The Global Tuberculosis Report 2013, published today by the World Health Organization (WHO), confirms that the world is on track to meet the Millennium Development Goals (MDGs) target of reversing TB incidence, along with the target of a 50 per cent reduction in the mortality rate by 2015 (compared to 1990).

The report also underlines the need for a “quantum leap” in TB care and control which can only be achieved if two major challenges are addressed, WHO stated in a news release.

First, there are around three million people – equal to one in three people falling ill with TB – who are currently being ‘missed’ by health systems. WHO estimates that 75 per cent of the three million are in 12 countries.

Also, the response to test and treat all those affected by multidrug-resistant TB (MDR-TB) is inadequate. Not only are the links in the MDR-TB chain weak, the links are simply not there yet, according to the report. WHO estimates that 450,000 people fell ill with MDR-TB in 2012 alone. China, India and Russia have the highest burden of MDR-TB followed by 24 other countries.

At the heart of both challenges, said WHO, is insufficient resources for TB.“Quality TB care for millions worldwide has driven down TB deaths,” said Mario Raviglione, WHO Director of the Global TB Programme. “But far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they receive is unknown.”

While the number of people detected worldwide with rapid diagnostic tests increased by more than 40 per cent to 94,000 in 2012, three out of four MDR-TB cases still remain without a diagnosis.

Even more worrying, WHO pointed out, is that around 16,000 MDR-TB cases reported to the agency in 2012 were not put on treatment, with long waiting lists increasingly becoming a problem. Also, many countries are not achieving high cure rates due to a lack of service capacity and human resource shortages.

“The unmet demand for a full-scale and quality response to multidrug-resistant tuberculosis is a real public health crisis,” Dr. Raviglione stated. “It is unacceptable that increased access to diagnosis is not being matched by increased access to MDR-TB care.

“We have patients diagnosed but not enough drug supplies or trained people to treat them. The alert on antimicrobial resistance has been sounded; now is the time to act to halt drug-resistant TB.”

Another challenge, according to the report, relates to the TB and HIV ‘co-epidemic’. While there has been significant progress in the last decade in scaling-up antiretroviral treatment for TB patients living with HIV, less than 60 per cent were receiving antiretroviral drugs in 2012.

The report recommends five priority actions that could make a rapid difference between now and 2015. These include reaching the three million TB cases missed in national notification systems by expanding access to quality testing and care services across all relevant public, private or community based providers, including hospitals and non-governmental organizations which serve large proportions of populations at risk.

Other priorities include addressing with urgency the MDR-TB crisis; intensifying and building on TB-HIV successes to get as close as possible to full antiretroviral therapy (ART) coverage for people co-infected with TB and HIV; increasing domestic and international financing to close the resource gaps – now estimated at about $2 billion per year – for an effective response to TB in low- and middle-income countries; and accelerating rapid uptake of new tools.

“The WHO Global TB report highlights the very big gains the global community has made in the fight against tuberculosis,” said Osamu Kunii, Head of the Strategy, Investment and Impact Division of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“We are now at a crucial moment where we cannot afford to let these gains go into reverse. We need the commitment of the international community to address the significant funding gap to fight this disease.”

“Lead poisoning remains one of the most important environmental health concerns for children globally, and lead paint is a major flashpoint for children’s potential lead poisoning,” said the World Health Organization’s (WHO) Director for Public Health and Environment, Maria Neira.

“The good news is that exposure to lead paint can be entirely stopped through a range of measures to restrict the production and use of lead paint.”

On the occasion of International Lead Poisoning Prevention Week of Action, WHO chose to highlight the role that governments play in protecting the health of workers, children and women of reproductive age through the adoption of procedures to eliminate the use of lead decorative paints and the provision information to the public on renovation of homes where lead paint may have already been applied.

The Week of Action runs from 20-26 October 2013. This year’s theme – Lead-Free Kids for a Healthy Future – underscores the importance of avoiding the use of lead paint and using safe alternatives in order to prevent children coming to harm from lead poisoning.

