World health officials warn the war in Ukraine is taking a heavy toll on the mental health condition of millions of people, requiring an urgent increase in mental health and psychological support.

“An estimated almost 10 million people may currently have a mental health condition, of whom about 4 million may have conditions which are moderate or severe,” said Hans Kluge, World Health Organization regional director for Europe.

Speaking in the Ukrainian city of Zhytomyr, Kluge said he met Thursday with first lady Olena Zelenska, who summed up the prevailing situation in the country by telling him that “everyone in society has to become a psychologist.”

Managing the critical situation, he said, “requires an all-government and all-society effort.”

Data and evidence gathered by Ukraine’s Ministry of Health and WHO in recent months show the major priorities and challenges that need to be addressed are mental health, rehabilitation, and community access to health services.

The latest estimate by the U.N.’s Office of the High Commissioner for Human Rights finds more than 7,000 civilians have been killed and nearly 12,000 injured since Russia invaded Ukraine nearly one year ago.

Kluge said rehabilitation of victims of the war must not be delayed but made available now.

“We are doubling the support on rehabilitation,” he said, “including treatment for war-related injuries, which are often horrific for adults and children alike.”

The latest WHO needs assessment survey finds that one in 10 people express difficulty in accessing medicine for various reasons, including damaged or destroyed pharmacies and the unavailability of supplies. One-third of those surveyed said they could not afford to pay for the medicine they need.

The survey also highlighted the need to pay more attention to the treatment of people with non-communicable diseases. Kluge noted that 44% of those surveyed said they had difficulty receiving care for chronic conditions.

“The most common were cardiovascular diseases, notably hypertension, but also diabetes and kidney disease, and then, of course, there is routine immunization that is weak,” he said.

The carpet bombing of Ukrainian cities, missile strikes and artillery fire by Russian forces has put much of Ukraine’s health care system out of commission.

In a media interview a few days ago, Ukraine’s minister of health, Viktor Liashko, said 1,218 health care institutions have been damaged, including 540 hospitals, 173 of which were completely destroyed.

Kluge said the WHO has verified nearly 780 attacks on health care services, calling it “unforgivable.” He said, “Any attack on any health and health care is clearly a breach of international humanitarian law.”

Speaking from Poltava Oblast, Jarno Habicht, WHO representative for Ukraine, said the health system was functional depending on the region. For example, in areas regained from Russia, such as Bucha, Irpin and Kharkiv, “access to health care is more difficult.”

“Primary health care centers, which have been attacked — more than 780 attacks —need to be rebuilt. These centers need water, these centers need electricity, these centers need health care workers to come back,” he said.

There were, however, hopeful signs of recovery, Habicht added, noting that 20% of health facilities have been rebuilt by charities and private-sector investments.

“So, that means that the health system is also healing itself,” he said.

The U.N. refugee agency estimates more than 8 million Ukrainians have fled to neighboring European countries as refugees, and an estimated 7 million are displaced inside Ukraine.

Habicht also said the WHO’s latest “health survey shows that the internally displaced people have more barriers to access to care” than those who have left the country.

Overall, he said, Ukraine’s health system is under stress but working, and in regained areas, rebuilding infrastructure and attracting more health care workers is critical.

As the war enters its second year, he said, “We need new specialists, we need to do faster training for nurses as well for the doctors.

“We need more mental health specialists … and physiotherapists to ensure that children have enough support that they can move around, they can go to school, and their life can go on.”

Kluge, who is on his fifth visit to Ukraine within the past year, noted the need for continued international humanitarian support. “Unfortunately, after what I saw, I cannot tell that the impact of the war on the health of the people in this country is going to diminish.

“I am very concerned it will in the coming months actually increase,” he said.
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Imagine if your dog or cat could use words to let you know when they’re angry, lonely or in pain. Well now they can, thanks to an innovative communication tool that’s helping them express themselves more effectively. VOA’s Julie Taboh has more.

Camera: Adam Greenbaum           

Produced by: Julie Taboh, Adam Greenbaum  
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Avian flu has reached new corners of the globe and become endemic for the first time in some wild birds that transmit the virus to poultry, according to veterinarians and disease experts, who warn it is now a year-round problem.

