UN Geneva Press Briefing - 19 April 2024
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Press Conferences | UNFPA , OHCHR , WHO

UN Geneva Press Briefing - 19 April 2024

PRESS BRIEFING BY THE UNITED NATIONS INFORMATION SERVICE

19 April 2024

Impact of Attacks on Healthcare in Gaza

Dominic Allen, United Nations Population Fund (UNFPA) Representative for the State of Palestine, said that he had just returned from his latest 10-day mission in Gaza. Six and a half months of Israeli military operations in Gaza had created a humanitarian hellscape. Tens of thousands of people had been killed. Two million Palestinians had endured death, destruction and continued to suffer from despair.

Fear remained ever present, as a military incursion in Rafah would compound the humanitarian catastrophe. Mr. Allen said he was terrified for the one million women and girls in Gaza right now, and especially for the for the 180 women giving birth every day in inhumane, unimaginable conditions.

One man who Mr. Allen met at Al Aqsa hospital had lost 50 of his extended family members, who were killed from an airstrike which collapsed a building in which they were living. He said that his mother and brother’s bodies and hearts were broken. Mr. Allen had also met with a youth leader who had helped to set up a camp on the sand in Rafah and to deliver shelter, food and water. Her parents had been killed two months ago, but she had been able to continue supporting her community.

Mr. Allen also recounted the look in the eyes of Iman, a humanitarian worker who worked with the UNFPA team, upon seeing the burnt-out carcass of the home he had built with his wife, which encapsulated his family's dreams and his personal aspirations for the future. These people, and all the incredible Gazans enduring so much, had no choice but to go on. They were all calling for a ceasefire now.

During his mission, Mr. Allen visited around 10 hospitals, many medical points and gender-based violence safe spaces. Some of those hospitals were laying in ruin and some were being rebuilt to support the health system, which was hanging by a thread. Hospitals were a lifeline for the pregnant women of Gaza.

In Eastern Khan Younis, the level of destruction was difficult to describe. It was very similar to the destruction in Gaza City. One hospital in Khan Younis was being restored and would start to provide a semblance of emergency medical services soon.

In Al Amal Hospital, the second most important hospital across the Gaza Strip, what Mr. Allen saw broke his heart. Medical equipment, such as ultrasounds, had cables that had been cut and screens smashed. The wanton destruction in the maternity ward was purposeful. UNFPA and international non-governmental organization partners were working to restore electricity and safe water in the hospital and reestablish this medical lifeline.

Mr. Allen said he had stood beside a warehouse of Nasser Hospital, to which UNFPA delivered supplies many months ago, which was literally burning. He had had to avoid unexploded ordnances on his visit to Al-Khair Hospital, a referral hospital for maternal care. It was unrecognisable from two months ago – there was seemingly no working medical equipment, the maternity ward and birthing rooms stood silent and there was an eerie sense of death.

Phenomenal, heroic work had been done by doctors in Gaza City to create a small primary healthcare focal point for UNFPA amidst the rubble of a half blown-out building. It had antenatal care and postnatal care and was providing basic medical support. The maternal healthcare centre in Shifa, the most important hospital in terms of its tertiary care and for UNFPA, stood in rubble. Workers were trying to rehabilitate some of the emergency rooms to get it up and running again, but it would not be used for maternity care again.

The one hospital referring all safe births in North Gaza was the Al Sahaba Hospital, which UNFPA was supporting with supplies since the end of October. This was the only place pregnant women were able to go in North Gaza. The Al Awda Hospital was overwhelmed with trauma cases and was not supporting maternity care.

The Emirati Hospital was the major lifeline for women in Gaza. Right now, it was supporting around 50 or 60 births a day, including 10 to 12 caesarean sections. In this visit, UNFPA delivered lifesaving oxytocin to the hospital. There was a sense of fear about what might happen at Emirati, given its importance for pregnant women in Gaza.

UNFPA had delivered a 40-foot mobile maternity unit, which International Medical Corps UK would operate as part of its maternity work in Gaza. It would be delivering five other units to the organisation and others soon to ensure safe births.

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was the backbone for the humanitarian response in Gaza. Mr. Allen visited three UNRWA schools, where there were emergency medical points operating. UNFPA was deploying midwives in these schools to hear the needs of pregnant women. It would soon deliver more midwifery kits to these schools. The work of UNRWA workers on the ground was inspiring.

Mr. Allen had also visited the UNFPA Youth Advisory Panel. They had become positive humanitarian agents in Rafah, building shelters for 300 people, delivering water and supplies. They were afraid of what a Rafah military operation would bring, and they demanded an immediate ceasefire.

Mr. Allen also visited several women-led organisations. Women in Gaza feared for their safety and dignity. Through UNFPA staff, there were reports of growing intimate partner violence and child marriage. There was also a lack of menstrual health management supplies.

UNFPA had concerns for the healthcare system overall. Pregnant women could only go to give birth at three of the ten partially functioning hospitals. UNFPA was working to ensure that life-saving health supplies could be delivered and was working with local partners to help gender-based violence survivors to seek support. It was also delivering dignity kits, hygiene kits and menstrual hygiene management kits. Psychological first aid, mental health and psychological first aid remained a priority. UNFPA was also engaging with youth to support their own communities.

There was a sword hanging over Rafah, Mr. Allen said. There was palpable fear about what would happen if ground military operations started in Rafah. Rafah was a haven for 1.2 million Gazans. Where would the people living under plastic sheets and shelters in indescribable conditions go? Where would they get access to food, water, to shelter and health care?

There was a way to stop Gaza from further plunging into a deeper abyss. There needed to be a massive influx of aid and assistance delivered safely to people in need. An immediate humanitarian ceasefire was the only solution to the huge catastrophe in Gaza.

In response to questions, Mr. Allen said it was unclear who had damaged medical equipment, but it had clearly been purposefully damaged. There had been several reports from doctors that there were not sufficient supplies of anaesthesia for carrying out C-sections. Because the health system was crippled, women were giving birth and having to be discharged within a matter of hours. UNFPA wanted to increase midwives in the region and provide more post-natal care. There was an increased number of complicated births; some doctors had reported a doubling in complications. This was due to dehydration, malnutrition, and fear. One doctor said that he no longer saw normal-sized babies. The looming famine would have a direct impact on women. Fear increased stress and other complications that led to more pre-term births.

Mr. Allen said he travelled to Gaza regularly. For the most recent mission, he was there from 8 until 17 April. The mission was conducted with the World Health Organization (WHO) and UNRWA. The inter-agency humanitarian country team, which included United Nations agencies, had daily contact with Israeli authorities. The United Nations had been very clear regarding the danger of a ground offensive in Rafah.

In general, aid could be delivered through a very narrow pipeline only. Thus, the number of dignity kits was currently insufficient. While there were other entry points opening for food, those could not be used for dignity kits. Midwifery kits were opened at crossings and torches were removed. The oxygenator unit included in the mobile maternity unit could also not be delivered. Other agencies were also having difficulty delivering equipment such as generators.

Getting data on maternal and infant mortality was very difficult. UNFPA coordinated with partners working on reproductive health to collect what data it could. Anecdotally, it was hearing reports of an increase in still births, but there was no data on the situation thus far.

Rolando Gómez, Chief of the Press and External Relations Section at the United Nations Information Service (UNIS) in Geneva, said United Nations Secretary-General António Guterres had spoken yesterday to the Security Council, calling for an immediate ceasefire as well as the immediate release of all hostages held in Gaza. Ending hostilities in Gaza would significantly diffuse tensions across the region, he said.

Philippe Lazzarini, Commissioner-General of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), had two days ago spoken about why the agency existed, in lieu of a State that could deliver critical public services to people in Gaza.

 

Concerns over Rising Tensions in Rakhine State, Myanmar

Jeremy Laurence for the Office of the United Nations High Commissioner for Human Rights (OHCHR) said intensified fighting in Rakhine state between the military and the Arakan Army, alongside tensions being fuelled between the Rohingya and ethnic Rakhine communities, posed a grave threat to the civilian population. There was a grave risk that past atrocities would be repeated.

Since the year-long informal ceasefire between the two sides broke down last November, 15 of Rakhine’s 17 townships had been affected by fighting, resulting in hundreds of deaths and injuries, and taking the number of displaced to well over 300,000.

Rakhine state had once again become a battleground involving multiple actors, and civilians are paying a heavy price, with Rohingya at particular risk. What was particularly disturbing was that whereas in 2017, the Rohingya were targeted by one group, they were now trapped between two armed factions who have a track record of killing them. We must not allow the Rohingya to be targeted again.

The military had been fast losing ground to the Arakan Army throughout northern and central Rakhine. This had led to intensified fighting in the townships of Buthidaung and Maungdaw, ahead of an expected battle for the Rakhine state capital, Sittwe. The two townships were home to large Rohingya populations, putting them at grave risk.