Lead paint may be found in the home, on toys, furniture and on other objects. Decaying lead paint on walls, furniture and other interior surfaces creates lead-contaminated dust in the home that young children easily ingest. Mouthing lead-painted toys and other objects also exposes young children to lead. The sweet taste of lead paint means that some children even pick off and swallow small chips of paint.

WHO estimates that 143,000 deaths per year result from lead poisoning, with lead paint is a major contributor. Exposure also contributes to 600,000 new cases of children with intellectual disabilities every year, and the vast majority – 99 per cent – of children affected by high exposure to lead live in low- and middle-income countries.

Exposure to lead creates health problems for many years into the future. Even in countries that have banned leaded paint decades previously, such paint continues to be a source of exposure until it is finally stripped and replaced. The cost of replacing lead paint means that people living in older, poorly-maintained housing are particularly at risk, and this disproportionately affects economically-deprived communities.

“Paints with extremely high levels of lead are still available in most of the developing countries where paint testing has been conducted as part of the efforts of the Global Alliance to Eliminate Lead Paint,” said David Piper, the Deputy Director of the UN Environment Programme Division of Technology, Industry and Economics (UNEP DTIE) Chemicals Branch. “In most of the countries with lead paint, equivalent paint with no added lead is also available, suggesting that alternatives to lead are readily available to manufacturers.”

Worldwide, 30 countries have already phased out the use of lead paint. The Global Alliance to Eliminate Lead Paint, co-led by WHO and UNEP, has set a target of 70 countries by 2015.

At high levels of exposure, lead damages the brain and central nervous system to cause coma, convulsions and even death. Children who survive such poisoning are often left with intellectual impairment and behavioural disorders.

At lower levels of exposure, lead affects brain development in children, resulting in reduced IQ, behavioural changes such as shortening of attention span and increased antisocial behaviour, and reduced educational attainment. These effects are believed to be irreversible. Adults are at increased risk of kidney disease and raised blood pressure.

If adopted, the law would be in contravention to the provisions of the international drug control treaties, in particular the 1961 Single Convention on Narcotic Drugs, to which Uruguay is a party.

According to the International Narcotics Control Board (INCB), the law would also have serious consequences for the health and welfare of the population and for the prevention of cannabis abuse among the youth.

The INCB urged the Uruguayan authorities to ensure that the country remains fully compliant with international law which limits the use of narcotic drugs, including cannabis, exclusively to medical and scientific purposes.

Based in Vienna, the INCB is an independent and quasi-judicial monitoring body mandated to implement UN international drug control conventions.

“In line with its mandate, INCB has always aimed at maintaining a dialogue with the Government of Uruguay on this issue, including proposing a mission to the country at the highest-level,” the Board said in a news release, calling on the Uruguayan authorities to carefully consider all possible repercussions before taking a decision.

It also expressed regret that the Government refused to receive an INCB mission before the draft law was submitted to Parliament for deliberation.

The UN Office on Drugs and Crime (UNODC) also expressed concern over the proposed legislation and said it would continue to follow developments in Uruguay very closely.

UNODC spokesperson David Dadge said international drug control conventions remain the foundation of global efforts to curb elicit drug trafficking and provide prevention and treatment for drug users.

While he acknowledged that there are challenges that need to be addressed, he stressed that dialogue is need on how to stop drug traffickers and protect the health and welfare of people. “But this dialogue should be conducted on the basis of the agreed conventions, in line with international law.”

He noted that next year, the Commission on Narcotic Drugs will hold a high-level review of Member States’ implementation of the Political Declaration and Plan of Action on the world drug problem and said this would be an opportunity for countries to pursue a coherent approach to drug trafficking.

On June 26, 2013, the day after he was appointed, Health Minister Adonis Georgiadis brought back into force a regulation on the transmission of infectious diseases. The regulation, which was made public on July 1, 2013, was first introduced in April 2012 by Andreas Loverdos, the health minister at the time, but repealed in April 2013. During the year it was in force, the police used the regulation to detain people, especially those suspected of being sex workers, drug users, or undocumented migrants, for forced testing for HIV or other infectious diseases.