Reuters spoke to more than 20 experts and farmers on four continents who said the prevalence of the virus in the wild signals that record outbreaks will not abate soon on poultry farms, ramping up threats to the world’s food supply. They warned that farmers must view the disease as a serious risk all year, instead of focusing prevention efforts during spring migration seasons for wild birds.

Outbreaks of the virus have widened in North and South America, Europe, Asia and Africa, undefeated by summer heat or winter cold snaps, since a strain arrived in the United States in early 2022 that was genetically similar to cases in Europe and Asia.

On Wednesday, Argentina and Uruguay each declared national sanitary emergencies after officials confirmed the countries’ first infections. Argentina found the virus in wild birds, while dead swans in Uruguay tested positive.

Egg prices set records after the disease last year wiped out tens of millions of laying hens, putting a staple source of cheap protein out of reach to some of the world’s poorest at a time the global economy is reeling from high inflation.

Wild birds are primarily responsible for spreading the virus, according to experts. Waterfowl like ducks can carry the disease without dying and introduce it to poultry through contaminated feces, saliva and other means.

Farmers’ best efforts to protect flocks are falling short.

In the United States, Rose Acre Farms, the country’s second-largest egg producer, lost about 1.5 million hens at a Guthrie County, Iowa, production site last year, even though anyone who entered barns was required to shower first to remove any trace of the virus, Chief Executive Marcus Rust said.

A company farm in Weld County, Colorado, was infected twice within about six months, killing more than 3 million chickens, Rust said. He thinks wind blew the virus in from nearby fields where geese defecated.

“We got nailed,” Rust said. “You just pull your hair out.”

The United States, Britain, France and Japan are among countries that have suffered record losses of poultry over the past year, leaving some farmers feeling helpless.

“Avian flu is occurring even in a new poultry farm with modern equipment and no windows, so all we could do now is ask God to avoid an outbreak,” said Shigeo Inaba, who raises chickens for meat in Ibaraki prefecture near Tokyo.

Poultry in the Northern Hemisphere were previously considered to be most at risk when wild birds are active during spring migration. Soaring levels of the virus in a broad range of waterfowl and other wild birds mean poultry now face high risks year round, experts said.

“It’s a new war,” said Bret Marsh, the state veterinarian in the U.S. state of Indiana. “It’s basically a 12-month vigil.”

In a sign the threat is expected to persist, Marsh is seeking funds from Indiana’s lawmakers to hire an additional poultry veterinarian and poultry health-specialist. Indiana lost more than 200,000 turkeys and other birds over the past year, while total U.S. deaths top 58 million birds, according to U.S. government data, surpassing the previous 2015 record.

The virus is usually deadly to poultry, and entire flocks are culled when even one bird tests positive.

Vaccinations are not a simple solution: they may reduce but not eliminate the threat from the virus, making it harder to detect its presence among a flock. Still, Mexico and the EU are among those vaccinating or considering shots.

Global problem

Wild birds have spread the disease farther and wider around the world than ever before, likely carrying record amounts of the virus, said Gregorio Torres, the head of the science department at the Paris-based World Organisation for Animal Health, an intergovernmental group and global authority on animal diseases. The virus changed from previous outbreaks to a form that is probably more transmissible, he told Reuters.

“The disease is here to stay at least in the short term,” Torres said.

Torres could not confirm the virus is endemic in wild birds worldwide, though other experts said it is endemic in certain birds in places like the United States.

While the virus can infect people, usually those who have contact with infected birds, the World Health Organization says the risk to humans is low.

The form of the virus circulating is infecting a broader range of wild birds than previous versions, including those that do not migrate long distances, said David Suarez, acting laboratory director of the U.S. government’s Southeast Poultry Research Laboratory in Georgia.

Such infections of “resident” birds are helping the virus to persist throughout the year when it didn’t previously, he said.

Black vultures, which inhabit the southern United States and previously avoided infections, are now among the species suffering, said David Stallknecht, director of the Southeastern Cooperative Wildlife Disease Study at the University of Georgia.

The virus has also infected mammals like foxes, bears and seals.

“We all have to believe in miracles,” Stallknecht said, “but I really can’t see a scenario where it’s going to disappear.”

Crossing borders

High virus levels in birds like blue-winged teal, ducks that migrate long distances, helped spread the virus to new parts of South America, Stallknecht said.

