Face masks associated with reducing healthcare workers' risk of acquiring COVID-19

Early action to protect team members maximized Henry Ford's ability to care for patients during onset of COVID-19 pandemic

HENRY FORD HEALTH SYSTEM

Research News

DETROIT - A study published in the Journal of Occupational and Environmental Medicine from researchers at Henry Ford Health System has found that Henry Ford's early implementation of a universal mask policy in the COVID-19 pandemic was associated with reducing the risk of healthcare workers at Henry Ford acquiring COVID-19.

Through retrospective analysis of an internal hospital quality metric reporting analytics database that was not associated with electronic medical records, researchers discovered a correlation between the implementation of Henry Ford's universal mask policy and a significant drop in the rate at which its Healthcare workers tested positive for SARS-CoV-2. As COVID-19 diagnoses and hospitalizations across the State of Michigan continued to rise through late March 2020, the cases among Henry Ford's healthcare workers began to fall. By the time the first peak in COVID-19 cases occurred in the general population, the rate of cases among Henry Ford healthcare workers was already trending downward.

"This research reinforces the fact that mask wearing is effective in reducing the risk of acquiring COVID-19 and validated our decision early on to implement the universal mask policy, not only to protect our team members, but also to ensure they are able to care for members of the community who had contracted COVID-19," said Steven Kalkanis, M.D., CEO of Henry Ford Medical Group. "At Henry Ford Health System, our universal mask policy issued on March 26, 2020 ensured all staff, both clinical and non-clinical, received surgical or procedural masks and mandated that staff wear a mask at work while also following all other personal protective equipment requirements. Our hope is that the findings of this study continue to encourage members of the community to wear a mask in line with Centers for Disease Control and Prevention recommendations."

Healthcare workers have a threefold increased risk of reporting testing positive for SARS-CoV-2, the virus that causes COVID-19, compared to the general population, according to a study published in Lancet Public Health. As of March 22, 2021, the Centers for Disease Control and Prevention (CDC) has reported more than 450,000 SARS-CoV-2 infections among healthcare workers in the U.S. since the onset of the pandemic, and nearly 1,500 COVID-19 related deaths among healthcare workers.

From March 12 - August 10, 2020, 19.2% of healthcare workers at Henry Ford were symptomatic for COVID-19 and underwent SARS-CoV-2 testing. Before March 28-30 - the single changepoint in the data when the rate of new cases began to trend downward - the odds of a tested healthcare worker having a positive SARS-CoV-2 test result doubled every 4.5 - 7.5 days. After March 30, the odds of a tested healthcare worker having a positive result reduced by half every 10.5 - 13.5 days.

"This effort would not have been possible without the leadership of our executive team, including our president and CEO Wright Lassiter, III, Dr. Steven Kalkanis, chief clinical officer Dr. Adnan Munkarah, and chief operating officer Bob Riney," said Dee Dee Wang, M.D., Director of Structural Heart Imaging at Henry Ford Hospital and principal investigator of the study. "At a time when much was unknown about the novel coronavirus, this initiative truly helped keep our healthcare workers safe. I would also like to acknowledge Dr. Betty Chu, our associate chief clinical officer and chief quality officer; Dr. William O'Neill, director of our Center for Structural Heart Disease; Dr. Geehan Suleyman, medical director of Infection Control; Dr. Marcus Zervos, chief of our Infectious Disease division; and so many others who were instrumental in the creation and successful implementation of our universal mask policy."

With the arrival of COVID-variants in the community, even with COVID-19 vaccines now being rolled out, healthcare workers and community members should remain vigilant and continue to wear a mask in accordance with CDC recommendations.

Henry Ford is providing onsite expertise and oversight for the vaccine administrations, medical care and operations at the Ford Field mass vaccination site. Vaccines administered at Ford Field are in addition to Michigan's regular statewide vaccine allotment. Key facts to know:

- Will operate seven days a week from 8 a.m. - 8:30 a.m. for eight weeks

- The U.S. Air Force will provide vaccination support

- 68 vaccination pods will be set up on the Concourse at Ford Field. Vaccinations are open to those who meet the Michigan Department of Health and Human Services vaccine guidelines.

Registration and appointment scheduling are being managed by Meijer. People may register in the following ways:

- Online at clinic.meijer.com/register/CL2021

- Text EndCOVID to 75049

- Call the State of Michigan COVID hotline at 888-535-6136 (Press 1) Monday-Friday 8 a.m. - 5 p.m. and Saturday/Sunday 8 a.m. - 1 p.m.

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About Henry Ford Health System

Founded in 1915 by Henry Ford himself, Henry Ford Health System is a non-profit, integrated health system committed to improving people's lives through excellence in the science and art of healthcare and healing. Henry Ford Health System includes Henry Ford Medical Group, with more than 1,900 physicians and researchers practicing in more than 50 specialties at locations throughout Southeast and Central Michigan. Acute care hospitals include Henry Ford Hospital in Detroit, MI and Henry Ford Allegiance Health in Jackson, MI - both Magnet® hospitals; Henry Ford Macomb Hospital; Henry Ford West Bloomfield Hospital; and Henry Ford Wyandotte Hospital.

The largest of these is Henry Ford Hospital in Detroit, a quaternary care research and teaching hospital and Level 1 Trauma Center recognized for clinical excellence in cardiology, cardiovascular surgery, neurology, neurosurgery, and multi-organ transplants. The health system also provides comprehensive, best-in-class care for cancer at the Brigitte Harris Cancer Pavilion, and orthopedics and sports medicine at the William Clay Ford Center for Athletic Medicine - both in Detroit.

As one of the nation's leading academic medical centers, Henry Ford Health System annually trains more than 3,000 medical students, residents, and fellows in more than 50 accredited programs, and has trained nearly 40% of the state's physicians. Our dedication to education and research is supported by nearly $100 million in annual grants from the National Institutes of Health and other public and private foundations.

Henry Ford's not-for-profit health plan, Health Alliance Plan (HAP), provides health coverage for more than 540,000 people.

Henry Ford Health System employs more than 33,000 people, including more than 1,600 physicians, more than 6,600 nurses and 5,000 allied health professionals.

 

The case of the cloudy filters: Solving the mystery of the degrading sunlight detectors

NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY (NIST)

Research News

 

IMAGE: TWO EUV FILTERS THAT WERE USED IN A SPACE FLIGHT. THE WRINKLY LOOKING FILTER ON TOP IS MADE OF ZIRCONIUM; THE SMOOTHER BOTTOM FILTER IS MADE OF ALUMINUM. EACH FILTER... view more 

CREDIT: ANDREW JONES/LASP

More than 150 years ago, the Sun blasted Earth with a massive cloud of hot charged particles. This plasma blob generated a magnetic storm on Earth that caused sparks to leap out of telegraph equipment and even started a few fires. Now called the Carrington Event, after one of the astronomers who observed it, a magnetic storm like this could happen again anytime, only now it would affect more than telegraphs: It could damage or cause outages in wireless phone networks, GPS systems, electrical grids powering life-saving medical equipment and more.

