One billion threatened by cholera: UN

A man hands out water bottles to people waiting on patients infected in an outbreak of cholera, receiving treatment in north Lebanon. (AFP/File)
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Updated 19 May 2023
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One billion threatened by cholera: UN

  • The UN branded the outlook bleak, saying it did not have the resources to fight the outbreaks
  • "WHO estimates that a billion people across 43 countries are at risk of cholera," said Henry Gray, the UN health agency's incident manager for the global cholera response

GENEVA: One billion people in 43 countries are at risk of cholera — a “pandemic killing the poor” — despite prevention and treatment being relatively straightforward, the United Nations warned on Friday.
The UN branded the outlook bleak, saying it did not have the resources to fight the outbreaks, and the longer it took to start waging the battle, the worse the situation would get.
Between the World Health Organization and the children’s agency UNICEF, the UN is seeking $640 million to fight the infectious disease, warning of a “cholera catastrophe” if action is not ramped up immediately.
“WHO estimates that a billion people across 43 countries are at risk of cholera,” said Henry Gray, the UN health agency’s incident manager for the global cholera response.
So far this year, 24 countries have reported cholera outbreaks, compared to 15 by mid-May last year.
Countries that are not usually affected by cholera are being affected and case fatality rates are far exceeding the typical one in 100.
Gray blamed the rise in cases on poverty, conflict and climate change, as well as the population displacements they trigger, which take people away from safer sources of food and water, and from medical support.
“With the increase in the number of countries affected by cholera, the resources that were available for prevention and response are more thinly spread,” he told a media briefing.
Cholera is contracted from a bacterium that is generally transmitted through contaminated food or water.
It causes diarrhea and vomiting, and can be especially dangerous for young children.
Jerome Pfaffmann Zambruni, the head of UNICEF’s public health emergency unit, said the rise in cases was “a wake-up call.”
“There is a pandemic killing the poor right in front of us and we know exactly how to stop it, but we need more support and less inertia from the global community because if we don’t act now, it’s going to get worse,” he said.
“We know how to treat it. We know how to control it. It’s not easy but it’s simple.”
Although cholera can kill within hours, it can be treated with simple oral rehydration, and antibiotics for more severe cases.
But many people lack timely access to such treatment.
Outbreaks can be prevented by ensuring access to clean water and improving surveillance.
But the lack of funds for rapid response will cost lives that could have been saved, said Gray.
“The overall solution is long-term investment in wastewater infrastructure,” he added.
The campaign is not helped by the dearth of vaccines.
Around 36 million cholera vaccine doses were produced last year, but it is not seen as an attractive product for manufacturers, as there is effectively no market in wealthy countries.
Over 18 million oral cholera vaccine doses have been requested this year, but only eight million have been made available, bringing prevention campaigns to a halt.
Rather than the full two doses, only one is being issued to recipients “to try to spin it out,” said Gray.
The number of available doses could double by 2025 and then double again by 2027.
“We won’t have enough, even with those numbers, if the current trend for cholera cases continues,” said Gray.
Cholera cases steadily declined over 10 years but the trend reversed in 2021.
The most heavily affected countries so far this year are Malawi and Mozambique.
Nine other countries are deemed to be in “acute crisis“: Burundi, Cameroon, the Democratic Republic of Congo, Ethiopia, Kenya, Somalia, Syria, Zambia and Zimbabwe.


Trump officials say Israel’s plans helped lead the US into Iran war

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Trump officials say Israel’s plans helped lead the US into Iran war