Facing defeat, the military had outrageously started to forcibly conscript, bribe and coerce Rohingya into joining their ranks. It was unconscionable that they should be targeted in this way, given the appalling events of six years ago, and the ongoing extreme discrimination against the Rohingya, including the denial of citizenship.

Some reports said the military was forcing the Rohingya recruits or villagers to burn ethnic Rakhine homes, buildings, or villages. Ethnic Rakhine villagers had allegedly responded in kind by burning Rohingya villages. The United Nations Human Rights Office was trying to verify all reports received, a task complicated by a communications blackout throughout the state.

Disinformation and propaganda were also rife, with claims that “Islamic terrorists” had taken Hindus and Buddhists hostage. This was the same kind of hateful narrative that fuelled communal violence in 2012 and the horrendous attacks against the Rohingya in 2017.

Since the start of the year, the Arakan Army had positioned itself in and around Rohingya villages, effectively inviting military attacks on Rohingya civilians.

On 15 April, the Médecins Sans Frontières office and pharmacy were torched in Buthidaung, along with some 200 homes. Hundreds had fled and were reported to be taking refuge in a high school, the grounds of the former hospital, and along roads in Buthidaung town. With both the Maungdaw and Buthidaung hospitals having been shut by the military in March and with the conflict intensifying, there was effectively no medical treatment in northern Rakhine.

The alarm bells were ringing, and we must not allow there to be a repeat of the past. Countries with influence on the Myanmar military and armed groups involved needed to act now to protect all civilians in Rakhine State and prevent another episode of horrendous persecution of the Rohingya.

In response to questions, Mr. Laurence said OHCHR did not have a presence in Myanmar but was engaged through normal diplomatic channels with the Arakan Army and the Permanent Mission of Myanmar in Geneva. 

OHCHR was aware of reports that Aung San Suu Kyi had been moved. Its position was that she and all 20,000 political prisoners in Myanmar needed to be released.

Rolando Gómez, Chief of the Press and External Relations Section at the United Nations Information Service (UNIS) in Geneva, said the Secretary-General had recently appointed Julie Bishop of Australia as the Special Envoy on Myanmar to replace Noeleen Heyzer of Singapore. The United Nations also had the Independent Investigative Mechanism on Myanmar, which was very active in Geneva. This was a dire situation that the United Nations was looking at from various angles.

Attack on Iran by Israel

In response to questions, Jeremy Laurence for the Office of the United Nations High Commissioner for Human Rights (OHCHR) said OHCHR was aware of reports of an attack on Iran by Israel. It was hard to gather real information from both sides involved.

It urged all parties to take steps to de-escalate the situation and called on third States, particularly those with influence, to do all in their power to ensure that there was no further deterioration in an already extremely precarious situation. It was deeply worried by the potential humanitarian and human rights cost if this escalation led to a wider conflict in the Middle East.

Rolando Gómez, Chief of the Press and External Relations Section at the United Nations Information Service (UNIS) in Geneva, said the Secretary-General was also calling for de-escalation of the situation. Earlier in the week, he issued a statement strongly condemning the escalation of the situation caused by the large-scale attack on Israel by Iran.

Update on H5N1 Situation Globally

Dr. Wenqing Zhang, Head of the Global Influenza Programme, World Health Organization (WHO) said recently, avian influenza H5N1 viruses had been detected in dairy cows and goats in the United States. Since March 2024, infections in 29 herds in eight different states had been reported.

On 1 April, the United States notified WHO of a laboratory-confirmed human case of H5N1 in Texas. This person worked at a dairy cattle farm, where he was exposed to cows presumed to be infected with the virus. So far, the H5N1 viruses identified in cows and the human case remained avian viruses and showed no increased adaptation to mammals.

Avian influenza H5N1 first emerged in 1996 but since 2020, there had been an exponential growth in the number of outbreaks in birds. In addition to birds, an increasing number of mammals had been affected, such as minks, seals, sea lions and foxes.

Now there were multiple herds of cows affected in an increasing number of states of the United States, which showed a further step of the virus spill over to mammals. Farm workers and others in close contact with cows needed to take precautions in case the animals were infected. The virus had also been detected in milk from infected animals. While investigations were ongoing, it was important for people to ensure safe food practices, including consuming only pasteurised milk and milk products.

The case in Texas was the first case of a human infected by avian influenza by a cow. Bird-to-cow, cow-to-cow and cow-to-bird transmission had also been registered during these current outbreaks, although many were still under investigation. These suggested that the virus may have found other routes of transition than those previously understood.

While this might sound concerning, it was also a testament to the strong disease surveillance which allowed WHO to detect the outbreak. WHO was working closely with the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (WOAH), its “One Health” partners, on updating a joint risk assessment for H5N1, which it would publish in the coming days.

Human infections with H5N1 remained rare and were tied to exposure to infected animals and environments. Since 2003, close to 900 human cases of H5N1 infection had been reported. Infections in humans ranged from mild, even asymptomatic, to severe.

Any time there was a human case of infection with an animal influenza virus, countries were required to report it to WHO under the International Health Regulations. Detailed investigations took place to prevent potential further transmission, to allow for understanding of the source of infection and characterisation of the virus, and to inform clinical management of sick persons and other pandemic preparedness activities. This allowed WHO to ensure that the risk that H5N1 and other avian influenza viruses posed was carefully managed.

WHO used virus characterisation and other available information to update the risk assessment and “candidate vaccine virus” as part of pandemic preparedness. Having candidate vaccine viruses ready allowed WHO to be prepared to quickly produce vaccines for humans if this became necessary. For this particular H5N1 virus detected in dairy cows, there were a few candidate vaccine viruses available from the WHO Global Influenza Surveillance and Response System (GISRS).

While WHO and partners were reviewing and assessing risks for H5N1 avian influenza, they called on countries to remain vigilant, rapidly report human infections if any, rapidly share sequences and other data, and reinforce biosecurity measures on animal farms.

In response to questions, Dr. Zhang said the virus had only been detected in cows in the United States. There was a high virus concentration in raw milk, but it was unclear how long the virus could survive in raw milk. WHO was recommending that people consumed pasteurised milk and milk products.

There had only been one human case associated with the outbreak and was most likely transmitted through direct contact with cows. A report suggested that it was transmitted though milking devices. FAO had developed guidance on the consumption on dairy products and the effects of the pasteurisation process.

The United States case had led to only mild conjunctivitis symptoms. Around half of the 900 human cases were fatal. The cases reported in Europe and North America were all mild. There was a need to investigate in detail the morality caused by the virus.

WHO could not predict whether the virus would spread to cows in other countries. However, the virus had crossed several continents through birds. Vigilance was needed, including surveillance of both humans and animals.

Countries were equipped to detect the virus if it appeared. There were a couple of candidate vaccines for this variation of H5N1 that could be distributed if a pandemic were to develop. Member States needed to notify WHO of novel human infections within 48 hours. There had been delays in the past due to the confirmation process.

H1N1 and H3N2 were seasonal influenza viruses. There was also a variation of influenza in swine that WHO was monitoring for transmission to humans. There were different clades of H5N1, and there were other subtypes such as H5N6 and H3N8. In these subtypes, human infection was very rare and usually picked up in hospitalised cases.

WHO had found that there were no new changes associated with the susceptibility of the currently available antivirus.

Announcements

Rolando Gómez, Chief of the Press and External Relations Section at the United Nations Information Service (UNIS) in Geneva, said the Committee on the Elimination of Racial Discrimination (112th session, 8-28 April, Palais Wilson), was concluding this morning its review of the report of Moldova.

The Committee Against Torture (79th session, 15 April – 10 May) would begin next Tuesday morning its review of the report of Azerbaijan.

The Conference on Disarmament would open the second part of its 2024 session on the 13 May, still under the presidency of the Islamic Republic of Iran.

On Monday, 22 April at 10:30 a.m., the International Labour Organization would hold a press conference to launch the report “The impacts of climate on occupational safety and health,” which was embargoed until 22 April at 11:30 a.m. Speaking would be Manal Azzi, Senior Specialist on Occupational Safety and Health, and Balint Nafradi, Technical Officer on Occupational Safety and Health Data.

On Monday, 22 April at 1:30 p.m., OHCHR would hold a briefing on the health situation in Gaza. Speaking would be Tlaleng Mofokeng, Special Rapporteur on the right to health.

 Mr. Gómez also congratulated the newly elected committee for the Association of Accredited Correspondents at the United Nations, and said he looked forward to working with them throughout the year. 