Sun-facing satellites monitor the Sun's ultraviolet (UV) light to give us advance warning of solar storms, both big ones that could cause a Carrington-like event as well as the smaller, more common disturbances that can temporarily disrupt communications. One key piece of equipment used in these detectors is a tiny metal filter that blocks out everything except the UV signal researchers need to see.

But for decades, there has been a major problem: Over the course of just a year or two, these filters mysteriously lose their ability to transmit UV light, "clouding up" and forcing astronomers to launch expensive annual recalibration missions. These missions involve sending a freshly calibrated instrument into space to make its own independent observations of the sunlight for comparison.

A leading theory has been that the filters were developing a layer of carbon, whose source is contaminants on the spacecraft, that blocked incoming UV light. Now, NIST scientists and collaborators from the Laboratory for Atmospheric and Space Physics (LASP) in Boulder, Colorado, have found the first evidence indicating that carbonization is not the problem, and it must be something else, such as another possible stowaway from Earth. The researchers describe their work in Solar Physics today.

"To my knowledge, it's the first quantitative, really solid argument against carbonization as the cause of the filter degradation," said NIST physicist Charles Tarrio.

What Are They Good For? Absolutely Everything

Most of the light produced by the Sun is visible and includes the rainbow of colors from red (with a wavelength of around 750 nanometers) to violet (with a wavelength of about 400 nm). But the Sun also produces light with wavelengths too long or short for the human eye to see. One of these ranges is extreme ultraviolet (EUV), extending from 100 nm down to just 10 nm.

Only about a tenth of a percent of sunlight is in the EUV range. That tiny EUV signal is extremely useful because it spikes in tandem with solar flares. These eruptions on the surface of the Sun can cause changes to Earth's upper atmosphere that disrupt communications or interfere with GPS readings, causing your phone to suddenly think you are 40 feet away from your true location.

Satellites that measure EUV signals help scientists monitor these solar flares. But the EUV signals also give scientists a heads-up of hours or even days before more destructive phenomena such coronal mass ejections (CMEs), the phenomenon responsible for the Carrington Event. Future CMEs could potentially overload our power lines or increase radiation exposure for airline crew and passengers traveling in certain locations.

And nowadays, the satellites do more than merely give us warnings, said LASP senior research scientist Frank Eparvier, a collaborator on the current work.

"In the past few decades we've gone from just sending out alerts that flares have happened to being able to correct for solar variability due to flares and CMEs," Eparvier said. "Knowing in real time how much the solar EUV is varying allows for the running of computer models of the atmosphere, which can then produce corrections for the GPS units to minimize the impacts of that variability."

The Mystery of the Cloudy Filters

Two metals are particularly useful for filtering out the massive amounts of visible light to let through that small but important EUV signal. Aluminum filters transmit EUV light between 17 nm and 80 nm. Zirconium filters transmit EUV light between 6 nm and 20 nm.

While these filters begin their lives transmitting a lot of EUV light in their respective ranges, the aluminum filters, in particular, quickly lose their transmission abilities. A filter might start by allowing 50% of 30-nm EUV light through to the detector. But within just a year, it only transmits 25% of this light. Within five years, that number is down to 10%.

"It's a significant issue," Tarrio said. Less light transmitted means less data available -- a little like trying to read in a dimly lit room with dark sunglasses.

Scientists have long known that carbon deposits can build up on instruments when they are subjected to UV light. Sources of carbon on satellites can be everything from fingerprints to the materials used in the construction of the spacecraft itself. In the case of the mysteriously cloudy UV filters, researchers thought carbon might have been deposited on them, absorbing EUV light that would otherwise have passed through.

However, since the 1980s, astronomers have been carefully designing spacecraft to be as carbon-free as possible. And that work has helped them with other carbonization problems. But it didn't help with the aluminum EUV filter issue. Nevertheless, the community still suspected carbonization was at least partially responsible for the degradation.

Make-Your-Own Space Weather

To test this in a controlled setting, NIST researchers and collaborators used a machine that effectively lets them create their own space weather.

The instrument is NIST's Synchrotron Ultraviolet Radiation Facility (SURF), a room-sized particle accelerator that uses powerful magnets to move electrons in a circle. The motion generates EUV light, which can be diverted via specialized mirrors to impact targets -- in this case, the aluminum and zirconium satellite filters.

Each filter was 6 millimeters by 18 mm, smaller than a postage stamp, and only 250 nm thick, about 400 times thinner than a human hair. The sample filters were actually slightly thicker than real satellite filters, with other small changes designed to prevent the SURF beam from literally burning holes into the metals. During a run, the back side of each filter was exposed to a controlled source of carbon.

To speed up the testing process, the team blasted the filters with the equivalent of five years' worth of space weather in a mere hour or two. Incidentally, getting that kind of beam power was no sweat for SURF.

"We turn SURF down to about half a percent of its normal power in order to expose the filters to a reasonable amount of light," Tarrio said. "The satellites are 92 million miles away from the Sun, and the Sun's not putting out an awful lot of EUV to begin with."

Finally, after exposure, researchers tested each filter to see how much EUV light in the correct wavelength range was able to pass through.

The team found that transmission was not significantly different after exposure versus before exposure, for either the aluminum or the zirconium. In fact, the difference in transmission was just a fraction of a percent, not nearly enough to explain the kind of clouding that happens in real space satellites.

"We were looking for a 30% decrease in transmission," Tarrio said. "And we just didn't see it."

As an extra test, the scientists gave the filters even larger doses of light -- the equivalent of 50 years' worth of ultraviolet radiation. And even that didn't produce much of a light transmission problem, growing just 3 nm of carbon on the filters -- 10 times less than researchers would have expected if carbon was responsible.

So If It's Not Carbon ...

The real culprit hasn't yet been identified, but researchers already have a different suspect in mind: water.

Like most metals, aluminum naturally has a thin layer on its surface of a material called an oxide, which forms when aluminum binds with oxygen. Everything from aluminum foil to soda cans has this oxide layer, which is chemically identical to sapphire.

In the proposed mechanism, the EUV light would pull atoms of aluminum out of the filter and deposit them on the filter's exterior, which already has that thin oxide layer. The exposed atoms would then react with the oxygen in water from Earth that has hitched a ride on the spacecraft. Together, the exposed aluminum and water would react to form a much thicker oxide layer, which could theoretically be absorbing the light.

Further SURF experiments scheduled for later this year should answer the question of whether the problem really is water, or something else. "This would be the first time that people have looked at the deposition of aluminum oxide in this context," Tarrio said. "We're looking into it as a serious possibility."

-- Reported and written by Jennifer Lauren Lee

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Where do the gender differences in the human pelvis come from?