Countries including Peru, Ecuador and Bolivia in recent months reported their first cases.

Ecuador imposed a three-month animal-health emergency on Nov. 29, two days after its first case was detected, the country’s Ministry of Agriculture and Livestock said. So far, more than 1.1 million birds have died, the ministry said.

Infections in Uruguay and Bolivia put the disease close to top global chicken exporter Brazil, which has never confirmed a case. Brazilian Agriculture Minister Carlos Favaro said on Wednesday the country investigated three suspected cases, but test results came back negative.

“Everyone is focused on preventing the flu from reaching our country,” said Gian Carlos Zacchi, who raises chickens for processor Aurora in Chapecó in Brazil’s Santa Catarina state.

Some experts suspect climate change may be contributing to the global spread by altering wild birds’ habitats and migratory paths.

“The wild bird dynamics have shifted, and that’s allowed the viruses that live in them to shift as well,” said Carol Cardona, an avian flu expert and professor at the University of Minnesota.

Farmers are trying unusual tactics to protect poultry, with some using machines that make loud noises to scare off wild birds, experts said.

In Rhode Island, Eli Berkowitz, an egg producer and chief executive of Little Rhody Foods, sprayed the disinfectant Lysol on goose poop on a walkway of his farm in case it contained the virus. He also limits visitors to the farm, a more traditional precaution.

Berkowitz said he is bracing for March and April when migration season will pose an even greater risk to poultry.

“You’d better buckle up and hold on for your dear life,” he said.

 
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The confirmation of more bird flu cases in South America raised alarm bells in Brazil, which remains free of contagion even after its close neighbors Argentina and Uruguay confirmed cases there on Wednesday. 

In a press conference to discuss the global sanitary hazard, Brazilian Agriculture Minister Carlos Favaro said Brazil, the world’s biggest chicken exporter, would bolster measures to prevent outbreaks as the virus continued to spread. 

Until now, bird flu cases had been detected in commercial farms in Bolivia, which borders Brazil, and in Peru and Ecuador, Favaro said. 

On Wednesday, cases in wild birds were confirmed in Uruguay and Argentina, sparking a health emergency in both. 

In recent days, Brazil also investigated suspected cases of the highly pathogenic bird flu. 

The suspect cases occurred in wild birds in Rio Grande do Sul state, where many Brazilian meatpackers operate, and in domestic birds, ducks and chickens with bird flu symptoms in Amazonas state, according to the minister. 

None of the suspect cases turned out to be avian influenza, he said. 

Avian flu, which has reached new corners of the globe, has become endemic for the first time in some wild birds that transmit the virus to poultry, experts said. 

The virus has spurred import bans in some countries and pushed egg prices to record highs in some parts of the world. 

Brazil is home to some of the world’s biggest meatpackers. It has never registered a bird flu case. 

But since late last year, the Brazilian meat industry has been on high alert. Most of Brazil’s chicken processors operate in southern states, making the discoveries in Uruguay and Argentina worrisome. 

“It should be remembered that the situation in Uruguay (affecting wild birds) is an example of a case that would not suspend trade and exports of poultry products, in accordance with recommendations established by the World Organization for Animal Health,” Brazil’s meat lobby ABPA said in a statement. 

The Uruguayan government declared a state of national sanitary emergency after detecting bird flu in five dead black neck swans between the departments of Maldonado and Rocha. 

“It’s very important to isolate wild birds from domestic birds, especially sources of food and water,” Virginia Russi, a technician from the agriculture ministry of Uruguay told a news conference. 

Argentina’s Agriculture Secretary Juan Jose Bahillo also confirmed its first cases of bird flu in wild birds, leading it to declare a sanitary emergency and reinforce measures against the disease. 
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Cameroon’s health ministry has dismissed a report of two suspected cases of Marburg virus in the country after a first deadly outbreak in neighboring Equatorial Guinea. Health officials along the border said Tuesday there were two suspected cases of the severe hemorrhagic fever in Cameroon after Malabo confirmed nine deaths and sixteen possible infections. Despite dismissing the reported cases, Cameroon’s health ministry says it is increasing surveillance and travel restrictions along the border.