“It’s deeply worrying that it took the new health minister only one day to bring back a regulation that violated human rights and stigmatized vulnerable groups, and that proved counterproductive to protecting public health,” said Judith Sunderland, senior Western Europe researcher at Human Rights Watch. “If the government is serious about addressing HIV and other infectious diseases, it should focus on access to health care and public information.”

Health Regulation No. GY/39A “Amendments That Concern the Restriction of the Transmission of Infectious Diseases,” states that mandatory health examinations will be required, as well as isolation and compulsory treatment, for diseases of public health importance. The regulation includes a long list of such diseases, including influenza, tuberculosis, malaria, polio, syphilis, hepatitis, and other sexually transmitted infections, including HIV.

However, the regulation specifies certain groups as a priority for testing, including people who use intravenous drugs and sex workers, undocumented migrants coming from countries where such diseases are endemic, and people living in conditions that do not meet “minimum standards” of hygiene, including the homeless, according to HRW, adding that the regulation also states that the government will respect international human rights conventions and protocols, which very strictly limit the use of mandatory testing, isolation, and compulsory treatment.

“The regulation does not specify how the mandatory testing will be carried out.It gives police the authority to assistin enforcing isolation, restriction quarantine, hospitalization,and treatment. Forcible testing is a violation of bodily integrity and autonomy. Although detention on public health grounds is permitted in certain circumstances, people should not be detained solely to conduct forced medical procedures, including testing for HIV,” HRW said.

The initial introduction of the regulation in April 2012 resulted in the roundup of dozens of women alleged to be sex workers, who were then forced to take HIV tests. Those found to be HIV positive were arrested and charged with causing intentional grievous bodily harm, a felony, or attempted bodily harm, for allegedly having unprotected sex with customers while HIV positive.

The police and media outlets published and broadcast the women’s personal data, photographs, and information from their medical records of their HIV-positive status. Many of the women arrested during the 2012 crackdown were detained pending trial for months before they were finally acquitted by the courts, who found no strong evidence for the charges. The final five were released in March 2013 from pretrial detention after being acquitted.

In May 2012, Human Rights Watch, Positive Voice – Greek Association of People Living with HIV, and the European AIDS Treatment Group, wrote a joint letter to the UN special rapporteur on health about abusive practices in Greece with respect to public health. The issues included the arrest, criminal prosecution, and compulsory HIV testing of sex workers, and the separate law still in force that provides for the administrative detention and compulsory medical testing of migrants and asylum seekers based on their health condition.

Independent organizations in Greece have told Human Rights Watch that the 2012 arrests and public health regulations have deterred people at risk of HIV from seeking testing and services. In a joint report published in January, the European Centre for Disease Prevention and Control and the Fundamental Rights Agency of the European Union urged Greece to investigate thoroughly and promptly the actions taken against migrants, intravenous drug users, and alleged sex workers with respect to forced HIV testing and publication of personal data. The report said Greece should always consider and mediate to avoid potential negative public health consequences in future policy formulation directed at populations vulnerable to HIV, such as irregular immigrants, intravenous drug users, or sex workers.

“The decision by Minister Adonis Georgiadis to reimpose the regulation used for forced HIV testing is a big step backward for human rights and public health,” Sunderland said. “Addressing infectious diseases such as HIV, hepatitis, and tuberculosis requires investing in health services, not calling the police.”

The report, Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence, represents the first systematic study of global data on the prevalence of violence against women – both by partners and non-partners.

Some 35 per cent of all women will experience either intimate partner or non-partner violence, according to the report, which was released today by the UN World Health Organization (WHO), in partnership with the London School of Hygiene & Tropical Medicine and the South African Medical Research Council.

It also finds that intimate partner violence is the most common type of violence against women, affecting 30 per cent of women worldwide, according to a WHO news release.

“These findings send a powerful message that violence against women is a global health problem of epidemic proportions,” said WHO Director-General Margaret Chan. “We also see that the world’s health systems can and must do more for women who experience violence.”

The report details the impact of violence on the physical and mental health of women and girls, ranging from broken bones to pregnancy-related complications, mental problems and impaired social functioning.

Among its key findings on partner violence was that globally, 38 per cent of all women who were murdered were killed by their intimate partners. Also, women who have experienced partner violence are almost twice as likely to experience depression or abuse alcohol.