A comparison with chimpanzees provides surprising insights

UNIVERSITY OF VIENNA

Research News

 

IMAGE: PHOTO OF A FEMALE HUMAN PELVIS AND SKULL OF A NEWBORN BABY. (© BARBARA FISCHER) view more 

CREDIT: PHOTO OF A FEMALE HUMAN PELVIS AND SKULL OF A NEWBORN BABY. (© BARBARA FISCHER)

Fossil remains of the human pelvis are rare because the pelvic bones do not preserve very well. Therefore, it has remained unclear when human sex differences in the pelvis evolved: jointly with upright walking, or later, together with the large human brains. "We have discovered that the pattern of sex differences in the human pelvis is probably much older than previously thought", says evolutionary biologist Barbara Fischer.

A team of biologists from the University of Vienna, the KLI for Evolution and Cognition Research, and the University of Calgary compared pelvic sex differences in humans with those in chimpanzees, the most closely-related living species to modern humans. Chimpanzees have much easier births than humans, because their fetuses are smaller. "We analyzed 3D data of pelves for these two species and found that they show the same pattern of sex differences, despite large overall species differences," says Fischer. Yet, the magnitude of the differences was only half as large in chimpanzees, compared to humans. The striking similarity of the pattern of pelvic sex differences in humans and chimpanzees strongly suggests that it was already present in the common ancestor of the two species. This implies that all the extinct hominin (human-like) species, including e.g., the Neandertals, probably had the same pattern.

Many mammals give birth to larger fetuses, relative to the birth canal of their mothers, compared to humans, e.g., bats and certain primates. These animals possess adaptations in their pelves to facilitate birth of large babies. At the same time, there are other mammals with tiny neonates, e.g., cats and opossums, which also have subtle sex differences in their pelves that resemble the human pattern. This suggests that these similarities in the pattern of pelvic sex differences reflect an old and evolutionarily conserved mammalian pattern. "We think that modern humans did not evolve this pattern de novo, but that we inherited it from earlier mammals that faced the same problem, namely having to give birth to relatively large fetuses," says Fischer. When our brains became increasingly large over the course of human evolution, the magnitude of pelvic sex differences was therefore able to increase rather rapidly, as the pelvic pattern and the underlying genetic and developmental machinery were already in place and did not have to evolve anew.

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Publication in Nature Ecology & Evolution:
Barbara Fischer, Nicole D.S. Grunstra, Eva Zaffarini, Philipp Mitteroecker (2021)
Sex differences in the pelvis did not evolve de novo in modern humans. Nature Ecology & Evolution, in print.
DOI: 10.1038/s41559-021-01425-z

Most US Covid deaths ‘could have been mitigated’ after first 100,000, Birx says

Richard Luscombe 

The “vast majority” of the almost 550,000 coronavirus deaths in the US could have been prevented if Donald Trump’s administration had acted earlier and with greater conviction, according to one of the public health experts charged with leading the pandemic response at the time.

© Photograph: Jim Watson/AFP/Getty Images Dr Deborah Birx listens during a coronavirus taskforce briefing at the White House on 18 April 2020.

Dr Deborah Birx was the White House coronavirus taskforce coordinator in the Trump administration and is among six leading medical experts involved in the then government’s efforts to fight the outbreak who will assess errors, missteps and moments of success, during a CNN documentary to be broadcast on Sunday night.

Birx, who last week took a controversial new private-sector job as medical adviser to an air cleaning company in California, will point to the Trump administration’s failure to learn from or respond quickly to the first wave of infections that swept the country in early spring 2020.

“I look at it this way. The first time we have an excuse,” Birx tells CNN’s Sanjay Gupta in the programme entitled Covid War: The Pandemic Doctors Speak Out.

She goes on: “There were about 100,000 deaths that came from that original surge. All of the rest of them, in my mind, could have been mitigated or decreased substantially.”




Trump was criticised for downplaying the seriousness of the virus, making numerous false claims, including that its effects were no worse than flu, predicting Covid-19 would “just disappear” and referring to it in racist terms. He pressed for cities and states to reopen through last summer as a second wave pushed the death toll higher.

He also ridiculed the wearing of masks and made outlandish claims such as suggesting injecting disinfectant into the body could be a legitimate coronavirus treatment, which experts slammed at the time as dangerous.

A Columbia University study last year found 84% of deaths could have been prevented with an earlier shutdown, CNN reported.

Birx, who often praised Trump, claimed in January she had been “censored” by the White House and had considered quitting. But her decision to speak out in tonight’s documentary was criticised by other prominent pandemic experts.

“This happened on her watch,” Jonathan Reiner of George Washington University told CNN, adding that Birx had “a duty to stand up and speak up”.

Birx also recounted that after last August she said publicly that the virus was “extraordinarily widespread” and spreading in rural areas, and because of the “clarity that I brought about the epidemic” she was subject to “horrible pushback” from the White House and received aggressive phone calls from Trump.

Another doctor featured in the documentary, Robert Redfield, the former director of the Centers for Disease Control and Prevention (CDC), appears to repeat Birx’s claims of censorship by the administration.

Stating he was “allowed to have opinions now”, Redfield will claim, without evidence, that he believes Covid-19 was created in a Chinese laboratory.

“If I was to guess, this virus started transmitting somewhere in September, October in Wuhan,” he said. “That’s my own feelings, and only opinion.”

The World Health Organization has called the assertion “extremely unlikely”, while Dr Anthony Fauci, the US government’s head of infectious diseases, also downplayed it in a White House briefing on Friday.

“Obviously, there are a number of theories. Dr Redfield was mentioning that he was giving an opinion as to a possibility, but again, there are other alternatives, others that most people hold by,” Fauci said.

Birx and Redfield are not serving in Joe Biden’s administration, while Fauci has been retained by the new administration’s White House team, as the leading infectious diseases adviser to the president.

The programme will air as the CDC reports more than 50 million Americans are now fully vaccinated and Biden targets 200m vaccinations in his first 100 days in office. The CDC, however, remains “deeply concerned” about rising infections even as vaccinations set daily records.

Fauci will tell Gupta that his push to go “all out” on pursuing a vaccine as early as January 2020 “may have been the best decision I have ever made”.

Manitoba had very little snow this winter, which has some worried we're in for a drought

Sarah Petz 

CBC

3/28/2021

 

© Marina von Stackelberg/CBC It's been a dry fall and winter for Winnipeg and many parts of southern Manitoba, and that could spell bad news for farmers wanting to plant their crops.

It's been one of the driest years on record for Manitoba, and that has some people, particularly farmers, worried the province will face a drought this year.

Parts of southwestern Manitoba have seen less than 20 millimetres of precipitation since Nov. 1, which is close to 30 per cent less than normal, said Rob Paola, a retired Environment Canada meteorologist who runs the popular website and Twitter account @robsobs.

Winnipeg had its third driest winter on record, with only about 25 millimetres of precipitation in December, January and February, he said.

"We've had almost no snowstorms the entire winter, and now as we get into spring, that storm track is still kind of bypassing us to the south, and we're missing out on these big weather systems," he said.