 

Teleprompter
[Other language spoken]
Thank you for joining us here at the UN office at Geneva for this press briefing today, the 19th of April.
We have three agenda items for you today.
We have the situation in Gaza's hospitals.
We have Myanmar and the concerns over rising tensions in Rakhine State.
And we have an update from WHO on H5 N 1, the situation globally.
So we'll start off immediately with Mr Dominic Allen, who's UNFPA is representative for the State of Palestine, who's joining us from Jerusalem, who will again speak to the situation in Gaza's hospitals.
Over to you, Dominic.
Well, thank you very much.
And indeed, I just, I'm speaking to you from East Jerusalem, having returned a few hours ago from my latest mission in Gaza, this time a 10 day mission, leaving with our UNFPA team on the ground.
And let me share a few things.
I think first of all, as the Secretary General himself has said in Gaza, 6 1/2 months of Israeli military operations have created what I saw on the ground, which is a humanitarian hellscape.
10s of thousands of people have been killed, 2,000,000 Palestinians have endured death, destruction and continue to suffer from despair.
And my impression coming back to East Jerusalem today is that fear remains ever present as a military incursion in Rafa would compound the humanitarian catastrophe.
Now for UNFPA and our particular focus.
I am terrified for the 1,000,000 women and girls in Gaza right now, and especially for the 180 women giving birth every single day and giving birth in inhumane, unimaginable conditions.
So let me share a few personal stories from from Gazans on the ground, some reflections from the mission that I've undertook and a number of missions into Gaza in in the Eastern Han units together with the World Health Organisation.
And then some of the priorities that we see for sexual and reproductive health and gender based violence in Gaza in terms of the fear that I spoke of and the desperation and frankly the unparalleled strength of Gazans.
3 personal stories which I would share with you.
One of a gentleman called Meisara who I when I went to visit the AL Aqsa Hospital in the middle area.
He had lost a few weeks ago thirty of his extended family members and a few days ago an additional 20 if the extended family members.
And whilst there I, I met with his mother and his his brother, who were both bodies have been bodies have been broken.
But when I when I, when I spoke with his mother, not only her body is broken, but her heart is broken.
If you can imagine 50 extended family members, men, women and children, killed from an air strike which collapsed a building in which they were living in this indiscriminate loss of civilian life.
Second person that I met with Angkum, a youth leader, and I'll speak about her work when I come to the more programmatic side.
But again, sitting with Angkum in a tent on the sand in Rafa in a camp, which Angkum as a youth leader has helped build and deliver supplies and deliver shelter, food and water.
But she's doing this having having had her mother and father killed two months ago and speaking about that personal loss, but her ability to to continue going and supporting her community.
And finally, Ayman, one of the humanitarian workers there who actually works with, with our team from UNFBA, has worked for the UN for over a decade.
And Ayman accompanied me on a mission with the World Health Organisation to Gaza City, where we visited Al Shiva Hospital, Indonesia Hospital and a medical point, which again, I'll speak to in a moment.
But just to share the this, this personal story, when you stand with Ayman and he, his home, his family home, he has beautiful children who I got to sit with in Rafa as well.
And to see the look in his eyes as he visited his home which is in the same neighbourhood as Al Shifa.
The first time he'd seen the burnt, the burnt out carcass of the home which he built with his wife and encapsulated his family's dreams, his personal aspirations for the future.
And they're gone.
And across these three individuals, my Sara, Anka Ayman and the many, many personal stories of the incredible Gazans who are enduring so much, one thing that they say is that they have got no choice but to go on.
But secondly, the clear message which remains, which the Secretary General and the United Nations have maintained as well, is that they all call for a ceasefire now.
Now aside from those personal stories, let me speak to the mission itself, the 10 days that I was within Gaza and I think during the 10 days, and this is the frame for the for this, for my briefing.
Now, of course, I visited around 10 hospitals, many medical points, many of the GBV safe spaces with a focus again from UNFB for maternal health.
Now some of those hospitals are laying in ruins, they are rubbled, some of them because there is a health system hanging by a thread and some of those hospitals are clinging to life themselves whilst they are a lifeline for the pregnant women of Gaza on the a number of the missions.
So last Wednesday, together with the World Health Organisation, we visited Eastern Han Unis, the first time that I've been in Han Unis, having worked in Gaza, Palestine for a couple of years and seeing the level of destruction in Kanunis is very difficult to describe, very similar to the destruction in Ghazi city.
And I described Ghazi city last month as being dust.
I feel the same around Kanunis as well, in the family units.
We visited the Alamal hospital, which was in the hoping when we met with the hospital director.
[Other language spoken]
It's not going to be providing maternal health services, but it's going to at least try and start to provide some semblance of an emergency medical point, supported by the World Health World Health Organisation and the the Red Crescent Society there.
Also, we visited the NASA Hospital Complex, the second most important hospital across the Gaza Strip and UNFPA together with WHO and UNICEF over years have supported this hospital.
There is a specific maternity ward which we ourselves have worked on for years.
And having known and visited NASA Hospital many times before October last year, but also having visited it recently, in January on my recent visit and delivered supplies there, what I could, what I saw, it breaks my heart again.
It's indescribable what we see there is medical equipment, purposefully broken ultrasounds, which you you will know is a very important tool for helping ensure safe births with cables that have been cut, screens of complex medical equipment like ultrasounds and others with the the screens *******.
So purposeful wanton destruction in the maternity ward, aside from the fact that the water and sanitation will be needed to be looked at, the electricity, the the generators.
So the, the situation that that's again with the World Organisation in the coordination role they're looking to with INGO partners and with partners on the ground trying to get that up and running again to provide a lifeline.
But I stood beside the warehouse which we delivered supplies many months ago and it was literally burning and there's so much work to do in terms of trying to re establish that lifeline.
We also visited the Jordanian Field Hospital and the Alpha Hospital and the Alpha Hospital was a maternity hospital up until two or three months ago till the huge incursion into Khan Eunice and I myself visited and we put UNFPA provided maternity supplies because whilst NASA hospital was overwhelmed at that time with trauma care and full of Idps and now remains empty.
Now our hospital was a referral hospital for maternal care and I mean we had to be.
We have to be careful for unexploded ordinance together with unmasked.
We visited not sure and walking through the the the entrance into Al Qaeda, it was unrecognisable from when I went and visited 2 months ago.
There wasn't it didn't seem as if there was any piece of working medical equipment, the birth, the maternity ward, the birthing birthing rooms that I visited earlier stand silent.
There should be a place of giving life and they just have an eerie sense of death.
On Monday, that was in, that was last Wednesday in hand units on Monday then, as I mentioned, we went to it was a city we visited A PMRS, the Palestinian Medical Relief Society Medical Point.
Phenomenal heroic work by the doctors in Gaza City amidst huge rubble.
They've created a small primary healthcare focal point for UNFBA.
It has antenatal care, post Natal care, there was a midwife there, there was an OBGYN who's coming in to help provide medical support to pregnant women, as well as the other prime healthcare work that's there.
Incredible.
Amidst the rubble, amidst the blown out half building they are, they are being able to provide some sort of basic medical support.
Then we went to Al Shifa, which was the most iconic hospital in Gaza, the most important in terms of its tertiary care.
And for UNFPA, again, the maternity building itself stood in rubble.
And this is a chief hospital somewhere where again UNFPA together with WHO, UNICEF and partners have provided over many years support to build the capacity to ensure safe births in Gaza.
And again it lays in complete ruin.
We also visited Indonesian Hospital in Bet Lahia, further north from Gaza City and was amazed to see that they're already trying to re rehabilitate some of the emergency room to get it up and standing again, but it won't be used for maternity care again.
The one maternity hospital that is referring all cases for safe births in Gaza and the north of Gaza right now is the Sahaba Hospital, which UNFPA has been supporting with supplies since since the start of this, since start of October.
And we continue to support.
But that is the only space where pregnant women were able to go in the middle area.
As I mentioned when I spoke of the case of Mysara and his heartbreaking family situation, we visited the AL AXA hospital and it again is it is overwhelmed with trauma cares.
The emergency department was overwhelmed with with cases coming through.
It right now is not supporting maternity care because in the middle area, the one functioning, partially functioning hospital is the outer hospital, which again UNFA and partners are providing support to ensure safe births.
And then down in in the South, in Rafa, I visited the Emirati hospital, which is a major lifeline for pregnant women in Gaza right now.
It's supporting to around 50-60 births every single day, including 10 to 12 Caesarean sections.
I've visited that numerous times on my previous missions into Gaza.
[Other language spoken]
On this occasion, we delivered life saving oxytocin, which they're going through at an incredible rate because of the number of births which their maternity ward is overwhelmed with.
And again, the the sense of fear for what may happen at Emirati given its importance for pregnant women in Gaza.
So those three hospitals for maternity care, Sahaba in the north, allowed in the middle area and Rafa in the South.
But I also visited the IMC and UK Med field hospitals, which UNFP is also supporting with supplies and also with mobile maternity prefabricated units, mobile maternity units.
And it was incredible to see one of these units that UNFP has delivered to 40 foot mobile maternity unit, which IMC will operate as part of their maternity work.
