the rodent (long tail) is present that transmits this disease [virus].

"In contrast to previous seasons, this year [2019], there were positives for this disease in Gran Chaco province, including fatalities," Montenegro commented. "Epidemiological surveillance there is being implemented, as well as in areas such as Padcaya and Bermejo."

The official explained that in these localities, the rodent that transmits the disease [virus] to families is present, and with agricultural activities, [people] move into places where this animal lives, and so new cases of patients with hantavirus [infections] are registered every year.

In order to prevent this illness, it is recommended that rodent control campaigns be done to reduce their populations, openings in houses be sealed, and that residents reduce the possibility for rodents to make nests within a radius of 30 meters [100 ft] around the house, and eliminate items that could attract these animals near the house (food, grain, garbage). Workers should employ protective measures during agricultural tasks and cleaning work.

Initial symptoms include fatigue, fever and muscle pain, especially in the thighs, hips and back. Also, patients may present with headache, dizziness, chills, nausea, vomiting, diarrhea and abdominal pain. [These symptoms may progress rapidly to respiratory difficulty requiring mechanical ventilation (hantavirus cardio pulmonary syndrome). Death can occur. - ProMED Mod.TY]
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[The hantavirus involved in the above cases is not mentioned. Cases of hantavirus infections in Tarija department are not new. Tarija department is endemic for hantaviruses, and cases occur there sporadically. Last year (2018), there were 11 cases. The previouslyreported 2015 cases of hantavirus pulmonary syndrome (HPS) that occurred in Tarija department were confirmed. As noted in the previous comments, earlier cases of hantavirus pulmonary syndrome have been reported from tropical, lowland areas of Bolivia, including 7 cases in Tarija during 2014. The specific hantaviruses involved in these or previous cases in Bolivia were not given.

In the lowland Amazon Basin of Bolivia, the rodent hosts of the hantavirus that might be involved in these hantavirus pulmonary syndrome (HPS) cases, with their images, include the following: - Laguna Negra virus (_Calomys laucha_ <http://www.faunaparaguay.com/images/Calomys%20laucha%20enciso%2031aug2011.jpg> and _C. callosus_ <https://eee.uci.edu/clients/bjbecker/PlaguesandPeople/Calomyscallosusb.jpg>); - Bermejo (Chaco rice rat _Oligoryzomys chacoensis_ <http://www.faunaparaguay.com/oligorizomyschacoensis.html>); and - Oran (_O. longicaudatus_ <http://calphotos.berkeley.edu/imgs/512x768/0000_0000/0711/1203.jpeg>).

Since previous cases in Tarija department have occurred in Bermejo, perhaps Bermejo hantavirus was involved.

Dr. Jan Clement commented that there is a need to be able to differentiate Seoul (SEOV) as a causative agent, but that is hampered by the fact that most current commercial ELISA or WB formats do not contain (anymore) a SEOV antigen, so that a preliminary presumption of a hantavirus infection can even be missed in non-research laboratories (ibidem, and: Reynes J-M, Carli D, Bour J-B, Boudjeltia S, Dewilde A, Gerbier G, et al. Seoul virus infection in humans, France, 2014-2016. Emerg Infect Dis. 2017;23:973-7;  <https://wwwnc.cdc.gov/eid/article/23/6/16-0927_article>.

SEOV is widely distributed around the world in the brown rat and is likely found in Tarija department. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Tarija, Tarija, Bolivia: <http://healthmap.org/promed/p/12643>]
Date: Tue 21 May 2019
Source: ZBC (Zimbabwe Broadcasting Corporation) [edited]

The Zambezi Parks & Wildlife Management Authority (Zimparks) says it has managed to contain the anthrax outbreak in the Zambezi Valley which claimed 6 elephants, 3 buffalo, a lion and an impala. Zimparks, which has been working together with other stakeholders following the outbreak of anthrax in Zambezi Valley, confirmed that the infectious disease has now been brought under control.

Zimparks Public Relations Manager, Mr. Tinashe Farawo said the authority is pleased to have contained the disease, adding that measures are being put in place to strengthen surveillance mechanisms. "We can confirm that we have managed to contain the anthrax diseases in the Zambezi Valley thanks to efforts by our officers and support from private stakeholders," said Mr. Tinashe Farawo.

The disease killed a number of hippos in Binga last year [2018]. Anthrax is usually transmitted by feed and water contaminated with spores, which can lie dormant in the soil for many years. The primary sign of anthrax in grazing animals is sudden death, often with bloody discharges.
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[So far so good, but I must point out that nature is illiterate and does not read the announcements of senior bureaucrats. She does what she does. Hopefully Mr. Farawo is correct but we should wait a couple of weeks at full alert.