This is concerning heading into warmer months as it leads to increased risk of wildfires, grass fires and even forest fires if it gets into central and northern Manitoba, he said.

For farmers, it means less soil moisture as they plant their crops.

Bill Campbell, president of Keystone Agricultural Producers, said crop production will be compromised if Manitoba doesn't see some timely rains.

"It's a huge concern, because I would say our subsoil moisture is gone and that bank account of moisture will not be there to kind of get us through the tough times if we have that scenario of no moisture through the summer," he said.

It's a huge investment for farmers to plant their crops, and there's no guarantee that there will be sufficient moisture through the spring and summer to allow the crops to grow properly, he said.

"And when we seed it, we don't get it back. Like, you can't go and say, 'Well God, I'd like to get some of that investment back, please. Can I get it out of the dirt?'" he said.

"It's an investment that you rely on Mother Nature to provide the moisture in the right environment so that we have a crop to harvest."

Another concern is feed for livestock. If cattle can't feed on grass, that means farmers have to purchase feed, Campbell said. If there's no feed to purchase, farmers will have to sell their livestock.

It has a huge impact on the Manitoba economy, he said.

Still, the situation can turn around quickly if the province sees even an inch of rain in April, he said.

"An inch of rain would get us a lot more comfortable," he said.

The first provincial flood forecast of the year said spring flooding is very unlikely and Manitoba is looking at a drier spring.

New York lawmakers agree to legalize recreational marijuana

ALBANY, N.Y. — New York is poised the join the growing number of states that have legalized marijuana after state lawmakers reached a late-night deal to allow sales of the drug for recreational use.

© Provided by The Canadian Press

Democrats who now wield a veto-proof majority in the state Legislature have made passing it a priority this year, and Democratic Gov. Andrew Cuomo’s administration has estimated legalization could eventually bring the state about $350 million annually.

“My goal in carrying this legislation has always been to end the racially disparate enforcement of marijuana prohibition that has taken such a toll on communities of colour across our state, and to use the economic windfall of legalization to help heal and repair those same communities,” Sen. Liz Krueger, Senate sponsor of the bill and chair of the Senate’s finance committee, said.

At least 14 other states already allow residents to buy marijuana for recreational and not just medical use, but New York’s past efforts to pass marijuana legalization have failed in recent years.

The legislation would allow recreational marijuana sales to adults over the age of 21, and set up a licensing process for the delivery of cannabis products to customers. Individual New Yorkers could grow up to three mature and three immature plants for personal consumption, and local governments could opt out of retail sales.

The legislation would take effect immediately if passed, though sales wouldn’t start until New York sets up rules and a proposed cannabis board. Assembly Majority Leader Crystal Peoples-Stokes estimated Friday it could take 18 months to two years for sales to start.

Adam Goers, a vice-president of Columbia Care, a New York medical marijuana provider that’s interested in getting into the recreational market, said New York’s proposed system would “ensure newcomers have a crack at the marketplace” alongside the state’s existing medical marijuana providers.

“There’s a big pie in which a lot of different folks are going to be able to be a part of it,” Goers said.

New York would set a 9% sales tax on cannabis, plus an additional 4% tax split between the county and local government. It would also impose an additional tax based on the level of THC, the active ingredient in marijuana, ranging from 0.5 cents per milligram for flower to 3 cents per milligram for edibles.

New York would eliminate penalties for possession of less than three ounces of cannabis, and automatically expunge records of people with past convictions for marijuana-related offences that would no longer be criminalized. That’s a step beyond a 2019 law that expunged many past convictions for marijuana possession and reduced the penalty for possessing small amounts.

And New York would provide loans, grants and incubator programs to encourage participation in the cannabis industry by people from minority communities, as well as small farmers, women and disabled veterans.

Proponents have said the move could create thousands of jobs and begin to address the racial injustice of a decades-long drug war that disproportionately targeted minority and poor communities.

“Police, prosecutors, child services and ICE have used criminalization as a weapon against them, and the impact this bill will have on the lives of our oversurveiled clients cannot be overstated,” Alice Fontier, managing director of Neighborhood Defender Service of Harlem, said in a statement Saturday.

New York's Legal Aid Society also hailed the agreement. “This landmark legislation brings justice to New York State by ending prohibition, expunging conviction records that have curtailed the opportunities of countless predominately young Black and Latinx New Yorkers, and delivers economic justice to ensure that communities who have suffered the brunt of aggressive and disparate marijuana enforcement are first in line to reap the economic gain,” the group said in a news release Sunday.

Melissa Moore, the Drug Policy Alliance’s director for New York state, said the bill "really puts a nail in the coffin of the drug war that’s been so devastating to communities across New York, and puts in place comprehensive policies that are really grounded in community reinvestment.”

Cuomo has pointed to growing acceptance of legalization in the Northeast, including in Massachusetts, Maine and most recently, New Jersey.

Past efforts to legalize recreational use have been hurt by a lack of support from suburban Democrats, disagreements over how to distribute marijuana sales tax revenue and questions over how to address drivers suspected of driving high.

It also has run into opposition from law enforcement, school and community advocates, who warn legalization would further strain a health care system already overwhelmed by the coronavirus pandemic and send mixed messages to young people.

“We are in the midst of the COVID-19 pandemic, and with the serious crisis of youth vaping and the continuing opioid epidemic, this harmful legislation is counterintuitive,” said an open letter signed by the Medical Society of the State of NY, New York State Parent Teacher Association, New York Sheriff’s Association and several other organizations March 11.

New York officials plan to launch an education and prevention campaign aimed at reducing the risk of cannabis among school-aged children, and schools could get grants for anti-vaping and drug prevention and awareness programs.

And the state will also launch a study due by Dec. 31, 2022, that examines the extent that cannabis impairs driving, and whether it depends on factors like time and metabolism.

“One of the things that no country in the world has and everybody wants is a way to quickly and easily figure out if someone’s high or impaired on cannabis,” University of Buffalo psychologist and professor of community health and health behaviour R. Lorraine Collins said. “Research is being done to find systems that can do that. But I think those efforts will not come to fruition for awhile.”

The bill also sets aside revenues to cover the costs of everything from regulating marijuana, to substance abuse prevention.

State police could also get funding to hire and train more so-called “drug recognition experts.”

But there’s no evidence that drug recognition experts can tell whether someone is high or not, according to Collins, who was appointed to Cuomo’s 2018 working group tasked with drafting cannabis regulations.

“I think it’s very important that we approach that challenge using science and research and not wishes or unsubstantiated claims,” Collins said.

Collins pointed to a 2020 report from the American Civil Liberties Union that found that Blacks are almost four times more likely to be arrested for marijuana possession compared to Whites, based on FBI statistics.

“Every New Yorker should be concerned about how these laws will be implemented or how those ways of examining drivers will be implemented in different communities,” Collins said. “It’s not likely to be equal.”