“This new data shows that violence against women is extremely common. We urgently need to invest in prevention to address the underlying causes of this global women’s health problem.” said Professor Charlotte Watts, from the London School of Hygiene & Tropical Medicine.

Fear of stigma prevents many women from reporting non-partner sexual violence, the survey finds. Other barriers to data collection include the fact that fewer countries collect this data than information about intimate partner violence, and that many surveys of this type of violence employ less sophisticated measurement approaches than those used in monitoring intimate partner violence.

“The review brings to light the lack of data on sexual violence by perpetrators other than partners, including in conflict-affected settings,” said Naeemah Abrahams from the South African Medical Research Council. “We need more countries to measure sexual violence and to use the best survey instruments available.”

The study highlights the need for all sectors to work together to eliminate tolerance for violence against women and to better support women who experience it. New WHO guidelines, launched with the report, aim to help countries improve their health sector’s capacity to respond to the problem.

“The report findings show that violence greatly increases women’s vulnerability to a range of short- and long-term health problems; it highlights the need for the health sector to take violence against women more seriously,” said Claudia Garcia-Moreno of WHO. “In many cases this is because health workers simply do not know how to respond.”

The guidelines stress the importance of training all levels of health workers to recognize when women may be at risk of partner violence and to know how to provide an appropriate response.

They also point out that some health-care settings, such as antenatal services and HIV testing, may provide opportunities to support survivors of violence, provided certain minimum requirements are met.

WHO will begin to work with countries in South-east Asia to implement the new recommendations at the end of June.

The broad based Maternal and Neonatal Tetanus Elimination Initiative, in which various United Nations agencies participate, said that since 1999, over 118 million women of child-bearing age have been vaccinated against tetanus in 52 countries.

Many of these women received their tetanus vaccine as part of a campaign which included other life- saving interventions for children – such as immunization against measles, Vitamin A supplements, de-worming tablets and information on umbilical cord care.

Tetanus kills one newborn baby every nine minutes and almost all of these babies are born in poor families living in the most disadvantaged areas and communities. The disease is transmitted when children are born in unhygienic conditions, and non-sterile materials are used to cut the umbilical cord, or are applied to the umbilical bump. At that point, the mother’s life is also in danger.

Tetanus is easily preventable with a vaccine administered to the mother. With at least three protective doses that cost about $2, the mother and her future newborns are protected for five years.

In a news release, the Initiative said that despite the progress half the 59 priority countries, some 28 other have still not reached the elimination goal. The main challenges to eliminate the disease are a lack of access to communities because of insecurity, cultural barriers, competing priorities, and inadequate funding.

The countries that have eliminated maternal and neonatal tetanus are: Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, China, Comoros, Congo, Cote d’Ivoire, Egypt, Eritrea, Ghana, Guinea Bissau, Iraq, Liberia, Malawi, Mozambique, Myanmar, Namibia, Nepal, Rwanda, Senegal, South Africa, Tanzania, Timor Leste, Turkey, Togo, Uganda, Vietnam, Zimbabwe and Zambia.

Shortly after the Initiative was launched in 1999, it was estimated that over 200,000 deaths of newborns were caused by tetanus every year. By 2010, this number dropped to an estimate 58,000.

The Initiative is an international private-public partnership that includes national governments, the UN Children’s Fund (UNICEF), World Health Organization (WHO), UN Population Fund (UNFPA), the GAVI Alliance, USAID/Immunization Basics, Centres for Disease Control and Prevention, Save the Children, and the Bill & Melinda Gates Foundation, among others.

The report, which covers the first three months of 2013 in Iraq, Jordan and Lebanon, shows that more than 1 million refugees need treatment for a wide range of both common and conflict-related conditions, Adrian Edwards, spokesman for the UN High Commissioner for Refugees (UNHCR) told journalists in Geneva.

Mr. Edwards explained that the situation is particularly challenging for those with chronic and other costly health conditions, such as diabetes, hypertension and cardiovascular illnesses, as well as expensive referral care more commonly diagnosed and treated in middle-income countries. The report was primarily based on information from established refugee camps, except for data from Lebanon.