Health Minister Manaouda Malachie says Cameroon does not yet have any suspected cases of the Marburg virus, despite reports of two possible infections.

Health officials in Cameroon’s South region on Tuesday said a teenage boy and girl suffering from high fever were rushed to a hospital Monday in Olamze, on the border with Equatorial Guinea.

The health officials said the children were suspected of being infected with the Marburg virus, are in isolation, and are responding to treatment.

But Malachie seemed to contradict those reports when he spoke Wednesday to state broadcaster Cameroon Radio Television.

Malachie says the decision by Cameroon to stop Marburg virus, an illness like Ebola, by restricting movement along the border with Equatorial Guinea is so far yielding fruit. He says as of Wednesday at midday central African time, Cameroon had not reported any deaths or suspected cases of Marburg virus.

Malachie says civilians should avoid contact with animals and people who have travelled to Equatorial Guinea and make sure people with fever, fatigue, and blood-stained vomit and diarrhea are isolated.

But Malachie warned its porous border with Equatorial Guinea, which confirmed Monday its first outbreak of the deadly virus, puts it at risk.

Cameroon last week said it restricted movement along the border after Equatorial Guinea quarantined hundreds of people in Kie-Ntem Province, where the hemorrhagic fever was first reported.

The World Health Organization says Equatorial Guinea sent samples to the Pasteur Institute in Senegal, after an alert by a health official on February 7, and one of them tested positive.

The WHO says Marburg was transmitted to people from fruit bats, spreads between people via bodily fluids, and has a fatality rate of up to 88%.

Marburg is in the same family as the Ebola virus but, unlike Ebola, there are no vaccines for Marburg — just treatments for the symptoms such as dehydration and fever.

Health officials from Cameroon and Gabon, which also shares borders with Equatorial Guinea, met Tuesday in Yaoundé and agreed to work together to prevent the virus from spreading.

University of Yaoundé sociology lecturer Francois Bingono Bingono was in the meeting.

He says the frequent movement of people across the borders will make stopping the virus a challenge.

Bingono says in 2020 Cameroon and Equatorial Guinea restricted movement along their border to protect their populations from COVID-19, but civilians on both sides did not respect the order. He says people living on both sides of the Cameroon-Equatorial Guinea border belong to the same ethnic groups, speak the same language, and celebrate happy events or mourn sad events together.

Bingono says health workers not known in border communities are struggling to educate locals that a deadly virus threatens their lives.

He says they will need traditional rulers to help convince their people.

The U.S. Centers for Disease Control and Prevention says the virus was first identified in 1967 in simultaneous outbreaks in laboratories in Marburg and Frankfurt, Germany, and in Belgrade.

Marburg is not new to Africa but is relatively new to West Africa.

An outbreak in Ghana in September last year killed two people, while Guinea recorded one death from the virus in 2021 — the first known case in West Africa.

The WHO reported previous outbreaks in Angola, the Democratic Republic of Congo, Kenya, South Africa, and Uganda.
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Plumes of smoke, questions about dead animals, worries about the drinking water. A train derailment in Ohio and subsequent burning of some of the hazardous chemicals has people asking: How worried should they be? 

It’s been more than a week since about 50 cars of a freight train derailed in a fiery, mangled mess on the outskirts of East Palestine near the Pennsylvania state line, apparently because of a mechanical issue with a rail car axle. No one was injured in that wreck. But concerns about air quality and the hazardous chemicals on board the train prompted some village residents to leave, and officials later ordered the evacuation of the immediate area as fears grew about a potential explosion of smoldering wreckage. 

Officials seeking to avoid the danger of an uncontrolled blast chose to intentionally release and burn toxic vinyl chloride from five rail cars, sending flames and black smoke again billowing high into the sky. The jarring scene left people questioning the potential health impacts for residents in the area and beyond, even as authorities maintained they were doing their best to protect people. 

In the days since, residents’ concerns and questions have only abounded — amplified, in part, by misinformation spreading online. 

More on what we know: 

Controlled burn  

Vinyl chloride is associated with increased risk of certain cancers, and officials at the time warned burning it would release two concerning gases — hydrogen chloride and phosgene, the latter of which was used as a weapon in World War I. 