The bill allows cities, towns and villages to opt out of allowing adult-use cannabis retail dispensaries or on-site consumption licenses by passing a local law by Dec. 31, 2021 or nine months after the effective date of the legislation. They cannot opt out of legalization.

______

Peltz reported from New York City.

Marina Villeneuve And Jennifer Peltz, The Associated Press

USA

Amazon hit with lawsuit over claims that it failed to provide employees with required 30-minute lunch breaks

ztayeb@businessinsider.com (Zahra Tayeb) 8 hrs ago


 Amazon is under fire over workers' rights. 

Dinendra Haria/SOPA Images/LightRocket via Getty Images

A former Amazon worker filed a lawsuit against the company over claims of missed lunch breaks.

The lawsuit claimed employees were denied the required 30-minute meal break for a five-hour shift.

It also claimed workers had to deal with serious understaffing issues and immense workloads.


A lawsuit against Amazon that claimed workers did not receive adequate lunch breaks at a California fulfilment center is moving ahead.

The case was transferred to US District Court California, Northern District, on Friday after its first filing in San Francisco County Superior Court in February.

Former employee Lovenia Scott is alleging that Amazon denied staff the required 30-minute meal breaks for each five-hour work period under Californian legislation.

The suit claimed meal-break periods were shortened "due to the time spent listening and responding to work-related obligations on their walkie talkies," which workers were allegedly required to carry with them.




In addition, the lawsuit alleged workers were instructed to take a break "if and when they could get it."

But according to Scott, who worked in the Vacaville warehouse, there were serious staffing issues and so much work being imposed on workers, it was unlikely they would be able to take their breaks if they wanted to finish their work on time.

Insider has approached Amazon for comment.

These are not the only allegations over workers' rights that Amazon has faced in recent weeks. Reports of workers urinating in bottles back in 2018 re-emerged after a Twitter spat between the company and Democratic senators, including Bernie Sanders, over the matter.

A delivery driver in the Detroit area told Insider that rather than urinate inside the vans, she used to hold it to the point of bladder infections.

Amazon delivery drivers also reported that they had to defecate in bags and struggled to change menstrual pads.

The company denied the claims about "peeing in bottles" and tweeted "if that were true nobody would work for us." However, documents showing Amazon was aware of drivers' practice of urinating in bottles and defecating in bags were published by The Intercept on Thursday.

 

German union calls four-day strike at Amazon sites ahead of Easter

BERLIN (Reuters) - The trade union Verdi has called for workers at six Amazon sites in Germany to go on strike from Sunday evening for four days in the latest attempt to try to force the U.S. e-commerce group to recognise collective bargaining agreements.

© Reuters/Rick Wilking FILE PHOTO: 

A box from Amazon.com is pictured on the porch of a house in Golden

Verdi said the strikes at Amazon's sites in Rheinberg, Werne, Koblenz, Leipzig and at two locations in Bad Hersfeld signalled an "unofficial start" to wage talks for the retail and mail order industry, which are due to begin in the next few weeks.

"Amazon is making a mint in the coronavirus crisis. For this reason alone, wage evasion must be stopped there," said Verdi representative Orhan Akman.

Verdi is demanding a pay increase of 4.5% for workers in the retail and mail order industry.

"This must also be possible at Amazon this year," Akman said.

Amazon has faced a long-running battle with unions in Germany over better pay and conditions for logistics workers, who have frequently staged strikes since 2013.

Germany is Amazon's biggest market after the United States.

Amazon says it offers excellent pay and benefits. It has said during past calls for strikes over 90% of employees in the logistic centres worked as normal.

(Reporting by Caroline Copley; editing by Emelia Sithole-Matarise)

Killing of youths sparks protests in northwest Pakistan
By Jibran Ahmad and Saud Mehsud

su

© Reuters/AKHTAR SOOMRO People chant slogans demanding an investigation following the deaths of four teenagers in Jani Khel area in Bannu District of Khyber Pakhtunkhwa (KPK) province, during a protest in Karachi,

PESHAWAR/DERA ISMAIL KHAN, Pakistan (Reuters) - Thousands of protesters broke through a police blockade in northwestern Pakistan on Sunday as they tried to march on the city of Bannu and then on to Islamabad to demand a government probe into the deaths of four young men who they allege were tortured and killed by security forces.

© Reuters/AKHTAR SOOMRO People sit with black flags as they demand an investigation following the deaths of four teenagers in Jani Khel area in Bannu District of Khyber Pakhtunkhwa (KPK) province, during a protest in Karachi,

Police fired tear gas in an attempt to keep them from entering the city of Bannu, which lies on the way to Islamabad, on Sunday evening.

The protesters were carrying the bodies of the four young men, aged between 15 and 20, found in a shallow grave on March 21 in the town of Jani Khel, outside Bannu.

© Reuters/AKHTAR SOOMRO People chant slogans demanding an investigation following the deaths of four teenagers in Jani Khel area in Bannu District of Khyber Pakhtunkhwa (KPK) province, during a protest in Karachi,

"The government didn’t pay any attention to us and left us alone to mourn the slain boys," Haji Mohammad Wali, one of the protesters, told Reuters by phone.


Relatives of the dead, alleging they died during interrogation by security forces, held a sit-in in Jani Khel for nearly a week, refusing to bury the bodies until an investigation was opened against an army officer they said was responsible.

A Pakistani military spokesman declined to comment about the incident on Sunday, and the military has not commented publicly on the case.

The central government has not commented on the case.

Officials of the Khyber-Pakhtunkhwa provincial government, including Chief Minister Mahmood Khan, travelled to Bannu on Sunday to meet with protesters.

"This incident is a challenge for my government and law enforcement agencies," Khan said in a statement, adding those responsible for the deaths will be held accountable.

The protesters said that after their demands for an inquiry went unheard they decided to march to Islamabad - 300 km (190 miles) away - and local police tried to stop them by placing barricades in Bannu.

The four dead boys had been missing for several weeks, according to their relatives. Relatives said their bodies bore signs of torture when they were found.

Protests were also held in the port city of Karachi on Sunday.

The town of Jani Khel is part of the former semi-autonomous tribal areas, a region along the Afghanistan border that served as a base for the Taliban, al Qaeda, and other jihadist groups until a series of Pakistani military offensives drove them out.

Rights groups have accused the military of carrying out extrajudicial detentions and other abuses in the area - a charge the military has consistently denied.

As Canadian Pacific Railway bulks up, rival Canadian National takes a few attention-grabbing measures of its own

Kevin Carmichael 

Postmedia

2/27/2021

6

© Provided by Financial Post CN has recognized that it’s no longer sufficient for big companies to focus exclusively on maximizing profits.

Canadian Pacific Railway Ltd.’s plan to purchase Kansas City Southern will vie for business story of the year, but its long-time rival, Canadian National Railway Co., also has been doing some things that could help it down the road.

The former Crown corporation has recognized that it’s no longer sufficient for big companies to focus exclusively on maximizing profits. The public, including a growing number of investors, now demands more. So, while CP was bulking up, CN was getting serious about ESG, the emerging force in markets that demands a commitment to the environment, social concerns and enlightened governance in return for access to a pool of capital worth hundreds of billions of dollars.