He said that as of last night, 1,401,435 Syrians had registered as refugees in the region or were pending registration. This corresponds to 30 per cent more than the total envisaged under the current Regional Refugee Response Plan by end June 2013 – for which around 55 per cent of funding has so far been received.

“An updated plan is due to be presented to donors in late May. UNHCR continues to roll out additional capacity as funding comes in,” he added.

With nearly 2.5 million Syrian refugees throughout the entire region, the report cites two major problems facing the health system. First, with low funding for the refugee crisis, the challenge of providing access to quality health care for Syrian refugees is growing – particularly for people living outside of camps.

Secondly, the increasing numbers of people needing medical help is straining existing health services in each of the affected countries.

“Both issues are a matter of serious concern to UNHCR,” Mr. Edwards stressed, adding: “We continue, with our partners, to provide medical care for refugees in the camps in Jordan and Iraq. But for those refugees who live outside of camps, often in urban settings, the situation is more difficult.”

In terms of the overall health situation of Syrian refugees, the UNHCR report shows a “mixed” picture. Syrian refugees are not reported to be suffering from high rates of mortality and acute malnutrition. Mortality at the Za’atri camp in Jordan, for example, is reported at 0.1 per 1,000 people per month, while global acute malnutrition in children below five years is less than 5.8 per cent – neither rate being outside norms seen in the region. This is in contrast to many other humanitarian situations in other parts of the world.

“However, preventive services, chronic disease treatment and expensive referral care are not sufficiently provided at a cost that refugees, despite the support provided by governments and humanitarian agencies, can afford,” he said.

Meanwhile, at a reception and concert in New York last night for Syrian children, Secretary-General Ban Ki-moon recalled his visit to Za’atari camp last December. He was struck by how many children there were, lining the road “cheering, running and full of fun and mischief.”

Yet, he said, there was no disguising that their lives had been massively disrupted. “Most had fled with their families with only what they could carry. Many had witnessed or ensured unspeakable atrocities.” Almost 2 million children are internally displaced, and more than 600,000 have fled Syria as refugees, he added.

With no end to the conflict in sight, the Secretary-General called on the Security Council and countries in the region to come up with a unified position that can persuade all actors to come to the negotiating table. “We risk an entire generation of children being scarred for life. The children of Syria are our children. They need our help,” he implored.

In a joint news release, the Director-General of the World Health Organizations (WHO), Margaret Chan, and the Executive Director of the Global Fund, Mark Dybul, said significant funds need to be mobilized to prevent the spread of multi-drug resistant TB, also known as MDR-TB.

“We are treading water at a time when we desperately need to scale up our response to MDR-TB,” said Dr. Chan. “We have gained a lot of ground in TB control through international collaboration, but it can easily be lost if we do not act now.”

In 2011, 1.4 million people died due to TB, with the greatest per capita death rate in Africa. MDR-TB presents a major threat, with an estimated 630,000 people ill worldwide with this form of TB today.

WHO and the Global Fund said the $1.6 billion is needed to fill the funding gap in 118 low- and middle-income countries, the majority of which are located in Africa. These funds could enable full treatment for 17 million TB and MDR-TB patients, and save some 6 million lives in the next three years.

“It is critical that we raise the funding that is urgently needed to control this disease,” said Dr. Dybul. “If we don’t act now, our costs could skyrocket. It is invest now or pay forever.”

The call for an increase in funds for TB comes ahead of World TB Day on 24 March, which commemorates the day when Robert Koch discovered the mycobacterium that causes tuberculosis in 1882. The Day seeks to raise awareness about the global epidemic and efforts to eliminate the disease.

In addition to the $1.6 billion annual gap in international financing, WHO and partners estimate that there is a $1.3 billion annual gap for TB research and development for the 2014-2016 period, including clinical trials for new TB drugs, diagnostics and vaccines.

Prior to the crisis in Syria, more than 90% of medicines were locally produced.

Since then, the effects of economic sanctions, currency fluctuations, difficulty in the availability of hard currency and an increase in operational costs have negatively affected the production of medicines and pharmaceutical products.

