Millions suffer from environmental ills in Aral Sea Basin

Five million people in parts of Uzbekistan, Kazakhstan, and Turkmenistan live in a toxic environmental wasteland due to the destruction of the Aral Sea and pollution of the surrounding land. A canal system built in the 1960s to irrigate cotton fields of Central Asia has diverted as much as three quarters ofthe water destined for the Aral Sea, leaving former fishing towns more than 60 miles from the sea. Some 35,000 square kilometers of what was once sea is now highly salinated and polluted land, and toxic salt storms commonly blow through the communities in the region. The economy has been devastated, leading to the collapse of health-care structures. The region has one of the highest levels of anemia in the world and one of the highest levels of tuberculosis in the former Soviet Union.

2.6 million face famine in Sudan

The famine in southern Sudan produced mortality rates that in some areas equaled or exceeded those reported in Ethiopia during the crisis of 1985. During one week in mid-July, 120 people were dying each day in the area of Ajiep (pop. 17,000) in the province of Bahr el Ghazal, and many other villages recorded catastrophic death rates. Not only were there no blockbuster concerts in supportof the victims, few people seemed to know about the famine at all.

Drug-resistant disease grows internationally

Resistance to the drugs that treat tuberculosis, malaria, sleeping sickness, andother infectious diseases is growing rapidly. Some strains of malaria-which infects 300 to 500 million people a year and kills nearly three million are resistant to most of the available drugs. The most resistant malaria in the world occurs on the Thai-Cambodian and Thai-Burmese borders. Most internationalpharmaceutical companies however have eliminated research programs for malaria, so it is unlikely that there will be many new drugs to combat resistant malaria within the next five to 10 years.

Pan-African cholera epidemic sweeps 14 countries

In the aftermath of the El Nino floods, Africa faced one of its most geographically far-reaching cholera epidemics since the widespread re-emergence of the disease in the 1960s. The disease leap-frogged across 14 countries duringthe winter of 1997-98, infecting at least 168,011 people and killing more than 7,000. Experts at the World Health Organization (WHO) say that official figuresmost likely represent fewer than half the victims. Cholera also swept through Latin America in 1998, infecting 38,169 people and causing more than 300 deaths.

Rise in number of street children follows global economic slump

The growing global economic crisis increased the number of children who live on urban streets, straining the coping mechanisms of societies from Romania to Rwanda to Guatemala. The problem-once mainly a result of migration from rural to urban areas-is compounded by internal armed conflict and sudden economic collapse around the globe. In Madagascar's capital, Antananarivo, more than 6,000 children who live and sleep on the street receive no
public services and face frequent police harassment. In the Philippine capital of Manila, repression of the estimated 75,000 street children is on the rise. Many of the children have families but poverty compels them to beg for money on city streets, where they often face arrest. For Manila's 5,000 to 7,000 "full-time" street children with no family, neither prison nor public rehabilitation centers offer care for the serious trauma, such as sexual abuse, that many have suffered.

Civilians mutilated in Sierra Leone

The February 6, 1998, ouster of the leaders of a coup that had taken control of Freetown eight months earlier sent rebels into northern and eastern Sierra Leone, where fighting ensued. Within weeks, Freetown's Connaught Hospital was receiving hundreds of civilians suffering from ghastly mutilations, such as armsand ears severed by machetes. The kidnapping and harassment of aid workers ensured little international presence in the affected areas. The defeated soldiers' effort to sow intimidation worked: it was so dangerous that
journalists could not cover the story from the areas where the atrocities took place. Only months later, when a human rights report of the atrocities was issued, did the public first learn about the situation.

Women deprived of health care in Kabul, Afghanistan

In July 1998, international relief agencies were expelled from Kabul, the capital of Afghanistan, after months of unsuccessful negotiations with Taliban authorities. The Taliban had placed severe restrictions on women's access to health (to the point of forcibly removing 12 women from a hospital on October 19, 1997) and attempted to ghettoize non-governmental organizations in an unequipped facility far from the populations they served. Before their expulsion, international aid groups had achieved some success in providing necessary care in this country with one of the world's highest rates of maternal mortality. At the end of 1998, Afghan women remained trapped in a vicious paradox: they cannot be treated by male physicians, yet women have been barred from medical education.

AIDS ravages sub-Saharan Africa

While sporadic reports indicated that AIDS was spreading rapidly in Africa, newsstories tended to focus on the AIDS problem in individual countries, obscuring the tremendous breadth of the epidemic. No one but the relief workers on the ground was prepared for the October 27 report by the United Nations, which said that, in several Sub-Saharan nations, one in four adults is infected with HIV. Ninety-one percent of the world's deaths from AIDS have occurred in the 34 Sub-Saharan countries and in some urban centers more than one-third of pregnant women test positive for HIV. Given the scope of the epidemic and local health systems' ill-preparedness, medical aid groups are juggling not only the prevention and treatment, but also the profound societal problems stemming from social stigmatization.

Hundreds of thousands flee war in Guinea-Bissau

A civil war raged from June to November 1998 in this tiny African nation. By the end of June, between 200,000 and 300,000 people (one-fourth to one-fifth of the country's population) had fled the capital, Bissau City, as a result of the conflict which broke out on June 7 between troops loyal to president Joao Bernardo Vieira and insurgents. Many people who were displaced toward the cities located along main roadways are still too afraid to return to their homes, despite a peace process that is now underway. With Senegal and Guinea closing their borders for long periods during the conflict, the passage of fuel, food, and medical supplies was often halted, frustrating attempts to aid the displaced people.

Sleeping Sickness may affect 300,000 per year

Epidemiologists estimate that more than 300,000 people per year are infected with sleeping sickness-a disease that is deadly if left untreated. Found in 36 African countries, the disease hits Angola, Uganda, Sudan, and the Democratic Republic of Congo the hardest. One of the main difficulties associated with sleeping sickness is that a key drug used to treat the later stage of the disease, the arsenic derivative melarsoprol, which is injected intravenously, causes death in 5 percent of the cases in which it is used. In addition, patients are showing resistance to melarsoprol. The best drug to treat late-stage sleeping sickness, eflornithine, is no longer manufactured because its high price puts it out of reach to the people who need it in the developing world.