A couple of days after CP announced the KCS takeover on March 21, CN revealed that it was on track to join its Calgary-based rival as one of only a handful of big Canadian corporations that has significantly diluted the influence of older white men in their board rooms.

CN said it had nominated Denise Gray , president of South Korean lithium-ion battery maker LG Chem Ltd.’s North American unit, to join a board that will be reduced to 11 directors from the current 14. Gray, who is Black, would ensure that Montreal-based CN will be overseen by a set of directors that more closely mirrors the larger population, one of the objectives of Bay Streeter Wes Hall’s BlackNorth Initiative , an effort inspired by the global backlash that followed the killing of George Floyd by a white police officer in Minneapolis, Minnesota, last year.

A minor reshuffling of directors will strike some as insignificant, and others as slavishly faddish. Another way to think about it: embarrassing. Only about 30 per cent of directors and 18 per cent of executives at S&P/TSX companies were women in 2019, according to Catalyst , an advocacy group. Visible minorities filled about six per cent of board seats, according to a review by Osler, Hoskin & Harcourt, a law firm.

Regardless, leadership diversity is fast becoming a tenant of modern governance. Scholarship shows that companies that are dominated by older white men have too many blindspots. They lose out on young talent that’s adamant about working only for employers that reflect their values. They risk alienating customers, politicians and regulators.

“At the heart of the CEO agenda, is the imperative to build and maintain trust,” Nicolas Marcoux, head of consultancy PricewaterhouseCoopers Inc.’s Canadian unit, said at a virtual event sponsored by the Toronto branch of the Canadian Club on March 23. “ESG is no longer a nice-to-have. It’s a must-have.”

To be sure, CN chief executive Jean-Jacques Ruest’s senior management team remains entirely white and mostly male. (The roster of vice-presidents is less monochromic).

But Ruest will be the only CN executive on the docket when shareholders vote at the company’s virtual annual meeting on April 27. The independent nominees are an even split of men and women, the same as CP. That matters to investors who decide where to deploy their money based on ESG assessments. CN is betting that its rivalry with CP and American railroads such as CSX Corp. will be decided by more than shipping costs and arrival times in the future.

© Christinne Muschi/Bloomberg files CN chief executive Jean-Jacques Ruest.

“Our longer-term goal is to be at the leading edge of ESG best practices across North America and globally,” Ruest and Robert Pace, the boar chair, said in a letter to shareholders ahead of next month’s annual meeting.

Achieving that objective is going to take some more work. CN tends to say the right things, and often backs up its words with action: the company has cut the greenhouse gas emissions spewed by its locomotives by 40 per cent since 1993, earning high marks from at least one outfit that tracks companies’ commitment to fighting climate change.

Still, it’s unclear that CN has put much distance between itself and its competitors when it comes to ESG. Sustainalytics, a unit of Morningstar Inc. that does ESG research, says CN and CP are both “low risk,” so an ethical investor could buy either stock without violating her or his principles. The firm currently rates CP slightly higher — 30th out of 335 transportation companies (1,611th out of a universe of 13,676 companies), while it ranks CN 34th (1,683rd overall).

“With respect to ESG, the whole world is moving that way,” Pace, who has led CN’s board since 2014, said in an interview earlier this month. “The trend is wide. It’s deep. We just have to make sure our goals and aspirations are real and we can deliver.”

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Too often, companies’ ESG initiatives emphasize what they are doing about the environment. Perhaps the most interesting part of CN’s recent efforts is that its focus is wider than climate change. It said last month that the tenure of independent directors will be limited to 14 years and that they will be allowed to serve on a maximum of three public boards including CN.

More importantly, the company also said that it would create an advisory council of Indigenous people, a recognition that CN tracks cross some 110 First Nations communities. Pace said the decision was partly inspired by the protests that disrupted rail traffic ahead of the pandemic, but that it also reflects an admission that Indigenous voices had been ignored for too long.

“The whole country has taken a long time. We all have to do our part,” Pace said. “W e had to step here and make some changes. That’s what we’re going to do.”

Financial Post

• Email: kcarmichael@postmedia.com | Twitter: carmichaelkevin

Correction: An earlier version of the story incorrectly stated that CP’s board it entirely white. We regret the error.

Myanmar mourns, protests after crackdown's deadliest day yet

YANGON, Myanmar — Mourners flocked to the funerals of those killed in the deadliest day of a crackdown on protests of last month's coup in Myanmar, as demonstrators, uncowed by the violence, returned to the streets Sunday to press their demands for a return to democracy.

© Provided by The Canadian Press

A day earlier, security forces killed at least 114 people, including several children under 16, according to local media — a shocking escalation that prompted the U.N. rapporteur to accuse the junta of committing “mass murder” and to criticize the international community for not doing enough to stop it. There were reports that the violence continued Sunday.

At a funeral in Bhamo in the northern state of Kachin, a large crowd gathered to chant democracy slogans and raise the three-finger salute that has come to symbolize resistance to the military takeover. Family and friends were paying their respects to Shwe Myint, a 36-year-old who was shot dead by security forces on Saturday.

The military had initially seized her body and refused to return it until her family signed a statement that her death was not caused by them, according to the Democratic Voice of Burma, a broadcast and online news service.

Mourners also used another funeral as a show of resistance. In Yangon, the country's largest city, they flashed the three-finger salute as they wheeled the coffin of a 13-year-old boy. Sai Wai Yan was shot dead by security forces Saturday as he played outside his home.

The Feb. 1 coup that ousted Aung San Suu Kyi’s elected government reversed years of progress toward democracy after five decades of military rule. It has again made Myanmar the focus of international scrutiny as security forces have repeatedly fired into crowds of protesters. More than 420 people have been killed since the takeover, according to multiple counts. The crackdown extends beyond the demonstrations: Humanitarian workers reported that the military had carried out airstrikes Sunday against guerilla fighters in the eastern part of the country.

The junta has accused some of the demonstrators of perpetrating the violence because of their sporadic use of Molotov cocktails and has said its use of force has been justified to stop what it has called rioting. On Saturday, some protesters in Yangon were seen carrying bows and arrows.

Saturday's death toll far exceeded the previous single-day high that ranged from 74 to 90 on March 14. The killings happened throughout the country as Myanmar’s military celebrated the annual Armed Forces Day holiday with a parade in the country’s capital, Naypyitaw.

“Today the junta of Myanmar has made Armed Forces Day a day of infamy with the massacre of men, women and very young children throughout country,” said Tom Andrews, the U.N.'s independent expert on human rights for Myanmar. “Words of condemnation or concern are frankly ringing hollow to the people of Myanmar while the military junta commits mass murder against them. ... It is past time for robust, co-ordinated action.”

Those calls were echoed by others. U.N. Secretary-General Antonio Guterres said he was shocked by the killings of civilians, including children, and a group of defence chiefs from 12 countries also condemned the violence.

