A/HRC/19/73 45. Other important risk factors for the development of noma are unsafe drinking water and dehydration, poor sanitation including due to unsanitary housing conditions and close proximity to unkempt livestock. 101 46. Noma can reach its terminal phase in the extremely short timespan of three weeks.102 WHO identifies four stages of the disease and the treatment of noma differs accordingly. In the early stage, when the gingiva is bleeding and has lesions, the onset of noma can be treated in a manner which is “simple, effective, low-cost”103 with disinfecting mouth rinses and daily food with vitamins. 104 During the next phase, involving swelling of the face and fever, mouth rinses, administration of antibiotics and nutrients supplementation is essential.105 These have been shown to prevent progression from the initial ulceration to the extensive gangrene, which require emergency care and, in the latter stage, costly reconstructive surgery.106 Survivors suffer disfigurement and functional impairment. Doctors describe the restriction of the jaw movement and the loss of part of the maxilla, mandible or other facial bones as the usual consequences of noma.107 Without reconstructive surgery “[a] child who survives is unlikely ever to be able to speak or eat normally again.”108 47. As was noted in a previous section, the death rate associated with noma is very high. However, if recognized early and treated correspondingly with oral hygiene, antibiotics and nutritious feeding, mortality can drop from 70–90 per cent to approximately 20 per cent. 109 Hence, early recognition of the clinical signs of this disorder and timely treatment is critical for saving the lives of children affected by noma. 48. By addressing the predisposing factors to noma, the occurrence of this disorder can be lowered; a comprehensive perspective is needed. Therefore, addressing oral hygiene as well as chronic and acute malnutrition should be a priority in the fight against noma. Vaccination against infections such as measles that weaken the immune system would considerably cut the incidence of noma.110 Taking decisive action to improve sanitation and access to clean drinking water and adequate housing, and to provide information on oral hygiene and on the importance of breastfeeding, while keeping a focus on the vulnerable children and their mothers from poor rural areas and slums, are all essential in the fight against noma. Overall, the fight against extreme poverty is certainly also a fight against noma. C. Initiatives to combat noma and alleviate the suffering of children affected by the disease 49. Prompted by reports from several NGOs and some Governments about the recrudescence of noma, WHO organized the first information session on noma at the World Health Assembly in 1989.111 This was followed, in 1994, by the adoption of a five-point 101 102 103 104 105 106 107 108 109 110 111 16 P.E. Petersen, “World Health Organization global policy for improvement of oral health – World Health Assembly 2007”, International Dental Journal, vol. 58, 2008, p. 117. WHO campaign “Acting against Disease, Open the Mouth of Your Children. Acting Against Noma”. Bos, Surgical Treatment, p. 18. WHO campaign “Acting against Disease”. Ibid; Bos, Surgical Treatment, p. 18; Srour, “Noma in Laos”, p. 539. Ibid. Barmes, “The need for action”, p. 1113. Ibid. Bos, Surgical Treatment, p. 18 Fieger, “An estimation”, p. 406. Bos, Surgical Treatment, p. 15; see, for the important input of Edmond Kaiser,