Maps of Zimbabwe can be seen at

For a description of Hwange national park, go to
<https://en.wikipedia.org/wiki/Hwange_National_Park>.

Hwange is in the western part of the country bordering Botswana and Zambia
(<https://en.wikipedia.org/wiki/Hwange>). - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Matabeleland North Province, Zimbabwe:
Date: Mon 20 May 2019, 2:49 PM
Source: KDKA [edited]

Pennsylvania's Secretary of Health, Dr. Rachel Levine has announced that the state has declared a hepatitis A outbreak with 171 cases in 36 counties. According to the map provided by the Department of Health, Allegheny and Philadelphia counties are hit the hardest with anywhere between 31-50 cases.

The counties hit hardest by this outbreak are Philadelphia and Allegheny, but we have seen an increase of cases throughout much of the state," Dr. Levine said. "We are taking this action now to be proactive in our response to treating Pennsylvanians suffering from this illnesses and prevent it from spreading. The best way to prevent hepatitis A is through vaccination."
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[Pennsylvania is the latest (now almost half of the states in the USA) to declare a hepatitis A outbreak. As the numbers of cases continue to rise in a number of states, and news of smaller (so far) outbreaks occur in others, the question at the end of ProMED post http://promedmail.org/post/20190104.6241686 by a Kentucky official, "This is a disease of developing countries.

One has to ask: Why are we seeing it in the USA?" is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations among their midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Pennsylvania, United States: <http://healthmap.org/promed/p/240>]
Date: Thu 16 May 2019
Source: AllAfrica, The Guardian report edited

A serving medical doctor has been infected with Lassa fever while 2 persons were confirmed dead in Kebbi state. Another medical doctor disclosed this yesterday [15 May 2019] when The Guardian visited the Federal Medical Centre (FMC), Birnin Kebbi. He said that 2 children died last week [week of 6 May 2019] as a result of the Lassa fever while a medical doctor, who was doing his primary assignment treating the patients, was also infected.

"You see, the management of the FMC has opened a special unit called isolated unit for the Lassa fever patients. We still have some patients inside. Also, a medical doctor, who was managing some patients last month [April 2019], has also been infected and he is presently on admission," he said.

Meanwhile, the state's Commissioner for Health, Alhaji Umar Kambaza, who confirmed the incident, said they were aware of the cases in the state but the government is working towards them.  [Byline: Michael Egbejule, Ahmadu Baba Idris]
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[The dates of occurrence of these cases is not given. Presumably, they were hospitalized after 12 May 2019 when the Nigeria CDC update was issued. It is indeed unfortunate that an attending physician became infected in the hospital. Nosocomial infections are not unusual when personal protective equipment and barrier nursing measures are not employed. - ProMED Mod.TY]
Date: Sun 19 May 2019
Source: Vax Before Travel [abridged, edited]

The eastern African country of Ethiopia has been reporting measles outbreaks for many years, however, in 2019, new information indicates children are the ones most vulnerable for this infectious disease.

According to reporting by the European Commission, approximately 54% of the 4000 measles cases in Ethiopia reported during 2019 affected children under 5 years of age.

Moreover, over 60% of the children had never received their 1st measles vaccine dose.

This new data estimates that by the end of 2019, about 3.5 million children will be susceptible to the measles virus, mainly because of the failure to achieve the 'herd-immunity' necessary to interrupt transmission.

Moreover, these Ethiopian children are not the only under-vaccinated population.

An estimated 169 million children missed out on the 1st dose of the measles vaccine between 2010 and 2017, or 21.1 million children a year on average, said UNICEF on 25 Apr 2019.

And, the measles virus is one of the leading causes of death among children, particularly in developing countries. An estimated 100,000 measles deaths occurred globally in 2017.

Ethiopia announced it would aggressively confront this under-vaccination issue by integrating the measles vaccine 2nd dose (MCV2) vaccination into the routine immunization program in the 2nd year of life.

The Ethiopian Ministry of Health said about 3 348 363 children will receive measles vaccine 2nd doses.

Dr Chatora Rufaro, World Health Organization (WHO) Ethiopia representative said in a press release, "The introduction of the 2nd dose of measles vaccination in Ethiopia will significantly contribute to a reduction of measles morbidity and mortality as well as the overall child mortality by preventing measles outbreaks."