U.N. Special Adviser on the Prevention of Genocide, Alice Wairimu Nderitu, and U.N. High Commissioner for Human Rights, Michelle Bachelet, said: “The shameful, cowardly, brutal actions of the military and police – who have been filmed shooting at protesters as they flee, and who have not even spared young children – must be halted immediately.”

But it's still not clear what action is possible — or how quick it will be. The U.N. Security Council has condemned the violence but not advocated concerted action against the junta, such as a ban on selling it arms. China and Russia are both major arms suppliers to Myanmar’s military as well as politically sympathetic, and as members of the council would almost certainly veto any such move.

If the Security Council isn't able to do anything, Andrews called for an emergency international summit. Already many countries have already imposed some sanctions and threatened more, but it’s not clear what further action governments will take. Human rights group Amnesty International also criticized the hesitancy to do more.

“U.N. Security Council member states’ continued refusal to meaningfully act against this never-ending horror is contemptible,” said Ming Yu Hah, the organization’s deputy regional director for campaigns.

In the meantime, protesters have continued to rally in Myanmar's streets. In one demonstration in Yangon, a small group made its way through a residential area that the day before had seen chaos with police shooting at demonstrators and the protesters responding with fireworks and Molotov cocktails. The march finished without incident.

But there were reports on social media that more protesters were killed Sunday.

In addition to unleashing violence against demonstrators, the military is also continuing to battle ethnic Karen fighters in the country's east. About 3,000 villagers from territory controlled by the Karen fled across the border to Thailand on Sunday after Myanmar military aircraft dropped bombs on a Karen guerrilla position, said workers for two humanitarian relief agencies.

The Karen National Union is one of more than a dozen ethnic organizations that have been fighting for decades to gain more autonomy from Myanmar’s central government.

The tension at the border comes as the leaders of the resistance to the coup are seeking to have the Karen and other ethnic groups band together and join them as allies. So far the ethnic armed groups have only committed to providing protection to protesters in the areas they control.

The Associated Press

Full supermoon in March 2021: When to see the 'Worm' moon

By Megan Marples and Ashley Strickland, CNN 


See the "Worm" supermoon glow in the March sky this Sunday.

© Owen Humphreys/Press Association/AP The Worm moon will peak Sunday afternoon and is the fourth closest supermoon of 2021.

The moon will be fullest at 2:48 p.m. ET on Sunday afternoon, according to NASA.

This will be the year's first supermoon, meaning the moon is slightly closer to Earth and therefore appears bigger and brighter in the sky. The Worm supermoon is the fourth brightest moon of 2021, according to Earth Sky.

© Apu Gomes/AFP/Getty Images The Milky Way is seen from the Glacier Point Trailside in Yosemite National Park, California.

In the Hindu month of Phalguna, this month's moon marks the Holi Festival, according to NASA, which celebrates the beginning of spring.

The Native American tribes in the South call the March full moon the Worm moon because of the earthworm casts, soil that the worms digest, become visible as the ground thaws.

Other Native American tribes have different names for the full moon in March that still relate to animals, according to the Western Washington University Planetarium website.

The Algonquin tribe northeast of the Great Lakes call the March full moon "namossack kesos" or "catching fish." In the northern plains of Canada, the Cree tribe call it "migisupizum" or "Eagle moon."

Typical of a normal year, 2021 will also have 12 full moons. (Last year had 13 full moons, two of which were in October.)

Here are all of the full moons remaining this year and their names, according to The Old Farmer's Almanac:

April 26 -- Pink moon

May 26 -- Flower moon

June 24 -- Strawberry moon

July 23 -- Buck moon

August 22 -- Sturgeon moon

September 20 -- Harvest moon

October 20 -- Hunter's moon

November 19 -- Beaver moon

December 18 -- Cold moon

Be sure to check for the other names of these moons as well, attributed to the different Native American tribes.

Here is what else you can look forward to in 2021.

Meteor showers

There is a bit of a wait until the next meteor shower, the popular Lyrids, in April. The Lyrids will peak on April 22 and will be best seen in the Northern Hemisphere -- but the moon will be 68% full, according to the American Meteor Society. This may make the meteor shower less visible.

The Eta Aquariids follow soon after, peaking on May 5 when the moon is 38% full. This shower is best seen in the southern tropics, but will still produce a medium shower for those north of the equator.

The Delta Aquariids are also best seen from the southern tropics and will peak between July 28 and 29 when the moon is 74% full.

Interestingly, another meteor shower peaks on the same night -- the Alpha Capricornids. Although this is a much weaker shower, it has been known to produce some bright fireballs during the peak. It will be visible for those on either side of the equator.

The Perseid meteor shower, the most popular of the year, will peak between August 11 and 12 in the Northern Hemisphere, when the moon is only 13% full.

Here is the meteor shower schedule for the rest of the year, according to EarthSky's meteor shower outlook.


October 8: Draconids
October 21: Orionids
November 4 to 5: South Taurids
November 11 to 12: North Taurids
November 17: Leonids
December 13 to 14: Geminids
December 22: Ursids


Solar and lunar eclipses

This year, there will be two eclipses of the sun and two eclipses of the moon -- and three of these will be visible for some in North America, according to The Old Farmer's Almanac.

A total eclipse of the moon will occur on May 26, best visible to those in western North America and Hawaii from 4:46 a.m. ET to 9:51 a.m. ET.

An annular eclipse of the sun will happen on June 10, visible in northern and northeastern North America from 4:12 a.m. ET to 9:11 a.m. ET. The sun won't be fully blocked by the moon, so be sure to wear eclipse glasses to safely view this event.

November 19 will see a partial eclipse of the moon, and skywatchers in North America and Hawaii can view it between 1 a.m. ET and 7:06 a.m. ET.

And the year ends with a total eclipse of the sun on December 4. It won't be seen in North America, but those in the Falkland Islands, the southern tip of Africa, Antarctica and southeastern Australia will be able to spot it.

Visible planets

Skywatchers will have multiple opportunities to spot the planets in our sky during certain mornings and evenings throughout 2021, according to the Farmer's Almanac planetary guide.

It's possible to see most of these with the naked eye, with the exception of distant Neptune, but binoculars or a telescope will provide the best view.

Mercury will look like a bright star in the morning sky from June 27 to July 16, and October 18 to November 1. It will shine in the night sky from May 3 to May 24, August 31 to September 21 and November 29 to December 31.

Venus, our closest neighbor in the solar system, will appear in the western sky at dusk on the evenings of May 24 to December 31. It's the second brightest object in our sky after the moon.

Mars makes its reddish appearance in the morning sky between November 24 and December 31 and will be visible in the evening sky between January 1 and August 22.

Jupiter, the largest planet in our solar system, is the third brightest object in our sky. It will be on display in the morning sky between February 17 and August 19. Look for it in the evenings of August 20 to December 31 -- but it will be at its brightest from August 8 to September 2.