Environmental officials say that monitors detected toxins in the air at the site during the controlled burn and that officials kept people away until that dissipated. They say continuing air monitoring done for the railroad and by government agencies — including testing inside nearly 400 homes — hasn’t detected dangerous levels in the area since residents were allowed to return. The U.S. Environmental Protection Agency has shared air monitoring results online. 

Continuing concerns 

Even in communities beyond East Palestine, some residents say they worry about long-term effects of even low-grade exposure to contaminants from the site. The village has scheduled a town hall at the local high school Wednesday evening to hear questions from residents, whose concerns have included lingering smells, how to ensure accountability for the cleanup, and what to make of pets and livestock that have appeared ill or died since the derailment. 

The risk to such animals is low, according to the Ohio Department of Agriculture, which recommended that people contact a local veterinarian for any concerns about their livestock or pets’ health. The department hasn’t received any official reports about livestock or pet illnesses or deaths directly related to the incident, though making such a determination would require a necropsy and lab work, the Agriculture Department said. 

Ohio Health Department Director Bruce Vanderhoff cautioned at a news conference Tuesday that residents who were worried about lingering odors or headaches since the derailment should know that those can be triggered by contaminant levels in the air that are well below what’s unsafe. 

The derailment also highlighted questions about railroad safety, though federal data show accidents involving hazardous materials at this scale are very rare. Trains were rolling past East Palestine again soon after the evacuation order was lifted. 

Ground and water 

Contaminants from derailed cars spilled into some waterways and were toxic to fish, but officials have said drinking water in the area has remained protected. 

In addition to vinyl chloride, at least three other substances — butyl acrylate, ethylhexyl acrylate, and ethylene glycol monobutyl — were released into the air, soil or water, according to a U.S. Environmental Protection Agency letter putting rail operator Norfolk Southern on notice about its potential liability for cleanup costs. 

Norfolk Southern’s response has included efforts to remove spilled contaminants from the ground surface and nearby streams, as well as air quality monitoring, soil sampling and residential water well surveys, according to its preliminary remediation plan. 

The Ohio Department of Natural Resources estimates the spill affected more than 11.2 kilometers (7 miles) of streams and killed some 3,500 fish, mostly small ones such as minnows and darters. 

A plume of contaminants that includes butyl acrylate formed in the Ohio River in the first days after the derailment and on Tuesday was flowing slowly, nearing Huntington, West Virginia, Ohio Environmental Protection Agency officials said. 

The contaminant amounts found so far don’t pose a risk for cities that rely on the river for their drinking water, and the plume is continuing to be diluted as it moves farther along, the state EPA said. 

In response, some water companies have shut off their intakes or increased treatment processes as a precaution. 

Social media claims  

As with any developing situation, misinformation and hyperbole about the derailment have spread online in recent days. 

Social media users, for example, falsely claimed that drinking water is contaminated throughout the entire Ohio River basin, when many areas in the multistate region are not affected by the chemical release. 

Footage of dark, ominous clouds has also spread with claims it showed East Palestine post-burn, despite the fact that the footage appeared online as early as November 2022. 

As information continues to develop, disinformation experts emphasize that people should exercise caution before sharing unverified claims. 

Cause of accident 

Investigators examined the rail car that initiated the derailment and have surveillance video from a home showing “what appears to be a wheel bearing in the final stage of overheat failure moments before the derailment,” the National Transportation Safety Board said Tuesday. Its preliminary report is expected in two weeks. 

Rail operator Norfolk Southern and the NTSB haven’t publicly answered one of the big questions about the February 3 derailment, however: Exactly when was the crew alerted to a mechanical issue with a rail car axle — the suspected cause — and did they respond appropriately? 

A wayside defect detector alerted the crew to a mechanical issue “shortly before the derailment,” and emergency braking was initiated, a National Transportation Safety Board member said that weekend. 

Security video from two businesses in Salem, Ohio, shows the underside of one rail car glowing brightly from an apparent fiery axle, indicating the train might have traveled more than 32.1 kilometers (20 miles) with that malfunction before the derailment, the Pittsburgh Post-Gazette reported. The NTSB says it’s reviewing that video. 