And IMC and UK Med are doing phenomenal work in supporting and we will be delivering additional units of that size for basic emergency obstetric care and comprehensive but more complicated emergency objective care cases to both UK Med and IMC in addition to other also on the mission.
Then we also, I think 2 of the highlights to to put forward one is UNRWA.
UNRWA is the backbone for the humanitarian response in Gaza.
And I visited 3 schools which have been transformed into designated shelters and in those shelters there are emergency medical points.
And UNFPA together with the Palestinian Medical Relief Society and UNRWA have formed a partnership to deploy midwives because pregnant women are not getting enough access to pre and post Natal, pre and post birth healthcare.
So we are deploying a number of midwives into these.
And we went and we went and visited together with the UNFPA section, reproductive health and emergency specialist, those midwives to hear about how they're seeing the cases, how are they able to function, what's more support and supplies and hearing their needs.
We will then be delivering in midwifery kits to enable them to do their work and try and do more with those getting more midwives deployed so that more of those pregnant women in those shelters, which I call them shelters, they're, they're apparently safe havens, but we know how many have been hit previously.
They have not been deconflicted sufficiently, but also the conditions are indescribable in terms of what these pregnant women and the civilians in Gaza are having to endure in these UNRAR shelters.
Again, supported by the amazing inspirational work of those UNRAR workers on the ground.
Finally, the youth, the youth visit this youth youth advisory panel that UNFPA and partners have been supporting for quite some years.
They were an advisory panel to help to elevate youth voice in Palestine.
And I visited a one of the one of the shelters or one of their interventions.
Incredible, incredible work, incredible conditions.
First of all, it's it's within one of these informal camps in Rafa on the sand, these youth advisory panel members, members of the community, members of young people who wanted to two years ago be a part of helping create a positive future for Palestine.
And now they've transformed into humanitarian agency themselves.
They have built tents, they're delivering water safe and and food and Anger and Ahmed, who I met with couldn't have been clearer in in elevating their youth voice.
Not only are they helping to create shelters and support their communities, but they are very, very clear from them.
The youth, from the midwives, the doctors that I met with, the civilians that I spoke with, everybody is calling for a ceasefire and their fear for what may come.
Finally, we also visited a number of the women's LED organisations.
UNFP is concerned of course for gender based violence, but the broader impact on women and girls as well and hearing from the women directly on this and previous visits and hearing from those women leaders in Gaza.
The big concerns are for of course their safety.
They are fearful for what may come and aside from being a parent or being a mother, they also have concerns for their own dignity.
There is an insufficient supply of menstrual hygiene management items.
UFP has been working with partners to try and get as many as possible to those women in need.
But also the risks of gender based violence, sexual violence and child marriage have increased.
And we heard directly on my team, my Gender Based violence or the UNIPA Gender Based Violence and Emergency specialist heard from Gazan women who spoke of their direct impact of intimate partner violence of child marriage that they're suffering.
And that's why aside from this mission last week, together with, as I mentioned, the number of missions to to Gaza City in the north or Eastern Cran Eunice, thanks to the partnerships with the World Health Organisation, with OCHO, with UNRWA, UNICEF and, and many parts of the UN and importantly, those local NGOs who are doing incredible work whilst being displaced and under fear without sufficient food, water, shelter.
I think to zoom out for a moment for UNFPA, if I speak to what we see as the priorities right now for section reproductive health, I think as you've heard from me, our concerns are for the healthcare system overall.
I mentioned the three, only three of the 10 partially functioning hospitals where women, pregnant women can go to give birth and the capacities that they are running at in terms of the Emirati in which you can only spend a number of hours after giving birth to until you until the pregnant women, until the new, new mothers have to be discharged.
And for Zarian sections, it's a less than a day.
So capacities are a big priority and that's why, as I mentioned, UNFPA has gotten one big prefabricated maternity field unit in there this last week.
And we have another 2 arriving into Al Rishi Airport next week on cargo flights.
And we have another three behind that as well to deploy to ensure that safe births can be supported and assured to the extent possible.
[Other language spoken]
UFP has been working since the start to ensure those reproductive health kits, those life saving medicines and medical equipment get in and get to the doctors and midwives who need them.
And thirdly, increasing the number of capacities this I mentioned that the medical emergency medical points with more big wives, more access to antenatal and overall sexual reproductive health care.
On GBV side, our priorities are also three.
It's first of all how given what had happened from October, the referral pathways for what a gender based violence survivor would seek in Gaza have been destroyed.
So we're working with our local partners with and university coordinates, the gender based violence subcluster of a team of different local partners, NGOs and international partners to look towards how GBV survivors can seek support clearly from the women of Gaza.
They're asking for more access for menstrual hygiene management items.
And we have dignity kits, hygiene kits, mental hygiene management kits, together with UNRAR, UNICEF, WHOUNFPA, we are seeking to get as many of those dignity kits inside Gaza.
And I say dignity, there is very little or no dignity in Gaza for the women of Gaza right now.
And then finally, and this isn't just for pregnant women, this isn't just for GBV survivors.
It isn't just for the women and girls of Gaza, but psychological first aid, mental health and psychosocial support remains a key priority amidst the fear and desperation that hangs.
And I think that's where also in our youth work that is PFA, psychological first aid remains a priority and supporting the youths who are enabling many of the amazing community work local level in those camps and engaging with their with the youth themselves to support their own communities.
I think that's where maybe my final point, aside from priorities, I leave Gaza and arrive in Jerusalem today with a great sense of fear.
The areas there is a sword hanging over Rafa.
There is a palpable fear from the from the Gazans who I who I spoke with, the midwives, doctors, pregnant women, my fellow colleagues who are in Gaza, that the fear of what will happen if a ground, military ground incursion happens in Rafa.
Because right now it's a haven for 1.2 million Gazans.
[Other language spoken]
And the tents, and I say tents, but pieces of plastic and shelters in these indescribable conditions to imagine what they are meant to do if a military incursion happens.
Where are they meant to go?
Where will they get access to food, water, through shelter, to healthcare And again when we've spoken with the the hospital directors of the Emirati hospital, which in the middle of Rafa is a lifeline for the pregnant women of Gaza for the number of births I mentioned, 50 to 60 births every single day with 11:50 Caesarean sections.
It's unthinkable that what may happen again, and maybe I can stop here in terms of my briefing, but there is a way to stop Gaza from further plunging into a deeper abyss.
And that is that there must be a massive influx of aid and assistance, and not only getting it across the border, because you'll have heard from the broader humanitarian community, it's not only about access to get the aid into Gaza.
It's getting in and to the people who need it, those safe, the ability to move safely and deliver that aid safely to where it's most needed for those people in need.
And with that is the final call, which I again, I echo my fellow, my fellow humanitarian workers, I echo the voice of the Gazans that I met with and from the from the United Nations, from the Secretary General, from UNFPA in calling for an immediate humanitarian ceasefire, which is the only solution for this huge catastrophe right now in Gaza.
Thank you very much.
Thanks very much to you, Dominic, for this very comprehensive briefing.
And, and as heartbreaking as it is and dire, there's a situation, as I take this opportunity, colleague, just to remind you that yesterday we shared with you the remarks by Antonio Guterres, the Secretary General to the Security Council, in which, as, as we just heard, he echoed his call for an immediate ceasefire, as well as the immediate release of all hostages held in Gaza.
And he says ending the hostilities in Gaza would significantly, significantly diffuse tensions across the region.
And, and since we spoke about UNRWA, of course, we echo that UNRWA is indeed the backbone.
And I draw your attention to the statement that we shared with you 2 days ago, in fact, from Philip Lazzarini, in which he talks about why the agency exists, that is in lieu of a state that can deliver critical public services to the people in Gaza.
[Other language spoken]
We have Satoko from Yomiyo Shimbun, who's online.
Satoko, over to you.
[Other language spoken]
You're unmuted.
You want to try to pose your question?
[Other language spoken]
So maybe you may need to disconnect and then connect again.
In that case, I'll take a question in the room of Nina from AFP.
[Other language spoken]
Thank you for this briefing.
I was wondering if you mentioned the intentional destruction of equipment in hospitals.
I was wondering if you could say that this was done by the Israelis while they were in there and if you've spoken with them specifically about this and what their reaction is.
And also when it comes to conditions for, for giving birth in Gaza, if you could say a bit more about what what that means for women.
I mean, the C sections for instance, with are they being done now?
Do they have anaesthetics?
And also are the fact that they have to be discharged so quickly and if you have any numbers you mentioned, sorry, if you have any information about low birth rates by the children being born?
[Other language spoken]
So on the first question, I don't know who damaged the medical equipment.
It's clearly just been purposefully damaged as I described and for which we took pictures as well together with this joint mission with the World Health Organisation seeing cables cut but is not a by product of of of an accident seeing cables cut on an ultrasound machine or screens that have been ******* without any other damage surrounding them.
So I can't speak to who did it, but I can speak to the impact it will have because some of these medic specialised medical equipment, I know the World Health Organisation and some of the more complex issues which aren't necessarily to do with maternal health, but they've spent years trying to negotiate their their ability to enter Gaza.