WASHINGTON: The Trump administration and its allies in Congress presented a shifting new justification Monday for the US attack on Iran, with House Speaker Mike Johnson suggesting that the White House believed Israel was determined to act on its own, leaving the president with a “very difficult decision.”
The Republican was speaking late Monday after a classified briefing at the Capitol, the first for congressional leaders since the start of the war, a joint US-Israel military campaign that killed Iran’s Supreme Leader Ayatollah Ali Khamenei and has quickly spiraled into a widening Middle East conflict. Hundreds have died, including at least six US military service personnel.
Johnson said the attack on Iran was a “defensive operation” because Israel was ready to act against Iran, “with or without American support.” He said President Donald Trump and his team determined that Iran would immediately retaliate against US personnel and assets.
“The commander in chief has said this is going to be an operation that is short in duration,” Johnson said. “We certainly hope that’s true.”
The remarkable shift in the Trump administration’s stated rationale comes as the hostilities deepen and widen across the region. The president himself estimated the war could drag on for weeks. The administration plans to seek supplemental funds from Congress to support the military effort, lawmakers said, in stark contrast to the president’s America First campaign not to entangle the US in actions abroad.
Secretary of State Marco Rubio said the “hardest hits are yet to come” as the US is determined to continue attacking Iran for as long as it takes with an “even more punishing” next phase in the war.
Rubio described what was essentially a potentially ripple effect that he said posed an “imminent threat” to the US
“We knew that there was going to be an Israeli action,” he said. “And we knew that if we didn’t preemptively go after them before they launched those attacks, we would suffer higher casualties.”
Rubio said that while the US would like to see the Iranian people rise up and be rid of the regime, “that’s not the objective,” he said. “The objective of this mission is to make sure they don’t have these weapons that can threaten us and our allies in the region.”
Trump’s shifting rationale sparks detractors
Rubio, Defense Secretary Pete Hegseth and other administration officials delivered the classified briefing as Congress weighs a war powers resolution that would restrain Trump’s ability to keep waging war without approval from the House and Senate.
Trump himself, speaking at the White House, laid out four objectives for the war, saying US forces are out to destroy Iran’s missile capabilities, wipe out its naval capacity, stop the country from obtaining a nuclear weapon and ensure “that the Iranian regime cannot continue to arm, fund and direct terrorist armies outside of their borders.”
“This was our last, best chance to strike — what we’re doing right now — and eliminate the intolerable threats posed by this sick and sinister regime,” Trump said.
Trump met repeatedly with Israeli Prime Minister Benjamin Netanyahu as they sought to curb Iran’s nuclear program, including last month at the White House.
Hegseth earlier Monday vowed this is not an “endless war,” even as he warned more US casualties are likely in the weeks ahead.
But Sen. Mark Warner, the top Democrat on the Intelligence Committee, said: “There was no imminent threat to the United States of America by the Iranians. There was a threat to Israel.”
Warner said he has now heard four or five stated reasons for the attack. He demanded that Trump “come before Congress, and for that matter, the American people,” to make his case for war — and the exit plan.
Several Democrats delivered blistering speeches against the war. “Are we now such an enfeebled nation that Israel decides when we go to war?” said Sen. Jeff Merkley of Oregon, voice rising.
War powers as a check on presidential power
The moment is a defining one for Congress, which alone has the authority under the US Constitution to declare war, and for the Republican president, who has consistently seized power during his second term with his own executive reach.
Trump took the nation to war at a particularly vulnerable time, as the Department of Homeland Security is operating without routine funds because of a standoff with Democrats over their demands to restrain his immigration enforcement operations. The potential wartime costs in terms of lives lost and dollars spent are dividing the parties, and potentially Americans themselves.
Unlike the run-up to the Iraq War in 2003, which included long debates in Congress in the aftermath of the Sept. 11, 2001, attacks, or the more recent US military strikes on Venezuela that proved to be limited, the joint US-Israel military attack on Iran, called Operation Epic Fury, is well underway, with no foreseeable end in sight.
“It’s worrisome,” Rep. Adam Smith, the top Democrat on the House Armed Services Committee, told The Associated Press.
Smith said of Trump: “He is not trying to making his case to the Congress or the American people. He unilaterally decided to do this.”
In fact, Congress has declared war just five times in the nation’s history, most recently in 1941, to enter World War II a day after the Pearl Harbor attack. Over time, presidents of both major political parties have accumulated vast authority to engage in what are often more limited US military strikes.
Johnson said tying Trump’s hands right now would be “frightening” as he works to defeat the war powers resolution.
Even if Congress is able to pass the measure this week, the House and the Senate would be unlikely to tally the two-thirds majority needed to overcome a presidential veto.
Next steps for Iranian people uncertain
As the Trump administration encourages the Iranian people to rise up and choose new leaders, there did not appear to be widespread US support for any effort at democracy- or nation-building.
“We would love to see this regime be replaced,” Rubio said. “If there’s something we can do to help them down the road, we’d obviously be open to it. But that’s not the objective.”
A top Trump ally, Sen. Lindsey Graham, R-S.C., said he never bought into the you-break-it-you-own-it concept in wartime.
“If there’s a threat to America, deal with it,” he said over the weekend. “That doesn’t mean you own everything that follows.”