Pennsylvania Governor Josh Shapiro said on Tuesday that Norfolk Southern had mismanaged the disaster from the outset and that its actions hampered the response from local and state agencies. He also said the company had been unwilling to look at alternatives to intentionally releasing and burning the five cars filled with vinyl chloride. 

“Prioritizing an accelerated and arbitrary timeline to reopen the rail line injected unnecessary risk and created confusion,” Shapiro said in a letter to Norfolk Southern CEO Alan Shaw. A message seeking comment was left with the company. 
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Health rights campaigners in Malawi are welcoming a national campaign against a record cholera outbreak, which has affected all 29 districts in the country and killed nearly 1,400 people.

President Lazarus Chakwera launched the campaign Monday, pledging to reduce the transmission and mortality rate of the water-borne illness. Chakwera said the spread is largely because people in the country are not following good hygiene practices.

“And because the behavior is not changing, the situation has become dire,” he said. “So far, over 1,300 funerals have happened around the country because of cholera. And the disease is still spreading at an alarming rate. We are getting between 500 to 600 cholera cases every day in our health facilities throughout the country.”

The campaign, known as “Tithetse Kolera” or “Let’s end cholera,” focuses on repairing water kiosks across the country and helping people construct toilets in their homes.

Chakwera said statistics show that about 40 percent of Malawians do not have toilets and instead use the bush to relieve themselves.

Several organizations in Malawi have long been running campaigns against the practice of open defecation, but with little result.

“We are human beings with dignity, not animals that can just use any place as a toilet. If any place is not a toilet, don’t treat it as a toilet,” Chakwera said. “And a toilet is not something that is given to you by the government or something that is donated from abroad or something that comes down from heaven. It is something you give yourself as a human being because you respect yourself better than an animal.”

Health authorities say they hope the campaign will help reduce the cholera fatality rate from the current 3.6% to 1%.

Health rights campaigner George Jobe welcomed the campaign, but said the government should go further by ending myths and misinformation associated with the outbreak.

Jobe, who is also executive director for the Malawi Health Equity Network, cited two recent incidents in Lilongwe and Balaka districts, where angry members of the community assaulted medical workers and vandalized two public health facilities, forcing them to close. The community members accused the medical workers of deliberately infecting patients with cholera-infested vaccines.

“The current cholera seems to be different from previous outbreaks of cholera just because the current one was preceded by COVID-19. So, we shall continue to provide some piece of advice to the government that when we are doing awareness raising, we must be mindful that we are also fighting with reductions of COVID-19,” Jobe said.

Chakwera ordered the reopening of the closed health facilities and assured the health workers that they would receive maximum security.

In the meantime, the Africa Centers for Disease Control and Prevention and United Nations have pledged their support toward the success of the cholera campaign.

“The United Nations is currently in the process of preparing a multisector cholera appeal to increase the capacity of the U.N. and NGOs to support the government of Malawi. It will be launched next week,” said Rebecca Donto, the United Nations’ resident coordinator in Malawi.

Local media have reported that Malawi needs an additional $40 million for an effective cholera response. 
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Equatorial Guinea announced its first outbreak of the Marburg virus, a highly infectious disease similar to Ebola, the World Health Organization said in a statement Monday. 

The small central African nation of about 1.6 million people reported nine deaths and 16 more suspected cases after a sample sent to a laboratory in Senegal on February 7 came back positive. 

Health Minister Mitoha Ondo’o Ayekaba told reporters that a health alert had been declared in Kie-Ntem province and the neighboring district of Mongomo, after consulting with the World Health Organization and the United Nations, Agence France-Presse reported.

The nine deaths occurred between January 7 and February 7, Ayekaba said.

The Marburg virus has a fatality rate of up to 88% and spreads from person to person through direct contact with bodily fluids, WHO said. The disease comes from the same family of viruses as Ebola. Symptoms consist of high fever and severe headache, with many patients developing hemorrhagic symptoms within seven days.

WHO said officials have been deployed in Equatorial Guinea to “trace contacts, isolate and provide medical care to people showing symptoms of the disease.”

“Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Dr. Matshidiso Moeti, the WHO regional director for Africa.

WHO said there are currently no vaccines or antiviral treatments for the virus. However, oral rehydration therapy and treatment of certain symptoms can improve chances of survival, it added.

Some material for this report came from The Associated Press and Agence France-Presse. 
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