And it puts back the health system by many, many fold.
On the situation for for women giving birth.
Thank you for the question on that.
I think in terms of Caesarean sections, we have had a number of reports and anecdotal evidence from, from doctors.
I myself spoke to the anaesthesias in the Sahaba hospital in the north of Gazias.
As I described, it's the hospital in northern Gaza which is providing the only maternal health services in the north for, for referrals for, for those complex or basic emergency obstetrics.
And the anaesthesiologist there said that he does not have sufficient supplies of anaesthesia.
So where he would want to have full, full anaesthetic for C sections, it's at lower levels.
So that the, that's, those are the reports which which we've received and I heard with my own ears.
Indeed, the situation for, for, for births overall, because of this health system being completely crippled.
The throughput first of all, in terms of trauma cases which overwhelm emergency rooms and therefore displace maternal healthcare.
And the throughput which I described in Emirati hospital, for example, indeed means that women are giving birth and having to and having to be discharged within a matter of a matter of hours.
Now that increases risks because what would usually happen with cheque UPS, post birth issues might be missed and the ability to come back to, to seek medical care may have to happen.
So we, we are deeply concerned about the, the ability to provide post Natal care.
This is why you heard me describing some of the designated emergency shelters.
We want to increase the number of midwives in the community and we're working with local partners to try and do that, including with with UNRAG.
In terms of the the data points, as I mentioned, we're estimating and attracting around 180 births every single day.
Usually 15% of those would come with some form of complications and would require comprehensive emergency or basic, basic comprehensive emergency obstetric care.
But the, again, from speaking with the, the, the, the, the, the doctors in the, in the maternity units and in those three hospitals, they are describing an increased number.
We don't have data points on how many and what is the percentage of those complicated births or complicated procedures, but there is absolutely an increase in the numbers.
Some doctors reported a doubling of what they previously had dealt with in terms of dealing with complications with birth.
And this is due to malnutrition, dehydration and fear which impact the the pregnant woman's ability to give birth safely and carry their baby to full term safely.
Indeed, you spoke to low birth weight.
Again, This was also a key message from Doctor Hyder, the medical director at the Emirati Maternity Hospital, who described by he described to me by saying he no longer sees normal sized babies in Emirati hospital given the numbers that are happening there.
That is an important anecdotal data point for us in terms of what they're saying.
Again, this is where the compounding nature of the malnutrition and the food insecurity.
We've spoken over the past weeks, the United Nations around the looming famine and that has a direct impact on pregnant women.
The colour, the caloric intake requirements for both pregnant and lactating women are higher.
And because they are sustaining more than their own lives, the lives of their babies and the needs for hydration, water is also clean.
Access to clean water is also increased, especially for lactating women.
So, and then finally, as I mentioned, fear, fear has a, has a, has a huge role to play in terms of increasing stress, hypertension, blood pressure, which again increases complications and could force more earlier preterm births in order to give birth safely.
So I hope that helps provide some some more context to the difficult, very challenging ability for for pregnant women to give birth safely in Gaza right now.
Thanks, Dominic.
I believe it does help very much.
The colleague from Yomiri asks a question online.
She's asking specifically the dates for the mission.
You just undertook and the UN agencies that were involved, if you could, if you could respond to that.
[Other language spoken]
Yes, I mean, I, I come in as the representative for your FBI go in and out of Gaza regularly as my third such mission.
We have our international team on the ground.
So my my time in and out of Gaza itself was I, I entered last Monday at the public calendar, which was the 8th of April and I exited on Wednesday the 17th.
The missions that we undertook to Eastern Can Eunice was last Wednesday together with the World Health Organisation, OCHA and UNRATH and that was on the 10th of April.
And then our joint mission to the to, to, to Graza city, to Al Shifa, the Indonesian Hospital and the Palestinian Medical Relief Society medical point in Gaza was undertaken on Monday the 15th of April.
And again, that was with the leadership of WHO together with Archer and Unrah.
Very helpful.
Thanks very much, Dominic.
[Other language spoken]
We have a question now from Imogen, folks of BBC.
[Other language spoken]
[Other language spoken]
Thanks for that.
And Dominic, thanks very much for all the information.
It's very, very important.
[Other language spoken]
This question though, is a bit more housekeeping and maybe more, maybe more for you, Rolando.
It's just because Unruh was mentioned the the report on Unruh comes back comes out on Monday.
I believe it's being published in New York.
But can we make sure that the UN correspondents in Geneva get a copy under embargo and that we can also view possibly participate in the the press conference?
Because, you know, the coverage has been covering that angle has been a big part of our work here too.
So, and from my point of view, it's I'm, I'm supposed to be covering it.
I'm not in New York, but I'm allocated it.
So it couldn't be.
Can we ensure that that happens?
I will certainly relay that message.
We already have expressed that to our colleagues in New York.
You rightly point out the target date I think is Monday, this coming Monday for that report.
So we'll definitely echo those those sentiments to our colleagues and see what we can do.
Just I'm taking note that Dominic, colleagues are asking if you can share your notes, that would be most helpful.
And then we have a question up from Lisa Schlein of the Voice of America.
Lisa, over to you.
Thank you, Rolando, and good morning to you, Dominique.
I'd like to 1st know what, what personal contact, if any of you have had with the Israeli authorities in regard to all these fears, horrible fears that you have mentioned about the possible offensive in Rafa and what measures, possible measures might be taken in order to protect this one vital hospital that apparently still functions at least in some ways or other.
Also, are you having difficulty in getting Dignity supplies and other supplies that are so necessary into Gaza?
Are you being obstructed in any way?
I'm thinking perhaps particularly we're talking about anaesthesia.
You don't have enough of that apparently.
Is this for instance, considered a dual use purpose, that is that it might be diverted in some way for some sort of fighting or going to Hamas or whatever it is?
Anything you could talk about that would be helpful.
[Other language spoken]
[Other language spoken]
So on the 1st, I mean the United Nations course and for UNFPA, we're part of a humanitarian country team which has a daily contacts with, with with the Israeli authorities.
And I think the the Secretary General himself has even spoke of what the risks are in terms of the possible military incursion into Rafa.
So I think we've been from the UNS very clear in terms of our concerns with the Israeli authorities, including on the health system as you referred to Lisa.
So thank you for that.
On the difficulty on getting supplies in for a UNFBAI think a couple of points of challenges that we've had.
Dignity kits have not yet had any challenges in getting in.
Our only challenge is that the overall ability to get assistance into Gaza is through a very, very narrow pipeline.
And it's been a very narrow pipeline for some time.
And I spoke earlier about the compounding impact of of malnutrition on pregnant women, for example, after 6 1/2 months being unable to receive sufficient nutrition and food security and hydration, what impact that will have after 6 1/2 months.
It's the same for the assistance getting in.
Whilst the UN and humanitarian community has been working through a very narrow pipeline over a significant amount of time, that means that the number of dignity kits, for example, are insufficient at the moment.
Inside Gaza there has been a prioritisation for the most urgently needed items, but it is a prioritisation through a very narrow pipeline.
And whilst there are other possible entry points opening up, especially when I'm focused around food, those do not yet include items for, for, for dignity kits, for example, in terms of them, the medical items, I speak for UNFPA in terms of the items that have had had challenges in getting in.
We have had, we've had the majority of our supplies for, for the, for these reproductive health kits which have the emergency obstetric care items, the medicines, the coal chain items, which again is very challenging because the anaesthetics, the oxytocin and other items which have to maintain a coal chain throughout.
Very challenging to get inside into Gaza and then distributed safely and to maintain the cold chain throughout.
[Other language spoken]
We have had some kits and I mentioned about these midwives that we've deployed together with Unrar in the designated shelters, those midwifery kits which are a neat little bag in which a midwife can has all of the necessary small supplies, equipment that she would need to conduct her activities.
Those kits were opened at the crossing at some point and were opened up and and torches actually were removed.
Now having been in those which we which we didn't receive any information on because again, the UN doesn't have people inside the specific crossings.
When supplies move forward at Karen Shalom within the crossing, we receive it on the other side and then dispatch again led by Unrar of the crossing doing phenomenal logistical work.
And then for UNFP, we take our supplies and move them through together with the logistic logistics cluster.
And it's at that point that we receive our supplies and we can see that these torches which should be able to enable a midwife to, to, to support her midwifery services have been removed.
And then finally I described these mobile maternity units that UNFPA has been focused on, on getting in as well.
We had as I mentioned one enter into Gaza last week that thankfully was coordinated to get in.
It took quite a number of days back and forth at the crossing in order to get it in.
But in order to get it in the the oxygenator unit, the oxygen machinery that as part of this huge 40 foot container, which has an operate, has a delivery room, has an operating theatre for comprehensive emergence of obstetric care for safe births.
The oxygen device was actually unable to make it through.
Which again creates a challenge for how that that that one P that one unit as part of the this one particularly going to the IMC field hospital will be able to function and support safe births.
So there have been challenges.
There are other agencies who have also received significant challenges in terms of getting a number of items in.
I think of the generators, we we saw ourselves at the LML hospital, the major generator there, which has been destroyed.
They're functioning of smaller generators.
And again, that's going to impact the ability of the health system to function water and sanitation equipment and other items which are are life saving in nature and are needed in Gaza right now.
Thanks, Dominic.
Lisa, is that a follow up or legacy hand?
My legacy hand is available at all?
No, no, no, that's available at all times.
But this is a follow up.
[Other language spoken]
Old hand, new hand very quickly.
Do do you have any numbers?
I don't know if it's possible to gather such information, but do you know how many women and babies may have died as a consequence of not having the care that they need?
In short, no.
[Other language spoken]
We are as UNFPA.
We coordinate under the Health cluster Sexual Reproductive Health Task Force working group with all, as many partners who work on reproductive health as possible.
And we have been trying to to get and have access to data.
In terms of maternal mortality, again we we hear anecdotal, anecdotal evidence from doctors, the head of the NICU units, the neonatal intensive care units of, of babies that are increased number of stillborn births of the impact of, of this, of this, as I said, the the malnutrition of their inability to access safely the maternal health facilities, which is life saving in nature.
[Other language spoken]
There was a, a modelling which was produced by the London School of Hygiene and Tropical Medicine together with John Hopkins University, which looked at various scenarios and the impact based on the demographics of Gaza have likely impact on maternal mortality.
I'm sure we can share a link to that work.
It's called Gaza-, projections.org.
And they did some modelling which which we think has a tells a very important story about the impact on on women and girls and babies and neonatal, tragic neonatal deaths in in Gaza.
Thanks very much.
Yeah, those notes would be most helpful.
So I take this opportunity and then more questions.
I don't see any other hand.
So I'd like to take this opportunity to thank you very, very much for briefing our journalists here in Geneva, Dominic, and of course, for the very important work you and your agency are doing in Gaza.
We'll now shift to Myanmar.
Jeremy Lawrence of the Office of the **** Commissioner for Human Rights is here.
Who's going to speak to concerns of a rising tension in Rakhine State.
[Other language spoken]
Yes, thanks Rola.
Yes, the the **** Commissioners issued a statement earlier this morning which you should have all received.
Intensified fighting in Rakhine state between the military and the Arakan Army, alongside tensions being fuelled by the between the Rohingya and ethnic Rakhine communities pose a grave ****** to the civilian population.
There is a grave risk that past atrocities will be repeated.
Since the year long informal ceasefire between the two sides broke down last November, 15 of Rakhine's 17 townships have been affected by fighting, resulting in hundreds of deaths and injuries and taking the number of displaced to well over 300,000.
The Rakhine state has once again become a battleground involving multiple actors and civilians are paying a heavy price, with Rohingya at particular risk.
What is particularly disturbing is that whereas in 2017 the Rohingya were targeted by one group, they are now trapped between two armed factions who have a track record of killing them.
We must not allow the Rohingya to be targeted again.
The military has been fast losing ground to the Arakan Army throughout northern and central Rakhine.
This has led to intensified fighting in the townships of Booty Dong and Mangor ahead of an expected battle for the Rakhine state capital Sitway.
The two townships are home to large Rohingya populations, putting them at grave risk.
Facing defeat, the military has outrageously started to forcibly conscript, bribe and coerce Rohingya into joining their ranks.
It is unconscionable that they should be targeted in this way given the appalling events of six years ago and the ongoing extreme discrimination against the Rohingya, including the denial of citizenship.
Some reports say the military is forcing the the Rohingya recruits all villages to burn ethnic Rakhine homes, buildings or villages.
Ethnic Rakhine villages have allegedly responded in kind by burning Rohingya villages.
The UN Human Rights office is trying to verify all reports received, a task that is being complicated by a communications blackout throughout the state.
Disinformation and propaganda are also rife, exemplified by claims that Islamic terrorists have taken Hindus and Buddhists hostage.
This is the same kind of hateful narrative that fuelled communal violence back in 2012 and the horrendous attacks against the Rohingya in 2017.
Since the start of the year, the Ara Khan Army has positioned itself in and around Rohingya villages, effectively inviting military attacks on Rohingya civilians.
On the 15th of April, the Medicine Som Frontier office and Pharmacy were torched in Booty Dong, along with some 200 homes.
Hundreds have fled and are reported to be taking refuge in a **** school, the grounds of the former hospital and along roads in Booty Dong town.
With both **** Da and Booty Dong hospitals having been shut by the military back in March, and with the conflict intensifying, there is effectively no medical treatment in northern Rakhine.
The alarm bells are ringing and we must not allow there to be a repeat of the past countries with influence on the Myanmar military and armed group, armed armed groups involved must act now to protect all civilians in Rakhine State and prevent another episode of a renders persecution of the Rohingya.
[Other language spoken]
Questions for Jeremy.
Here we have Antonio Brotto of Spanish news agency.
[Other language spoken]
My question is not related with Myanmar is about Middle East.
I don't know if I can ask the question.
[Other language spoken]
Lisa has her hand up as well as see is this on Myanmar, Lisa Yes and it's not a legacy hand.
[Other language spoken]
Jeremy it Does OHCHR have any presence in Myanmar?
Do you have any contact at all with the military?
You talked about the situation being unconscionable.
It seems as if the military leaders have no conscience.
How do you, I'm sorry, this is a horrible, horrible story which never quits, but how do you ever make a difference?
How do you ever get across to them?
[Other language spoken]
I had read that she had been moved to house arrest as opposed to I guess she had been confined in the prison prior previously.
[Other language spoken]
[Other language spoken]
So with respect to no, we don't have a presence in in Myanmar.
[Other language spoken]
Yes, we are engaged with through our usual diplomatic channels.
[Other language spoken]
We have been engaged with, for instance, the indirectly with the Arakan Army via its political wing and the same when it comes to engaged with the permanent mission here in Geneva.
We have we contact them and to check on information received.
And with respect to Aung San Suu Kyi, yes, we're aware of reports of that.
She has been moved now.
Our position remains the same on Aung San Suu Kyi, along with some, I think it's 20,000 other political prisoners of conscience who are being held in in military detention.
All of them have to be released.
[Other language spoken]
Maybe just take this opportunity to remind you of the fairly recent appointment by the Secretary General of Julie Bishop of Australia as a special envoy on Myanmar, who replaced Noeline Hazer of Singapore, who stepped down earlier.
And we also, of course, have the Independent Investigative Mechanism on Myanmar, which is very active here in Geneva.
So indeed, it is a dire situation which we are looking at from various angles.
Further questions on Myanmar before we take Antonio's question, I believe on Gaza, no, I don't see that.
So maybe if you don't mind, maybe I'll just turn back to you, Antonio, for question on the Middle East.
[Other language spoken]
[Other language spoken]
So the espiral of attacks between Iran and Israel is continuing today.
We have heard about the alleged Israeli drone attacks on Iranian, saw it.
So I wonder if if your office has any comments on this situation in the Middle East.
Yes, thanks for your question.
Like you, we're aware of the reports and it's hard to gather real information because from both sides involved.
But what we can say is something quite clear.
We urge all parties to take steps to de escalate the situation and call on third states, in particular those with influence, to do all in their power to ensure there is no further deterioration in an already extremely precarious situation.
Of course, we're deeply worried about the potential humanitarian and human rights cost if this escalation leads to a wider conflict in the Middle East.
Thank you, Jeremy, and just again, as I mentioned earlier, the Secretary General also called for de escalation of the situation.
He echoed this.
Rather, he ordered this to the Security Council in the statement yesterday which we shared with you, and then earlier in the week we shared with you a statement on on his behalf which strongly condemned the serious escalation represented by the large scale attack launched on Israel by Iran.
So of course, de escalation is the keyword here.
[Other language spoken]
[Other language spoken]
Rolando, I have a question for Germany, Jeremy, about Gaza as well.
[Other language spoken]
[Other language spoken]
officials had discussed the possibility of this attack yesterday and according to the statement, officials agreed on defeat of Hamas in Rafah.
My question is, do you have any information on that and how do you comment this Israeli attack attempt?
[Other language spoken]
[Other language spoken]
So I I I can't share anything more beyond what I've just said, which I think is to go back to what Rolando also said.
[Other language spoken]
That's simple.
Yes, de escalation and ceasefire is what we've been saying umpteen million times.
So this is really the help further questions for Jeremy before we release him from here.
OK, I don't see that's the case.
So thank you very much as always Jeremy, for joining us.
I would like now to invite our colleague from the World Health Organisation, Dr Wenking Zhang, who is head of WH OS Global Influenza Programme.
And Tarek, if you can step up as well, we'd much appreciate that.
Doctor Zhang is 1 moment.
Sorry about that.
Doctor Zhang is Head of World Health Organisation Global Influenza Programme and again this is an update on the H5 N 1 situation globally.
Dr Zhang, over to you.
There we go.
[Other language spoken]
Thank you very much.
Recently, any in France H5 N 1 viruses have been detected in dairy in dairy cows and goats in the in the United States of America, and since March 2024, infections in 29 herds in eight different states in the US have been reported.
On the 1st of April, the US notified the WHL of a laboratory confirmed human case of H5 N one in Texas.
This case worked at a dairy cattle farm where he was exposed to cows presumed to be infected with the virus.
So far, the H5 N 1 viruses identified in the cows and in the human case remain avian viruses and there's no increased adaptation identified to mammals any.
In France, H5 N one first emerged in 1996, but since 2020 we have seen an explanational growth in the number of outbreaks in birds.
In addition to birds, an increasing number of mammals have been affected, for example, minks, foxes, seals and sea lions.
Now we see herds of cows affected in an increasing number of U.S.
states, which shows a further step of the virus fear over to mammals.
Farm workers and others in close contact with cows should take precautions in case the animals are infected.
The virus has also been detected in milk from infected animals.
While investigations are ongoing, it is important for people to ensure safe food practise, including consuming only pasteurised milk or milk milk products.
The case in Texas is the first case of an human infection of any human infected by any influenza by a ***.
Bird to ***, *** to ***, and *** to bird transmission have been registered during these current outbreaks, although a lot is still under investigation.
These suggest that the virus may have found other routes of transmission other than what we previously understood.
While this sounds concerning, it is also a testament to strong disease surveillance which allows us to detect the virus.
WHO is working very closely with FAO and the War our One HealthPartners on updating our joint risk assessment on H5N1, which we expected to be to be published in the coming days.
Human infection with H5N1 remains rare and are tied to exposure to infected animals and environments.
Since 2003, close to 900 human cases of H5 N 1 infection have been reported.
Infections in humans have ranged from mild, even asymptomatic to severe.
Anytime there is a human case of infection with an animal virus, countries are required to report it to WHO under the International Health Regulations and the detailed investigation will take place to prevent and to stop potential further transmission.
To provide clinical management to sick persons and other important public health measures to understand the source of infection, to characterise the virus and other and conduct other pandemic pandemic prependence activities.
So all these allow us to ensure that the risk associated with ZH 5, N 1 and other MA influenza viruses on public health is carefully managed.
One of the ways WHO does is using the virus characterization and other available information to update the risk assessment and the candidate vaccine viruses as part of pandemic preparedness.
Having candidate vaccine viruses ready allows us to be prepared to quickly produce vaccines for humans if this becomes necessary.
For this particular H5 N 1 viruses virus detected in dairy cows, there are couple candidate vaccine viruses available from from the WHO's Global Influenza surveillance and Response system, Githras.
While WHO and its partners are closely monitoring, reviewing, assessing and updating the risks associated with the H5 N 1 and other any influenza viruses, we call on countries to remain vigilant, rapidly report human infections if any, rapidly share sequences and other data and reinforce bio security measures on animal farms.
Thank you very much.
Thank you very much.
Doctor Zhang, we have a couple of questions for you.
We'll start with oh, it will start in the room.
OK, So let's take Christine first of German news agency.
[Other language spoken]
[Other language spoken]
Sorry about that.
Thank you for that briefing.
Could you clarify the detection in cows?
Is that restricted to the US?
And could you speak more about the detection of the virus in milk and what exactly the precautions are?
Does that mean raw milk cheese should not be consumed all over the world or is that restricted to the United States?
[Other language spoken]
[Other language spoken]
[Other language spoken]
So so far, yes, the information we have so far is the virus detection is only in cows in US.
With regards the virus detection in milks, we also received the report that there there's very **** virus concentration in raw milk in raw milks, but exactly how long the virus would be able to survive in the milks?
In the milks it is remain under investigation.
So from WHO, from public health perspective, we recommend that people really should consume pasteurised milk or milk products.
OK, thank you very much.
Nina, do you have a question from AFP, our gentleman press?
Thank you for taking my question.
I also have a question, similar question on, on the milk.
So if I understand correctly, this hasn't contributed to any human cases yet of the of the virus.
Is that correct?
And also if you say people should consume pasteurised milk products, so that would mean that we should steer away from unpasteurized cheeses, for instance, is that what you're, is that what you're saying?
[Other language spoken]
So, so far, there's only one human case was detected associated with the with the outbreaks.
And this case had exposure to to the cows and most likely is is through the direct contact of the cows presumed to be to be infected with with this H5 N 1.
We we don't have the information that this case actually got the infection through through milk itself.
The information is a direct contact with the cows in the during the outbreak.
So with, with regards what what would happen to those milk and milk milk products is FAO and or as they have relevant guidance developed, I really would suggest people would look into into that resource of information with the highest authority.
[Other language spoken]
Yeah, so, but just for that recommendation, it's it's worldwide, even though this has only been found in cows in in the US.
And is there reason to I believe is why would it only be found in in cows in the USI mean, I, I assume we should perhaps expect it to be be spread elsewhere.
[Other language spoken]
Yeah, exactly.
I think we, we, we are not able to really predict how wild again this virus will be spreading into, into cows in other countries.
But the trend is clear that the virus emerged in in 1996 and then in 2020, this very specific clade virus emerged circulating, spreading into Africa, Asia and, and, and Europe.
And then in 2022, it's cross to the North America and then into the South America itself.
And also in recent years we've seen the virus spill over to mammals and I think there are around 200 mammals, at least from the USDA's report reported that to have this virus detected from this 200 mammals itself.
So the trend is clear.
What is required is the vigilance and the disease surveillance programmes in countries.
And this would again come to the One Health, One Health approach, not only the surveillance in humans, but also in animals as well.
Thank you very much, Tarik.
If you have anything to add at any point, just let me know.
We have a couple of questions online for you, Doctor Catherine Fiancan of France.
[Other language spoken]
Catherine yes, thank you, Orlando.
Good morning and thank you so much for this briefing.
Doctor, first of all, could you please send us as soon as possible your notes because that will be very helpful for all of us.
The 2nd, I have a couple of questions related to the questions also asked to from my colleagues.
First of all, when you said that it was a direct contact with the ***, what does it mean direct contact?
Could you please elaborate on that?
Does it mean that the person was milking the the the the *** or do you know how it happened?
The other?
My other question is if you could tell us a bit more also about the way you detect it.
Do you have a kind of task test that would be used in the rest of the world?
As you mentioned that it you had some cases in cows before in the previous years?
And could you tell us more about the rate of death and also about vaccines, the level of research?
I know it's there are many questions and I I get back to what my, my 2 colleagues said about pasteurised products.
Does it mean that you found the evidence that the virus is dying when you heat the milk or the product above a certain degrees?
What about freezing, Does it affect also the virus or not or you're not at that level of investigation?
[Other language spoken]
Thanks very much for this list of questions and these are all very important and I'll go through one by one.
First, about the direct contact, what does that mean?
So according to the report from USDA, likely the transmission can occur through the for my TS or mechanical devices that used in milking practise.
But this and also this person worked worked in the farm.
But the details exactly what exactly this person worked in that farm.
I think I would have to look into the report of that.
And the second question is about a detection.
So yes, so there's ways available, the laboratory diagnostics available and countries both in the animal sector but also in the public health sector through the global system, countries are equipped to detect that virus if if the virus appear in their country.
So those diagnostics are not only available but updated.
Then you also have a question about the death itself.
So this case reported from the US have the contact with a *** actually had mild, had mild conjunctivitis symptoms.
So although so far, so far close to 900 human infections, so H5 N 1 and that was really from 2003.
And if we look at the overall cases, more than 1/2 or around 1/2 actually were reported as fatal as fatal.
But if we look at the details of this specific virus, 2344B clade virus, this is a virus circulating and infecting or detected in cows these days.
Actually, the case human case is so far occurred reported from from from North America and Europe.
They are all mild.
There's a case detected in China, it's fatal, but there are also a couple other cases detected in other countries also present severe but or recovered.
So this is about about the death question.
We need to look into details with regards exactly the mortality caused by the by the virus itself.
[Other language spoken]
So for Infreza, for the next Infreza pandemic vaccines, the pre penis is going on.
Actually there are close to 20 vaccines licenced for pandemic use.
So this is for Infreza, but the exact vaccines that can be used tailored for that specific pandemic, it will rely on the specific virus strain at that time merges and causing a pandemic.
But as a mechanism or the process is all in place.
And for this particular virus infecting cows in US, there are a couple of candidate vaccine viruses available.
So if imagine if that virus cause a pandemic tomorrow, then vaccine development and production basically could already occurring because a candidate vaccine virus are already available are being distributed to the manufacturers already.
So this is a preparedness and the readiness that the whole world we have so far.
You also have a question about pasteurisation and for this question I would really like to referring to the guidance developed from FAO and WAR on this particular about the process, about the quality of this pasteurisation process.
Thank you very much, Doctor.
Perhaps, yeah, for the last question, maybe you can reach out to colleagues at FAO who might be able to provide that guidance.
And we have another question for you, Doctor, from John Zaracostas of Franz Foncat.
And sorry, your second periodical, it's a drawing a blank here, John, if you could introduce that.
[Other language spoken]
The other one is The Lancet.
[Other language spoken]
Doctor Zhang, I was wondering if you could bring us up to speed on.
Under the International Health Regulations, member states are obliged to report to The Who when they have outbreaks of H1N1 or other influenza strains.
What is the average delay from the member state to The Who?
Are they reporting fast enough or there is a lag time?
And secondly, if you could bring us up to speed on some of the other influenza viruses that are fatal like H3N8 or H3 N 2 and where have they been found and how quickly have they been notified to The Who through your alert system?
[Other language spoken]
So under health, under international health regulation and Member states need to notify to report to WHO the detection or the confirmation of the of human infection with novel influenza virus within I think within 48 hours.
There's a very specific requirement of those.
There are certain delays or there were certain delays, but this was mainly due to the process of the confirmation because the influenza itself a virus, it could be seasonal influenza and which are not notifiable.
So how actually to confirm whether this is a really a novel virus?
This might take some time.
So there were delays in the past due to this type of process.
You actually also mentioned about H1N1 and H3 N 2.
So we need to be, I just would like to clarify it here is that for inferenza, the seasonal or human inferenza circulating and these are H1N1 and H3 N 2.
But there are also viruses circulating in swine in swine population like and where we call that variant in friends of virus.
So if a human infection of that swine H1N1 or H3N2 viruses, we would also encourage member states to report as well.
And there are laboratory diagnostics as previously a colleague asked laboratory diagnostics available to differentiate the seasonal influenza and the swine influenza.
So this is a mechanism in place.
[Other language spoken]
A quick follow up from you before we go to Lisa.
John, yes, I was wondering if if Doctor Zhang also had some details on the H3N8 virus outbreaks, if you can bring us up to speed on that.
And secondly, do we have some figures from your sister agencies, the number of poultry that have been culled worldwide?
And is there similar efforts to cull cows?
And also I think it's been found also in goats, if I'm not mistaken.
Yes, thanks very much.
Actually for any influenza, as you rightly said, it's not just H 5:00 and 1:00, there's also H5 N 6 and even for H5 N ones there are different clades.
The the, the case only the current case infected in US, it's clade 2344B.
But probably you'll recall there are other cases also reported in Southeast Asia just early this year.
It was caused by a different clade 2321C.
And so this is a different clades whiz in H5 virus, but there are also other subtypes as you said age 3 and 8, there's also age 10 and five.
So there are different subtypes of those any influenza virus infection, but those other subtypes.
So if human infection is very rare, it is really very rare and sporadic.
And usually it was picked up from from like from hospitalised cases, from severe cases.
But this is rare.
It's individual of those I don't have actually have the number of the all the information about the culling, etcetera.
So maybe you can send an e-mail and certainly I'm very happy to connect with our colleagues in in FAO and a war that would be very helpful.
Thank you, Doctor.
One final question from Lisa of Voice of America.
Lisa, over to you.
[Other language spoken]
[Other language spoken]
Doctor Zhang, you mentioned that half of the death that that half of the 900 people who were infected over a number of years have died.
So this is when it does occur, fairly **** mortality rate.
And you also said that the United States and Europe only had mild cases.
So where did most of these, where did these deaths actually occur?
Were they in Africa?
Were they in developing countries?
That they have to do with the sanitary conditions and the manner in which animals were being treated.
And then is there a treat?
You're talking about vaccines, but that's preventive, I guess.
What about treatment?
How, how if somebody becomes infected, what do you do?
[Other language spoken]
Thank you very much for this question.
Yes, this close to 900 cases occurred since 2003.
And at those beginning US, most of the cases were detected in Southeast Asian or East Asia.
And it is true as I said, if we look at the specific clade of the viruses like in the current 2-3 years ZCH 5 and one actually in the past two years, So cases in US and and and and Europe, they, they were really mild.
So it could be recur, it could be related to the virus profile itself and it could also related to the surveillance as well because for the detection of asymptomatic cases, it would require certainly more or more intensive surveillance in order to pick up an asymptomatic cases.
While in the early years after 2003 in Southeast Asia, maybe the surveillance was focusing on those severe cases in those population.
So that comes up with a **** mortality rate.
An example is that if we look at the mortality rate among cases in ICU, certainly it was much higher than if we look at among all hospitalised cases or all those with the symptoms.
So this is I would I would referring to both the surveillance but also the virus profile itself.
And we really need to look at the virus in different place because it comes out with different figures on mortality.
Good question about treatment antivirus and also I didn't mention here indeed.
So one of the monitoring aspect of WHO is to look at the susceptibility of the currently available antivirus.
And we are very happy to see to say that when we look at the current viruses, including the viruses detected in cows and that human case, there's no change or there's new no mutation in the viruses associated with the reduction of the susceptibility of available antiviral drugs, including the baloxavir as well as osotamivir.
Thank you very much.
I think Nina had a follow up question or another question perhaps.
[Other language spoken]
A follow up on what you were just saying when it comes to the number of cases, I guess if the surveillance has not picked up less severe cases in in Asia for instance, you're saying that there could probably be a lot more cases than those who that have actually been registered.
If you could answer that.
And then I just wanted to go back to my initial question on the the recommendations for pasteurised milk.
Could you clearly say if that recommendation is just for the US or if it is for if, if it's global?
[Other language spoken]
So about the sensitivity, actually you're talking about the sensitivity of surveillance, whether actually more cases could have been missed.
I think we are quite comfortably to say is that the surveillance itself has a different components.
You know the primary part is that we look at those people with symptoms.
So we call it the syndromic surveillance.
Those symptoms we test them and to find out actually what is the viruses cause their infection.
Complementary to that there are also other studies, for example serology studies.
There are also a, a, a, a focused surveillance, for example, surveillance just within as as a poultry workers or surveillance in the people involved in the investigation, in the investigation all the people like at the moment working in *** farms, etc.
So all these surveillance pieces were coming together would be able to get a better picture with regards to what extent the virus actually infect human itself.
So I think with all these together, we are quite comfortably to say that this Evan influenza virus H5 N 1 is still remain an Evan virus and it's infection in human it remains rare.
So this this is a comment I would want to put there with regards to recommendation about the use for people to use the pasteurised milk and milk products.
It's a similar to people to consume the cooked food instead cooked meat instead of raw meat.
This is the same.
This applies to to the whole world.
Thank you very much doctor.
This was a very useful briefing and engaging from the number of questions received, of course, very important.
[Other language spoken]
Just a note that Key, our colleague from FAO, does mention that enquiries on animal health.
She's happy to coordinate with experts in Rome should you have questions on that specific area.
So thank you again, Doctor, for joining us and for sharing this important information.
Before we wrap up, just a couple of quick announcements from me to highlight the meetings here in Geneva.
We have the Committee on the Elimination of Racial Discrimination, a meeting this morning, concluding this morning it's review of the report of Moldova and the Committee against Torture will commence it's session.
And this coming Tuesday morning the 23rd to review the report of Azerbaijan and press conferences, a couple to announce both.
For Monday the 22nd of April.
We have one from the International Labour Organisation on the launch of their report titled The Impacts of Climate on Occupational Safety and Health, and that's at 11:30 in this room.
At 1:30 in this room, the Office of the **** Commissioner for Human Rights, who you just heard from, will do a briefing on the health situation, health situation in Gaza.
And actually that is sorry.
That is a special rapporteur on the right to health, Tlaleng **** King, the special rapporteur on the right to health, who will be here at 1:30 on Monday and very last, just to more of a housekeeping, just to remind you of the announcement that we shared with you yesterday via e-mail to say that you're all invited.
Whoever is here in person is happy if you're willing to go upstairs to our third floor outside Room 8 at 1:15, there is a meeting currently underway with the principal, the directors of communications for the various UN agencies and programmes from all countries who are currently in Geneva for their annual meeting.
And there would like to meet with you.
For those of you who are are free at 1:15 in Room 8 to that meeting will take place.
And I should highlight that this is indeed a unique occasion to establish a personal contact with these colleagues from all over the globe.
That may be very, very last note.
A congratulations to Akanu on the election of their, well, the newly elected Akanu committee.
So extending congratulations to you and looking forward to working with you over the course of the year.
If there are no, oh, there are questions for me, what do you know?
[Other language spoken]
[Other language spoken]
Orlando, the ILO briefing is taking place Monday at 10:30.
[Other language spoken]
[Other language spoken]
I said I thought you said 11:30.
[Other language spoken]
[Other language spoken]
[Other language spoken]
I'm sorry.
[Other language spoken]
[Other language spoken]
[Other language spoken]
You're absolutely right.
[Other language spoken]
[Other language spoken]
[Other language spoken]
So 10:30 is the actual briefing.
The report is embargoed till 11:30 AM, so I apologise.
The briefing, 1030 in this room under embargo until 11:30.
Thank you for clarifying, correcting me.
No further hands up.
So I'd like to take this up and just thank you and have a good afternoon, good lunch and nice weekend.