Saturn's rings are only visible through a telescope, but the planet itself can still be seen with the naked eye on the mornings of February 10 to August 1 and the evenings of August 2 to December 31. It will be at its brightest between August 1 to 4.

Binoculars or a telescope will help you spot the greenish glow of Uranus on the mornings of May 16 to November 3 and the evenings of January 1 to April 12 and November 4 to December 31 -- but at its brightest between August 28 to December 31.

And our most distant neighbor in the solar system, Neptune will be visible through a telescope on the mornings of March 27 to September 13 and the evenings of September 14 to December 31. It will be at its brightest between July 19 and November 8.

Scale of Tigray horror adds to pressure on Ethiopian leader
Emmanuel Akinwotu 

Pressure is mounting on Ethiopia’s prime minister, Abiy Ahmed, as the scale of horrors from his war against the northern Tigray region gradually emerge, revealing massacres, mass sexual violence and fears of ethnic cleansing.

© Photograph: Nariman El-Mofty/AP 

Orthodox Christian refugees who fled the conflict in Tigray pray \

at a camp in Hamdeyat near the Sudan-Ethiopia border.

Ethiopia has for months insisted that its army’s operations, which began in October last year, have officially ended and solely targeted the Tigrayan People’s Liberation Front (TPLF) leadership and forces, which ruled Ethiopia for almost three decades before Abiy came to power.

Abiy’s government has repeatedly played down the most severe allegations against its forces in Tigray, and denied reports that Eritrean armed forces were active in Tigray fighting the TPLF.

Yet last week he finally conceded that Eritrea’s soldiers were “at the border area” between Tigray and Ethiopia’s former foe turned ally. Eritrea’s army was now retreating from Ethiopia, he said. Eritrea’s government has not publicly acknowledged any role in Tigray or confirmed its troops would retreat.

The independent Ethiopian Human Rights Commission last week said its investigations found over 100 people in the historic Tigrayan city of Axum were killed by Eritrean soldiers in November, confirming earlier revelations by Amnesty International and Human Rights Watch.

© Provided by The Guardian Ethiopia’s prime minister Abiy Ahmed, right, and Eritrea’s President Isaias Afwerki at Asmara airport last week. Photograph: Aron Simeneh/AFP/Getty Images


Reports confirming atrocities by Eritrean soldiers present in Tigray and revelations of the devastation of the past five months have fuelled international condemnation of both Ethiopia and Eritrea. The EU placed sanctions on Eritrea this week, amid concerns that many of the attacks could amount to crimes against humanity.

Reports by Amnesty International and Human Rights Watch have revealed several massacres and an explosion of sexual violence, torture and destruction of Tigrayan cultural and religious monuments and property.

Since aid groups and observers were granted access earlier this month, there has been a drip feed of shocking revelations. Last week, the aid group Médecins Sans Frontières (MSF) said its staff had witnessed extrajudicial killings on the road from Mekelle to Adigrat by Ethiopian troops. “We are horrified by the continued violence in Tigray, Ethiopia. This includes the extrajudicial killings of at least four men who were dragged off public buses and executed by soldiers while our staff members were present, on 23 March,” said Karline Kleijer, its head of emergency programmes.

Earlier this month, MSF said most of the more than 100 health facilities it had visited across Tigray had been looted, vandalised and destroyed in a deliberate and widespread attack on healthcare. What Abiy has insisted was a military operation against “criminals” has instead emerged as a bitter conflict waged against millions of civilians, with mass attacks and sexual violence driven by ethnic and historic regional divisions.

The military campaign against the TPLF, whom Abiy accused of attacking federal military camps and aiming to destabilise the country, has quickly recast the image of one of Africa’s youngest leaders who was awarded the Nobel peace prize for ending the long conflict between Ethiopia and Eritrea.

Amid a telecommunications blackout and the restricted movement of aid groups and international observers, many fear the true toll of the conflict may never be ascertained.

The United Nations, United States, European Union and aid groups have condemned violence in the region in recent weeks.

Thousands are thought to have died, with vast swathes internally displaced in the mountainous, agriculture region of five million people.

Nearly one million people remain inaccessible to aid groups, according to the UN, amid armed conflict with TPLF forces, which Ethiopia still maintains has officially ended.Earlier this month, in a leaked recording of a meeting between foreign diplomats and an Ethiopian army general, Yohannes Tesfamariam, he described the conflict in Tigray as a “dirty war” and civilian victims as “defenceless” in the most significant acknowledgement from Ethiopia’s authorities that fighting and threats to civilians were ongoing, particularly in Western Tigray.

The UN last week condemned “horrific forms of sexual violence” with more than 500 cases of rape reported in just five clinics in Tigray, and the numbers of actual cases likely to be far higher. “Women say they have been raped by armed actors, they also told stories of gang rape, rape in front of family members and men being forced to rape their own family members under the threat of violence,” explained Wafia Said, the deputy UN aid coordinator in Ethiopia in a briefing to member states.

On March 10, the US secretary of state condemned the violence, ramping up pressure on Ethiopia to end atrocities in Tigray. Following investigations, Antony Blinken said he had seen “very credible reports of human rights abuses and atrocities,” and that “forces from Eritrea and Amhara must leave and be replaced by ‘a force that will not abuse the human rights of the people of Tigray or commit acts of ethnic cleansing’.” Ethiopia dismissed Blinken’s statement as unfounded but said it would permit an investigation by the African Union.

On Monday the EU announced sanctions on Eritrea, dismissed by the country’s ministry of foreign affairs as “a futile attempt to drive a wedge between Eritrea and Ethiopia.”

Nearly 70,000 refugees have fled to camps in neighbouring Sudan since November, some suffering physical injuries from attacks in Tigray, others suffering from the horrors they witnessed before they escaped.

Before 26-year-old Elsa Berhe fled to Hamdayet town in Sudan, she was a midwife in Adwa, eastern Tigray and lived a comfortable life. In November, shelling and fighting destroyed much of Adwa. By early this year, several hospitals and clinics were destroyed, looted and taken over by Ethiopian forces. “I was secretly delivering home-to-home services for pregnant women,” she said. “There is gunfire every day, there is questioning every day,” she said, from the camp overlooking the Sudan’s border with Ethiopia. Attacks on medical officials had driven her to leave, she said.

“I saw an ambulance with a patient and a nurse,” when they were stopped by Ethiopian soldiers. “They killed the driver and the nurse and they drove away.” Later, she witnessed Eritrean forces gang rape a woman, Berhe said.“The international community has done nothing to stop the war. Destruction is happening, rape is happening daily and civilians are being killed.”

According to Adem Abebe, an expert at the Institute for Democracy and Electoral Assistance, the horrific nature of the conflict so far will probably lead to the TPLF remaining a long-term threat to Abiy. “Unless there is a negotiated settlement, the conflict will definitely be prolonged. But Abiy may now think that he has pushed the TPLF into a corner and that he is in a much stronger position to negotiate.”