The escalation of clashes has resulted in substantial damages to the pharmaceutical plants located in Rural Aleppo and Rural Damascus, where 90% of the country’s plants are based.

Many of the plants have reportedly been destroyed or are closed because the workers cannot access their work place.

As a result, local production of medicines has been reduced by 90%.

Additionally, the main government storage for imported medicines, which included most of the required needs for the first quarter of 2013, has been destroyed.

Assessments by  WHO indicate that insulin, oxygen, anesthetics, serums and intravenous fluids are no longer available inside Syria to meet needs, with health facilities and local pharmacies increasingly unable to provide medicines, particularly those for the continuous treatment of chronic diseases.

Until recently, WHO had been unable to assess the extent of damage to public health due to the lack of a reference pharmaceutical list assessed and validated by experts on the basis of WHO’s Essential Drug List.

To overcome this obstacle, health experts from Syria and pharmaceutical experts and health professionals from WHO and Jordan met in Amman to address critical shortages in medicines and medical supplies inside Syria, resulting in an updated Essential Medicines List for the entire country.

Reflecting disease profiles, current gaps and critical needs, the list is an essential tool for enhancing the effectiveness of the international community’s emergency health response by enabling projection and quantification of essential medicine requirements and the development of standard procurement procedures.

WHO has evaluated the needs for the next 12 months in terms of essential medicines, medical supplies, medical consumables and anti-cancer medicines and estimated that these will require a minimum of US$900 million.

A list of the most urgently-needed and life-saving items has also been developed, containing 168 items (92 urgently needed essential medicines, 33 cancer medicines and 43 consumables) and estimated to require US$ 467 million for 2013.

WHO calls on the international community for urgent support to cover these critical gaps in essential medicines inside Syria.

In March 2011, Japan was struck by an earthquake and tsunami that killed more than 20,000 people in the eastern part of the country. The tsunami also slammed into the Fukushima Daiichi nuclear power station, located in Fukushima Prefecture, disabling cooling systems and leading to fuel meltdowns in three of the six units.

The report, produced by the World Health Organization (WHO), concluded that for the general population inside and outside of Japan “the predicted risks are low and no observable increases in cancer rates above baseline rates are anticipated.”

However, the report also notes that the risk of specific cancers for the population living in the most affected parts of the Fukushima Prefecture is slightly higher.

“The primary concern identified in this report is related to specific cancer risks linked to particular locations and demographic factors,” said WHO Director for Public Health and Environment Maria Neira.

“A breakdown of data, based on age, gender and proximity to the nuclear plant, does show a higher cancer risk for those located in the most contaminated parts. Outside these parts – even in locations inside Fukushima Prefecture – no observable increases in cancer incidence are expected.”

For people in the most contaminated area, the report estimates that there is a 70 per cent higher risk of females exposed as infants of developing thyroid cancer over their lifetimes.

In addition, the risk of leukemia increased by 7 per cent for males exposed as infants, and for infant females there is a six per cent higher risk of contracting breast cancer. The report also notes that one third of the emergency workers who were inside the Fukushima nuclear power plant have an increased risk of cancer.

“The WHO report underlines the need for long-term health monitoring of those who are at high risk, along with the provision of necessary medical follow-up and support services,” said Dr. Neira. “This will remain an important element in the public health response to the disaster for decades.”

The report, ‘Health Risk Assessment from the nuclear accident after the 2011 Great East Japan Earthquake and Tsunami based on preliminary dose estimation,’ was carried out by scientific experts on radiation, epidemiology and public health, among others, who estimated risks in the general population in Fukushima Prefecture, the rest of Japan and the rest of the world.

Experts also stated that the psychosocial impact of the nuclear disaster may have a long-term consequence on the health and well-being of the population, and this should be addressed as part of the overall response along with the environmental impact to prevent future incidents of this nature.

“In addition to strengthening medical support and services, continued environmental monitoring, in particular of food and water supplies, backed by the enforcement of existing regulations, is required to reduce potential radiation exposure in the future,” said the Acting Director for WHO’s Food Safety and Zoonosis Department, Angelika Tritscher.