To notify visitors about Ethiopia's ongoing measles risks, the CDC issued an initial Level 1 Travel Alert in 2015. Since then, the CDC advises all visitors to Ethiopia to ensure they are immunized against the measles virus.  [Byline: Don Ward Hackett]
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[HealthMap/ProMED-mail map of Ethiopia:
Date: Mon 20 May 2019 08:47 IST
Source: The Hindu [abridged, edited]

The current global resurgence in measles is having its resonance in Kerala too, which has been witnessing a serious surge in the disease since January [2019].

Across the globe, huge local outbreaks have been caused by travel as well as the increase in unvaccinated populations.

In Kerala, however, the majority of the cases are reported from Thiruvananthapuram, which has good vaccination coverage and amongst people who are well-nourished and have received at least one dose of vaccine in their lifetime.

Kerala reports around 600 plus cases of measles every year. This year [2019], as many cases have been reported in the first 4 months itself, with over 50% cases in the 19-40 year age group. There are also cases in the less than 9 months age group, but fewer cases than before in the 1-5 years group.

Immunisation
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"When universal routine immunisation in childhood improves and the virus is still in circulation, the disease will naturally move to the older age group who may be unimmunised or whose vaccine-derived immunity has begun to wane. At a time when the state is moving towards measles elimination, adult measles is a major concern," a senior health official said.

Historically, measles has been a childhood disease. The epidemiological shift to older population presents new public health challenges because of the increased severity of the disease, especially in vulnerable populations like pregnant women and immunocompromised patients (HIV, organ transplant recipients on immunosuppressants, cancer patients), who cannot be vaccinated with the live attenuated measles vaccine.

"Earlier, nearly 90% of measles cases could be managed on out-patient basis. This year [2019], most cases are in the 19-35 age group and over 60% of the cases had to be admitted as in-patients, with a good percentage requiring ICU management," said R Aravind, head of infectious diseases at Thiruvananthapuram Medical College.

The changing epidemiology of measles has not just brought forth the several unknowns but also raised important questions on whether adult immunisation should be a policy, on vaccine potency and the adequacy of vaccine immune response.

Though measles vaccine is highly immunogenic, as part of the national measles elimination strategy, a mandatory 2nd dose at 15-18 months was introduced in 2010, so that there is better immune protection. It is fairly certain that those currently in the 18-40 years age group have not had the protection of the 2nd dose and may be one reason for the increase in cases in this age group.

The 1st vaccination age for measles has been fixed at 9 months because till then, the maternal antibodies transferred in utero are supposed to afford protection to the child. If vaccinated earlier, the maternal antibodies might interfere with the immune response to vaccine.

Susceptible
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However, at Rajiv Gandhi Centre for Biotechnology, the director, M Radhakrishna Pillai and team, who are currently studying the efficacy of measles vaccination in South India, have reported that children under the recommended vaccination age of 9 months are highly susceptible to measles.

SAT Hospital too has recently reported the death of an infant younger than 9 months due to measles.

"If the young mothers of the day do not have sufficient antibody protection, how do we protect infants younger than 9 months against measles? Given measles' age shift to older age group, should we move the vaccination age to 12 months for better vaccine response?

"Is a 3rd dose of MMR (mumps-measles-rubella) necessary? And should we recommend that all adults be given a dose of MMR as the virus is still in circulation? These questions need to be looked at from a research perspective by the State/National Technical Advisory Group on Immunisation," a public health expert said.  [Byline: C Maya]
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[HealthMap/ProMED-mail map of Kerala State, India:
Date: Fri 17 May 2019
Source: The Government of Hong Kong Special Administrative Region, press release [abridged, edited]

The Centre for Health Protection (CHP) of the Department of Health (DH) said today (17 May 20-19) that no additional case of measles infection had been recorded as at 4pm today and announced that the outbreak of measles infection at Hong Kong International Airport earlier has concluded.

A spokesman for the CHP said, "A total of 73 cases of measles infection were recorded so far this year [2019], among them 29 cases were associated with the outbreak among airport workers.

Regarding measles control measures implemented at the airport, a total of 23 persons had received measles vaccination at the airport vaccination station as at 6pm today [17 May 2019], bringing the cumulative number of vaccinations given to 8501 since 22 Mar 2019. The airport vaccination station will cease operation from [18 May 2019].

As for the blood test service, the DH earlier provided the measles serology test service to airport staff. A cumulative total of 777 blood samples have been collected. For the pilot service to provide measles serology testing for Filipino foreign domestic helpers working in Hong Kong, a total of 146 blood samples have been collected to date. Participants are notified individually of the serology results.
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[HealthMap/ProMED-mail map of Hong Kong: