“Goodbye!” yelled a man from the boat company. “Have a good trip!”

Government officials are largely absent from the Darién. The area is controlled by a criminal group known as the Clan del Golfo, whose members view migrants much as they view drugs: goods they can tax and control.

Once the migrants step off the boats, they are met by smugglers — typically poor men in the area who offer to take them into the jungle, starting at $250 a person. For an extra $10 they will carry a backpack. For another $30, a child.

Farline and her family spent the night in a tent at the edge of the jungle. In the morning, they set out before sunrise, alongside hundreds of others.

“I carry bags,” smugglers shouted. “I carry children!”

Soon, a vast plain became a towering forest. Farline clambered between trees, following her parents. Vladensky slept on his mother’s chest. Other children cried, the first to show signs of exhaustion.

As the group crossed river after river, tired adults began to abandon their bags. They clambered up and then down a steep, muddy slope, only to stare up at the next one. Faces that were hopeful, even excited, that morning went slack with exhaustion.

A woman in a leopard-print dress fainted. A crowd formed. A man gave her water. Then they all rose, picked up their bags and began to walk.

Today, after all, was just day one in the Darién, and they had a long journey ahead.

Julie Turkewitz reported from Necoclí, Colombia; Natalie Kitroeff from Mexico City; and Sofía Villamil from Necoclí and Bajo Chiquito, Panama. Oscar Lopez contributed reporting from Mexico City, and Mary Triny Zea from Panama City.

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This Ethiopian Road Is a Lifeline for Millions. Now It’s Blocked.

AFAR, Ethiopia — The road, a 300-mile strip of tarmac that passes through some of the most inhospitable terrain on earth, is the only way into a conflict-torn region where millions of Ethiopians face the threat of mass starvation.

But it is a fragile lifeline, fraught with dangers that have made the route barely passable for aid convoys trying to get humanitarian supplies into the Tigray region, where local fighters have been battling the Ethiopian army for eight months.

the world’s worst humanitarian crisis in a decade.

wrote on Twitter. “People are starving.”

Ethiopian prime minister, Abiy Ahmed, who won the 2019 Nobel Peace Prize, said last week that his government was providing “unfettered humanitarian access” and committed to “the safe delivery of critical supplies to its people in the Tigray region.”

But Mr. Abiy’s ministers have publicly accused aid workers of helping and even arming the Tigrayan fighters, drawing a robust denial from one U.N. agency. And senior aid officials, speaking on the condition of anonymity to avoid jeopardizing their operations, said the government’s stated commitment to enable aid deliveries was belied by its actions on the ground.

Aid workers have been harassed at airports or, in the case of a World Food Program official last weekend, have died inside Tigray for want of immediate medical care.

Tigrayan fighters had marched into the regional capital, Mekelle, hours after beleaguered Ethiopian soldiers quit the city. The city airport was shut, so the only way out of Tigray was on a slow-moving U.N. convoy that took the same desolate route out as the fleeing Ethiopian soldiers.

We drove down a rocky escarpment on a road scarred by tank tracks. As we descended into the plains of Afar, the temperature quickly rose.

publicized the flight but made no mention of the delays or harassment — an omission that privately angered several U.N. officials and other aid workers who said it followed a pattern of U.N. agencies being unwilling to publicly criticize the Ethiopian authorities.

Further complicating the aid effort: The war is now spilling into Afar.

In the past week Tigrayan forces have pushed into the region. In response Mr. Abiy mobilized ethnic militias from other regions to counter the offensive.

Mr. Abiy has also resorted to increasingly inflammatory language — referring to Tigrayan leaders as “cancer” and “weeds” in need of removal — that foreign officials view as a possible tinder for a new wave of ethnic violence across the country.

Ms. Billene, his spokeswoman, dismissed those fears as “alarmist.” The Ethiopian leader had “clearly been referring to a terrorist organization and not the people of Tigray,” she said.

Inside Tigray, the most pressing priority is to reopen the road to Afar.

“This is a desperate, desperate situation,” said Lorraine Sweeney of Support Africa Foundation, a charity that shelters about 100 pregnant women displaced by fighting in the Tigrayan city of Adigrat.

Ms. Sweeney, who is based in Ireland, said she had fielded calls from panicked staff members appealing for help to feed the women, all of whom are at least eight months pregnant.

“It brings me back to famine times in Ireland,” Ms. Sweeney said. “This is crazy stuff in this day and age.”

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Fear and Misery in an Afghan City Where Taliban Stalk the Streets

KUNDUZ, Afghanistan — The Afghan way of war in 2021 comes down to this: a watermelon vendor on a sweltering city street, a government Humvee at the front line just 30 feet away, and Taliban fighters lurking unseen on the other side of the road.

When the shooting starts, the vendor makes himself scarce, leaving his melons on the table and hoping for the best. When it stops, selling resumes, to customers now all too rare.

“I don’t have a choice. I’ve got to sell the melons,” said the vendor, Abdel Alim, speaking to New York Times journalists while he kept an eye on a lane within Kunduz city from which he said Taliban had emerged. “Most people have left,” he said. “There is fighting all the time.”

374,000 in Afghanistan’s north, and several other provincial capitals as well, as the Afghan government’s war with the Taliban enters a new and dangerous phase. For weeks, the insurgents have captured vulnerable districts across the country’s north, sometimes without even firing a shot. And on Wednesday, the Taliban said they had captured an important border crossing with Pakistan, at Spin Boldak — the fourth crossing they have seized in less than a month.

taken by the insurgents in 2015 and then again in 2016. Both times, the insurgents were eventually pushed back by the Afghan forces with help from American airstrikes. It was here that an American gunship mistakenly blasted a Doctors Without Borders hospital in 2015, killing 42 people.

This time, the Americans won’t be coming. The battle for Kunduz has become an intimate fight between Afghan opponents at close range.

“Every night they come to these houses and fire on us,” said the chief of police of Kunduz’s Third Municipal District, Sayed Mansoor Hashimi, looking out at now-vacant dwellings all around his police station. “Slowly, slowly they are tightening the circle.”

The war in Kunduz is intertwined with the fabric of the city. Shopping trips are planned between bursts of war. Residents no longer pay sufficient attention, said Marzia Salam Yaftali, the medical director at Kunduz Regional Hospital. “They are wounded in the streets or in the bazaar,” she said.

At the hospital, Ezzatullah, 14, lay in one of the wards, his legs wrapped in bandages: He lost both his feet when a mortar landed as he was playing outside his house. Three members of his family, including one of his parents, were killed.

“I can’t go to school now,” he said. Asked what he saw as his future, he replied firmly: “I want to be a man, to rebuild my country.”

The war, and the enemy, are inescapable. “We have to live here. Where can we go?” asked Ezamuddin Safi, a telecommunications worker who had to flee his home inside the city in early July. He was passing the day inside a small downtown restaurant.

“My 3-year-old boy, he screams when he hears the firing. He’s tired,” said Mr. Safi, 25. “Taliban are everywhere.”

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How Local Guerrilla Fighters Routed Ethiopia’s Powerful Army

A scrappy force of local Tigrayan recruits scored a cascade of battlefield victories against the Ethiopian military, one of Africa’s strongest. Times journalists witnessed the decisive week in an eight-month civil war.


SAMRE, Ethiopia — The Tigrayan fighters whooped, whistled and pointed excitedly to a puff of smoke in the sky, where an Ethiopian military cargo plane trundling over the village minutes earlier had been struck by a missile.

Smoke turned to flames as the stricken aircraft broke in two and hurtled toward the ground. Later, in a stony field strewn with smoking wreckage, villagers picked through twisted metal and body parts. For the Tigrayan fighters, it was a sign.

“Soon we’re going to win,” said Azeb Desalgne, a 20-year-old with an AK-47 over her shoulder.

The downing of the plane on June 22 offered bracing evidence that the conflict in the Tigray region in northern Ethiopia was about to take a seismic turn. A Tigrayan guerrilla army had been fighting to drive out the Ethiopian military for eight months in a civil war marked by atrocities and starvation. Now the fight seemed to be turning in their favor.

The war erupted in November, when a simmering feud between Prime Minister Abiy Ahmed and Tigrayan leaders, members of a small ethnic minority who had dominated Ethiopia for much of the three previous decades, exploded into violence.

airstrike had struck a crowded village market that day, killing dozens. We watched as the first casualties arrived at Mekelle’s largest hospital.

Days later, three aid workers from Doctors Without Borders were brutally murdered by unknown assailants.

In the countryside, the war was moving at a furious pace. Ethiopian military positions fell like dominoes. Hours after the Tigrayans shot down the military cargo plane, we reached a camp holding several thousand newly captured Ethiopian soldiers, about 30 miles south of Mekelle.

Clustered behind a barbed wire fence, the prisoners erupted into applause when we stepped from our vehicle — hoping, they later explained, that we were Red Cross workers.

Some were wounded, others barefoot — Tigrayans confiscated their boots as well as their guns, they said — and many pleaded for help. “We have badly wounded soldiers here,” said Meseret Asratu, 29, a platoon commander.

Further along the road was the battlefield where others had died. The bodies of Ethiopian soldiers were scattered across a rocky field, untouched since a fight four days earlier, now swelling in the afternoon sun.

Personal items cast aside nearby, amid empty ammunition boxes and abandoned uniforms, hinted at young lives interrupted: dog-eared photos of loved ones, but also university certificates, chemistry textbooks and sanitary pads — a reminder that women fight on both sides of the conflict.

Stragglers were still being rounded up. The next day, Tigrayan fighters marched five just-captured prisoners up a hill, where they slumped to the ground, exhausted.

Dawit Toba, a glum 20-year-old from the Oromia region of Ethiopia, said he had surrendered without firing a shot. War in Tigray was not like he had imagined it. “We were told there would be fighting,” he said. “But when we got here it was looting, robbery, attacks on women.”

“This war was not necessary,” he added. “Mistakes have been made.”

Driving off, we came across a figure sprawled on the roadside — an Ethiopian, stripped of his uniform, with several bullet wounds to his leg. He groaned softly.

The wounded soldier appeared to have been dumped there, although it wasn’t clear by whom. We drove him back to the prisoner camp, where Ethiopian medics did some basic treatment on the ground outside a school. Nobody was sure if he would survive.

Artillery boomed in the distance. The Tigrayan offensive was continuing to the north, using captured heavy guns against the Ethiopian troops who had brought them in. A platoon of fighters walked through, bearing a wounded man on a stretcher. Teklay Tsegay, 20, watched them pass.

Before the war, Mr. Teklay was a mechanic in Adigrat, 70 miles north. Then, last February, Eritrean soldiers fired into his aunt’s house, killing her 5-year-old daughter, he said. The following day, Mr. Teklay slipped out of Adigrat to join the resistance.

“I never thought I would be a soldier,” he said. “But here I am.”

As Tigrayans quietly mustered a guerrilla army this year, they drew on their experience of fighting a brutal Marxist dictatorship in Ethiopia in the 1970s and 1980s, under the flag of the Tigray People’s Liberation Front.

Then, Tigrayan intellectuals used Marxist ideology to bind peasant fighters to their cause, much like the Viet Cong or rebels in Angola and Mozambique.

But this time, the Tigrayan fighters are largely educated and hail from the towns and cities. And it is anger at atrocities, not Marxism, that drew them to the cause.

At the recruitment camp, instructors standing under trees gave speeches about Tigrayan culture and identity, and taught new recruits to fire an AK-47.

The wave of recruits has included doctors, university professors, white-collar professionals and diaspora Tigrayans from the United States and Europe, colleagues and friends said. Even in government-held Mekelle, recruitment grew increasingly brazen.

Two weeks ago, a T.D.F. poster appeared on a wall beside St. Gabriel’s, the city’s largest church. “Those who fail to join are as good as the walking dead,” it read. Hours later, Ethiopian soldiers arrived and tore it down.

Mulugeta Gebrehiwot Berhe, 61, a senior fellow at the World Peace Foundation at the Fletcher School of Law and Diplomacy at Tufts University, in Massachusetts, was visiting Mekelle when war erupted in November. I found him near the town of Samre, a leather-holstered pistol on his hip.

“I joined the resistance,” said the academic, who once helped broker a peace deal for the United Nations in Darfur. “I felt I had no other option.”

Even some Ethiopian commanders felt alienated by Mr. Abiy’s approach to the conflict.

Until late June, Col. Hussein Mohamed, a tall man with a gold-tooth smile, commanded the 11th Infantry Division in Tigray. Now he was a prisoner, held with other Ethiopian officers in a closely guarded farmhouse.

Of the 3,700 troops under his command, at least half were probably dead, said Colonel Hussein, confirming that he was speaking voluntarily. “The course of this war is political madness, to my mind,” he said.

He always had serious reservations about Mr. Abiy’s military alliance with Eritrea, Ethiopia’s old foe, he said: “They ransack properties, they rape women, they commit atrocities. The whole army is unhappy about this marriage.”

Still, Ethiopian soldiers have been accused of much the same crimes. I met Colonel Hussein in a stone-walled room, with a tin roof, as rain splattered outside. When the room’s owner, Tsehaye Berhe, arrived with a tray of coffee cups, her face clouded over.

“Take it!” she snapped at the Ethiopian officer. “I’m not serving you.”

Moments later Ms. Tsehaye returned to apologize. “I’m sorry for being emotional,” she said. “But your soldiers burned my house and stole my crops.”

Colonel Hussein nodded quietly.

Even before Ethiopian forces abandoned Mekelle on June 28, there were hints that something was afoot. The internet went down, and at the regional headquarters where Mr. Abiy had installed an interim government, I found deserted corridors and locked offices. Outside, federal police officers were slinging backpacks into a bus.

Smoke rose from the Ethiopian National Defense Forces’ headquarters in Mekelle — a pyre of burning documents, it turned out, piled high by detainees accused of supporting the T.D.F.

Weeks earlier, Ethiopian intelligence officers had tortured one of them, Yohannes Haftom, with a cattle prod. “We will burn you,” Mr. Yohannes recalled them saying. “We will bury you alive.”

But after he followed their orders to cart their confidential documents to the burn pit on June 28, the Ethiopians set Mr. Yohannes free. Hours later, the first T.D.F. fighters entered Mekelle, setting off days of raucous celebration.

Residents filled streets where young fighters paraded on vehicles like beauty queens, or leaned from speeding tuktuks spraying gunfire into the air. Nightclubs and cafes filled up, and an older woman prostrated herself at the feet of a just-arrived fighter, shouting thanks to God.

On the fourth day, fighters paraded thousands of Ethiopian prisoners through the city center, in a show of triumphalism that was a pointed rebuke to the leader of Ethiopia. “Abiy is a thief!” people chanted as dejected soldiers marched past.

The celebrations eventually reached the house where Mr. Getachew, the Tigrayan leader and T.D.F. spokesman, now descended from his mountain base, was staying.

As the whiskey flowed, Mr. Getachew juggled calls on his satellite phone while a generator rattled in the background. Mr. Abiy had once been his political ally, even his friend, he said. Now the Ethiopian leader had cut the power and phone lines to Mekelle and issued a warrant for his arrest.

Buoyed by victory, the guests excitedly discussed the next phase of their war in Tigray. One produced a cake with the Tigrayan flag that Mr. Getachew, sharing a knife with a senior commander, cut to loud cheers.

For much of his career, he had been a staunch defender of the Ethiopian state. But the war made that position untenable, he said. Now he was planning a referendum on Tigrayan independence.

“Nothing can save the Ethiopian state as we know it, except a miracle,” he said. “And I don’t usually believe in them.”

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Grief Mounts as Efforts to Ease Israel-Hamas Fight Falter

GAZA CITY — Diplomats and international leaders were unable Sunday to mediate a cease-fire in the latest conflict between Israel and Hamas, as Prime Minister Benjamin Netanyahu of Israel vowed to continue the fight and the United Nations Security Council failed to agree on a joint response to the worsening bloodshed.

The diplomatic wrangling occurred after the fighting, the most intense seen in Gaza and Israel for seven years, entered its deadliest phase yet. At least 42 Palestinians were killed early Sunday morning in an airstrike on several apartments in Gaza City, Palestinian officials said, the conflict’s most lethal episode so far.

The number of people in killed in Gaza rose to 197 over the six days of the conflict, according to Palestinian officials, while the number of Israeli residents killed by Palestinian militants climbed to 11, including one soldier, the Israeli government said.

began last Monday after Hamas fired rockets at Jerusalem following a month of rising tensions between Palestinians and Israelis in the holy city.

The Israeli Army says its goal is to destroy the military infrastructure of Hamas, the Islamist militant group that controls the Gaza Strip, a Palestinian enclave of about two million people that is under an Israeli and Egyptian blockade. Israel blames Hamas for the civilian casualties in Gaza, saying the group hides militants in residential areas.

housed two major international news outlets, The Associated Press and Al Jazeera, after calling the building’s owner and telling him to evacuate tenants. An Israeli strike also killed at least 10 members of the same family in a house in a refugee camp and caused collateral damage to a clinic run by Doctors Without Borders, a medical aid group.

Then on Sunday morning, the airstrike hit Ms. Abul Ouf’s home. Two relatives said that the strike killed two members of her immediate family, at least 12 of her extended family and more than 30 neighbors, and that it left her mother in critical condition.

In a statement, the Israeli Army said it had “struck an underground military structure belonging to the Hamas terrorist organization which was located under the road.” It added: “Hamas intentionally locates its terrorist infrastructure under civilian houses, exposing them to danger. The underground foundations collapsed, causing the civilian housing above them to collapse, causing unintended casualties.”

The American ambassador to the United Nations, Linda Thomas-Greenfield, urged restraint on the part of both Hamas and Israel during Sunday’s Security Council meeting, which was called to try to find a way to end the violence.

a day of talks Sunday with key Israeli officials and the Office of the Quartet, which mediates Middle East peace negotiations. He is scheduled to hold similar discussions on Monday with President Mahmoud Abbas of the Palestinian Authority, which governs parts of the West Bank but lost control of Gaza in 2007.

The conflict between Israel and Hamas has ignited a wave of related violence between Arabs and Jews within Israel itself this past week. That and demonstrations across the occupied West Bank have made analysts wonder whether Palestinians are on the verge of a major uprising, the third since the late 1980s. Protests and clashes were less intense on Sunday after a major crackdown by the police in Israel and by the Israeli Army in the West Bank.

But Arabs and Jews clashed in the Negev desert in Israel’s south, in East Jerusalem and in Lod, a mixed Arab-Jewish city in central Israel. The police response to the civil unrest over the past week has mostly focused on Arabs, following attacks on synagogues that some likened to a pogrom.

On Sunday, an umbrella organization for Arab leaders in Israel appealed to the international community to help protect Palestinian citizens of Israel “from violent attacks and human rights violations by both state and private actors.” The group added, “Palestinian citizens, collectively, are afraid for their lives.”

a case that has galvanized Palestinian national sentiment, setting the stage for the renewed conflict in Gaza.

The weekend’s rocket fire by Hamas and other Islamist militant groups in Gaza included a major barrage over central Israel early Sunday morning.

Most of those rockets were intercepted by the Iron Dome, an antimissile detection system partly financed by the United States. But where they hit, they brought terror on Israeli residents, particularly in towns like Sderot, close to Gaza’s perimeter.

One blast this weekend destroyed a fifth-floor apartment in Sderot, killing a 5-year-old boy, and ripped a hole in another, where Eli Botera, his wife, Gitit, and their infant daughter, Adele, were huddling in the baby’s bedroom.

“My wife was panicking and started to scream,” Mr. Botera said. “Eventually, it’s all up to God. Every individual must do what they can to protect themselves, but if it’s your destiny to die, you die.”

The deadliest attacks have been in Gaza — and chief among them was the airstrike on Ms. Abul Ouf’s home in Al-Wehda, a busy, wealthy district in Gaza City, full of shops and apartment blocks.

Ms. Abul Ouf was training to be a dentist and lived at home with her parents and siblings, relatives said. By Sunday morning, two were dead and three had been plucked injured from the rubble, relatives said. Ms. Abul Ouf’s father, a supermarket owner, was unscathed, having gone for a nighttime visit to fix a neighbor’s internet.

Ms. Abul Ouf was due to marry Mr. al-Yazji in two months. They last spoke early Sunday as the bombardment began, Mr. al-Yazji said.

“Hide,” he remembered telling her in a text message.

But the message never arrived.

Mr. al-Yazji spent hours on Sunday scouring the rubble for her. Government rescuers heaved away debris, stone by stone, and when they spotted a body, Mr. al-Yazji hurried over, the rubble’s grit and sand caking his feet.

The person was still breathing. But it wasn’t Ms. Abul Ouf.

The Israeli bombardment has forced 38,000 people to seek sanctuary in dozens of U.N. schools, the United Nations said. Gaza now faces power failures at least 16 hours a day, while damage to a desalination plant has threatened the access of about 250,000 people to drinking water, the United Nations said.

Israel’s airstrikes have also stopped all Covid-19 vaccinations and virus testing in the Palestinian enclave and raised the risk of viral contagion as civilians cram into shelters for safety, U.N. officials said.

Standing in the rubble Sunday, Mr. al-Yazji gave up hope of finding his fiancée by the midafternoon. He took a box of her dental equipment from the ruins, a small token to remember her by. Then he left with his brother for the nearby hospital where casualties from the airstrike were being taken.

After every new ambulance arrived, he rushed to its back doors to peer inside and see if Ms. Abul Ouf was lying within. Each time, he walked back disappointed.

After several hours, he went instead to the morgue. And there, lying motionless on a stand, was the body of Shaimaa Abul Ouf.

Mr. al-Yazji emerged hysterical with grief. “Be happy,” he said after identifying her body.

“I swear to God,” he added, “she was laughing.”

Reporting was contributed by Isabel Kershner from Sderot, Israel; Lara Jakes from Washington; Rick Gladstone from New York; Gabby Sobelman from Rehovot, Israel; and Adam Rasgon from Tel Aviv.

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Israel’s Gaza Strikes May Cause Covid Surge, U.N. Warns

Israel’s airstrikes and shelling of Gaza have stopped all Covid-19 vaccinations and testing in the Palestinian enclave and raise the risk of super-spreading as civilians cram into shelters for safety, United Nations officials said.

In an interview over Zoom on Friday as the sound of Israeli explosions shook their headquarters, the leaders of the U.N. Palestinian relief agency’s operations in Gaza and the head of the World Health Organization’s Gaza sub-office said they feared that a severe worsening of Covid-19 infections would be a side-effect of the death and destruction from the latest surge in hostilities.

The number of people in Gaza sickened from Covid-19 had been “just leveling off, and then this hit,” said the U.N. agency official, Matthias Schmale. “It is a grim situation.”

He said that unvaccinated Gazans were crowding into the schools run by his agency, known as the United Nations Relief and Works Agency, because the Israelis do not intentionally target those buildings — in effect making them bomb shelters. Now, Mr. Schmale said, those schools “could turn into mass spreaders.”

hit record highs in Gaza, which health experts attributed to the proliferation of the highly transmissible coronavirus variant first identified in Britain. In early May, Doctors Without Borders reported that the territory’s infections were topping 1,000 a day.

Sacha Bootsma, the W.H.O. official, said that before the vaccinations had stopped, 38,000 people in Gaza had received at least one dose of vaccine. That is less than 2 percent of the population of two million. Russia’s Sputnik vaccine and the Pfizer-BioNTech vaccine were given at three Gaza hospitals, and AstraZeneca’s vaccine was being administered at smaller health centers.

But now, Ms. Bootsma said, “People are not daring to visit health facilities. We are fearing this will have a major negative impact.”

By contrast, more than 60 percent of the Israeli population has received at least one dose of either the Pfizer-BioNTech or Moderna vaccines, and more than 55 percent are fully vaccinated, according to the Our World in Data project at the University of Oxford. However, the pace of vaccinations has slowed tremendously in recent months.

Under Covax, the international collaboration to provide vaccines to poor parts of the world, Gaza is supposed to receive enough vaccine to protect 20 percent of its population, the officials said.

But the deliveries, flown to Israel’s Ben Gurion Airport and then sent by land across the border to Gaza, have been indefinitely suspended because air service into Israel has been curtailed by the hostilities. Assuming they resume soon, it still remains unclear when Gaza’s border crossings might reopen.

“The biggest problem now is the borders are closed,” Mr. Schmale said. “Even if there were a delivery, we would not be able to receive any supplies.”

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Experts Call for Sweeping Reforms to Prevent the Next Pandemic

Some countries were not even aware that the regulations existed, his group reported. Others lacked laws vital to responding to outbreaks, such as those authorizing quarantines.

Changing those regulations would require “negotiations for years,” Dr. Wieler said, noting that the latest set took a decade to finalize. Instead, one of his committee’s major recommendations was to increase countries’ accountability for their obligations, including though a pandemic treaty and a periodic review of their preparedness that would involve other countries.

The independent panel also proposed creating an international council led by heads of state to keep attention on health threats and to oversee a multibillion-dollar financing program that governments would contribute to based on their ability. It would promise quick payouts to countries contending with a new outbreak, giving them an incentive to report.

“There’s only going to be the political will to create those things when something catastrophic happens,” said Dr. Mark Dybul, one of the panel members. These recommendations stemmed in part from his experience leading the President’s Emergency Program for AIDS Relief, known as Pepfar, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, he said.

But Dr. Wieler, who led the other international review, said that in general, creating new institutions rather than focusing on improving existing ones could increase costs, complicate coordination and damage the W.H.O.

The recommendations of panels after global emergencies have sometimes been embraced. The Ebola outbreak of 2014 and 2015 led to the creation of the W.H.O.’s health emergencies program, aimed at boosting the agency’s role in managing health crises as well as providing technical guidance. A report released this month noted that the new program had received “increasingly positive feedback” from countries, donors and partner agencies as it managed dozens of health and humanitarian emergencies.

The W.H.O. before the Ebola outbreak and after it are “two different agencies basically,” said Dr. Joanne Liu, a former international president of Doctors Without Borders and a member of the independent panel. Dr. Liu was one of the W.H.O.’s most trenchant critics during the Ebola response, and she noted a “marked improvement” in how quickly the agency had declared an international emergency this time.

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Cleric Lifts Iraq’s Faltering Vaccination Effort, but Perilous Summer Awaits

BAGHDAD — In a country where most people believe that God will protect them but their government won’t, it has taken a popular Shiite cleric to give Iraq’s stumbling vaccination program a boost.

Iraq has been bracing for a dangerous summer, with widespread skepticism over coronavirus precautions, a limited vaccine supply and a troubled health care system.

But last week, Moktada al-Sadr, whose lineage from a revered Shiite family commands respect among millions of Iraqis, was shown on video rolling down his robe and baring his arm for a Chinese Sinopharm vaccine in the holy city of Najaf.

Vaccination clinics throughout Najaf Province had until then recorded only around 300 vaccinations a day. Two days after the video was released, that number climbed to almost 2,000 a day until clinics ran out of vaccines on Wednesday. They expect to receive more in two weeks.

Covax, the global vaccine-sharing partnership, has allocated 1.7 million doses for the country of 40 million people.

Covax, Chinese donations of Sinopharm, and purchases of the Pfizer-BioNTech vaccine funded through a $100 million World Bank loan.

The vaccination program was meant to start with the elderly, health care workers, those with chronic conditions and security forces. Yet a significant number of Iraq’s roughly 200,000 health care workers are refusing vaccines, according to officials.

a fire swept through a Baghdad hospital for Covid patients after an oxygen canister exploded, killing more than 100 people, most of them patients and their relatives. The hospital lacked smoke detectors or sprinkler systems.

The health minister was forced to resign and other officials were arrested. Iraqi ministries are divvied up among powerful political parties with the health ministry under the control of the Sadr political bloc.

Mr. Sadr, who has tried to portray himself as above politics while still playing a key role in Iraq’s political system, has said any officials convicted of wrongdoing should be punished.

The health ministry has struggled to get its message across.

“Some people still do not believe in the existence of the virus and they do not believe in the effectiveness of the vaccine,” said Dr. Ruba Falah Hassan, in the ministry’s media office.

At many vaccination clinics outside the Sadr strongholds, there has been so little demand that any Iraqi with ID or foreigner with a passport can be vaccinated after a few minutes wait.

Near central Baghdad’s Palestine Street, about 30 people waited for a Sinopharm vaccine on plastic chairs in the Al Edreesi health care center on Thursday. In this middle-class neighborhood most of those waiting appeared to be professionals or university students.

“We ask anyone who took the vaccine to send a message of reassurance in their groups. ” said Afraa al-Mullah, from the health center’s media department. “Anyone who took the vaccine must speak and say, ‘Here I am. I’m fine, get vaccinated.’”

The more that word spreads that vaccines are not harmful, she hopes, the more Iraqis would agree to be vaccinated.

“Iraq’s population is 40 million, 20 million must get vaccinated,” she said, calling the 400,000 who have been inoculated “a drop in the ocean.” She added: “We have people that do not believe in coronavirus. How can we convince them to vaccinate?”

Falih Hassan and Nermeen al-Mufti contributed reporting.

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‘They Told Us Not to Resist’: Sexual Violence Pervades Ethiopia’s War

Mona Lisa lay on a hospital bed in Mekelle, the main city in war-torn northern Ethiopia, her body devastated but her defiance on display.

Named for the iconic painting, the 18-year-old Ethiopian high school graduate had survived an attempted rape that left her with seven gunshot wounds and an amputated arm. She wanted it to be known that she had resisted.

“This is ethnic cleansing,” she said. “Soldiers are targeting Tigrayan women to stop them giving birth to more Tigrayans.”

Her account is one of hundreds detailing abuses in Tigray, the mountainous region in northern Ethiopia where a grinding civil war has been accompanied by a parallel wave of atrocities including widespread sexual assault targeting women.

told the Security Council last week that more than 500 Ethiopian women have formally reported sexual violence in Tigray, although the actual toll is likely far higher, she added. In the city of Mekelle, health workers say new cases emerge every day.

The assaults have become a focus of growing international outrage about a conflict where the fighting is largely happening out of sight, in the mountains and the countryside. But evidence of atrocities against civilians — mass shootings, looting, sexual assault — is everywhere.

increasingly desperate pleas for international action on Ethiopia, led by senior United Nations and European Union officials, the pressure appears to be producing results. President Biden recently sent an envoy, Senator Chris Coons, Democrat of Delaware, to Ethiopia for talks with Ethiopia’s prime minister, Abiy Ahmed, that lasted five hours.

On Tuesday, addressing Ethiopia’s Parliament, Mr. Abiy publicly acknowledged that sexual assault had become an integral part of a war he once promised would be swift and bloodless.

said earlier this month.

The war started in November after Mr. Abiy accused the T.P.L.F. of attacking a major military base in a bid to overthrow his government. The T.P.L.F. ruled Ethiopia for nearly three decades until Mr. Abiy came to power in 2018, then retreated to its stronghold in Tigray where it began to openly defy the new prime minister’s authority.

In some ways, the bitter fight is driven by deeply rooted forces — longstanding land disputes, opposing visions over the future shape of Ethiopia, and a rivalry with Eritrea going back decades. But civilians, and particularly women, are bearing the brunt of the most disturbing violence.

Rocks, nails and other objects have been forced inside the bodies of women — and some men — during sexual assaults, according to health workers. Men have been forced to rape their own family members under threat of violence, Pramila Patten, the top U.N. official on sexual violence in conflict, said in January.

“Rape is being used as a weapon of war,” said Letay Tesfay of the Tigray Women’s Association, which runs a safe house for women in Mekelle. “What’s happening is unimaginable.”

called a concerted effort to destroy the region’s health care system. In his meeting with Mr. Abiy in March, Senator Coons said they discussed “directly and forcefully” the reports of widespread human rights violations including rape.

Whether Mr. Abiy delivers on his promise of bringing the perpetrators to justice, he added, “is going to be critical to any successful resolution of this conflict.”

marched into Mekelle on Nov. 28. Some said they had been raped by soldiers in the camps for displaced people on the edge of the city; others were abducted from their homes in rural areas and held for days as soldiers repeatedly raped them.

The doctor, who like several other medics spoke on the condition of anonymity for fear of reprisals from the authorities, produced a list of 18 registered sexual violence patients at the hospital. The youngest was 14. Most said their attackers were soldiers, he said.

In one bed, a 29-year old woman who asked to be identified only by her first name, Helen, trembled as she recounted how Eritrean and Ethiopian troops tied her to a tree near her home in Agula, 15 miles north of Mekelle, and assaulted her repeatedly over a 10-day period in late November.

“I lost count,” she said. “They took photos of me, poured alcohol on me and laughed.” Some of her assailants also shot dead her 12-year-old son, she added.

Selam Assefe, a police investigator working on rape cases at the Ayder Referral Hospital, corroborated Ms. Helen’s account.

Most sexual assault cases in Tigray, however, may not be recorded anywhere. Health workers said that officials are reluctant to register such violence, fearing the military could target them for documenting the crime. Patients often remain anonymous for the same reason.

Filsan Abdullahi Ahmed, Ethiopia’s minister of women, children and youth, insisted that the federal government was taking seriously the reports of sexual violence in Tigray, and had sent a task force including social workers, police and prosecutors to investigate.

While her own mandate was limited to providing victims with psychological support, Ms. Filsan said she had pressured Ethiopia’s attorney general to deliver justice. But it is a difficult process, she insisted.

“I cannot 100 percent confirm whom this is being committed by,” Ms. Filsan said, referring to the perpetrators.

The sexual attacks are so common that even some Ethiopian soldiers have spoken out. At a public meeting in Mekelle in January, a man in military uniform made an outburst that was broadcast on state TV.

“I was angry yesterday,” he said. “Why does a woman get raped in Mekelle city?” The soldier, who was not identified, questioned why the police weren’t stopping them. “It wouldn’t be shocking if it happened during fighting,” he said. “But women were raped yesterday and today when the local police and federal police are around.”

Haben, a waitress in Mekelle, was raped with two other women at the cafe where they work in December, she said. Her body is still covered in bruises from the assault.

“They told us not to resist,” she recalled. “‘Lie down. Don’t shout.’”

But even if they had shouted, she added, “there was nobody to listen.”

An employee of The New York Times contributed reporting from Mekelle, Ethiopia.

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A Collapse Foretold: How Brazil’s Covid-19 Outbreak Overwhelmed Hospitals

The virus has killed more than 300,000 people in Brazil, its spread aided by a highly contagious variant, political infighting and distrust of science.


PORTO ALEGRE, Brazil — The patients began arriving at hospitals in Porto Alegre far sicker and younger than before. Funeral homes were experiencing a steady uptick in business, while exhausted doctors and nurses pleaded in February for a lockdown to save lives.

But Sebastião Melo, Porto Alegre’s mayor, argued there was a greater imperative.

“Put your life on the line so that we can save the economy,” Mr. Melo appealed to his constituents in late February.

Now Porto Alegre, a prosperous city in southern Brazil, is at the heart of an stunning breakdown of the country’s health care system — a crisis foretold.

More than a year into the pandemic, deaths in Brazil are at their peak and highly contagious variants of the coronavirus are sweeping the nation, enabled by political dysfunction, widespread complacency and conspiracy theories. The country, whose leader, President Jair Bolsonaro, has played down the threat of the virus, is now reporting more new cases and deaths per day than any other country in the world.

125 Brazilians succumbing to the disease every hour. Health officials in public and private hospitals were scrambling to expand critical care units, stock up on dwindling supplies of oxygen and procure scarce intubation sedatives that are being sold at an exponential markup.

Intensive care units in Brasília, the capital, and 16 of Brazil’s 26 states report dire shortages of available beds, with capacity below 10 percent, and many are experiencing rising contagion (when 90 percent of such beds are full the situation is considered dire.)

a model for other developing nations, with a reputation for advancing agile and creative solutions to medical crises, including a surge in H.I.V. infections and the outbreak of Zika.

Mr. Melo, who campaigned last year on a promise to lift all pandemic restrictions in the city, said a lockdown would cause people to starve.

celebrated setbacks in clinical trials for CoronaVac, the Chinese-made vaccine that Brazil came to largely rely on, and joked that pharmaceutical companies would not be held responsible if people who got newly developed vaccines turned into alligators.

“The government initially dismissed the threat of the pandemic, then the need for preventive measures, and then goes against science by promoting miracle cures,” said Natália Pasternak, a microbiologist in São Paulo. “That confuses the population, which means people felt safe going out in the street.”

Terezinha Backes, a 63-year-old retired shoemaker living in a municipality on the outskirts of Porto Alegre, had been exceedingly careful over the past year, venturing out only when necessary, said her nephew, Henrique Machado.

But her 44-year-old son, a security guard tasked with taking the temperature of people entering a medical facility, appears to have brought the virus home early this month.

Ms. Backes, who had been in good health, was taken to a hospital on March 13 after she began having trouble breathing. With no beds to spare, she was treated with oxygen and an IV in the hallway of an overflowing wing. She died three days later.

“My aunt was not given the right to fight for her life,” said Mr. Machado, 29, a pharmacist. “She was left in a hallway.”

anti-parasite drug ivermectin as a preventive measure. The drug is part of the so-called Covid kit of drugs, which also includes the antibiotic azithromycin and the anti-malaria drug hydroxychloroquine. Mr. Bolsonaro’s health ministry has endorsed their use.

Leading medical experts in Brazil, the United States and Europe have said those drugs are not effective to treat Covid-19 and some can have serious side effects, including kidney failure.

“Lies,” Mr. Monteiro, 63, said about the scientific consensus on the Covid kit. “There are so many lies and myths.”

He said medical professionals have sabotaged Mr. Bolsonaro’s plan to rein in the pandemic by refusing to prescribe those drugs more decisively at the early stages of illness.

“There was one solution: to listen to the president,” he said. “When people elect a leader it is because they trust him.”

The mistrust and the denials — and the caravans of Bolsonaro supporters blasting their horns outside hospitals to protest pandemic restrictions — are crushing for medical professionals who have lost colleagues to the virus and to suicide in recent months, said Claudia Franco, the president of the nurses union in Rio Grande do Sul.

“People are in such denial,” said Ms. Franco, who has been taking care of Covid-19 patients. “The reality we’re in today is we don’t have enough respirators for everyone, we don’t have oxygen for everyone.”

Ernesto Londoño reported from Porto Alegre. Letícia Casado reported from Brasília.

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